Trusting Your Gut Instinct for Treatment Planning – PDP171

Is your gut instinct harming or helping patients?

Sometimes we’re just not sure which is the ‘best’ treatment plan to recommend or even if a single tooth is restorable. Dentistry is an art AND a science, which is why things are not black and white.

We sometimes get stuck in ‘analysis paralysis’ and rely on our gut instinct to save us.

But can we really trust gut instinct in decision making/treatment planning in Dentistry? Is it really serving our patients?

Watch PDP171 on Youtube

Protrusive Dental Pearl: Make sure to feel the root tip fragment (rub with your gloved index finger) after extraction – it should feel nice and smooth. The presence of sharp or jagged edges may suggest a potential root fracture, indicating that a fragment of the root might still be lodged in the socket.

Sign up for launch updates for Intaglio Mentoring – making high quality mentorship in Dentistry easy to find. Click Here to sign up for free!

Check out the recent Sectioning and Elevating for 2024 Webinar with Dr. Chris Waith on the Protrusive Premium App under the Premium Clinical Videos

Need to Read it? Check out the Full Episode Transcript below!

Highlights of the episode:
1:50 Protrusive Dental Pearl: Root Tips
2:59 Can we Trust our Gut instinct?
8:39 Trusting Your Gut Based on Experience 
12:27 When can your gut instinct be unreliable?
14:15 Importance of Mentorship
17:55 Unreliable Mentorship Example
19:03 What’s the BEST way to get mentorship?
20:16 Intaglio Mentorship 

If you liked this episode, you will also like GF019 Indemnity vs Insurance

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Click below for full episode transcript:

Jaz's Introduction: One of the most difficult things in dentistry is treatment planning and decision making. Let's face it, dentistry is as much of an art as it is a science and therefore, decision making can be really mind boggling. What is the best treatment approach? What is the best technique to use for this particular patient, for this particular problem?

It’s not so easy. And so in this episode, we’re going to explore, can you trust your gut instinct? Your intuition when it comes to making these often-complex decisions? Make sure you stay tuned all the way to the end of this episode. Make sure you don’t miss my number one advice for helping you with your daily tough decisions.

Hello, Protruserati. I’m Jaz Gulati. And welcome back to your favorite dental podcast. For those of you listening on Spotify or Apple or Google, thanks so much for joining us again. I might be sounding a bit different. My acoustics might be a bit different. And those of you watching, you’ll see that I’m in a strange room that’s kind of pink, rose colored in color.

I’m in my such as old bedroom in that kind of like the loft of my parents place in West London. It’s just kind of that weird time between Christmas and new year kind of thing. So by the time you’re listening to this, I hope you had an awesome Christmas and that you really had some lovely quality time with your loved ones and wishing you all a very happy new year ahead.

Now, before I share with you my lessons and reflections of whether we can trust our gut. I’m gonna give you your Protrusive Dental Pearl. Like every episode, every PDP episode, I give you a Protrusive Dental Pearl. It’s a pearl to do with extractions, which has been kind of like a theme for protrusive over the last month or so.

We had a recent webinar with Chris Waith on how to section and elevate molars, like which direction should you go in, which hand pieces you should and you shouldn’t use. So that’ll be out for replay soon. It’s already out for protrusive premium members, but I’m gonna find a way to make it more publicly accessible as well.

So stay tuned for that but a top tip I’ll give you after extraction like there wasn’t a number one. What’s the first thing you should do after an extraction, is the following. Like, when I take a tooth out, I was taught, and I’m passing this on to you, is make sure you get the tooth that you’ve just removed, you look at the root, and you rub your index finger, or a finger, a gloved finger, over the root tip.

It should feel nice and round and smooth. And sometimes there’s like a little abscess associated with it. That’s fine. But what you don’t want to feel is like sharpness, right? If something’s sharp or jagged, then that could indicate that actually there could be a root fracture and a piece of the root could still be in the socket.

For the more straightforward extractions and premolars and incisors stuff, you’re probably gonna find that it’s always nice and smooth. But for those trickier extractions where you had to you have to really try your best. And it kept breaking and it was like root field. And it’s one of those tricky extractions, loads of fragments.

