How much time do you have? Because we can do another hour on my thoughts on private equity. They called it red paste. Russian red. Russian red. So water must be the most dangerous substance in the world. No local anesthetic. So the dentist is actually exposing your nerve with no local anesthetic. So you just have to hold on to your chair. Great general dentists that provide great care. Absolutely. This is 2,000y old philosophy. Do the right thing. Welcome to the Ask the Dentist podcast with Dr. Olga Dogear, where your smile meets your overall health. Thank you so much for watching us and I am so grateful that you guys tuning in to my channel. And today I have a very special guest, true Viking Dr. Tron Hegel. He is endodontist, founder of four peak endodontics. He's a true expert in root canals. His practice is a leading practice in North Phoenix and the entire valley. He is a great source of knowledge. So we're here today to talk about and debunked a lot of controversy which we see on a daily basis seeing patients being in the trenches working five days a week and actually we're going to cover a lot of interesting topics today. So Dr. Can you tell me a little bit about why did you become an endodontist? Such an interesting field.

When I was in dental school, I really liked root canals. It was the one area where I found peace. When I sat down to do a root canal, I was happy. So the more root canals I did, the more I wanted to just only do root canals. So that's why I became an endidonist. That's wonderful. It's interesting because I remember dental school story too. I was an endodontic clinic and I was doing root canal. still remember tooth number was tooth numbers three and I was talking to my professor and I'm very hyperactive personality and I was asking my professor questions and I was deciding what field I want to go to and he said Olga don't go to endodontics I said why not he's like it does not fit your personality you're going to be bouncing around you cannot so that's so great that you found that peace and relaxation actually doing those procedures. Yeah, it's uh it takes a certain kind of kind I think to be an endodonist like being a pediatric dentist then. Yes, it has to be a certain personality for sure. Bouncing around and seeing crankets. Exactly. Yeah. So tell me a little bit about your background. So my understanding is you were born and raised in uh Norway. So, how did you end up in United States? Grew up in Norway, lived in Norway till I was about 25. Then I moved to Denmark, lived in Denmark for a couple of years and then I really wanted to try to pursue the American dream. Wanted the um tried to come to America and and experience that. It was just that's that that's where I thought I wanted to be. So here I am and 20 years later here I am. So Norway has like the biggest national fund. So my understanding Norway reached the true socialism, right? Because they can technically support the whole population because population is pretty small in Norway. 5 million people, right? 5 million people. Yeah. Um, I think the Norwegian socialized or government health care system is very similar to the Canadian system where I remember growing up my elderly grandmother needed a knee replacement. Mhm. and she just couldn't advance in the in the lines because she wasn't a contributing member to society. She wasn't paying taxes. She was retired. So there was no value in getting her healthy. Um whereas here you you just get your surgery and you move on. You can schedule it quick. Yeah. Mhm. But there are, at least back in the days, there used to be a long lines to get care. Um, and my perception was that there would be they would favor people who were of working age. Exactly. Mhm. Um o over the course of the past 20 30 years there's also been um a growth of private health care parallel to the government system so you can pay your way um and kind of cut the cut in front. Gotcha. Gotcha. And I think to some extent the government will even subsidize part of treatment in the private health care but I'm that might I I'm not going to work. Yeah. Yeah. Absolutely. Yeah. Yeah. So health care system in United States I've been in this country for 26 years. So I definitely see kind of shifting. So um and it's still we have something to compare with our childhood. For example, my childhood was completely different because I'm from Eastern Europe. So he's from rich part of Europe, northern part and I'm from Eastern part which was Soviet Union. So we had whole different situation there. So my memories are very interesting. I can talk about that. Um, but now being here for so many years, we do see this trend of local people who grew up in the United States. They kind of looking at Europe and saying, "Oh my god, the grass is greener over the ocean. They're doing so much better. Why don't we have free everything?" But it comes in a big price and there is much more nos and conditions which local people don't understand and don't see. And I think a government-run system is, and I'm going to offend a lot of Europeans and Norwegians saying this, but I don't think a governmentrun system, a singlepayer system, a socialized system, even in a rich country such as Norway is going to have as state-of-the-art technology, as cuttingedge technology as a private system such as in America. I do I think the American health care system has a lot of issues and problems that need to be resolved. Absolutely. Absolutely. Mhm. But do I still think that this is the greatest health care system in the world? Absolutely. Yeah. Do I think people

going on medical tourism trips to Turkey and Mexico and Thailand, again, no offense to these countries, are getting top-notch care? No. No. Do I think that the best doctors still are in America? Absolutely. Absolutely. Yes. For sure. And there's so many examples that you brought up. interesting topic because sometimes we see even dental uh it's of course depends on the doctor of course there is a great doctors in every country but on average sometimes we see certain things were done for example let's talk about China former Soviet Union Eastern Europe which I know how things were done for sure the the root canals for example they use that red paste and when I was preparing for our interview I actually read internet guys. True story. When I was 17 years old, I had root canal done on the back tooth and no local anesthetic. So the dentist actually exposing your nerve with no local anesthetic. So you just have to hold on to your chair and then the doctor tells you, "Okay, hold on just a little bit. I just going to put