Dr. Terry Shaw from Perth-Andover, in New Brunswick, Canada, has been placing composite since 1984. Listen as he shares advice on composite bridges, composite crowns, composite rehabs, why you don't need pins with composite and why you don't need liners & bases under composite.
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Stream Audio Here:
HSP #63 with Terry Shaw audio
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HSP #63 with Terry Shaw NoVideo
Links and References from the Show:
Dr. Shaw's profile on the Dentaltown forums: dkdocterry
One of Dr. Shaw's recent composite rehabs on the Dentaltown forums: http://www.dentaltown.com/MessageBoard/thread.aspx?s=2&f=101&t=241484&v=1
Dr. Terry Shaw's Bio:
I graduated from Perth High School in 1965 and the University of New Brunswick in Fredericton in 1969. My dental degree is from the infamous Dalhousie Dental School in Halifax, Nova Scotia in 1976. I have practiced in Perth-Andover, New Brunswick, Canada for the past 39 years. I am the Continuing Education Chairperson for the Atlantic Canada Academy of General Dentistry. I have been a Rotarion for 32 years as well. My wife & I have 2 grown children and I have 5 step children. I love my work as a dentist because in my mind it is the greatest job in the world. Improving people's smiles and their oral health. I still play hockey with an oldtimers hockey team (Perth Maroons) twice a week and have for 32 years.
Howard Farran: It is an honour and a privilege to be interviewing Terry Shaw today, who has been a Townie for years and years and Terry what I love about your posts, is that you talk so much about just down and dirty, day to day composites. I mean dentistry for the real man. You know a lot of people want to do…they want to talk about veneers or they want to talk about CAD CAM or lasers or all this fancy-dancy stuff, but as a real dentist in Phoenix, and you’re a real dentist in Canada, for every time you do a veneer case you’re probably going to do what…500 direct composites?
Terry Shaw: Right. Easily
Howard Farran: Easily, and so you’re the man. So tell us about yourself. You are… you live north of Maine?
Terry Shaw: Actually, we’re due east to Maine. We are about 70 miles from the top of Maine, we’re due east. There was no hospital in Perth-Andover. Very small community and we have a hospital now but we didn’t then.
Howard Farran: Very good. And didn’t they find some Viking explorer ships there like 10 years ago?
Terry Shaw: That is in Lansdowne Meadows up in Newfoundland. It’s about 1200 miles east of here, way out towards Greenland actually. Newfoundland is quite a way away from here. But they did. My wife and I have been there, they found a lot of trinkets and old needles. It was definitely Vikings.
Howard Farran: About what? About 1000 AD?
Terry Shaw: Yes, about 1000 AD. My wife actually is Danish so her parents came from Denmark back in ’48, so she’s a Viking.
Howard Farran: So what did they figure? Did they just turned around and left or do you think they tried?
Terry Shaw: No, they were there for quite a few years and they seemed…some people seemed to get down the coast because they talk about Vineland, and there’s certainly no vines growing in Newfoundland, and they think they went down the coast and they’re just not sure how far they went. Cape Cod, down the coast of the United States and Canada. They went down the East Coast.
Howard Farran: But they died out or?
Terry Shaw: No I think they probably went home and they probably went back to Iceland and Greenland and that sort of thing. I don’t know, we’re just speculating here.
Howard Farran: Well, and you graduated from probably the most famous dental school that ever lived in the history, ever since Facebook came out. The University of Dalhousie where a couple of young boys were posting girly pictures and inappropriate comments and…
Terry Shaw: I am sure about the pictures they posted, but they posted some pretty idiotic, dumb comments and they’re paying the price for it really. Probably some of them aren’t going to graduate this year. They were fourth year dental students and just testosterone got a hold of them I guess and sort of like locker room chatter and it should never have hit the news, really I don’t think, but anyway.
Howard Farran: Yeah I’ve raised four boys. They’re currently 19, 21, 23 and 25 so I’ve dealt with a lot of boy issues and I talk to many dental school deans. You know what dental school deans actually tell me, they tell me that girls are starting to reach menarche, like 10% by age 10 and they go through their crazy period you know, they’re done being crazy in the middle of high school and boys go to college and that’s when they, you know they get up to 1200 ml of testosterone per decilitre and I think last time at 52, I had mine checked, I’m at like 400 and they just do the craziest dumbest things. College are their craziest years.
Terry Shaw: I think their age matches their IQ at that point.
Howard Farran: Well put. My boys…it’s funny, they’d always ask me what time they have to be home and I would say, because all their other friends had a curfew, you know it was based on you know where the sun was in position to the earth or the moon and I would also say, I want to know who you’re out with? And they’d say I’m out with Alan Funk, I’d say okay you need to be home at nine o’clock, and they’re like Dad! And then they’d say another boy and I’d say if you’re with that boy, you can stay with him for 40 days and 40 nights, I’m not about that kid. So Terry tell me this, has CAD CAM machines replaced a lot of MOD composites? I notice you place so many amazing cases on Dentaltown. Tell us composite technique and what your thoughts are on composites?
Terry Shaw: Well a lot of the crazy stuff…I was amalgam up to about ‘83, ‘84 and ran into Ron Jordon in Monkton at a course and he was talking about posterior composites and that was way back and we put liquid acid etch all over teeth and sort of wink, wink don’t let it touch the dentin and…I started doing a lot of composites back in, oh probably ’84, ’85, ’86 and pretty well left the amalgam behind, just because it tended to bond the tooth together and over the years, in the 90’s I used to do quite a few Maryland bridges, you know it always broke my heart to have to cut into the lingual of an upper tooth and shave away some good healthy tooth structure to make room for my metal and also sometimes you know, you didn’t take quite enough off and a lot of the failures were probably due to maybe inadequate enamel removal. You’ve got thin metal, it flexes and pops off. Probably in ‘91, ’92, ‘93 I started doing it with composite and lo and behold they worked and I’ve probably done 600 or 700 of them by now. I just do them routinely and composite, I don’t have to touch the tooth, there’s no enamel taken away and the damn things work. I get some that are 5, 10, and 20 years old and have never been touched. I mean some of them do crack. I just run a big diamond through and rough it up, sandblast it, micro etch it and re-bond it. The soldered joints I think are the reason why the composite bridges work so well. They’re very huge, they’re very large. Remember when the old Tetris came out the and it was breaking and it was supposed to be the new great ceramic bridge material and it just didn’t have big enough solder joints and I think that is the reason that composite bridges do so well and also at the same time I started building teeth out of composite. Basically I take old crappy crowns off and do them in composite and a lot of these people didn’t have that kind of money. A lot of it was economical driven and lo and behold again, these silly (deteriorated sound). They’re working. They’re lasting. I remember years ago, Ron Jordon probably about ’84, ’85, ’86, he said in composite, you said basically what you get at 18 months is what you get and you know so that’s great. Composite wears, it protects itself. That is my line and you know you do these large fillings and occasionally they fail, but I don’t have a big problem with failure. I mean crowns fail, everything, in dentistry everything fails eventually you know. Anyway, so I don’t do a lot of porcelain. I don’t do a lot of veneers. I do then directly.