And those cases, you’re more likely to have this scenario where maybe the root tip has fractured and therefore in those cases, always really good to feel. And then, and I feel that yes, a root tip has fractured when you go back into retrieve it to make sure you attach it back on and just have a look.

Okay. Now, does it feel smooth? Have I got everything out? So simple little thing. I know the experienced colleagues are probably already doing this, but for the new grads, it’s a simple, easy thing to do. To give you that reassurance after a tricky extraction. Okay, so back to the main theme of trusting your gut.

Can we trust our gut instinct? Now, in life in general, when I’ve heard people outside of dentistry speak about business and life experience and coaches and that kind of stuff, they say that actually a really important part of business, being a business person is trusting your gut or success in any venture.

That gut instinct, it can be really, really powerful and that we should trust it. And we think this is like a survival mechanism. Like, you go back to like the cycle of evolution and whatnot. Our hunter gatherer ancestors, they needed to make some quick decisions and trust in their gut to make sure they survived.

So trusting your gut totally has a place. And what they find is that those individuals in research experiments, where they don’t have this capacity, obviously the gut decisions aren’t made in the gut, they’re made in the brain, certain parts of the brain. And when individuals lack that gut instinct ability, they get stuck in, like, this analysis paralysis.

And I think we’ve all been there, right? Like, we’re trying to decide, okay, how can I best help this patient? Should I choose ceramics? Should I use composites? Should I refer this? Or should I do it in house? These are the tough daily decisions we make. And it’s easy to fall into that analysis paralysis. So it’s really nice to actually have a gut instinct in dentistry.

But can we trust it? I think absolutely. Now, there is a caveat to this, but let me just expand on why I think gut instinct is a beautiful thing when it comes to dentistry and treatment planning and decision making. One of my mentors, Dr. Lincoln Harris, who’ve had a few times on this podcast before, I was at one of his lectures in Singapore, like six, seven years ago, and he made this really great point.

It was like a treatment planning day, and sometimes, when we’re treatment planning and we’re stuck between like four different treatment options for this patient. Well, firstly, if you don’t know exactly which is the best treatment plan, what should you recommend to this patient? You may not have asked enough questions.

So that’s number one, make sure you’ve asked enough question. Do they want something fixed? They want something removable. How long do they want it to last? What are their budgetary constraints? Are they totally against surgery? Or orthodontics, et cetera, et cetera. Sometimes asking more questions gets you the right answers, which leads you to the right decision, or the right treatment plan that’s appropriate for that patient as an individual.

But quite often, we’re still confused. We have this inner debate in our head, like what is the best plan for this patient? The best treatment approach, and quite often Lincoln said it very beautifully. He said, quite often, the first plan that you come up with, when you sit down, you write, okay, first step one, step two, step three, and then review.

That first plan that you came up with was probably the best one, because that first one is quite often led by your gut. And I do use this technique. When I’m a little bit confused, I go back to my first plan, and it seems to have helped me in my career. The other time, aside from treatment planning, where the gut instinct is so valuable, is red flags, right?

Like, we are all afraid of red flag scenarios, but in particular, red flag patients, right? It’s like when you see a patient and they say something. And you just feel it in your gut that, okay, I need to be really cautious here. And one thing I found is that I’m actually super cautious. I’m very particular about who I treat.

I’m very particular through experiences I’ve had in the past whereby I will not jump into complex dentistry. I’ll always do, and we should be doing this anyway, right? Like phase one and take it slow and take it simple. The more red flag vibes I get, like very rarely will I outright refuse to see someone, but the more red flags I get, I will just take it easy.

Right? I will make sure that maybe I will see them for their scaling and polishing. I will try and suss them out. I will do the oral hygiene. I will do the more basic things. I will take my time to think about it. I will take my time to present it. I’m not gonna rush into anything too definitive or too complex because I really want to make sure that I’ve established a good rapport with this patient and that I like this patient. The patient likes me and this sort of patient dentist relationship is gonna be fruitful for both of us in the future. And by being this cautious is how I’m able to be so enthusiastic about dentistry. I’m actually a really great cherry picker.

I championed this thing as general dentist. We should be amazing cherry pickers, right? We should take that low hanging fruit. And if it’s something really complex, like general dentistry is already so difficult guys, right? It’s the toughest thing ever. So why are we making our lives more difficult. If a patient gonna make your life difficult, then there’s plenty more fish in the sea.

