Jaz’s Introduction: Hello, Protruserati. I’m Jaz Gulati and welcome to the second episode of straightpril today we have a specialist orthodontist Dr. Mandeep Gosal following on from that last episode with the general dentist, Dr. Nick Simon, who does a lot of ortho. Let’s get the specialist perspective in because what we’re talking about is alignment only orthodontics, right? How does that sit with a specialist? What do they think? And more importantly, how can we serve you the dentist listening to this who wants to do more orthodontic cases, but you’re having to accept “compromises” right? Compromises in orthodontics, I explained it a little bit in the last episode. It’s like imagine someone’s got a large overjet and they got crowding but you only treat the crowding but you leave them with a large overjet, that is a compromised, that is potentially alignment only orthodontics, but is that the right thing to do? That’s exactly why I had Mandeep on today to speak about really saucy, really controversial, really cool topic and I think ‘gos’ as we call him did a fantastic job today I think you’re in for an absolute treat. He’s no stranger or he’s not fearful of the the beautiful controversy this poses and I’m know you’re gonna find this episode really entertaining. The Protrusive Dental pearl I want to share with you is to help improve your portrait photography, right. So if you’re doing orthodontics, you’re probably already taking portrait photos, I use my normal setup my Canon body, my ring flash, my lens, my macro lens, so I’m just using it for also my portrait photography. Now, a tip that I learned from Dr. Alina Ruzanova who’s an Estonian dentist, and she creates content for ripe global, and she has this fantastic several hour anterior dentistry series on ripe global, which I highly recommend you watch and I’ll put it in the show notes. So you can click on it and find it when you go to a protrusive.co.uk website. The tip that she gave me which really improved my portrait photography with a ring flash is the following. So without having to change my flash system is instead of pointing the ring flash at the patient, when you’re taking the photo, you actually detach the ring flash and you point it to the ceiling. And that gives you a much softer lighting like just look at the photograph I’m showing you now on the screen. This is before I started using this trick. And now this is after I started doing this trick now the annoying thing now is the poor before and afters I’m getting of those patients who I saw before I change the technique. It’s annoying because the lighting is not consistent. But I think for me, this is the best way forward because now generally, the portrait photos are getting are coming out much better, much nicer to see. So the trick is to detach your ring flash pointed up at the ceiling instead of pointing straight at the patient. Now if you’re wondering what settings I’m using? I’m using f 8.0 at ISO 800 and that’s what I’m using to create my portrait photographs like the one you saw. So let’s dive in. I don’t know waste your time because this is such a brilliant episode. Hope you enjoy on catching the outro

Main Interview:

[Jaz]
Dr. Mandeep Gosal, Welcome to Protrusive Dental podcast. How are you my friend?

[Mandeep]
I’m really good, Jaz. I’m really good. And you know, I’m a big fan of your podcast. So, you know, it’s an honor to be on here. I think I’m gonna really flip out I’ve written down a few phrases that if you say them, I’m just gonna absolutely lose my shit.

[Jaz]
Wait, that’s fine, but I can’t wait to know what the these phrases are. But honestly, I really appreciate people especially I mean, wow, you’re I mean you’re I can’t even fathom that, you know, specialists are listening to my podcast like I did from episode one. I just thought when I made it to help people transition to Singapore, and then it grew and grew and grew and honestly it’s an absolute honor that you know, a great dentist or specialist like yourself, listen, so I really appreciate that. But when you were talking with a very and I really appreciate you coming on for this, a very controversial, very saucy topic. So you know, no one likes controversy when they’re recording and stuff so I really appreciate you agreeing. You’re scaring me now. I don’t want to scare you but I think it’s really good because it is a very contentious subject. So guys, we’re talking about GDP-Ortho, and we’re talking about compromising, right. And I’ma let you tell your backstory to everyone in a minute goes but compromising is like such a nasty word that you’re compromising, you’ll give him a second grade treatment, you’re not doing good thing, but just go on Instagram and look at all the gdps that doing ortho, not all of them, but you know what I mean? Like before before I did my ortho diploma, I’d look at these cases. But all that looks great. It looks good, beautiful smile, it looks great. Now that I’ve done my diploma all still got a deep bite, oh didn’t collect the overjet, oh the canines a half unit class two like, it’s completely changed the way I look at them, which is insane. So if I’m doing that, specialists must be. I don’t know what you guys are biting. We might be biting something off every time you see this. But tell me, Gos, tell us a little about yourself and your background and where you work?

[Mandeep]
Well. Okay, so a bit about me, I qualified in 2003 from Sheffield, so, you know, Sheffield University alumni. And yeah, I then worked as a GDP after my brief stint in community. Or for about seven years, I worked as a GDP for seven years. Wow. I then at that stage we just had our first daughter. And it’s, and I know you’re, you know, a fairly new father as well. But it makes you reflect on your career, what kind of father figure you want to be, you know, what kind of what sort of things you want to inspire in your children. So I just thought, you know, I really always wanted to just do something, maybe specialize in something. And what I was finding was I was getting bored of single tooth dentistry a bit like yourself, you know, thinking more sort of full mouth. And it was the patients I was referring onto orthodontist that they were coming back, the sort of outcomes they were getting the sort of joy and the kind of this sort of stuff was changing their lives. And I thought, you know what, I would love to do that. Even though I had no experience I had done no, orthodontics myself. I was felt that was my calling. I had done quite a lot of PED. So I did a lot of PED and community. I actually, then when I thought you know what orthodontists might be for me, I took up a teaching post then pediatrics at King’s. So I was doing that traveling down from Nottingham to Kings just to beef up my CV ball to get a bit more experience. Because you know, I hadn’t done the DFT post, the hospital post or anything like that. So yeah, so I kind of stuck out like a sore thumb. Really, everyone else had a good career progression, you know, but life’s not like that for everybody else. You know, there’s a lot of people we leave dental school, we don’t really know what we want to do. And you kind of find something, you fall into something naturally, instead of having, you know, some people, year three of dental school, will I’m going to specialize in there. So I’m going to go do maxfacts and that’s great, but that wasn’t me. So I felt like you know, because I had then really thought through my career I thought about just make up stuff and start teaching some pediatrics and I really enjoyed the teaching side of it. I thought it was awesome. So I then applied to do orthodontics, I have to go through two years of applying to finally get on it’s very kind of cutthroat, very competitive, you know, hugely popular, you know, rightfully so. And the training is just absolutely awesome. However, the only place I got was in London, so we had to move down to London. You know, and I was just talking about yesterday with my wife, the sort of personal sacrifice you have to make to other family, not just me, you know, we had to come away, or both our families were here in the Midlands, you know, you have to go back down south in London, you know, for three years. But we carried on, you know, building our family as well, because we were both in our 30s you know, life doesn’t stop just because you’re on a specialty training program. So by the end, I started with one child, and then when I took my mo exams, I had three. So and in fact, I sat my exams and my youngest daughter was three weeks old, so and she really got me through my exams because she wouldn’t sleep at night, I would have to hold her, and I’d be revising, I’d have like, you know, profits textbook in one hand and hair on the other arms. I literally didn’t sleep for weeks. But it usually helped me because then you know, I sat my mo exams, and I ended up winning the gold medal.