Howard Farran: And that is one my biggest pet peeves among dentists and their…how the locker room talk. I mean they always…when two or more dentists get together, they always sound like engineers, when dentistry isn’t about civil engineering, mechanical engineering. It is really a biology issue. It’s the one trillion bacteria in our three pounds of dent microbiome and we see that people with gum disease don’t have decay rates, low decay rates, people with high decay rates don’t have gum disease. Sometimes they get on medications or catch viruses and catch yeast infection, at the end of the day they’re all going to fail from biology. But hey I want you to, there’s kids in here, we have a lot of dental students who are big fans of this podcast series. These are downloaded around the world. Walk the listener through your composite technique and try to be specific. My brand is that, with the internet no dentist should ever have to practice solo again, so give them name brands, specifics, ever thing they need to know what Terry is actually…what you’re using, what you’re doing and why?
Terry Shaw: Okay. Well I use rubber dam 99% of the time and after 39 years I think that’s a big part that alludes to a lot on Dentaltown. It’s a big reason for the success of composite dentistry, rubber dam- good isolation. You are always going to have fluid seeping out of the crevice around the tooth and if you don’t have it sealed off and isolated, you might as well forget about it. I see a lot of poor composite dentistry in my world. Anyway what I do…I am using, I believe it’s Bisco’s etch. I’m not even sure. A lot of the stuff, like that I don’t…it’s a gel and I always put it around the enamel first and then I flood the dentin with it. I try to etch enamel for 20 seconds and then the dentin probably 10, 15 and I rinse it profusely for a few seconds and then I dry it either with my suction or my air syringe. I watch it until I evaporate most of the liquid and there’s just a sheen to it, a little bit of a moisture and I’m still using ALL-BOND 2. It started in ’91, John Kanca was in Monkton Ron Jordan in about ‘89 or ‘87 something like that, and talking about dentin bonding and all that stuff so I’m still using that old, old, old technique because the damned stuff works. I understand it. I mix my primers, A and B primer together and I use a 3M foam pledget and they’re just foam applicators. The two drops go in a mixing well and the foam applicator will pick up about two thirds of that the first time and I dab that on usually five times, onto the dentin. I don’t try to put a lot on the enamel although a lot of times it’s impossible to avoid enamel, but it doesn’t do anything for the enamel, and I put five coats and then I go back to my well and get another, fill up the sponge again and I put on five more coats and it takes, probably takes a minute for me to do my priming technique. But you remember what it was like before we could etch and bond to dentin, and etching enamel has been rock solid forever and to be able to get the extra bonding strength with your dentin, I think it’s worth a minute of my time. You know, really, well if I do say two MOD’s on person, it probably takes me about an hour. What’s a minute, 60 seconds, to get a good primed hybrid surface and the other benefit- a lot of benefits to a hybrid surface, a good primed surface…well you…I never use a liner. I don’t use any Dycal, I don’t use bases under my composite and that’s what John Kanca taught me 25 years ago. I just put the resin on and light cure it, and a lot of times in the anterior, and sometimes I cure the resin and the composite together. So it just depends. I usually will cure my resin and then I put my composite in. I am using a micro hybrid. I haven’t gone to the nanofillers because they’re not as strong. Basically from what I’ve read they’re not as strong, they’re 30% weaker than the microhybrids. That’s 250 I tend to use most of the time. It is also cheaper because it’s not in vogue, like your ultra, your Filtek Supreme Ultra. They’re considerably more expensive and they polish better but they don’t, the nanofillers polish better, that is the biggest advantage but in the posterior I don’t that is a…in the anterior maybe more so, but in the posterior the polish is…you know the Z250 is fine in the posterior. It loses its shine in the anterior over probably six months. I’m not sure why. I’ve got a few patients who are able to maintain the Z250 almost as well as Renamel and I use Renamel in all, well most of my highly aesthetic cases I want enamel looking filings.
Howard Farran: Use Renamel, are you talking about Buddy Mopper’s Cosmedent in Chicago?
Terry Shaw: Yeah. Cosmedent yeah and that’s…at two feet you can’t tell if it’s Renamel or porcelain in my book and in my mind. It is certainly a lot cheaper to… and the composites bond together really well, the Z250 and the Renamel are very compatible. I’ve been bonding them together for 20 years now and haven’t had any great problems. So anyway, that’s sort of in a nutshell. I do most of my finishing with a 74 weight football shaped carbide and it’s got 30 flutes and when I’m done, it’s polished. The 30 fluted bur gives it a real nice shine, polish and you really don’t need to touch the tooth after that. On the labial I use a 7901 for most of my finishing and I use Sof-Lex discs. I always polish wet to start and dry to finish, because it seems to give it a better shine. It works quicker if it’s wet. The grain on the polishing disc, if you do it dry it doesn’t tend to stick around. It just seems to work better if it’s wet at the start. You get it polished quicker. And then when it’s dry it seems to give it a real shine. If you polish wet all the time, you won’t get the shine. You just don’t. Simple. At least I don’t.
Howard Farran: Who was that man that just walked by with the ponytail?
Terry Shaw: I didn’t notice. That’s my associate. I didn’t see him but anyway.
Howard Farran: That’s a dentist?
Terry Shaw: That’s another dentist in the office.