It’s noble to be able to help your patient and have that desire to help your patient. And maybe that’s your next step. Like you want to get develop in that particular field and you want to take this particular treatment on because it’s part of self development. But quite often, if you’re getting a lot of these red flag vibes, then it’s a good thing to refer because there’s someone out there with more experience who’s cleverer than you, who can do it better than you, and they’ve done this several times for on this type of patient.

And so why don’t we utilize that and treat the other 50 patients in the queue for that particular type of treatment? Now what I have found with red flags that I get is, quite often I’m wrong. I’ve seen now that my red flag goes off, my radar, my red flag radar goes off, let’s call it. But once I have gone slow, then actually I found that actually this patient is fine, and we’re gonna be okay.

And then I do the treatment, the more complex treatment or whatever. And I kind of know how best to interact with this patient, and the patient knows how I work, and we have this fruitful relationship that I had to work on initially, we had to work on it initially, but I’m glad I had that like red flag initially, so I trusted my gut to take it slow, but most patients I’m actually really happy that I took on.

I’d rather be cautious at the start. Like date them before you marry them is a common term in comprehensive dentistry. Like make sure you do your phase one. Cross all the T’s and dot all the I’s before you then do the more complex work. And it’s just nice. It’s nice to have a patient that you have really good rapport with before you do something fancy.

Because when you start doing fancy things, like, it’s kind of like a marriage. When you do an implant, when you do ortho and you’re in retention, it’s kind of like a marriage between you and the patient. So make sure you date them before you marry them. So what I’ve shared so far is some good advice I’ve had for my mentors and how I use it for my decision making, treatment planning, and also red flag patients, the kind of gut instinct and how you go slower.

But what does the research have to say about trusting our gut? What does the science have to say about trusting our gut? Well, it actually is quite encouraging. You see, I was listening to this book called The Science of Living. And so far, I’m like halfway through it. I’d say it’s a mediocre book. I’m not in love with it, but it’s one of those, it’s an easy listen, and some things you absorb, and it really catches on.

And one thing in Chapter 3 that really, really, I loved, and it was the inspiration for making this episode, was the following. It’s said that based on the research, we can and should trust our gut instinct. However, there is a really big caveat, there’s a really big thing we must consider, is that actually, you can only trust your gut instinct when you have prior experience of that particular problem or that decision making process, right?

So let me make this more tangible. And actually, before I make it more tangible and give you some concrete examples, if you’re into this kind of thing, another, I wasn’t gonna say another great book, but actually it was boring book, but it was like such great lessons, but boring book, I thought personally is thinking fast and slow.

Right? So I think it’s by Daniel Kahneman, a really great lesson. So, you know, there’s an app called Blinkist, which kind of just summarizes the books for you. And so I’d probably just go for the Blinkist version of this book. I think I did that actually by the end. I got through halfway through the book and I thought, this is a super boring book.

I’m liking the main lessons being shared. How can I extract these lessons quicker? And so I’m pretty sure I checked. I had a Blinkist subscription at the time. So I read the Blinkist review. And so if you’re into this kind of decision making and type one, type two brain and that kind of stuff and trusting your gut, if this is your bag, then definitely check out Thinking Fast and Slow by Daniel Kahneman.

So yes, those examples, right? So seasoned practitioners, those of you who have been practicing for you for years now, you will have seen like vertical root fractures. You’d have seen patients with cracked teeth and taken out teeth and looked at the teeth once you’ve extracted them and observed these cracks.

And over time you see these other patients who’ve had that crack for the longest time and they come back every checkup and you discuss the crack and nothing really has changed. And over time, because you’ve seen the ones that have failed and you’ve seen the ones that have survived, it gets stored in a certain place in the brain and you kind of use that information to form your gut instinct.

And actually, a really interesting paper that I saw on Instagram shared by Marcus Blatt. Like, if you’re not following Professor Marcus Blatt on Instagram, like, his is the best dental Instagram account ever, right? So I’ll put the link to that in the show notes. He’s like an encyclopedia of dentistry on his Instagram, right?

So he is absolutely brilliant. And I remember him sharing this post with a paper about, actually, general dentists. We’re actually pretty good over time in decision making of which cracks we should treat and which cracks we’re okay to monitor, right? And so actually, we need to give ourselves some credit here that actually, once you get some experience, we are good at doing this.