[Jaz]
Oh, well done. I mean, I love that story. And also the personal sacrifices that you made. No one talks about that, they are so real. I mean, I recently recorded it’s not published yet with a refugee, Syrian refugee that came through UK as a dentist in Syria and then he just had the ORE exam. And just listening about the sacrifices he has to make, to be able to become a dentist in UK and then organise yourself a specialist. Having to relocate and stuff. It completely throws a spanner in the works in terms of finances, living situation, family life like wow going from one kid to three kid and also what we can learn from your story is that so many of my friends who became orthodontists, they did the very much a traditional route they qualify maxfacts, PED post, next year they applied and then they got in or whatever or the year after they got in. So that’s the traditional route you see a lot nowadays, but you know, there’s something in it for all of the people listening today who maybe are five years maybe even 10 years qualified. One of my buddies, Albs Al Moogie in Sheffield. Hey, you might know Albs he might qualified same year as you?

[Mandeep]
We did. Yeah, me ABS Drew, we were all in the same year.

[Jaz]
What a legendary year. I mean, he is now a restorative I think he by now he might be restorative specialist now. So 11 years as a GDP and then he did his registrar training in restorative. So it’s never too late. It’s got such a long career. So I mean, any regrets?

[Mandeep]
No, not a single one. Not a single one. You know, all the way through maybe early on if you spoke to me a few months after finishing and we had moved back to Nottingham, we had no money I had no job. I had no connections. And I was literally working you know, a few afternoons here and there. I probably would have said oh my god, I regret this. What am I done? But now you know, seven years removed after becoming a specialist then yeah none. Zero.

[Jaz]
Amazing and gold medal amazing. Shows your work ethic. Gold medals, like given to the person who gets like the biggest, the best results, right?

[Mandeep]
Yeah, that’s right. So you know, Mo Al Museun is another gold medal winner. So you know..

[Jaz]
Only gold medal are on the podcast guys are only gold.

[Mandeep]
Honestly, you know, spoken about in the same sort of breath as Mo I think he’s pretty special. So yeah.

[Jaz]
He’s a really cool guy. So Mo if you listening to this, I doubt, you’re such a busy guy. But it’s great to have people like you on and so let’s dive in Gos and talk about compromising in orthodontics, GDP orthodontics. And one thing before we get into the meat of it is you spoke at that between 2003 and 2010. Now as a GDP, you didn’t do much orthodontics. Now, I’m going to pose a hypothetical scenario to you, do you know how many of your GDP friends and colleagues were doing orthodontics between those years? And if you look at it now, in the last seven years, maybe how many gdps are doing orthodontics? There must be a big difference. Do you think that in a parallel universe? If had you qualified some years later that maybe you’d be going down the GDP orthodontic route?

[Mandeep]
It’s funny, isn’t it? Because I’ve, I think I have posed that question to myself. You know, I’ve kind of looked at it thought when I qualified Jaz, you know, there wasn’t much in the way of courses. There wasn’t, you know, and if they were, well, how do you find out about those things? There was no social media, there was no, you didn’t have a network of dentists like you do now with tubules, and all sorts of things. You know, so it was hard to tap into things. So now I think it’s so much easier, which is great. Yeah, if you want to build your skills in a certain thing, you can do it. You don’t have to make the huge sacrifices and go sort of specialize as such. And so what I have done sort of things differently, maybe I would have dipped my toe into orthodontics first. Yeah. So maybe I would have you know, under mentorship, or you know, certificate or diploma program. You know, took on a good mentor, learn the sort of basics and then if I liked it, then gone on to do it. I think financially that would have been better. And location wise, obviously, you know, you just sort of stay where you are and you can incorporate into your own practice. But I definitely don’t regret it and in terms of the part your question about gdps doing orthodontics then and you’re doing it now, it’s exponential, it’s completely different Jaz, like it wasn’t rare at that time. Definitely not there was loads of people doing it. But it’s huge now and it’s you know, and it’s not necessarily driven by GDPs wanting to do it I think even back then, you know, GDPs want to do is it’s more accessible now, maybe wrongly or rightly driven commercially, you know, driven by companies so you know, Invisalign, huge, named as other sort of clear aligner companies out there who are you know, pumping in a lot of money. I think Invisalign advertising direct to the consumer. Yeah. So they are interacting, that they are so unique in that way, you know, you don’t get calls You know, advertising composites to patients right? No, they target the dentist. So they are this is a quality product, you need to be offering this to your patients for x y z Invisalign, or just literally go straight to the consumer. And so the consumer is coming to you asking for Invisalign. Yeah, and that’s there code for ‘give me straight teeth’ . But that’s the sort of the word really. So that’s really changed things. But also, you know, there’s I think there’s not a lot of regulation around companies. Yeah. So anyone I today between us we could develop, you know, something, it’s got brackets and wires, you know, fast braces got three wings. Traditionally, we have four wings. The speed has two wings. Well, why don’t we do five wings? Yeah, so let’s do five wings. There’s no one’s done that yet. So we’re calling the five wing, five month brace. You know, something like that. We could just do anything.