arsenic just a and I'll close it your tooth and I'll see you in a in a week." True story. Arsenic to kill the nerve and now we're talking about root canals causing health issues and problems and all that bias. So if you look at the whole world, China is a big country, India is a big country, United States, I mean Russia, all of those countries are huge and they use substandard practice and did it for years. And I'm not the oldest person in this. There's people who are older than me and who are younger than me and that that type of practice was still out there. They called it red paste. Russian red. Russian red. Yeah. It's um Yeah. But it worked it. So, so I feel like it's a little bit people do the best they can with what they have and that's it. It it it's kind of like this public health approach or this you do what you can to minimum expense. Yeah. Minimum expense, max maximum benefit, no technology. Yeah. And it it works to some extent. I mean it's Yeah. Yeah. But it works. But then when you But see this patient, you probably have difficulties fixing things. 100%. 100%. Right. Because um it's impossible to treat. It's impossible to treat. So now we kind of phasing into we're going to talk about endodontics and um there's so much controversy now in my job. I feel like I'm taking this u burden of divide deciding or trying to bring the best information to our patients and listeners because what we see in our practices we have a group of people who believe in one dogma and there's a group of people who believe in different dogma and now we as a practitioner our job is to explain and trying to deliver non-biased information. So, did you hear this whole controversy about root canals and cancer? Can you elaborate on that? Yeah. Um, so there's there's this movie that went around a few years ago, the root cause movie about how root canals will make you sick and how root canals will cause cancer and all sorts of ailments and um I think you used a great word. I think the word dogma um belief system. I think people are free to believe whatever they want. Um, personally, if if I believe that root canals didn't work, um, I would be a big fraud because that's all I do. I do them every day and I believe they work. I I think they're a great treatment to to preserve the natural dentition of the patient. Mhm. I think the problem with root canals as with general dentistry or with plumbing or with car mechanics a good endidonist will provide good treatment, excellent treatment, predictive treatment that will heal and that will preserve your tooth. just as a good plumber will do excellent plumbing work and your your plumbing will last for 30 years. A bad clinician, it it will fail and it it won't be successful and it will cause problems. Problems. Um just like a good crown will last a gold crown will last for 50 years. Yes. Yes. And we see that. Yeah. So the um you know one of the things in this root cause movie the the sensationalism of the movie is

x% 90% of women who have breast cancer have a a root canal treated tooth on the same side as um the the breast breast cancer. Mhm. And um you know this old saying, there are three kinds of lies. Lies, damn lies, and statistics. And and um my my favorite comeback with that is um 100% of serial killer 100% of serial killers drank water. So water must be the most dangerous substance in the world. Uh we should all avoid water at all cost. Um, so you think that there's no correlation between root canals and cancer in general? And where's this where's this came from? Like historically? Why why do they come up with this idea? I think personally I don't believe there's any correlation between root canals and cancer. Mhm. I don't think there's um any correlation between root canals in general and health issues in general. I don't believe there's any correlation between dental amalgam and health issues in general. I think dental amalgam is still a great material that is getting banned and replaced with other chemicals. Mhm. So we pick our poison technically because the modern feelings have certain type of plastics. They leak plast they're scared of plastic being in the brain. Right. So now we used to be afraid of mercury. Now we're afraid of plastic. So we're picking our poison. Yes. Literally pick peak your poison. Yeah. So the controversy is I think I know where it began. It began actually in 1910. There was a famous uh scientist Pierce, West Pierce, and he did study. We're talking about 1910. We don't know how well that study was designed but he come up with the idea that dental tubules can lick infection into bone and that would have systemic effect and people would develop autoimmune diseases, cancers, arthritis and so on. So that all controversy comes from back in 1910. So what you're referring to is somewhat correct and somewhat incorrect. Where I'm going to So this is this is ties into what he called the cavitation theory. Right. Yeah. Cavitation theory as well. Yes. Yes. Yes. Um do I believe that what he's referring to is correct? I'm not going to say that it's completely incorrect. What where he is correct is an infected root canal system harbors bacteria. Mhm. An inadequately treated root canal system, poorly done endodonic treatment will harbor bacteria. Yeah, of course. Yeah, bacteria will leak through dentinal tubules. Bacteria will continue to live in an improperly treated root canal system. Mhm. And continue to cause perapical pathosis, pathology, which is I believe the same as what he refers to as cavitation. only we call it periapical pathology or pathosis. Yeah. With that being said, root canals don't cause cavitation or periapical pathosis. Root canals, a properly done root canal and the dontic treatment should resolve this issue. It should remove the bacteria. Our goal is to eliminate the bacteria so that your immune system can heal. Yeah. Again, advances in in dental materials in dental technology has allowed us to do a better job at cleaning properly. Yeah. And and seal more properly. So to eliminate bacteria, eliminate leakage and induce healing. So do I think that root canals of 2025 are better than root canals of 2020 or 1990 or 1950? Absolutely. I think I think in general the technology has helped us become better clinicians and create more predictable outcomes and induce better healing. But I don't like this again the the sensationalism of oh my god root canals are are the root cause of all the world's problems. Um improperly done endodonic treatment is detrimental to oral health, systemic health. Sure. Absolutely. Just like bad plumbing will cause flooding in your house.