Let’s all just pat ourselves on the back that actually we can do this. So that’s an example of a gut instinct decision that you make based on experience. And when you have a bit of experience, you are able to make these decisions well. And so that was a really interesting paper. Another example of where someone with experience can trust their gut is treating teeth of a dubious prognosis.

Like, we’ve all done it where we’ve gone in and done some heroic dentistry and it failed catastrophically, and that lives on forever. Like, failure teaches failure is the best teacher ever, right? And so, we all have these cases already under our belt that we’ve learned from, and then when you see that scenario again, you think, okay, yeah, I made that mistake before, I’m not gonna do it again.

So often teeth with dubious prognosis and those other times where it has worked. And I guess the lesson here is predictability, right? When we’re doing heroic dentistry, it’s less predictable. And so the gut instinct informs us on which patient as an individual personality type we should be perhaps chanting the more less predictable dentistry and which tooth characteristics we should be mindful of when doing heroic dentistry.

And so once you have enough experience, you kind of trust your gut on whether you want to take on this challenge or not. Now let me give you an example of perhaps when your gut instinct may have let you down, and there’s a reason why it let you down, which kind of underpins this type of episode. And I will be getting soon to that major tip I’m going to give you.

It’s going to kind of like a cliche tip, but I think we all need to hear it again and again and again. Before we get to that, here’s an example where I think most of you listening, 99 percent of you would have been bitten by this is you’re newly qualified and you extract a tooth and you just fail miserably.

Right. And it’s because you didn’t appreciate, your gut was like, yeah, I think I can do this. It’s called like the Dunning Kruger effect. The Dunning Kruger effect is like people with less ability, novices, new grads, that kind of stuff. And no offense, new grad. I mean, I sucked as a new grad. I think we all need to appreciate that when you have less experience, you’re not going to be as good as someone who has more experience.

And so when you are less experienced, you have this trap of falling into this Dunning Kruger effect, whereby you overestimate your abilities. You don’t know what you don’t know, and then you get into It’s these situations and you think, oops, I kind of messed up here because I over egged my ability.

And then you really get humble, like you fail at a molar and you then look back at the radiograph and you think, well, actually, I didn’t notice that there was a subtle curve, or this root is particularly chunky on this root filled molar with significant carries, undermined tooth structure. Perhaps I shouldn’t have attempted extraction for this tooth, and perhaps this was one for referral, and this wasn’t the low hanging fruit that Jaz talked about, and perhaps I should have cherry picked a little bit better.

How do I know? Because I’ve done this, right? I’ve made these mistakes with root canals I shouldn’t have tried, and extractions which went a little bit Pete Tong, as they say in the UK. So I’m sharing this from experience, and I think a lot of you can relate to this, right? We lack experience. Sometimes it’s we over-egged our ability, and then either we don’t have enough of a gut instinct or our gut instinct leads us wrong.

And therefore, underpinning this main lesson that we can and should trust our gut, but only when we have enough experience in that problem or that field in which it relates to the issue that we’re talking about, right? If you have enough experience, you can trust your gut in dentistry. You totally can.

But when you’re lacking experience, you can’t trust your gut. And so it’s leading to the number one tip I’m giving you is that when you are less experienced in a field, now you could be 15 years, 20 years qualified, but you’re new with implants. And therefore it’s the same thing again, right? You are a beginner.

You’re a novice in implants. You’re a novice in orthodontics, whatever. And therefore you can’t trust your gut. Therefore you need a mentor. Right now, it’s a cliche that mentorship we talk. It’s like probably 30, 40 percent of all the protrusive episodes in history. We’ve talked about mentorship. I’m sure it’s probably the most tooted word in the entire podcast, right?

Mentorship is so, so key, but especially when you are new to a field or when you are not able to trust your gut, that’s when we need to borrow the thoughts or the gut feeling of our mentors. And having that self awareness is so powerful. Like being able to take a step back and say, you know what? I think I need some help here.

That is so, so powerful. And the earlier in our career that we’re able to do this, it’s just a beautiful, powerful thing. Our mentors can show us the blind spots that we just completely missed. And like using that example again of that time that I might have messed up an extraction and someone came and rescued me and then just watching them rescue me.