[Jaz]
If it’s anything like five guys is going to be awesome.

[Mandeep]
Yeah. You know, yeah, exactly. You know. So, I mean..,

[Jaz]
The one thing you haven’t mentioned that I’ve been thinking is the attitudes. I hope you don’t take offense or anyone any orthodontists like BOS take offense by this. But the attitudes of orthodontists and specialist orthodontist societies have become more tolerant. And what I mean is from following debates over the years, GDP orthodontics especially specialist, before, it was very much of a war. I felt, I mean, maybe you felt it as well, but as a GDP just watching standbys that, hey, these guys are at each other’s throats, there was publications and newspapers, you may remember all this sort of saga and whatnot. But now whether you guys want it or not, and I don’t mean it in that way. You guys have become more tolerant of that, hey, you know what they got these guys are going to do orthodontics. Let’s just now let’s become friends. And let’s help them out. And then when they need to refer, we’re here for them. Do you think that has come into it?

[Mandeep]
You know, you this is what I love about you, Jaz, you’re very perceptive kind of guy, you know, you’ve hit the nail on the head. In many ways, you know, a bit of a history about sort of orthodontist versus gdps. You know, under the the old fee per item program, especially in the 80s. There was a lot of GDPs doing orthodontics, mainly with removable appliances. So you would probably now see your own patients in their 50s 60s maybe even 40s, who would come in that have all premolars missing. Yet, you know, their teeth are hugely crushed in and they’ve got massive deep bites. Yeah. If you chat to them. “Have you had orthodontics before? Oh, yeah. As a teenager had some teeth out and either, but I had a removable brace.”

[Jaz]
Yeah. hear it all the time.

[Mandeep]
Yeah. So you can hear, you hear that all the time? Right? And so that and the history of that is it was a fee per item system. And in the 80s, the amount of money you got for removable appliances was huge. Yeah, he got a huge amount of money. So it was very profitable to do. And this could probably even span into the 90s. Right. But then, so what you had is gdps without much training, putting in removable appliances. And yet there was no way of monitoring quality. Yeah. So then what happened was, you know, a group of specialists in Cardiff, Manchester developed the occlusal index, like a par index to measure quality. So then they looked at past treatments, and graded them and then actually found, look, we’re doing x percentage of removable appliances. And the outcomes are absolutely rubbish. And in many cases going the opposite way. They’re going from good to bad. Because people are just doing awful treatment. So this then led this kind of loggerhead sort of, you know, moment where you had orthodontists going, hang on, this shouldn’t be right. So that’s really a bit of the sort of history. Yeah, so they then have to I think there was a court, it went to court or something, there was some sort of thing where they had to then put a stop on this kind of renumeration or removable orthodontics on the NHS. So that’s just the brief history so obviously, you know, establish orthodontists lived in that time. So they associate the GDP orthodontics with just this poor outcome removable appliances, and this that the other. I think now fast forward to 2020 Yeah, so now if we think about things, and GDP, we’re still doing lot more fixed appliances. Yeah. GDP is now for me, it’s the orthodontics they’re doing is privately driven. Yeah, there’s no more kind of, there’s not a lot of orthodontics done by gdps on the NHS. So, you know, if you’ve got patients now paying for treatment, they want a great outcome. Yeah. So it’s kind of almost this kind of circle where the outcomes got to be good. So the quality is got to be good. So now the pressures now on the GDP to go right, is this within my scope of practice? How do I now teach myself how to do this, how to teach myself how to do that? So I think, you know, and that’s the modern way of sort of thinking. So I think things have evolved. You know, the old guard is now moved on, you know, it’s the new Young Guard moving in. And I think we’ve all realized that actually, with all these companies now coming in, you know, people like, — huge when I sort of did it, you know, and for me, I’m hopefully they’re almost disappearing, because this was, you know, I am going to be on it, we’re going to be controversial. No, tell it, Jaz, the people doing — 10 years ago, are now promoting other sort of product. They don’t do — any more. Ask yourself why. It’s awful. Yeah. Because there is no, there is because within that it is just a lab driven, commercially driven system. Yeah. And you take impressions of anything or anyone, you take impressions of your dog tomorrow. You know, your Punjabi you probably haven’t got a dog. You know, but if you take the impression of your dog and you send it to that lab, they’re gonna fit it with braces. Yeah. Because there’s no one overseeing it. There’s no mentorship there. You know, so really, you know, so those days are gone.

[Jaz]
I think that was such a diplomatic answer, but then I only came to the end. I love that you said that. I love everything you said. I love it. It’s from the heart and I appreciate that but I will probably have to get my producer John Can you put beep makes it a company name I don’t want Protrusive Dental podcast get sued. But I love it. You know and for those who are not in our close circle, you can ask me which orthodontic system he was referring to, I’ll tell you but so that we don’t get into trouble here gos. I’m probably going to beat that one out. But hey, look all these terms right like SEO, short term orthodontics. I quite like the term AAO alignment. AOO, Alignment only orthodontics. Call it what you like different brands out there. CFast, Six Months smiles. What’s premiers ones called? Quick straight teeth. Quick straight teeth, and all so many around the world. So many of these systems. What do you think, Gos, about gdps and alignment only orthodontics as a sweeping statement? What’s your feeling as a specialist about that?