So talking about advanced technology now. So what are those advanced technologies which are emerging which are better compared to for example 1990s? What do we see and why root canals are better made in this late 2020s compared to last century 1990s for example? So where endidontics has gotten way better over the past 20, 30, 40 years is

although not the standard of care. Most endodontists will use a a microscope, a surgical operating microscope for better visibility, for better light. Again, it's not considered the standard of care. I'm hoping that the American Association of Endodonics will come out with a position statement that will make it the standard of care because I think you if you can't see well, you can't do well. And I think the the more the the better you can see, the better of a root canal you can do. And and um I'm a strong proponent of the microscope. We also routinely use um 3D um radiographic imaging cone beam computed tomography. Mhm. Which gives us a 3D image, 3D rendering of the tooth that we can slice in very thin slices on the screen and find canals, find anatomy, better visualize. It's like a GPS of the inside of the tooth so we know where we're going. Um, then the the the mechanical instruments that we use now are much more efficient. Um, in the '9s we started using nickel titanium for our instruments which is very flexible, very durable. So we can more accurately follow the anatomy of the the root canal system and and better clean um more predictably but also more accurately clean and um and debride the root canal system. And then once you have debrided and created um a path now we also have um a system that I believe in very strongly as a great way of disinfecting and cleaning the root canal system called gentle wave which is a multi-sonic um system that uses chemicals and sound waves. waves to create a a chemical and soundwave vortex to really clean and negative pressure to clean out the the root canal system to make sure it's clean as a whistle and completely disinfected. Mhm. And there are kind of two two competing or not necessarily competing but kind of a little bit competing uh fractions right now. The the people who think that gentle wave is the way to go and the people who think laser is the way to go. Okay. And personally, I think gentle wave is a more thorough way because it uses so much fluid. It uses almost half a liter. Uh so pine that's a lot. Half a liter. Yeah. Of of arrogant through the root canal system to to really disinfect. Um but laser would like bake it. Exactly. Basically that's so that is my thought process. A laser would you it it still activates what liquid is in the system but it doesn't it doesn't suck it out. It doesn't activate it. It just basically activates it and and kills but it doesn't clean. Doesn't clean. Yeah. I know exactly what you're talking about because I work with laser on a daily basis and what it does it kind of opens up like cuts but it doesn't really disinfect I would say I mean it disinfects at the size but for root canals you have to suck out all the goo which is in in the canal but laser would like bake it to the tubles. That's my That's my thought process, right? That's what you thought. Yeah. So, and then a third arrogant slash supplement here is also is ozone, which is something that also um works great. And I So, here is my thought process on this. The the absolute ideal combination here of treatment would be to run the gentle wave first. Get it clean as a whistle. Then maybe run a laser after you complete the gentle wave cycle just to make sure there's nothing more even though I feel confident that there is no more. Gotcha. Gotcha. And then at the very end, maybe you irrigate with ozone water to absolutely make sure there's nothing more. But I think it's overkill. I think it gets to a point where you're overthinking and overanalyzing and you're um and you're almost just wasting time. Yeah. Yeah. Yeah. Because you cleaned it on so many different levels already. Yeah. Technically, I mean, you can you you can become so neurotic about something that it it almost you're overdoing it. Of course. Of course. What about filling material? Like it used to be good aperture, still is good aperture, right? Yeah. So, sealers have evolved and and now this kind of ties in a little bit with pediatric dentistry because um uh a brilliant mind out at Lomolinda University, Mahmud Torabinad um and Leif Bachan at Yeah. L Melinda University, they developed MTA. Yes. Um which is basically Portland cement. Yes, it is. Um they discovered um probably about 20 years ago, late 90s, early 2000s that by just mixing sterile Portland cement and using that for pulpottoies, pulpecttomies, um would be a great material to to help inflamed but vital teeth continue to grow. Grow. Yes. Um, so in pediatrics, teeth that aren't done developing will continue to develop. Um, and so that was a great discovery probably about 20 years ago or so. About that. Yeah. And then more companies started running with MTA and that kind of um type of material and develop the bioceramic sealers. Yes. Yes. Yes. Yes. which again I now use um because they're highly biompatible and are I just see tremendous healing when I you know combine the gentle wave technology modern technology with these bioceramic materials we're seeing healing at rates that are would would have been unheard of 20 years 10 years ago 20 years ago Uh it it so it great advances and now talking about cavitation you technically when you do all those steps you describe the healing when we talk about healing we talk about bone the whole controversy about the cavitation and that bone actually heals and we see triculation bones restore and build back. Yeah. It It's just like a broken bone. You're So the cavitations that they referred to were technically just a broken bone that didn't heal correctly because of irritation because of bacteria. Yeah. So it's no different than an improper healing of a fracture in your bone. Of course. Yes. So again, you're giving your body a a clean a clean environment so that your immune system can help heal. Mhm. So nowadays for another controversial question people ask is so that technically it's a clean tooth but doesn't have vitality anymore right we feel it and everything else so it becomes more fragile right uh so what is the longevity of this tooth how long can it stay in the born with a new techn would it be better than for example 20 years ago with a new technology that fragility is still going to be an issue, right? The two still going to be fragile technically.