That has been one of the most powerful learning experience ever, right? I learned so much from those kind of experiences and our failures and trusting our mentors. And every time I’ve mentored someone, like they have said to me, like, whoa, I completely did not appreciate that perspective. And I remember when I was getting mentorship and I still seek mentorship, I’m like completely like blind to all this area and expertise that the mentor can give you.

Like you didn’t even, you don’t know what you don’t know. Right? And so the mentor’s role is to show you those areas that actually you completely miss because it’s just lack of experience. And this is the beauty of mentorship. The biggest problem with mentorship is where to find it. Like, this is the most common DM I get on Instagram or Facebook and emails, like I need a mentor.

Jaz I need a mentor. Where can I find a mentor? I work in this place. I work in that place. I work in this country. I need a mentor. And so it’s great for the Protruserati, you guys to have this self awareness is a beautiful thing that you need a mentor, but it’s tricky to find a mentor. I’ve been very blessed to have great mentors and principals that I had other colleagues.

A couple of my best mates are prosthodontists. So it’s great to have information and guidance from them, but not everyone is lucky. And a lot of dentistry is isolated. We work in rural areas. So finding a mentor is tricky. At the same time, we are so connected, right? With Instagram, with social media, with Facebook groups, we’re living in such a connected time.

And so, and on the one hand, it’s difficult to find mentorship. On the other hand, mentorship is technically everywhere. So what’s the best way in 2024 to get mentorship? Let me tell you what isn’t the best way. Okay. And I’ll give you my own personal experience, right? A lot of young dentists, they message me, and they’ll send me like a radiograph, and they’ll ask for an opinion, right?

And my thing is, I’ll either reply to you in two minutes, because like it’s there, and I like to deal with things then and there, or two weeks. It’ll might take me two weeks to get around to it. Or maybe you guys have been waiting for some months, and I haven’t replied yet. Now, please, if I haven’t replied, I’m so sorry.

It’s just buried somewhere in my DMs, or buried in some of my emails. I encourage you, if you’re waiting for a reply from me, please just resurface, bump that message. I will get back to you, I promise. I hate not replying. But what I do like doing is I like to look after you. So when I’m giving advice and help and guidance to all of you, I like to give it my best.

So if I’m not able to give it my best at that moment in time, I will defer it. And my systems are like robust, but they’re not robust enough. I do miss some messages now and again. So I’m really sorry. I promise you, I’m not ignoring you, right? What’s not a great way to get mentorship sometimes is when you message your mentor on Instagram, you send him a radiograph and say, Can you help me?

And so your mentors like seeing patients and they got busy life and maybe they’re picking up their kids and while they’re waiting to pick up their kids, they leave you a quick voice notes. Okay. Yeah, by the way. Yeah, this is gonna be tricky one. Make sure you do this and that and you’ll be fine, right?

And so the limited information that they have they give you their sort of expertise based on that limited information that you’ve presented to that mentor and the mentors like got a million other things to do. And it’s not a formal. There’s no formal arrangement here, right? There’s no accountability here.

And so it’s nice to have a little tip or some guidance. But true mentorship, when you need it, when you need someone to hold your hand for a case, like from beginning to end, that is difficult to do over social media. And you know what else is really difficult and actually frustrating is Facebook groups.

Like we see daily, right, on these big Facebook groups, like someone asking for opinion. And what happens when you ask for an opinion? Well, you’ve been there before. You get 20 different opinions on Facebook. Like, every single person has a different opinion, and you actually end up being more confused than where you were at the beginning.

Like, where do you, like, how do you even begin to tackle this problem now with, like, 25 different opinions? So, I realize there’s a big problem with the lack of mentorship. I mean, mentorship is technically everywhere, like I said. But the place to find dedicated mentorship with a mentor is showing some accountability and say, you know what, I’m gonna like give some proper time and look through all the materials and sit down in a designated space of my diary.

And there’s like a fair exchange and a fair exchange looks like this. A mentee pays a mentor, a mentor’s time is respected. And the mentee in return gets advice, hand holding, that’s going to really elevate them and get them to the next level for their cases, so they won’t need mentorship for that particular problem in the future, or they’re able to charge their patient appropriately to do a safe treatment that’s going to be predictable from the advice that was given by the mentor.