Howard Farran: Did you have him walk through with a ponytail just to make me feel even worse about being bald? Where you trying to ruin my day?
Terry Shaw: He takes ROGAINE to maintain that hair. His life isn’t worth living I don’t think…anyway.
Howard Farran: Okay I want to go back to a few points of what you’re saying. Okay you… when asked you your composite technique, the first thing you said was I use a rubber dam. Would you go as far to say that if you’re not using a rubber dam, or you can’t use a rubber dam? And let’s be frank, Terry, a lot of dentistry in many, many countries, they don’t have the suction, they don’t have the air or water syringe, but would you say that if you can’t use a rubber dam that you should use amalgam?
Terry Shaw: I wouldn’t really…I would say you probably should consider, I don’t know… getting another occupation. Rubber dam is…
Howard Farran: Why are you against…I’m sensing that you’re against amalgam?
Terry Shaw: No I’m not against them. I loved amalgam. No, no that’s not, I’m just saying if you don’t use rubber dam, I don’t know, I just don’t think you can do the same quality dentistry, day in and day out you just can’t do it. I don’t give a crap who you are, you can use an isolate or whatever. It’s really hard to do good dentistry without good isolation. Period.
Howard Farran: Do you ever use isolate?
Terry Shaw: I have never seen one. Oh well on Dentaltown under dental products. I don’t have one, no.
Howard Farran: Okay. Well, let’s go back…I also think you said something interesting. You do two MOD’s an hour?
Terry Shaw: Oh, well.
Howard Farran: I think… that you can’t…that you would schedule an hour for two MOD’s?
Terry Shaw: Probably yes.
Howard Farran: And you’re providing an outstanding service. I mean some of those composites that you post in Dentaltown, I just look at that and go damn, is this guy an artist or a dentist? If you can do two of those in an hour, I’m just saying something here where…you were talking about low cost. Well a lot of people can’t afford crowns and gold inlays. Like I only have seven restorations in my mouth and every one of them is a gold inlay and onlay, but I have money for that type of work but a lot of people who are doing the more expensive, like say a CAD CAM, might be spending three hours on that. So if you look at the fee of that and divide that by three hours, is each hour basically two MOD composites, you know, there’s a lot of money to be made in placing direct composites on people who have less money. That’s what I am trying to say. You don’t have to…
Terry Shaw: Yeah. I agree.
Howard Farran: I always want to remind dentists, there’s a hell of a lot more money in McDonalds than there is in Ruth's Chris Steak House.
Terry Shaw: For sure.
Howard Farran: But I want to go back to, I’m sensing some vibes about amalgam and you seem to be hesitant.
Terry Shaw: Oh no, I loved amalgam. I just don’t use it.
Howard Farran: Why did you quit?
Terry Shaw: Because you can’t bond the stuff for shit. It doesn’t bond. My composite reinforces the tooth. Well a lot of people poo-hoo that but the reality is that I don’t get the same amount of fractures and cusp fractures and stuff that you do tend to see with amalgam. When people come here…
Howard Farran: Okay, so what year did you get out of dental school?
Terry Shaw: ‘76
Howard Farran: And you said you did amalgam until ‘84?
Terry Shaw: Yeah ‘84, and I loved it. I carved marginal ridges and polished it and it was…
Howard Farran: So you did amalgam for eight years and then ‘84 until 2015, how many years is that?
Terry Shaw: 30.
Howard Farran: 30 years. So in that eight years of placing amalgams, you feel that you, through your own eyes and your own patient population, eight years of amalgams, you saw more failures with that than the preceding first eight years from doing composites from like say ‘84 to ‘92?
Terry Shaw: Yeah and…let me just quantify that a little bit. When I first started doing composites, probably in ’83, ’84, I did it for probably a year and then I went back to a course again and they said…whoever gave that course wasn’t quite as keen as the previous instructor and stuff and they said you should look at these long and hard and at the time I was using (deteriorated audio) as my first composite which is a microfill which wears well. Helio was a really nice material. I’ve still got Helio restorations lying around. So I looked at them really hard for the next six month and I did a few amalgams and I kept seeing them and I said shit, these things aren’t wearing, they’re looking good, what am I going back to amalgam for? Now though, if it bonded I would use it, but the bond strength is like 10% of the acid etching value you should get. The bond strength on amalgam to enamel is basically zilch. You know, they claim that you can bond it but the bond strengths in comparison to bonding to enamel is about 10% of the same, and nobody wants mercury in the mouth. We all know, you and I know that if you went to the FDA today with this new wonderful tooth material, had mercury in it, they would laugh you out of the building. You wouldn’t even get a chance to present your evidence. I mean, I’m not…I don’t replace every amalgam I see. I had a guy in here yesterday who wanted his amalgams out. I said you have got a couple of them, I’m willing to do a couple of bicuspids that are showing some wear. The rest of them are fine. I said they probably will go to your grave. They were actually very nice amalgams in his molars. He had a couple of ratty ones in the front. I said I had no problem to change those but I don’t change all the amalgams and, you know I’ve got amalgams in my mouth.
Howard Farran: Now what city do you live in? Are you on the coast?
Terry Shaw: No. We’re on the St. John River. I’s Perth-Andover. Perth-Andover. It’s a hyphenated word, two words…
Howard Farran: Is that a fishing village?
Terry Shaw: It used to be. Good salmon fishing here until they built the dams on the St. John River. We’re in a farming area, potato farming and lumber. We live in the woods basically, the forest. A lot lumber companies here. Irving and Frasier and a lot of farmers, here you know. McCain’s foods is the big employer here. They’re 25 miles above us and 25 miles below us.
Howard Farran: I have mixed feeling about dams, because yesterday the United States came out with a report that said that the average dam in America was 52 years old and I thought well, that’s good, I’m 52 years old. And then they said that is so damn old, they’re all falling apart and I went like wait a minute, 52’s not old. So those damn dams. So I want to go back to, when you said some people keep them more polished, and you use Renamel on anteriors and I have to admit, I have very different standards in my office for women anterior, actually women. Very high aesthetic needs. Someone comes in looking like me, we either just take them to the vet and put them down or use amalgam or gold, but do you think the toothpaste they’re using…remember Bob Ibsen, the founder of Den-Mat who then went onto create Rembrandt. He had that Rembrandt toothpaste. Do you think that girls that come in with lustrous looking composites, three four, five years old, they’re kind of out of the norm. Do you think that’s associated with these high polishing toothpastes like Rembrandt?