So, great question. Mhm. As I talked about the the nickel titanium files, the the the

and theodontics 20 years ago, 30 years ago before gentle wave, before all these latest modern advances kind of got into this, oh, we got to clean out the the roots so thoroughly. Mhm. So when nickel titanium first was introduced, but we didn't have these great disinfectant disinfecting technologies. The theory was, oh, we need to really bore out the roots. We need to have big prep. So they we would have big files that would really clean out the whole removing to structure inside the canal. Yes. So which would the more the more you hollowed out hollowed it out the weaker it got. Mhm. So but it was you know this is science. It's it's trial and error and and we learned from our mistakes and and now we know better. But people again did the best they could with what they had and that was the theory and that was the that that was how it was done. Now with the advancement in gentle wave with disinfection and and and really cleaning we're we've gone back to way skinnier preparations of the root canal system to preserve more root structure, preserve more um cementum and dentin so that we don't weaken the roots so we don't weaken the teeth. Um, do teeth become brittle after root canal? Well,

what purpose does the does the dental pulp really serve after the tooth is done developing? Once it's done developing, I'm not necessarily convinced that the pulp serves a purpose. Do I think a tooth becomes more brittle after root canal? Well, it kind of depends on how you you restore it. If you back in the days, we had big preparations. The the core material was often amalgam. Um, I I think we just put a lot of stress on these teeth with with really conservative root canal preparations with a good minimal bonded core buildup and a good well-made crown. There's no reason why a a tooth shouldn't last for life. For life. And the advantage of preserving your natural tooth with a root canal treatment versus extracting it and replacing it with a man-made titanium implant is your tooth. Even though it's dead because of the root canal treatment, it still is attached to your bone with periodontal ligament fibers, PDL fibers. So when you chew on a strawberry and you have that little strawberry seed, you're still going to feel that you're biting on a strawberry seed. You're still going to feel that if you have that stuck in your tooth, it's still going to irritate you. Yeah. An implant is as solid as this table that you feel like you're chewing on concrete so you don't get that sensation. You don't get that feedback. Feedback. Mhm. from the so now the question also new type of implants are emerging ceramic implants and again I understand downtime probably is a big one as well right because if you do root canal versus an implant we're all busy and timewise if you do root canal in a crown we're talking about I mean maybe three appointments Right? One with root canal and then adult dentist would general dentist will do prep and temporary crown then final crown or even one appointment. Nowadays we have those scanners we can do crown in the office. Compared to implant we're talking about placement of the implant waiting six months right to completely heal probably. Now we have healing abotment then we placing a crown. So time is very different. But statistically longevity is that do we have data what's like longevity of root canals versus ceramic uh implants or is it so new that we don't know the long-term difference. So I think the data obviously shows that the prognosis for an andidonically treated tooth versus a dental implant

are about the same. Mhm. So a a welltreated root canal treated tooth will last for a long time. 10 years, 20 years, 30 years. Mhm. M a dental implant that is wellplaced will last 10 years, 20 years, 30 years. Does anything last forever? Of course. No, we we don't last forever. Well, so that's the thing. Lifetime. We're only human. Yeah. Um, but I I don't like that some people think and some dentists sell that, oh, just take your tooth out, an implant will last forever because nothing lasts forever. Nothing lasts forever. It comes down to the patient, the patient's compliance, the patient's biology. Of course, the patients habits, diet as well, 100%. Mhm. diet, but hygiene practices, clenching, grinding, it comes down to um again the skill of the clinician, the just the the general health of the patient, systemic diseases, diabetes, and it also comes comes down to the expectations of the patient. But so when you're touching on on price and time, I a root canal treatment with a subsequent subsequent crown in the dentist's office

is still probably going to be significantly cheaper. Yeah. Or less costly than an implant and an implant crown done by a specialist. I So I I'm a specialist. I'm a strong proponent of seeking specialty care. Me, too. Do I think that there are great general dentists that provide great care? Absolutely. Do I think that there are general dentists that do beautiful root canals? Sure. Do I think there are general dentists that do great implants? Yes. If I'm going to get a root canal, I'm going to find the second best andidonist in the world to do it. Second best. Mhm. If um I need an implant, I'm going to find the best oral surgeon or periodontist or dental implantologist or endidonist because a lot of endidonists are also doing implants. And I just or or the best general dentist that is specializing in implants, but I don't want a jack of all trades. I want someone who has limited their practice and is doing a thousand of these per years. For sure. For sure. Plus technology. Yes. You some dentists can have that microscope but majority of specialists and the dentist would have the microscope and ability of have 3D scanning. Yeah. And the wave technique what you just mentioned. It's definitely sets you apart from majority of general dentist who has to do dentures, crowns, full mouth reconstruction, pediatric dentist, everything at the same time. We love general dances, don't get us wrong. But there's certain things which uh specialty actually definitely little bit above and beyond because for example pediatrics we we can do certain thing completely different because of the training we have that those additional. So for our audience and the dentist, it's not just dental school. We go to a specialty two to three years of just doing root canals day in and day out. Mh. So you getting good in it. If you doing it better and better and better with so many, you will get good in it. So that's that's what set us apart. I think specialties in general. Yeah. But there's so many beautiful and great practitioners out there. Of course. 