[Mandeep]
Personally, I think there’s too many terms. Yeah, there’s, I know you like anterior alignment orthodontics. Yeah, that’s fine. Hopefully I’m gonna change your mind in a few minutes. Yeah. But then you’ve got cosmetic orthodontics you even a few years ago had the European Society of aesthetic orthodontics. What the hell is that? Yeah, of course. Why? Because orthodontics is its aesthetic. So why do we need another kind of like? So it’s all this all, and also, if we as clinicians find it confusing, imagine if you’re a patient. Yeah. So you’ve Corinne and you see someone and you’re like, Okay, seeing a specialist. And he’s told me I need x y z. I’ve now gone and seen this other guy. And he said, he does cosmetic orthodontics. Awesome, because that’s what I want. This guy obviously knows much more than this person. So for me, and I always say it on Facebook is if someone like brings up these terms. orthodontics is just orthodontics. Yeah, that’s it. So if you’ve what you’ve done, if you’ve done we’ll come on to what pure anterior alignment orthodontics is, but if you believe you’ve done it for a patient, well, what you’ve done is you’ve gone through right these are my goals. These are the patient’s goals. For the health of this mouth, I need to do X, Y and Z or you know to produce a you know, a comprehensive sort of smile makeover, I need to do X Y Z and you’ve then done that treatment. If within that treatment, all you’ve done is align the front teeth, then you know, so be it you know but why call it something else? It’s orthodontics should just be orthodontics, because if we just call it orthodontics, then I think empowers people to then have more knowledge to sort of respect certain things and do things within their scope of practice. I think as soon as you start saying you know, alignment only orthodontics, cosmetic orthodontics or Then people start throwing their Well, it’s going to do this quick.

[Jaz]
STO. I mean, can you know six months smiles For example, let’s name an example. Like isn’t the name right? And you know, there’s so many issues with that. You believe very strongly that it should just be called orthodontics now, and I appreciate that. But there is a difference between like, what six months miles, what these anterior alignment, orthodontics, the aims of what they’re trying to achieve and what a specialist orthodontist is trying to achieve. Most of the time, not all the time, we know that in terms of a comprehensive results, so for those listening and be like, what do you what do you mean comprehensive? What do you mean compromise? What is the compromise? I don’t get it. Because not everyone knows that. Gos just explained. In your terms, what is comprehensive orthodontics? And what we might see nowadays, even if you don’t know you’re doing it is compromised orthodontics, which sounds terrible. But please in what do you think that is?

[Mandeep]
Jaz, if it was easy to explain, we would know the explanation already. Right? That’d be a definition out there that would all know, and would all sort of respect. So it’s the same question I tell you, all my delegates asked the same normally, so a few months in, they always they always turn around and say, could you explain like when we do compromise treatment, and when we do comprehensive treatment? And it’s a real head scratcher. Because it’s like, you know, every patient is their own beast, you know, so if you just kind of, you know, if you learn how to do things properly, yeah, then you can, you can also appreciate the downsides of having to achieve certain things. And then only then can you go through that with a patient and decide what sort of treatment that patient needs. Alright, so let me try to sort of break this down a little bit. I, the first statement I’m going to make is you cannot do any kind of compromise treatment if you don’t know what the comprehensive treatment entails. Agreed? Yeah, let me give you an example is let’s think about single tooth dentistry. So let’s think about extraction versus RCT. Yeah. So you’ve got a molar tooth, you know, your options, your compromise option could be well, let me take this molar out, I’m gonna leave a space, the upper cannot rub the teeth adjacent can, you know tip in words, obviously, you’re going to lose a tooth, or let’s do something to try to save it or let’s do an implant. If you didn’t know about those options, then how can you consent someone? or How can you actually take that tooth out? If you don’t know what the alternative options are? Yeah, so you know, let’s pretend someone a raised RCT out of your mind. And now all you were doing was extracting, because that’s all you knew, then you’re not doing the right thing for that patient. So I would say no one should be doing compromised treatment, if they do not know what the comprehensive treatment entails. So you know, people, so, you know, just to explain what compromise treatment would be. Loosely. Yeah. Let’s just sort of define it a little bit. Yeah. Let’s just say less defined compromise treatment as orthodontic treatment where you are accepting either a compromised occlusion. Yeah. compromised aesthetics or compromised health? Yeah. Okay. So occlusion. Yeah, so, lack of interdigitation. No overbite reduction. Yeah. So you are compromising because you are accepting an increased overbite. You’re exceptional.

[Jaz]
What’s wrong with an increase overbite, let’s go into it, let’s go here. I told you before, I’m going to go here. So look, if you’re going to try and achieve two millimeters of overjet, two millimeters overbite, that’s your like. That’s what the textbook says. What if you, What if I finish a patient with a five millimeter overbite, and so many of our patients have a five millimeter overbite, let’s say or let’s say percentages have a 55% overbite, and they’re happy, their teeth are aligned or whatever, and these are just non orthodontic just normal patients. Why do we, why is it important for it to be classed as not a compromise and the head towards more comprehensive category if you like, that you don’t finish with a more than 50% overbite. What is the rationale behind that?

[Mandeep]
The rationale here would be I would say three fold. Yeah, so one, let’s think about envelope of movement. Yeah. So if you are increased overbite that you’ve now got this anterior interference, you know, so it completely you’ve changed, especially if that person didn’t have have an increased overbite or didn’t have any anterior contact. And now you’ve, you know, without, because you’ve not decreased the overbite you have now, given them some anterior interference, right? So you actually, you’ve done that thing we were talking about in the 80s, where you’ve gone from healthy to unhealthy. Because you’ve not recognized that I need to do that. Yeah. So that was one. And then the other thing would be, you know, if you are aligning the top teeth, we always plan for retention. Yeah. So now for me, ideal retention in the upper arch would be fixed retention, and a removable retainer. Yeah. Now, without overbite reduction, where is that fixed retainer going to go? Yeah. So often people approached me going, Oh, I’m having trouble putting a fixed retainer around in the upper, you know, the patient is biting on it, or there’s no room for it? Or it’s come off? Or, you know, or some people go, Oh, I don’t believe in fixed retainers only. You think, yeah, the only reason you don’t believe them is because you know.. -You’ve already have space for it. -Yeah, you’ve already have space for it. So for me, like, that is the crux of it. So if we’re talking about adult orthodontics, let’s stick with adults. You know, overbite reduction is an absolute must for a fixed retainer. Absolute must, and it’s the is probably the one thing I always look for is an overbite. Because if you’re leaving an increased overbite at the end, you’re kind of encouraging tooth where you’re that fixed retainer is not going to last, you know, the envelope and movement, you know, it’s all over the place. So that’s the biggie. -Okay. I appreciate that. If you really yeah, if you really want to annoy an orthodontist, just send them before and afters with increased overbites that we’ve just read.