Terry Shaw: What it is, is the microhybrid, it doesn’t usually lose…the microhybrid, what was the one I used to use, because I got in a bit of an argument one time with Ross Nash at a course in Bermuda and I said the stuff, it was a micro hybrid, Kerr makes it, it’s still in use. What’s the name?
Howard Farran: Z250?
Terry Shaw: No, that’s made by the 3M. Kerr makes it…Herculite.
Howard Farran: Herculite.
Terry Shaw: And anyway, I said it won’t stay polished and he said oh yeah, you’ve just got to polish it right, and I said well whatever. But I’ve never found, it’s a microhybrid right, that classification and that’s what Z250 and Z100 is as well and they’re microhybrids and they just don’t tend to keep their high polish after six months but the guys…actually there are two gentlemen that have managed, I veneered their teeth and I did a rehab on them, and both of them keep the damn stuff just as shiny as almost looks like a microfill. I’ve asked them, and I’m not sure why but they don’t seem to know either.
Howard Farran: I also want to say, when you say you’re still using All-Bond, that’s Bisco?
Terry Shaw: Bisco, yeah.
Howard Farran: Which was Byoung Suh and he’s got what, three kids and a cousin running that outside of Chicago. What generation was that, was that third generation?
Terry Shaw: That’s fourth.
Howard Farran: Fourth generation, and what generation are we on now?
Terry Shaw: Seventh, eighth, ninth.
Howard Farran: Yeah and also, I have to agree with you. The first composite I have ever used was Heliomolar and that was in, I graduated dental school in 1987 so the first time I ever used it was probably in ’85, ’86, and I still love it the most and don’t you think that some of these old and tried and true, Ivoclar’s Heliomolar or a fourth generation Bisco A and B, don’t you think a lot of these new generations are almost, came out of the marketing department and it seems like a lot of dentists just, the only resourcefulness they have is how to drive up overhead. It’s like if they ever get any idea, it’s how to raise their overhead. They never can keep it simple stupid, use the old stuff that’s been around for 10, 20, 30 years. I know they’re looking at us two and thinking yeah, those guys are old timers and they should have their licence retired and, we probably look like a tyrannosaurus rex interviewing a stegosaurus rex, but the bottom line is, you said it first, it’s the lowest cost stuff. The next stuff is bloody expensive and could be bleeding edge, and some of the stuff I don’t understand, it’s like okay, you have to mix A and B, so like well we’ve got to get rid of that. I mean really, you can’t mix A and B? Really? You’ll try something bleeding edge for twice the money because you can’t mix a drop of A and B. I mean at what point do you just throw in the towel?
Terry Shaw: I don’t know how some of these guys get their dental degrees if they can’t mix A and B together and dab it on a tooth for a few seconds, for 30 seconds. Jeff Brucham, I’ve have heard him a couple of times and he is excellent on bonding, dentin bonding.
Howard Farran: Out of San Francisco?
Terry Shaw: Yeah, and his comparison is with hair conditioners. You know you get shampoo, you shampoo your hair and then you put conditioner on it. Well you can buy these shampoo hair conditioners but nobody likes them because they don’t work as well. It’s the same with these single bond systems. The bond strengths just aren’t there and you know you got, I’m always suspect when I see these results in the different magazines, because you know…you don’t see too many comparisons. I mean Kanca, with his materials, he’s got good materials and you don’t see too many comparisons across the board where they start with the fourth generation, use two or three of those, fifth generation and sixth and do the same test. Do the sheer strength test and all that. All you do is you read the publicity and dental products. 3M needs a new…they’ve got to keep the dental industry going so they make a new product. 3M does make good products, most of them do but they’re selling these new single bond systems and they’re convincing you that it’s cheaper or easier or some damn thing. It certainly isn’t cheaper but if they don’t work as well as the old stuff, why you would change? I’ve been burnt. I have been in this dental business for too long. I got drawers full of stuff in there that I gave away because it was the latest and greatest. I’m getting better at it, but the latest and greatest isn’t always the best. Simple as that.
Howard Farran: Well first in the interview you have a handsome dentist with a ponytail walk by, and then you follow that up with an example of shampoo and hair conditioner. So you’re just really trying to through me under a bus, aren’t you Terry? So basically I want to go to another question about the…well first of all that old stuff you have in your room, I’m telling you, the classified ads on Dentaltown, a lot of people don’t realize those are all free and I can give you names of 50 dental assistants where they dentist said, you go sell all that old crap, all those, every toy junk think I’ve ever bought and I’ll split the money with you and there’s dental assistants who’ve made five or ten grand in a week. Got rid of some of these big fifty thousand lasers, and the only thing I will throw a fourth generation under a bus is, I don’t know if it’s me or the system but, you know they say one drop A and one drop of B? Well how come when the A bottle is empty the B bottle is still half full? I never quite figured that out, maybe that’s why they are trying to go to one step. So are you…have your tried Kanca’s stuff? Do you use any of that or are your friends with John Kanca in Middlebury, Connecticut?
Terry Shaw: I know John fairly year from years ago because I was the CE Chair at the Atlantic AGD and he did probably five courses for us way back in the 80’s and 90’s and I used to see him in Bermuda with Ron Jordan and Peter Jordan’s crew there, clinical research and stuff. I like John. John is a straight shooter and I haven’t used him, I basically shouldn’t cop out, but they’re not widely available in my part of the world. I think you have to order them, I’m not sure where you order them actually in Canada. I’m not sure. You don’t see them advertised. Actually I did see something from a company called Sure Dental here just a week ago and it had a picture of John in it. His material is good stuff. John knows his business, he does.
Howard Farran: I want to expand Dentaltown magazine to Canada. For those viewers around the world, Canada demographically is another California. California is 10% of the United States and the United States is 330 million, California is basically 33 million, same as Canada. They have the same amount of dentists, the same size economy.
Terry Shaw: No, California’s economy is way bigger than Canada’s economy.
Howard Farran: Is it? Is it bigger?