100% of course yeah and we cannot it's few of us compared to general I think statistically 25% of root canals are done by endodontist and 75% are done by general dentist that's statistics you I I wouldn't even know that even sounds high to me I I would even think that a lower percentage would be documented on the grog AI to see what's the statistic we know but that could be could be it depends probably on the area also like in Phoenix probably even but I as a specialist can't see every root canal in the world like it's just we can only do so much of course so I encourage general dentists who feel comfortable and confident to to do nice root canals. Mhm. But it's all about knowing your limitations and no no no one to hold and no one to follow. I still remember from dental school there's MB2, right? The little extra canal which nobody can see and then it cause problems and people just don't know that they there's something which not visible probably unless you have a specialty microscope. Yeah. Yeah. So circling back to statistics uh in the United States there's about 15 million root canals done per year statistically according to Chad GPT and compared to European countries is um I think it's about seven um 7 million or percentage wise I mean population is definitely different. Why do you think it is? Do we do more root canals in US? Because we have this old technology and specialty compared to different countries. Why do they do less or they don't brush teeth as good? Just interested. European dentistry has been more public health focused,

more conservative in a way. Mhm. I I think Europe focuses a lot on prevention and more minimally invasive dentistry. Mhm. Um I think it maybe more patchwork dentistry. More cost effective dentistry. Mhm. I think Americans are more worried about their looks, about their Yeah. aesthetics with elective dentistry with crowns and veneers. Mhm. Your teeth are going to be more traumatized and teeth don't like to be worked on. Exactly. No dentist is the best dentistry. For sure. 100%. And there's nothing beating a natural tooth, right? For sure. So whenever you put a bur to a tooth, the nerve inside the tooth is going stop. And you can only do that so many times before the nerve has just had enough and gets so angry that it wants a root canal. Exactly. So in Europe, there has never been a tradition for cosmetic dentistry. Mhm. I think at least traditionally it was almost considered malpractice in Europe to do cosmetic dentistry cuz it wasn't necessary. Interesting. Huh. So you European dentists at least from the countries where I have lived have kind of frowned upon and and almost made fun of America's vanity. how you know we want it's the Hollywood smile. We want white, bright white, straight white, shiny teeth. Shiny teeth. And um but again, I think that kind of ties into the more aggressive treatment you do, the more subsequent treatment you're just going to get. Mhm. Um I also think that the public health system in Europe, you know, they pull a lot of teeth. That's what I was thinking. That's what I was thinking because it's cheaper for the taxpayer system and easier to do just extractions. Yeah. And probably the government system does not cover implants. I would believe so. Right. I think in at least in Scandinavia and in northern European countries, I know that there's some government reimbursements for implants at least now or yeah, it's one of those things where if it's medically necessary, you get reimbursed. I don't know the system to get medically necessary. We know how that system work here. I'm sure it's over there. It's very difficult. It definitely has to be approved and Yeah. Yeah. Yeah. It's the same with orthodontics. I know that a lot of children get free orthodontic care. Um, you know, if if you have very misaligned teeth and and bad occlusion, but I don't think you would ever get away with getting free or or greatly reimbured orthodontic care just for cosmetic reasons. It would have to be medically medically some kind of syndrome or something bigger than just miscellanees. Yeah. Yeah. But then again, that's where in America, you'd be hardressed to find a single kid without braces when they're 12 cuz we want them to grow up and have straight teeth and pretty teeth. And it's Yeah. And what about new technology like touching up on pediatrics going back to pediatric no stem cells. So I took a class last year was kind of a joint symposium between pediatric dentistry and endodics. I actually flew to um uh Portugal. Okay. Uh it was very interesting. So it sounds like with the advancement of uh stem cell technology and understanding that we have our own stem cells in our body, we might revitalize like at least young developing dicians uh permanent dicians. What what is research on that? What is your stance on that? So there's even even 10 years ago or 15 years ago when I was in my training um the there there's been a lot of research on on revitalizations and you know scaffolding and stem cells. Scaffolding. Yeah. Yeah. Yeah. What is that for our audience? Isn't it a collagen scaffold that um gets placed inside the tooth and then you introduce bleeding in stem cell but I don't want to be quoted on this and I don't want to neither do I be be deemed incompetent because I know my limitations. So personally I'm not that's that's not the kind of literature I sit and read at night. That's good. Just because it just doesn't seem like we're quite there yet. It's and it's been ongoing for so long. You know, the the other day I saw something. Oh, and we've heard about this for a long time. How Japanese researchers are now able to grow teeth in dappen dishes and soon implants will no longer be and soon you can just But my question is, how much is that going to cost? Yeah. And how what's the application of this? It, you know, we again we can overthink things and be so idealistic and oh, we're going to only have healthy teeth. It almost to me it almost ties into this reversal of aging and this fountain of youth and we all we don't want to get old and we don't want to die. But you know what? Nothing lasts forever. Nothing lasts forever. And how much time and effort honestly to me be I'm a dentist. I love saving teeth. I love teeth. But how much time and money and research money re research efforts are