[Jaz]
That’s when you go on Instagram, and you’re not liking this post with the beautiful line teeth, with deep overbites, because after studying some orthodontics, I can’t stop noticing that and I look back, my old cases are like, Oh, my goodness. Not that. I am correcting all these overbites to the degree that you are, and I’m being very honest, here I are. And I love what you said earlier that and you read justified me doing my diploma, if you like and doing further education, because I did have this feeling that hey, was it really necessary to do spend money and spend time and spend hours studying when a lot of my colleagues have no formal education on orthodontics, and they and they’re doing an A loving and they’re doing great orthodontics and stuff. Compromise cases, fair enough GDP-Orthodontics, and they’re doing great, and I thought, hey, was this necessary? But then I think exactly what you said that now I feel so much more confident doing an orthodontic assessment. And I don’t feel the need in the majority of the cases I see now to have to refer to the specialist, for them to hear from the specialist what the compromise or the what the comprehensive option is. Because I feel totally confident say okay, if you want the comprehensive, it will take two and a half years. There’s our aims. Okay, but here are some things that we could compromise. And maybe you’re cringing as I’m saying this, and I do and patients will always pick the easier quicker route, right? So this is the toughy. This is the real tough thing about orthodontics, right, patients, whether they know what’s good for them or not. But so often they’ll say “what looks good? What’s easier? One year versus two years. Extraction vs non extraction? So it’s tough. It’s such a tough one to consent, even as someone who has further education, orthodontics, it’s just a minefield, isn’t it?

[Mandeep]
Is it but you know, that’s for me, you know, there’s three types of consent, right, with a patient like that there’s, you know, proper consent procedure, and I’ll come to what that should be. Yeah. But then there’s the other two types of consent that happen in most GDP-Orthodontics, Jaz. So maybe this be a bit controversial. There’s the sort of blind, leading the blind consent. Yeah. So the GDP, I have no idea what the comprehensive plan would be here. I don’t know how I’m going to correct this centerline shift or overbite, so I’m just going to tell them look, I can refer you to a specialist. It can take two and a half years. Yeah, two and a half years seems to be that magic kind of number. Right. So you know, yeah. I know how many adults in two and a half years with a treatment? Yeah, probably about 10%. Yeah. So I don’t know where who came up with that number. That’s the one that we’re keeping. Because maybe someone did some sort of test on the public and thought that if you want to put them off orthodontics, say two and a half years. -Not two, but the extra half. -The extra half fills it, right? If you say two, that’s like they think oh, that’s doable, because they can’t let, that’s just two Christmases. That’s all right, two and a half is like whoa, three summers, man. That’s two Christmases, three summers. Forget about it. Yeah, so there’s that the blind, leading the blind consent. And, really, you know, that is not a proper consent procedure. Yeah, cuz you just thrown in something there. And I’ll tell you I was on a course recently, and the guy standing out well known, you know, in a lot of respect for him. But he, you know, he was saying that, you know, the course was all about selling more Invisalign, basically saying he was saying, obviously, Look, you’ve got to consent your patients properly. And I tell all my patients that if they want to achieve the gold standard treatment, they should have surgery. Now, that is excessive. I was like, Whoa.

[Jaz]
Wow, even I yeah, you saw me I raised my eyebrows,’what?’

[Mandeep]
Like, really everything. And then he said, proudly, I’ve not had a single patient take me up on it. I’m like, because you don’t see you can’t just throw things in there. Like that is just, you know, that’s the blinding the blind, you don’t be, if you don’t know what the comprehensive plan is. You cannot consent for it. So your consent is for me invalid. Yeah. And putting in the notes, I offered them referral to a specialist. You know, actually, you know, it doesn’t mean anything. It means zero.

[Jaz]
That is gold right there guys, because yeah, that is Wow, that is really powerful you said that so because this how lots of gdps operate what we do orthodontics, say in the note, referral offer to specialist, patient declined. Didn’t fancy two and a half years patient offered six months of treatment to align the front teeth patient happy. That’s a concern over because then that in the GDP feel safe that hey, you know what I offered? I’ve done my duty. I’ve done my due diligence I’ve offered right. So that is a great way to put it.

[Mandeep]
Yeah, no, completely right. And now let me bring to the other type of consent. The other consent that is even more dangerous, is a loaded consent procedure. Yeah, now we’re loadedconsent procedure is where you kind of have an interest in one procedure, because you can do it. Yeah. And you are now consenting a patient again, you probably don’t know what the current comprehensive plan is. But what are you going to do in that consent? Are you, part of you is now their salesperson, right? Because you’ve got Invisalign on your back. They’re saying, look, go platinum, go platinum, like, come on, you go platinum, you need another like 10 patients this quarter, go, go, go, go go. Yeah. So literally, you are now in a loaded situation where you’ve got this undue pressure from a company, or, you know, other sort of financial pressures. Or just lack of knowledge of anything else, right. But you can do something. Yeah. So you are now more dangerous, because all of a sudden, you know how to do something, you know how to use the system.

[Jaz]
To make it tangible. You said it already, so someone who can only offer clear aligner treatment, and they’re doing it, any company, whatever, but they’ve never done fixed appliances, MBT, prescription brackets, that sort of stuff. And they can only offer all be it to an nth degree, but only offer one system which may not be able to achieve the ideal aims. Like for example, we all know it’s possible. But we all know it’s more difficult to correct the overbites with a clear aligner systems, right? So you’re saying this situation where the GDP is very fluent in one language, one system, but because they can’t do the other systems then putting all on the one system? Is that what you mean?