And that’s what I think the future of mentorship looks like, which is why I’m proud to say I am a co founder of a new venture we’re starting basically to solve this big problem in dentistry, right? Like, how can we connect mentors who are really passionate about being a proper mentor and having the proper channels to do it and proper platform to do it with the mentees who are so hungry for this mentorship?

So introducing to you something called Intaglio. Now, Intaglio, as you know, you might have heard me for those onion chopping fans out there who have been following the podcast for many years. Intaglio is like my favorite word in dentistry. So I’m so glad when I came, when I met with these passionate dentists.

So Intaglio was set up by these dentists who want to work together to solve this problem, this big problem, this big itch that needs scratching of mentorship. And I’m proud to say we’re some few months away from launching this platform and I would love for you to join. If you are a mentor who wants to have maybe a Friday and set up Zoom calls and have people visit you and to give mentorship and get paid for it, then please sign up on intagliomentoring. com. That’s intagliomentoring. com. I’ll put it in the show notes.

And if you are someone who needs a mentor, like if you have a removal pros patient and you’re stuck on where to go, then you’ll find someone on Intaglio. If you are an orthodontist or a budding orthodontist, or you’ve got a few clear aligner cases and you’re struggling with it, then why don’t you check out Intaglio in the future?

You’ll have like people who are experts at clear aligners who will be there to help you. So if you go to intagliomentoring. com, no matter which side of the line you’re on, whether you’re on the someone who craves mentorship or someone who craves to become a mentor, there’s a space for you on intagliomentoring. com. And so, so that you get the first updates and the best deal the initial launch deal that Protrusive is quite famous for doing, I would sign up and keep in the loop, and we’re gonna get in touch with you, this is gonna be just absolutely amazing. I’m so excited to reveal this to you for the first time, so that when you are in a scenario, Well, you’re not able to trust your gun because of a lack of experience in that field.

You know that the home of mentorship is going to be intaglio mentoring. com. The kind of things that we have in the pipeline is like one on one zoom sessions, which is great, but a really cool thing that we tested out a few months ago. This is like a super exciting, right? So get this, right? I was there with my loop mounted camera, right?

And I was filming a procedure on a patient. I was doing this huge class two multiple surface restoration on a lateral incisor and I was actually live streaming it to Zoom to the founders of Intaglio as we’re doing this excited to test this technology and this kit out, right? And so I had my Bluetooth headphones on and so I was able to hear the questions that the guys were asking and through some clever technology they were able to see through my share screen, they were able to see everything I was seeing through my loops.

Right? And so they were seeing a live procedure. Can you believe they were seeing a live procedure way better than over the shoulder? When you’re over the shoulder, someone just difficult. See what you’re doing. Like this was zoomed in times five with beautiful lighting. They will see exactly what I was doing.

And they were asking me questions like, hey, just why did you pick this matrix? And what about this? And what about that? And I was answering it because I was mic’d up just like I am now. And this was such a powerful experience. We all came away like, wow, this is the future of mentoring right? So we’re so excited to sort of take you on this journey and please do join us.

If you’ve ever been part of any protrusive launches before, you know that we really do look after you. There’s not a protrusive launch per se. I’m a small part of this massive production, but I’m so proud to support this and be a co founder of Intaglio Mentoring. I just want to get the word out now, so you guys have something to look forward to in intagliomentoring. com and I hope you join us.

So to wrap up guys, trust your gut, but sometimes when you’re lacking experience. You need a mentor. Thanks so much for listening all the way to the end. I hope you liked that one. It was like a off the cuff. These ones I found really challenging, like these solo episodes.

So I really, really appreciate it. And if you enjoyed this episode, the lessons shared, please, please do share it with an associate, a colleague, a friend, and that recently someone must be saying that their child. Some reason enjoys listening to producers on a podcast as they’re sleeping like my podcast apparently sends them to sleep. So even one like, you know play it for children and help them sleep.

You’d be my guest All right, so I hope you enjoyed that onion chopping session. I’ll catch you same time same place Listen have a fantastic 2024 protrusive is growing with literally just reached 1 million downloads which I’m super proud about but I’ll be launching a little celebratory Instagram reel for that soon. So thanks so much for listening all the way to the end guys.

I’ll catch you same time same place next week.

Hosted by
Jaz Gulati

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