we going to spend on growing a tooth? Can't we cure cancer instead? I mean, wouldn't that be better spend research money? For sure. For sure. I mean let's I mean I I hope it's a future with new AI emerging technology. So I think we are facing some type of exponential progression in science. I agree with that. And then we most likely face some kind of shift in paradism because we've been doing kind of similar type of dentistry for the past 100 years. Yeah. And I always was thinking like we can we we now can cure certain cancers, right? But we cannot cure the decay. That always was my question. Yeah. So, but the Mhm. the difference with curing decay is the tooth forms from the inside from the pulp. Yes. Once the tooth is done forming, there's no blood supply to enamel. There's no blood supply to dentin, right? I can see how you potentially could regrow pulp and get pulp revitalization. Mhm. But how do you unless you actually grow a brand new tooth in a dapp dish or like a tooth bud? But then my question is this little tooth bud in the dappen dish, how does that know which tooth it's going to grow into shapewise? Right. Yeah. Does it know if it's a right front tooth or a left front tooth or a lower mer or an upper m? That's a good question. So again, it sounds very idealistic and just plus how can it not become like a melablastoma, right? Yeah. Yeah, it's a cancer like a bad one. How how do we direct these cells to grow? Unless you have a stem cell from the original toothbud tooth you're extracting, but you don't. Mhm. So I I I guess I'm not smart enough to or I'm not honestly interested enough in the technology because it seems so sci-fi to me at this point. Yeah. Growing TSI I mean I I have not heard more than that's what you're talking about that Japanese research but revitalization it seems like it's very very promising. That's more that's more intriguing to me. Intriguing. Yeah. And some I saw some amazing X-rays actually how completely necrotic to on a preolar on a teenager completely form and with no treatment except reveritalization. Yeah. And that's intriguing to me too. If we could if instead of gutaerta I would fill the tooth with some sort of scaffold and and cells to just stimulate growth of nerve tissue. That would be great. Yeah. Um yeah I think those cases are already here. Yeah. But then I mean other questions would be emerging regarding that in terms of behavior management and everything else. I think it would be a great technology to combine with my gentle wave technology because I would assume you would need a completely sterile environment. I think you would need to eliminate as much bacteria as you as you can. So hopefully we're moving in the right direction. Yes. Hopefully. Hopefully. Definitely. Yeah. Um what do you think we didn't cover in our conversation about endodonics? because there's a lot of confusion, a lot of controversy, a lot of questions in our population. What do you see in your practice? What bothers you? What bothers me the most in general? Mhm. Whether it's dentistry or endodontics or plumbing, it's people who don't take pride in their work. Mhm. My whole practice philosophy is

if you put yourself in the place of the patient or your customer, you're always going to do what's right. My practice philosophy is to always strive for perfection, to always diagnose properly, offer the ideal treatment, alternative treatments that might not be as ideal in my opinion, but ultimately it's the patient's decision, decision and body. Yeah. Um but if the patient and I and my referring doctor decide that we are going to save this tooth with endidonic treatment, my my practice philosophy is I am going to offer my patients the absolute best treatment to my ability with the best technology with the best materials. And what bothers me the most is when my esteemed colleagues don't feel the same way. When it's when our treatment becomes driven by profit. When our treatment options or or choices or not or if the patient isn't even given a choice if it's because they don't know because they don't know because you're not educating your patient. That is my my biggest complaint. My where I really get worked up is when I see that people were rushing treatment, didn't care about doing a beautiful job, were didn't care about it. It's it seems rushed. It seems inappropriate. It really makes me angry. Um and I I have been blessed. I work with so many talented and caring general dentists in the Scottsdale and Phoenix area that are focusing on treating people well, doing the best dentistry and we work together as a team to achieve the best possible outcome for our mutual patients. of course, whereas I feel like a a lot of people don't necessarily care about patients to that extent and it and it and I'm sorry if I'm offending my colleagues out there by saying that, but that's how I feel. Completely I agree with you. We we need we need we just need to put ourselves in the place of the patient. How do you want to be treated? Exactly. It it's it comes down to the golden rule. This is like Mhm. This is 2,000y old philosophy. Yeah. Do do the right thing. The right thing. Exactly. Plus now we kind of dentistry is changing and it becomes more corporate and then you see some sometimes very negative outcomes because now that and I feel for those dentists because now they pressure under management to produce right they have to meet the quarter they like we have our practice private practices and we are the ones who are in charge. church we are not dominated by some type of general management who has to um kind of speed things up and achieve certain benefits at the end of the months. So I feel like overall the healthcare kind of shifting towards that corporate mentality which unfortunately not very good for patients. Welcome to the Ask the Dentist podcast with Dr. Olga Dogear where your smile meets your overall health. So since you started practicing and since like we started practicing pretty much same time, did you notice like the shift in dentistry that first of all in my case when I opened my first office I had just one or two neighboring practices. Now corporate dentistry kind of taking over and they're placing specialty practice almost on every single corner and then they present this like a cheaper I guess more economical they take all the insuranceances they negotiate better deals with suppliers they have um I mean completely system is like tailored towards this corporate slash I mean you talk about DSO private equity all