[Mandeep]
Exactly right. Yeah. Because I, you know, you’re now the GDP, you only know how to use this. So you’re now going to talk about how we’re going to do this compromise, and we’re not going to be able to correct this, but we’re going to do this really well, we’re going to do that, we’re going to do this. And you know, you kind of it’s a loaded consent procedure, because what is the patient going to choose? They’re gonna choose whatever option you give them to you, you’ve really got to put the interest of the patient in front of you. You know, and that’s number one in our GDC sort of, you know, and also our ethical code, right? Yes. So it for me, I the way I approach things now, I don’t do any pre surgical or surgical orthodontics. Yeah, so I don’t do any of that. I also do very little of just restorative treatment. Yeah, I do a lot of post orthodontic restorative treatment. So now when a patient comes into my chair, and they’ve got spacing, but you know, a nice smile. And yet the teeth are undersized. So I’m like the spacing is due to you know, microdontia. So really, this patient really needs you know, either, you know, composite buildups of those spaces, or you know, other treatments apart from orthodontics. I would then Go through my consent after taking records and measurements, I would go through my consent procedure and I, my consent would be look, you know, to get a really good smile, and an excellent result, you can have this done. So let’s say that’s restorative treatment only. Or, you know, you can have a little bit of pre restorative alignment, and then some, you know, restorative treatment, if that made it easier and give you a better result, however, you’re then going to need, you know, retention, lifelong retention. So you know, a compromise to that would be, you know, accept that this tooth might be slightly larger than this tooth this, this and this, and maybe you’re planning digitally and all that sort of stuff. And then the patient says to me, and I have loads of these where they go, yeah, that’s the one for me. That’s what want to do. I then say, excellent. Let me send you back to your dentist. Let me send you to this person. Yeah, I don’t tell him beforehand. But I’m not going to be able to do it. Yeah, I, these are your options. This is the benefit of this, this is the benefit of that. What do you think? So and I think we should approach our orthodontic patients in exactly the same way. Yeah, we should know what the comprehensive plan is, we should present it in a way where we give all the benefits. And health wise, we give a realistic time that can be achieved. So maybe as a professional, we should just say, look, let’s get rid of this two and a half and start saying 18 months to two years here. We then consent the patient without them knowing that we’re going to have to refer them out for them to have one procedure and not the other. Yes, and it’s the same with surgery. In my practice, I would then say, look, we know you can have this done, but the outcome is going to be no x y z, it’s going to be exponentially better. You know, you’ve come in complaining about this. However, I think you don’t like your smile, because you know, your jaw is too far forward, or you’re too far backwards. So I really think this is going to be better for you rather than just the aligner fix but the other. And if they go for it and great, I then break it to him that brilliant, I’m going to have to refer you on to hospital. So you know, that’s how consent should be done. You know, so the loaded consent procedure is just wrong. You know, it’s hard to get out of that habit, especially when we’ve become a bit too salesy. It’s not a dirty word, selling is not a dirty word. You know, but there’s too much focus. Now, if you look at Instagram, or you just flick for your dentistry magazine, you know, it’s all about, you know, how to get more clear aligner patients? How to get more fixed appliance treatment? Yeah, if I run a course tomorrow, about you know 100 patients a year, I said, you know how to get 100 clear aligner patients a year?

[Mandeep]
I tell you, you know, I’d have I’d sell out in 10 minutes. Yeah. If I decide to run a course on , right, let’s spend 18 months learning how to, you know, do fixed appliances and clear aligner treatment and how to treatment plan to a certain degree, you know, people are going to come rushing. Yeah, so you know, it’s people want as a profession, all of a sudden, we want quick, fast, we want to be able to offer the best to our patients, but in a real kind of efficient route. We want to do it as quickly as possible. So in a way, it used to be our patients who were you know, wanting things easily and fast and but now as a profession we’ve done it and I tell you be careful what you wish for right? Be careful what you wish for. Because if you are then going actually I can get you know this many patients I can do it without any training. I can do it hang on a minute I can now do it contactless. Yeah. The whole COVID thing has taught me is Yeah, I can do video consultation. I could do it over photos. I can even deliver the aligners straight from Invisalign to you, all will use this monitoring system so you just do it on the phone or hang on a minute. Oh, that someone’s bought in attachment less aligner. Guys, guys, we’ve got an attachment less aligner. Come on. Let’s get on board. Let’s do this. What have you just created that you’ve just created smile direct club?

[Jaz]
Absolutely. I’ve thought about that. You’re totally right. I mean, all these hands off systems that were what’s the difference between us and direct smile club?

[Mandeep]
Yeah, so you know, how many orthodontists in this country are sitting around going ‘Ah, smile direct club, What a joke.’ We’re not because I’m not losing any patients to them. Yeah, the GDP is. So a lot of orthodontists let me be controversial again, you know, are just sitting back laughing their asses off. Yeah. Because like, no, because they were in the same Position 10 years ago, GDP-Orthodontics went whoosh, you know, STO, or alignment only this that the other day we’re like, Whoa, like without I’ve just spent three years, man. I’m just like I’m about two kids. And, you know, a bedsit in Wimbledon, you know. And I’ve been studying hard like and you know, no sleep. And now you these people can offer x, y and z and they’re bragging about I’ve done 100 patients, I’ve done this many patients, or you know, you’ll get someone on Facebook, or I’ve got like so many clear aligner patients. Now I’m thinking about just quitting dentistry and just doing clear aligners. It’s just a good idea, guys, like, you know, it’s like come on by you just random. So we’re seeing back and just laughing our asses off now. Because now is the dentist, all of a sudden going, Oh, but how come they provided these clear aligners to patients without any, like no dentist overseeing it, it’s like, come on.

[Jaz]
I never thought about that. It’s so true, because that’s what the orthodontist must have been looking and feeling. When GDP-Orthodontics boom, it’s amazing that GDP is can now look at direct to home orthodontics and thinking the same way. I mean, that’s really fascinating. Wow, that was awesome. I love that controversy there. I’m gonna really pick your brain now say that people from listening to this will not suddenly stop doing compromise treatments, because that’s a daily, It is his daily GDP-Orthodontics. But my first put my hand up and say, We do it all the time. I mean, the evidence is on social media, right? So no one’s gonna suddenly stop. But maybe after listening to you Gos, today, it could be a bit more reflective, right? And maybe take a step back and identify the need for education where we feel we need to and I love your three types consent, that is gold, right there. So I really thank you for sharing that with us. But so we can leave now as a reflective practitioner, but also go away with some really tangible gems here is, can you think of one or maybe two scenarios, maybe you have loads, I don’t know, where perhaps the GDP should, you might even help someone really in a lot by telling them these are a couple of situations where you definitely should not compromise in this case, or that kind of case. Because this will really save your butt if you refer or if you yourself, choose to arm yourself with knowledge and treat this type of case comprehensively.