Terry Shaw: O hell yes. California, you know it’s the land of fruits and nuts basically. Raymond Bertolotti told me that a long time ago.
Howard Farran: Yeah Raymond. That’s a blast from the past. Raymond Bertolotti. I saw him on Dentaltown posting the other night. I love that guy and his wife Mary is adorable. But…what other low hanging fruits…pins, is anybody still using pins? Do you see in Canada? Do you think there is any need? I mean some of these composites cases you are doing are big cases. I mean tell us your thoughts on pins.
Terry Shaw: No pins. You don’t need pins with composite. I don’t know where I was taught that, but that’s something that has been sort of known for 20 plus years I think. I had a patient in the other day and he had had an upper six molar with three big pins in it and I just shuddered. The guy had it done last summer and you know… I don’t know why you would put a pin in under a composite. There really is not much retentive value there.
Howard Farran: Okay and, I agree with that, but what about liners and bases? I mean that seems to be… it seems like there’s a lot of differing opinions on that. What are your views on liners and bases?
Terry Shaw: I don’t use them. Basically Kanca said 25 years ago, that if you get a hybrid layer you plug the dentin tubules, case over. There is no advantage to putting you know, if you got a bleeding pulp, high wall pulp tooth cap, I use TheraCal for a small pulp cap.
Howard Farran: TheraCal?
Terry Shaw: TheraCal is the new stuff from, I don’t know, who makes TheraCal? Is that Ultradent or is that Bisco?
Howard Farran: Is that calcium hydroxide?
Terry Shaw: No, it’s not calcium. I don’t think. I think it’s lithium…I don’t know what the hell it is. I better not say…anyway TheraCal, they advertise the hell out of it now.
Howard Farran: Just Google it.
Terry Shaw: Yeah, well it is a good, if you are going to use pulp capping thing, but why do you bother, that is my question? If you’ve got a hybrid layer, if you’ve primed your dentin properly it’s sealed. Just put your resin on and put your composite and save yourself all the steps of…it’s just another way to do the fillings quicker. If you want to save time, don’t use pins, don’t use any liners or bases. They are not necessary. I have been doing, I don’t have a lot of abscesses under these big composites. I mean you’ve seen a lot of them. There is not much tooth structure left and they go on, they chug along. They are primed. You know I just don’t see the sense of it.
Howard Farran: Talk more about bulk fill versus increments, what are your thoughts on that?
Terry Shaw: Well most of the teeth I fill, regular routine say MOD would take me probably four to five, six increments maximum. As I understand it, the bulk fills are not very good on… you can’t use them on the occlusal surface because they’re too soft, If I’m not mistaken and everybody is going to have to a layer over the occlusal. Well that’s two steps. It doesn’t take me that long. I have a curing light, Ultradent curing light. It works really well. I do a 10 second cure usually.
Howard Farran: And is that, okay Ultradent, that’s Dan Fischer … ok Ultra… that is Dan Fischer in South Georgia, Utah? Is that a LED light?
Terry Shaw: Yes, it’s a good light. It’s got three lights. There are three bulbs in it, so you get each of your wavelengths and I cure my resin 10 seconds and I cure the increments ten seconds, and I do the mesial wall, I do that in one piece. I wedge it in, I do the distal wall. If it’s a really deep filling I don’t wedge it. I put it 2mm into the margin and then I harden that and then I wedge that because I’m using plastic matrices and if you wedge them really hard they will deform and get stuck. So that’s what you don’t want to have happen, so I usually will fill the matrices around the gingiva held against the gingival wall by the rubber dam and just the friction. Then I use a matrix band a lot of times and get a Tofflemire to hold it, but I just put 2mm incisory and harden that, then I wedge and then I get a good contact.
Howard Farran: What is the name of that Ultradent light? Does it have name?
Terry Shaw: Oh yeah, there’s a big ad in the…
Howard Farran: Okay so I want to back you up a little bit. What you said was very, very profound, that it’s counterintuitive. You think the harder you place that wedge in there, the more you’re going to separate the teeth and you are going to get a tighter contact, but you’re saying what happens is that you deform the plastic and now you’re defeating the purpose of the wedge. Let’s talk about contacts because a lot of dentists tell me that the reason they prefer making indirects and taking an impression and either send them to a lab or an optical impression to the lab, or using CAD CAM, CEREC. Planmeca just bought E4D, is the contact. You just said you’re just using a regular old Tofflemire which came out of the amalgam era. Have you tried any of these other matrices? Like you’ve got Garrison and all these other ones, Triodent? Talk about contacts. How do you get a contact and how specifically do you get a contact and how do you do that?
Terry Shaw: Well there are several ways. I’ve got some very small thin bands that I got for clinical research. They’re very, very…one or two thousands of an inch, whatever it is. They are really tiny, but I use mostly Premier Dental’s contour matrix bands. They’re blue coloured now, and like I said, I wedge them just like you would a regular metal matrix band, or if I feel that the gingival box is deep, I will add 2 mm roughly and put that…cure that and then I put my wedge against that and in that way I don’t deform the band into the box. You know you can, we wedged amalgam for years mind you, and you got good contact. Actually a lot of times your contacts are too damn good. You know they were too tight. I don’t know how many times over the last you know 30 years I’ve taken metal matrix finishing strips, the Brasseler ones and gone between amalgams to relieve the contact pressure because you couldn’t hardly floss with them, and I’ve done that numerous times and I do that a lot today even with composite, because a lot of times the damn contacts are tight and especially if some of the composite ones are sharp, they’ll tear your floss even though they’re not bad contact, they are just tight and the occlusal sometimes…and people do them, they don’t open an embrasure on the occlusal surface. One way I do that is a 7901. I’ll drag it across back and forth at a 45 degree angle, lay it right down in the contact and just drag if back and forth and open up the contact, not the contact, open up the embrasure on the occlusal sort of thing, so you can get the floss started so it’s not too sharp angles on the occlusal.
Howard Farran: That flossing must be a Canadian issue because Americans don’t floss. You’ll never have an American come in and say it frays the floss. They’re usually like yeah I get my teeth flossed twice a year and you do it both times. So that’s interesting what you said. So you’re filling the gingival floor before you place the matrix? I mean before you place the wedge? That’s a profound idea. That’s a heck of a pearl. I bet a lot of dentists out there are scratching their heads there thinking that is a hell of an idea.