of that so what is your input on that do you see that so excited to talk about this we shouldn't start with that yes I have seen a shift I think we all have experienced this shift and I I dread this shift and I dread this development and I am angry about this development because I became a dentist to take care of people because I want to give people the best possible care to help people achieve health. Mhm. Um, it's great if we can make people pretty, but more than anything, just proper and appropriate care and caring for and about people. Get them out of pain. Get them out of pain. That's one of the biggest things. Yeah. Get them healthy. Yeah. When I opened my office, I started for Peaks andodontics in 2018. So, we're coming up on we're we're at seven and a half, eight years. I already had some experience. I've been an associate with a couple of really fantastic endidonists um who I still consider great mentors and friends. One is Tom Mlammy who's now mostly retired, great inspiration, fantastic endidonist, Dr. Oari here in in Arizona, another fantastic endidonist. um kind people who care about people going into this tail spin. So when I started four peaks and seven years ago, I wanted to build a practice that was state-of-the-art. I I focused on setting up an office that was elegant, comfortable, and elegant, aesthetically pleasing. So, you feel like you're a guest in my house when you're coming to see me. Mhm. I wanted state-of-the-art equipment. I only wanted the best. The initial investment might be higher. Yes. But my outcomes, my results, my the joy of me using that nicer equipment every day is much greater. I only buy top-notch materials. I only want to offer my patients the best. I take my time doing a root canal. when corporate comes in, when a a DSO, a dental servicing organization backed by private equity, comes in and buys a dental office or an endidonic office, they're going to go through your books and your supply list and find cheaper alternatives. Of course, they're going to tell you, "Oh, you're spending 30 minutes on a patient, an hour on a patient. Well, we need to cut that. We need to we need to work faster here. We need to Oh, these materials are too expensive. We need to find something cheaper." You can use people at the same time put on videos. Literally, I don't when I sit down and I treat the patient, once I sit down to treat the patient, I don't get up until the patient is done. Yeah, that's obviously not how a pediatric dentist is because that is like organized chaos. Chaos for sure. Yeah. But for an endidonist, I know a lot of endidonists will like, oh, I'm just they have two or three people going at the same time and they like jump around. Mh. And that's again, as a patient, that's not how I want to be treated. I want my doctor's full focus, of course. And um that's how I set up my office as a as a comfortable environment that is low slower pace with the highest quality equipment, materials, practices so we get the best outcomes. And as much as these private equity firms and DSOs are telling dentists, sell to us, nothing will change. You will still be the doctor. you will have all your autonomy. Everybody that I'm talking to that have fallen into this trap, they're all miserable. And I'm sorry again to There might be a happy colleague out there who sold who is who is so happy that you did. Good for you. Mhm. But the majority of people that I talk to are like, well, this is nothing what they told me it was going to be like. Exactly. I regret it. so much things do change. You are no longer the boss of you of you. Yes. And the sad thing also that I see that I feel is and I'm going to take heat again. Okay. I feel like with a corporate leadership, a corporate non-d dentist regional manager overseeing. Yes. Telling you, oh, your numbers are down, your numbers are below, you need to produce more. Yeah. Yeah. People are being sold dentistry instead of being treated for the conditions that they have. They are being sold unnecessary treatment and I'll die on that hill. Like I I truly believe that there is because of this DSO private equity mentality, people are being oversold. people are overtreated and it and it breaks my heart because that's not how I want to be treated and as a profession to a certain extent because some dentists agree on that we're shooting oursel in the foot because I work for corporate dentistry as well and I remember seeing so many management I was shocked that there's a pediatric manager there's a regional manager there's a orthodontic and pediatric manager. Yeah. And it's just me and all of them have some type of uh uh propositions some type of goals and somehow for all they require is the I am the one who needs to bring it to them. Yeah. Through what? If the child has low risk for example of cavities I have no hesitation to tell you good job mom your kid is good or opposite I see for example um children and I like private practices like your practice for example because if we refer I don't feel hesitation that it would be overtreated like if I'm not sure on my side if that tooth needs root canal and on some teens it's kind of hard to say because it looks big the cavity but then they are not consistent with their responses so when I send it to private practice I know they will come back just if need root canal they will have root canal if they don't need root canal they would not have vital revitalization would happen or some type of treatment which if I send them to corporate it's 100% going to come back with root canal y so that's what you by over treating. Absolutely. Mhm. And I you know there's there are corporate endidonists in this town and the I would say the joke is but it's not joke. It's very serious but the the perception is people know this if if I send a patient there. They're going to they're going to walk out with a white line. They're going to they're going to get a root canal for sure. Um whereas again I take great pride in diagnosing properly. Mhm. I over the past um seven eight years that I've been in my office I I ran the numbers I've um run statistics on this three three kinds of lies right statistics so I've ran the I've run the numbers on my in my own practice and I turn away about 40% of people who are returning to me. Oh wow, that's a lot. So yeah, that's why I'm not rich. I I should just treat everybody who comes in into my office and charge them $2,000 and be rich like these other guys, I guess. But I don't because I want to sleep at night for sure. 40% of people that come into my office don't get a root canal. That's a big percentage. It is a big percentage but I am also getting referrals from other endodontists who are unable to diagnose what's going on. So the fact that other specialists in my own profession are leaning on me to help diagnose tells me that I'm on the right track. I'm doing something right. Mhm. DSOs unfortunately like I said I I think in general it's that internal greed which drives people and I I am concerned for the future of our specialty in general for dentistry because what happened to for examp