[Mandeep]
So yeah, I think everyone’s off the gems, right. Everyone’s often like, right, you know, what case? Don’t I compromise? What should I compromise? For me, you know orthodontics operates in the fourth dimension. Yeah, is what I mean by that it’s one of the only treatments you can do to a patient whereby you are making an adjustment, you are not going to see the benefits or the you know, the outcome of that adjustment for six weeks. -Long game. -And when they come in, yeah, so it’s a long game, right? So then they come in, and then use it. So if you don’t know what it’s gonna look like in six weeks, then you know, there’s something wrong, because then how can you communicate that with the patient? So, for me the cases, I would always have a plan B. So now, do you think I don’t do any compromise treatment? Yeah. If you think like.

[Jaz]
I mean, Mo taught me on the, you know, Mo taught me and, you know, I know that specialists had need to compromise. Now and again, and it’s sometimes it’s patients opt for that, they sometimes the patients who wants it, and when it’s safe to do so, you guys obliged, right?

[Mandeep]
Yeah, exactly. So you know, it’s like a patient centered treatment. Yeah, this is an elective treatment, the patient’s in charge, you know, they’re not going to no one dies of, you know, Malaligned teeth or not having class one on molar or anything like that. So, you know, so let me empower you guys a little bit. Yeah. I’ll give you a little bit. Yeah.

[Jaz]
Thank you.

[Mandeep]
Yeah. But the way I would sort of think about it, you’ve got to think about treatment, like a dartboard. So this is how I do it in my head. So high, you know, when you’re teaching something, you’ve got to break down what you do in a, into protocols and the system. So the way I broke it down for me is I look at it as a dartboard. So your comprehensive outcome is the bull’s eye. Yeah, that’s the bull’s eye, to get things in that bull’s eye you need you know, your overjet down to about two to three millimeters overbite reduction class one molars you need the teeth, the correct inclination. You need you know, interdigitation, midline, correct. Nice smile or good tooth show on smiling. Teeth of the correct shape, color. Yeah, good. You know, connector lenghts, good embrasures you know, so when I think about, you know, comprehensive assessment and outcomes, I’m not just thinking about orthodontics, you’ve got to think about the color, you’ve got to think about shape of teeth. – The face. – Think about the face. Yeah. So, you know, you always talk about, you know, going from single tooth to full mouth dentistry. Well, what about full face dentistry? Yeah, orthodontics is full face dentistry. Yeah, it’s, for me, it’s the holistic and analog grandfather of smile design. Yeah, you know, so if we think of it as a bull’s eye, those are all your outcomes. So you’ve got to then plot where the patient is with regard to the bull’s eye. Yeah. So what I mean by that is, you know, what is their tooth show on smiling? If it’s, if you can only see two millimeters? Well, then they’re really far from your bull’s eye. Yeah. Because you want about 100% to show with a millimeter of gingiva. So the further they are away from the bull’s eye, you plot it. Yeah. Right? Interdigitation, plot it. Overbite, plot it. Yeah. At the end of that treatment, you would then know, okay, they’ve got, you know, my 10 features and none of them are in the bull’s eye, then you know, this is a common, whatever you do, you’re going to compromise. So you’ve got to pick the worst feature. And try to get that as close to the bull’s eye as possible. Yeah. If you can get it in the bull’s eye. And then all the other ones, you’ve got to get him close to the bull’s eye. Yeah. So you’ve got to, so even compromise treatment should be assessed comprehensively there. And you know, it’s the outcome that should be a compromise, not your treatment mindset. Your treatment mindset should be comprehensive, usually comprehensively everything and loads of people, you know, because the word compromise is encourages lazy orthodontics, yeah, encourages, you know, poor outcomes. So I don’t like the word compromise, saying I this is compromised orthodontics or you know, because don’t set out to do compromise orthodontics because even a compromise outcome is amazing. And should be approached comprehensive.

[Jaz]
Sometimes it’s the most patient centered, and I’m being very controversially, I’m not saying orthodontists aren’t patient centered at all. But sometimes that’s a perception that gdps have that, hey, you know what the ortho wants, they want to get everything, you know, class one and whatnot. But really, we as GDPs were giving the patient the smile they want in a timeframe that’s realistic to them. That’s a theory that GDP, well not a theory a viewpoint that GDP is have. But I think you’d, orthodontist would argue that hey, the most patient centered is the orthodontist because they are doing everything by the book to get them the long term stability, for example, we don’t talk about stability enough, right by getting the overbite helps with that as well. All these things. So you know, I think it’s such a fascinating debate. And I love your thought on that.

[Mandeep]
Yeah, look, and then, you know, that’s it. So you plot all those things. Now, in some people, the size of your bull’s eye is tiny. Yeah. Because they’ve got a skeletal deficiency. Yeah, they’ve had previous extractions, they might have perio, you know, stable, but, you know, history of periodontal disease. Yeah. And you know, and they might not have the finances. Yeah. So that every, with all those factors that the bull’s eye is time, what are your chances of hitting that bull’s eye? Near enough or zero? Yeah. So those are your compromise cases. Yeah. You know, I’ve got a skeletal too know, patient doesn’t want surgery, or, you know, they’ve had previous extractions. So I’m left with this half unit class two molars, you know, further extractions are just now going to crush the facial profile. We’re increasingly labial face, nasolabial angle, you know. So those are the cases where you think actually, you know, my outcome, what your assessment should be comprehensive, your outcome you’re compromising on a few of those points that you plotted in your head. But the rest you try to you know, correct now in terms of orthodontists you know, not being patient centered or you know, too focused on this that the other it’s a bit like you know, in the matrix, right? You get the option of a blue pill or the red pill. Is that right? Was it blue and red and he take a Neo takes blue, right? I need to rewatch this film with my 12 year old but he picks the blue. Yeah.