Terry Shaw: Well, what you can do if you’re nervous about getting an overhang and I do it sometimes, but a lot of times I can see in there with my magnification and my headlight. That’s the other great thing besides rubber dams. Those three things, if I didn’t the rubber dam and head light and the magnification I’d probably quit dentistry. It’s just that important and if you ever use it, after a year you’ll never give up any of those three things. If you use them regularly you know.
Howard Farran: I’ll tell you what, I bought myself a back up because I one day went in there and my, something had happened and the lens had fogged and I said I’m not doing dentistry, and they’re all like oh come on, you can do it without them. I’m like no…once you use that. So be specific… what brand of magnification are you using?
Terry Shaw: I’m using Designs for Vision.
Howard Farran: Designs for Vision, and what magnification?
Terry Shaw: Two and half. I tried the three and half and I found that I couldn’t find my hands and I only gave it a half a day trial and I just said, I see well enough. I listen to these guys talk about scopes and stuff, they’ve got five and ten times magnification and they try to make you feel inadequate and they probably do but I think two and a half is a minimum but, I just found the three and a half was, I don’t know, I couldn’t…it’s a learning curve with it and I just didn’t bother.
Howard Faran: I noticed your associate walking by with the ponytail, he had magnification too?
Terry Shaw: Oh yeah. Nowadays, the last three, four or five years, two and a half is compulsory straight out of dental school. It’s required.
Howard Farran: And I want to say something that you know every time I hear a dentist complaining like, what do you do when your hygienist has been with you for like eight years and you go in there and you do a hygiene exam and they have left a big old chunk of tartar on there and I’m like, well you’re wearing loupes, how come your hygienist isn’t? So I buy them for all my hygienists, all my assistants, but you’re right everybody stays at two and half but me. I did the 3.8, is it 3.5 or 3.8 next up from Designs?
Terry Shaw: Well Designs for Vision is 3.5. I had some.
Howard Farran: I went up to that and I’m in love with that, but yeah…magnification. You can’t expect your dental assistant and your hygienist to be in the same league as you if you can see.
Terry Shaw: I have two hygienists and the younger one took to the magnification like a duck to water and she loves it and her work is better now for sure because she sees everything. She sees so much better and the other girl is older and she doesn’t want to do it, but I wish she would because if you use it for month, you’ll never go back, you know. I told her I’d pay half of it but actually after six months I said you’re good, I said as long as you stay here for at least a year, and after a year I paid the whole thing and I told her if she stayed less than a year she’d have to pay half of it but she’s been here five or six years now.
Howard Farran: So. I’ve noticed that you’re a hockey fan, and hockey does not promote oral health. All hockey does is knock teeth out.
Terry Shaw: And I’m evidence of that. I’ve got three front teeth rattled when I was a kid. When I was 20, hockey stick in the mouth, three crowns and three posts and cores and stuff yeah. Long time ago. It’s good for business, we actually we don’t see hardly any hockey injuries anymore. My wife did smack my son in the mouth playing hockey in the basement, playing street hockey in the basement and I had to do a root canal on his front tooth and he was nine years old. But we don’t see hardly any hockey injuries in the dental office.
Howard Farran: But I noticed…I have heard that in Canada, everything beneath the pro’s, a face mask is mandatory.
Terry Shaw: Oh yeah. They’re face shields.
Howard Farran: Yeah, but the pro’s don’t use them?
Terry Shaw: No, you know the pro’s is an image thing, but most of them do wear the shields on their eyes. That’s the only reason I would wear a shield is for your eyes, to hell with your teeth. You can get your teeth fixed but your eyes you can’t.
Howard Farran: But the pro’s…I don’t ever see hardly pro hockey players wearing shields.
Terry Shaw: Oh they wear eye shields, a lot of them do. Yeah.
Howard Farran: Eye shields?
Terry Shaw: Yeah, you see the helmet. You probably don’t see the shield because it only comes down to their nose, but a lot of them wear them, a lot of them do.
Howard Farran: And your greatest citizen now lives up the street from me. Dwayne Gretzky.
Terry Shaw: Well he at one time probably, for sure. Did you do his teeth?
Howard Farran: No I didn’t do his teeth, but…
Terry Shaw: But somebody did it. He didn’t have that teeth, those teeth haven’t left Canada, I know that.
Howard Farran: That’s so funny when they built that team down here, the Phoenix Coyotes and man, during a game they will pan to the bench and everybody I guess takes their (unclear) off for the game because they will pan that whole bench and I think all the players combined only have 30 or 40 teeth. They’re all missing front teeth in large numbers. So I want to take, I’m two thirds down, 40 minutes down and only got 20 minutes left. I want to switch gears. I don’t want to frame you as someone who does just composites. You have been doing dentistry for three decades, you know.
Terry Shaw: Almost four.
Howard Farran: Almost four decades. So I want to ask you a couple of questions. You have 5000 American children coming out of dental schools each year. They’re carrying on average 250 000 to 300 000 dollars in student loans. If your own child that your wife was abusing in the basement with a hockey stick, knocking his front teeth out, if your own child was walking out of dental school right now in the United States or Canada and was packing 250 000 to 300 000 dollars of debt. What fatherly advice would you give that young child?
Terry Shaw: I’d tell him to get the hell out of the cities. I know that, parts of northern Maine are underserviced. Not sure how much money he’ll will make, but you’d at least make a pretty good living and, that’s a tough question really. We have the same thing in Canada. I mean they’re not probably coming out with $300 000 but 200 000. I know my associate here, when he graduated he was $200 000 in the hole and he’s associating in Canada and when they associate, most of the people, the deal is you get 40% of what you gross. That’s a pretty standard thing and most guys will practice, associate two or three years and then they’ll buy in or whatever or else they’ll take off on their own, but it’s harder and harder to do that. In the States I think you’ve got a lot more dentists per capita than we do. I’m not sure how many are graduating a year in Canada, but I don’t think it’s anywhere near the number you guys are graduating. It’s a tough question.
Howard Farran: Well you’re saying something profound and that is in America, two thirds of the graduates go to where half of the people live in the 170 largest towns.