twoarmacies rightopoly Walgreens yeah and CVS and I am truly afraid that in the future in dentistry will be two big corporates and that's it and you have no options you have no choices so us as a dentist I think we should preserve that private practice feel and private practices and don't fell into this category when you just take develop and sell and then at the end your kids if they want to do it might not be able to do what you been doing. I think that's a valid point. I think what has happened to pharmacists is sad. It's very sad. Again, growing up, I remember the pharmacy on the corner, which was owned by the pharmacist, and the pharmacist was there and it it was familyowned and operated just like our dental practices. Yes. And and now even in Norway there's more and more chains or more corporate um it seems like not to the extent as it is here but it seems like it's going in that direction in in Europe too. Mhm. But yeah, I I feel truly sorry for our colleagues, the pharmacists, cuz h how sad your dream was to become a pharmacist, and now your only option is basically to join either CVS or or Walgreens, and that's it. That's it. Yeah. Um and I agree. I don't want the next generation of dentists to be left with three choices of three corporations that they can join. But I I am so concerned that our profession is turning into just car salesman just working for these corporations. Oh, we're just going to sell you a crown. We're just going to sell you a crown. They're just going to sell you stuff that because there are so many layers of management that need their salaries. Exactly. To keep the corporations afloat. Afloat. Yeah. And the doctors in general become like soldiers literally in this whole worker beast. Worker beast. Yeah. in this whole pyramid of CEO and then multiple management on different levels and doctors working and they're trying to do their best. They're trying to stay ethical as much as they can but unfortunately they're squeezed squeezed into forced forced. Yeah. And it happens in dentistry. I don't I think we still okay but we see the trend but medicine it's pretty much gone. Yeah. Technically there's very few private practices. Yeah, it's it's funny that you bring this up, but I I uh my mother is still in Norway and I actually spoke with her this morning. Um you know, again, this is another area where technology has made our lives better because when I first moved away when I was 18 years old, I would go down to the corner on Sundays and pick up the pay phone and I would call my mother. Yes. And then we would agree on Okay, we're going to do the same thing next Sunday. And now her her picture is in my phone and I and I call her any time and it's feels like we're in the same room and not 5,000 miles away. But my mother is pushing 70 and she has had the same dentist for 30 years and she's gone every year and she's gotten her teeth cleaned and she brushes and flosses and there's it's it her dentistician has been maintained for 30 years and she's doing just fine. Well, now her dentist retired and some fresh grad young guy bought this office. And my mother was so upset because here she's being scalded by this young guy who says that, "Oh, your teeth are so horrible and your yours, you know, we're so sad." Getting into this getting into this sales pitch of, "Oh, we got to we got to we got to fix this and we got to fix that." Thank goodness I I know a lot of good people ac around the world. So I picked up the phone and I called a great dentist that I know in Norway and who I know will now take good care of my my mother hopefully for the next 20 years. Mhm. It's sad that the old school practitioner, the solo pharmacist, the We're we're a dying breed. We're we're disappearing. The you know the the little deli on the corner is no longer there. The the tailor is no longer there. It's all everything is corporate. Yes. And it's everywhere. It is. And it breaks my heart that if that is the direction that dentistry is taking. It sure seems like that's the way it's going. But I'm going to I'm going to try for as long as I can to to maintain a solo practice that focuses on taking care of people and not worried about the corporate profit. Exactly. And provide the care from your heart. From heart. From heart. and do the right decisions and buy the best materials and look into that advanced technology because I'm sure those corporate probably don't buy the microscopes. They probably using loops or if they because it's expensive. It's expensive. Bottom line. Yeah. It's always the bottom line. Yeah. Oh, it's kind of a sad note. Yeah, it is. It's a It's a sad topic. It's a sad topic. Yeah, it's a sad topic, but we hope for the future. We hope that technology will maybe bring us something new. Hopefully. Hopefully. Maybe we'll grow those teeth you worry about. All we can hope for is that the good wins in the end. That's what I'm hoping. Yes. I whether you believe you know what, whatever you call this good, if it's karma always wins. if if you believe in a god or if it's just the the greatness of the universe. But hopefully by doing the right thing in the end be truthful to yourself. I would say the truth wins. Yeah. The truth and belief that's those are milestones which actually define us as a human beings as a good people. Yeah. Because if you lose that, you lose your identity. That's that's it. Thank you so much for your time and for coming here and doing this podcast with me. I appreciate it. And for our listeners, if you have any questions about your root canals, I'm trying to stay in the middle, not succumb to any dogmas on any sides. center is where we belong. Please share this video with others and if you have any questions about root canals, we have the best and the dentist here and we can answer all the questions. Thank you. Thank you. Welcome to the Ask the Dentist podcast with Dr. Olga Dogear, where your smile meets your overall health.