Terry Shaw: Yeah.
Howard Farran: And then one third will go where they’re needed. I mean we see this, Canada, I mean Canada…what is Canada like twice the size of the United States in square kilometres?
Terry Shaw: It could be. It’s pretty huge.
Howard Farran: Yeah and we see that over and over in America where, those kids who go to those small towns where they’re needed. I mean supply and demand. You should go where you’re wanted and they always want to go where nobody wants them. I want to ask you another question. These dentist coming out of school, a lot of them are complaining about $250 000 dollars of student loans, but then they walk out of school and they’ll buy a $150 000 CAD CAM and $150 000 CBCT 3D X-ray machine and $50 000 laser. It’s like man, you just doubled your dental school debt with three purchases. So if it was your daughter that just walked out of dental school and she said dad, I’m already $250 000 into this, I’m going all the way. I’m going to do another $250 000 and get a CEREC and a CBCT and a laser. What would you tell her about that? If she’s thinking I need to do that to be a good quality dentist like my dad. What would you tell her?
Terry Shaw: Well, actually I’m encouraging my daughter. She’s finishing her masters in kinesiology right now and I’ve been encouraging her to go into dentistry and she’s thinking, I think she is going take a couple of courses next year and try to get in, but I certainly…I know there’s a young fellow, five or six miles away, and he bought a practice and man, they laid some money into that thing and they renovated six operatories and all new equipment, a CAD CAM and a digital X-ray and I think they spent $300 000, $400 000 and I know he’s not as busy as he’d like to be, and I think when you get that far in debt, your judgement…you’ve got to be careful because you see those fillings and how they’re not that bad. I see a lot of stuff and it’s getting worn and chipped I say well, we’ll catch that next time and keep an eye on it and you know check it in seven or nine months, a year. I don’t jump all over it. My associate on the other hand, he’ll see patients of mine when I’m not here and when I get back and there’s guys coming in for three new fillings and I say well, look we’ve been watching those fillings for several years. I don’t sort of need the money I guess and I don’t need the business. I’m in a good position, but if I was hungry and had $200 000, $300 000, $400 000 in debt I might be inclined to do those fillings and you know, is it a bad decision? They’re probably going to have a better filling, you know, where is the point where you decide to let it go for another year or do you jump on it and do? You know that’s a judgement call and that’s a hard thing to do.
Howard Farran: Well like how they say, the easiest dollar earned is a dollar in taxes saves. The second easiest dollar earned is a dollar in expenses saved and the hardest dollar you’ll ever earn is doing another dollar of sales and paying your overhead and trying to take home a dollar and it’s amazing how some dentists just, they just have no problem with 40-45% overhead and other dentists I mean, it’s like when they hit 75% overhead, the only thing they’ll do in the next five years is to figure out how to get it to 80%. I mean like I said, their only resourcefulness is spending money and driving up the red and we’re talking about how, if you don’t have the money, you don’t have the money so there’s no use spending it. Now on your associates, are they an employed associate or are you a partner with them?
Terry Shaw: Well that’s a good question. The office building I have is in a flood zone now. The river flooded here a few years ago and if you wanted to buy this building, you can’t get a mortgage from the banks because it’s part of the flood zone and the banks won’t touch anything in a flood zone, so he’s not keen on buying the building. So it’s sort of up in the air. We’re trying to…I’m not sure what we’re going to do.
Howard Farran: So can I ask how old are you doc? How old are you?
Terry Shaw: I’ll be 68 in three weeks.
Howard Farran: Okay. Do you remember when we were little they were saying the planet was cooling?
Terry Shaw: Yeah.
Howard Farran: And know they’re all saying it’s warming. Do you think it turned into a flood zone because in your lifetime, do you think it’s global warming that’s causing the oceans to rise?
Terry Shaw: Well that is part of it. It is definitely the climate because we get a lot more swings. Prior to the problem here in the Brunswick, about two thirds, let’s see what is the figure, approximately 10 000 square miles of northern Maine all drains in to this river, a lot of the rivers in northern Maine, they drain north and then they drain east into Canada, into New Brunswick. So we’ve got a lot of water coming at us and Maine gets a lot of snow and they have been cutting the forest. It used to be your forest were trees, it rained, the snow would lay under the trees and the sun didn’t hit it until May or June. Now it is just bare, there are not a lot of trees, or they are very small, so it melts a lot quicker. The run off is faster. It just bang and within a week or two everything melts and it’s running by us and that is a big part of it. So that’s not really global warming, it’s global warming caused by man cutting all the damn trees down. So there’s a lot of combinations, a lot of things but you know global warming is definitely a part of it because the north of Canada, the Eskimo’s, and the ice is melting. The polar bears don’t have any ice flows any more because the damned ice is melting.
Howard Farran: I want to say one thing to the viewers though. A lot of these kids will go out and they’ll get a job and they get paid, like in the big cities, like in Phoenix, I pay my associates 25% because there are two dental schools, there are a thousand gazillion dentists, but I know to get a dentist to go into these very small towns, they will pay them 40%, sometimes 50% because that’s supply and demand. You might be the only guy who will live in a town of 5000 but I want to, what I want to get across to these young kids, humans are control freaks, they’re territorial, they want to buy into a piece of rock and I just want to remind them that, marriage…you find someone you want to have sex with and get naked with and have children and that fails half the time. And now you’re going to marry an old dentist who you don’t get naked with, don’t have sex with you don’t have children, you don’t celebrate holidays and it’s just gosh…it’s almost usually a really bad idea and I would tell a young kid that if you’re working in an office and you’re getting 40%, that means half the dentists- the average overhead in America is 65%. So if you’re locked in on 40%, you already have 5% less overhead than the average dentists in America, and you don’t have any of the stress of ownership. You’re not carrying debt, you’re not paying interest on money. My God why? And I still, how many marriages do you know where they dated for five years and it was just like beautiful, and then they get married and the whole thing goes to crap and two years later they’re divorced and…I don’t know.
Terry Shaw: I think that happened to me.
Howard Farran: Well what part of that story?
Terry Shaw: I guess it was 10 years. No, I was divorced.
Howard Farran: Oh okay, and yeah so that’s true. The only women who want my autograph, they want it on an alimony cheque and…so then also, you’re a member of the Academy of General Dentistry. If a young kid came up to you and said, hey boss, you know do AGD, is that a good thing? Do you recommend that? How did that affect your career?
Terry Shaw: Well in my case, the courses that I was going to, when I first heard Ron Jordan and John Kanca, were put on by AGD and probably 10 years after those courses, one of the guys involved in the AGD pestered me a little bit and I joined it probably 15 or close to 20 years ago now. So I am part of the academy and we provide three courses a year. Three one day courses a year, usually in Monkton, New Brunswick and we get anywhere, probably from 50 to 150 people at our courses. The nice thing is being part of the executive, we get to pick the guys that come to talk. The speakers. The CE speakers, so if there’s somebody I would like to hear, or see we try to get them so that’s good for me and I also go to a fair amount of CE. I enjoy CE, I enjoy learning. It’s nice to keep ahead of the curve a little bit or try to.
Howard Farran: I want to say to the younger viewers what AGD did for me and that is, I think when young kids come out of school and they take their own courses, they just take a few little areas because that’s what you are interested in and I remember when I signed up for the AGD, you know I went to get my FAGD and then I saw that I had to take, it was like 16 classes in like eight different areas or whatever. It was 500 hours over five years, take a test. But they spread out and I got so mad because I called the guy that talked me into joining and I said I don’t want to take classes in these subjects and he just Howard, you know you need to cross train and the greatest implantologist Carl Misch was, because he was a removable prosthetic guy first, and he’d see these people putting dentures on four implants and a hitter bar and then be complaining that the implant was weak and snapped and Carl said well your bit was off so bad, that was the worst denture I’d ever seen and Carl was always saying to learn how to do fixed removable, you need to learn removable first. I look at the TMJ people, I mean they say things that, if you just did one single orthodontic case in your entire lifetime, you would know is crazy and they’ve never done an ortho case so I mean you have to learn ortho to understand occlusion. I mean everything is cross training and what I liked about it, how many times would you walk into a convention and take a dental pharmaceutical course on different antibiotics when you can have a super sexy implant course or bone grafting, but you’re like I’ve got to go take this pharmacy course because I’m trying to get my FADG and then later my MAGD, and then when you’d get done with that course, you’re like God damn, I’m glad I took that course and so I never would have taken half the courses. In fact the funniest thing was, to do the implants, I literally was yelling at he guy saying, I’m not ever going to place implants. Why can’t I take something else? He said Howard, just take the implant course. So to knock out my whole deal, I signed up for Carl Misch’s seven three day weekends, like you just knock out that requirement, and little did I know that by the end of the first day I was in love with Carl Misch, I was in love with implants and it was all brought to me by the AGD, forcing me into this curriculum so and then the second thing. The second thing I would say about the ADG is that, when you join and you go to those meetings, it’s the friends that you make because you’re sitting, I mean how many friends have you made in the AGD that have, they have similar interests like you. I mean some dentists are into CE and others aren’t and to have, to walk into these meetings and have all these CE junky friends and then they turn into your bike riding friends and jogging friends and in my case drinking buddy friends, so I’m down to just three and a half more minutes. Give your daughter that just walked out of dental school, any more fatherly advice from a man who’s coming up on four decades of doing dentistry and they’re just coming out of dental school. What other low hanging fruit advice would you give her?
Terry Shaw: Well as I have said in the little blurb I sent to Rebecca there, I enjoy my work. I think dentistry is the greatest job in the world. You get to change people’s smiles or improve their smiles. They come in with pain and they walk out very thankful and they pay me money to do this, which I find very amazing and they pay us good money and I just think I’m very fortunate to be where I am at this point, and retirement, a lot of people are at me, going am I going to retire? I’m probably going to work for a few more years and I might work for longer, I don’t know. As long as I’m healthy, and I am relatively healthy. I just, you know retirement scares the hell out of me and a lot of people do it today, you see a lot of people over the age of 65 continuing to work and some of them into their 70’s and I can’t imagine that you’ll retire when you’re 65.
Howard Farran: Well I was going to ask, I was going to tell you that I think retirement is crazy. I know so many that’s, for basically, the only save investment you would have would be a government bond that pays 5% and you would need a million dollars for every $50 000 a year you’re going to make and I know, I was talking to a good friend of mine last night, Kenny Anderson. He just celebrated his dental office, 50 years and we were sitting there and he’s like he still does Tuesdays and Thursdays from six to noon and still makes more money than you and I, you know still just crushing it, and it’s like he still loves it, he gets out of the house. I think the deal about the retirement is, they work crazy hours till the end then they just cut it off and sell the practice, well then the government is going to take half your money. Why don’t you just kind of slow down and enjoy life? If you quit working Fridays, if you hate staying late, quit doing that. I think the goal should be every year you work one hour less and make one dollar more. One of my dentist friends always says that he’d rather be beaten with a belt than do a root canal. Well then that’s what endodontists are for. Just do what you like, gradually slow down and play because when you don’t retire, you’re going to make so much money by staying in the game. It’s much healthier and it’s a better lifestyle.
Terry Shaw: Well I’ve worked 32 hours a week, four days a week for the last 30 years so, you know I’m done between Thursday night at five o’clock and Monday morning at five o’clock, that’s half a week. I basically work my four days in half of a week and then have half a week off and that’s good on your head. Real good.
Howard Farran: Yeah, absolutely. Well Terry, I just want to thank you for your 1200 posts on Dentaltown. You’re a meat and potatoes guy. You’re always showing great dentistry. So many people have, you know I’ll say why do you like Dentaltown, and they’re always name dropping you, you know watching your techniques and again, everybody wants to talk about these sexy Star Wars CBCT and lasers and all that stuff and man, you’re just keeping it real on daily, family dentistry, direct composites, four generations, still in love with the old stuff and man, I just wish all my viewers on Dentaltown or iTunes or YouTube would actually log on and do a search for Terry Shaw and Terry, thank you so much for all that you do for dentistry and for Dentaltown. And tell your daughter that if she doesn’t go to dental school, that’s it’s a hell of lot easier to marry a dentists than to go to dental school. All right Terry, thanks again for all you do buddy. Alright bye-bye.