[Jaz]
I’m not helping you because it’s one of my secrets. I haven’t seen the matrix. So there we are.

[Mandeep]
Painful. This is painful. I’m never gonna listen to you again. Anyway, you’ve got to watch the matrix. Yes, so anyway, so I’ll tell you the story, right? I’m not going to tell you the whole story, just about the pills.

[Jaz]
I know about the pills, because if somebody means about it, you know which pill your

[Mandeep]
He takes a blue pill, but the key is, you know, he gets warmed. Yeah, he’s warned, if you take the blue pill, it’s going to open your eyes up to everything, and you are not going to be able to unsee or to deprogram your brain again. Yeah. So it’s just like the blue pill. But now you can see it, you’re almost going to want to unsee it. Yeah. So and now there’s someone else within Neo’s team who also took this decision, but decided God, this blue pill life is rubbish. Yeah. Catch me back to the matrix. Yeah, he’s like, just put me back in the matrix, you know? Because I just don’t want to know all these things. So with orthodontist, with specialist orthodontists, you know, they’ve taken the blue pill. Yeah, they can’t unsee it. So unfortunately, when the patient’s in the chair, even though you’ve had that chat with them, oh, yeah, don’t worry, this is going to take nine months, we’re going to do this, then this and this, you know, you cannot bring yourself to leave them with a deep bite, you cannot bring yourself to accept, you know, poor interdigitation on a certain area or a tooth that slightly slanted or a slight black triangle, you just can do it. And it doesn’t matter how much you try how much you look at your bank balance and think, Oh, my God, I know, I need to just restart reducing my appointment times and start just, you know, D bonding x, y and z cases, they want to be debonded. I’m only treating myself goddamnit. You know, you can’t stop. Yeah, because you’ve taken the blue pill. And I’m sorry, you can’t reattach yourself to the matrix. It’s not gonna happen.

[Jaz]
This is amazing, because obviously this analogy is just because you I totally agree with you having done a diploma in orthodontics. Wow. I mean, that’s exactly how I feel. We’ve just summed up how I feel. Because now when I come to seeing treatments, I mean, yes, I still compromise. I still compromise on midline, there’s still do all these things. But I’m so much more aware of it. And I have that feeling that, I can’t unsee it. You’re so right. I can’t unsee it. And it’s the same with endodontics. It’s the same with endodontics. The more endo you learn, right, and the more protocols you start using your attempts and EDT or 17% EDTA. Because you want to get rid of the, you know, open up the tubules and whatnot. When you start doing this part of the protocol, when you start sterilizing your GP points, you can’t go back to not doing it. You can’t go back to not using EDTA you can’t go back to not following the full protocol, because it feels like you’re cheating. It feels like it feels wrong. It feels wrong inside and you feel like you’re not doing the best of your ability. Wow, that is really powerful. Yeah, yeah, you feel dirty, right? You’re like that. – As much as anything as an ortho endodontics. Endo is the first thing that came to mind. Oh, my God, that’s exactly how I felt about endo. The more I learned I couldn’t unlearn it. I couldn’t unsee it. I couldn’t then do my endos in 45 minutes. I couldn’t. And now they take me for molars, take me at least two, two and a half hours in over two appointments. Okay. Whereas before I could easily do in an hour, what’s the difference? And I now see all these things, which I didn’t see before. And I can’t bring myself to do it more profitably. I can’t because it has to be done. Right? Wow, that is amazing.

[Mandeep]
That’s it. It is true, Jaz you know, and there’s that analogy isn’t isn’t there? You know, you can’t treat what you can’t see. Yeah, but I would say you know, once you see it, you cannot unsee it, and you cannot help but treat it, you are going to treat it because you’ve seen it, you know, and you can’t unsee it now. And I even you know, it’s all about rapport, I would say a large amount of my adult patients leave with very comprehensive outcomes, they, you know, invariably end up wearing their braces for longer than we plan. But you know, what, guess what, they don’t complain, because, you know, I would over egg how much it’s gonna take. Yeah, and I’ve because I’m not there to sell them. And I would even say to him, if I wanted to sell you this treatment, I’m telling you, it is going to take six months, but it’s not going to take six months, it’s more likely going to take this, this and this. And you know what? They’re on board because they trust you. They like you. They appreciate your honesty. So loads are too many GDP are too scared to say, look, it’s gonna take you this time. And you know, one of the biggest sources of complaints in GDP-Orthodontics it’s time, that you promised it’s gonna take six months now, why have you promised it’s gonna take six months? Because it’s in the name of the system.

[Jaz]
Well, I like the way you put it in that suggests a communication gem right there that you know, it’s a great way to put it if I’m going to sell you this treatment. I will say this once, but it’s not. I just really like that one line. I just think everyone should use it. I think it’s great. – Yeah, I use that all the time. – I like that but you’re gonna hate me for one thing I say to my patients, Gos, you’re gonna hate me. I’m sorry. Okay, I go. I say orthodontists are like builders, okay? They’ll tell you it takes 15 months, but it take two years. I say that all the time. We all have a bit of a laugh.

[Mandeep]
Very, very funny, you know, because we’re recording this around the dentinal tubules. orthodontic month. Yeah. Which actually you’ve hijacked because you’ve thrown in a bit of an occlusion kind of day, and they just like, randomly and but the funny thing is right, you know, druce with our right, it’s got to be 45 minutes, you know, and I was thinking exactly like you’ve said, but not in the way you said it. I was thinking, you know, you tell orthodontists to do something for 45 minutes, that is going to each of them is going to deliver a two hour lecture. And that’s what it’s been like. Some of them have come back from work, I work late, late on Mondays, I’ve not been able to log on. So I go on about, you know, half nine and thank are God they let me watch the replay, it’s still ongoing. treatment, there’s like money. So in a way, Jaz, you’re not wrong with your analogy, which is why it’s funny, most things that are funny are true. So you know, I like that, you know that.

[Jaz]
But that’s not to be dismissive. It’s just something to laugh about itself is nothing in that way at all. But but that’s we’re coming to the end of our time. And thank you so much for sharing all those things can just because like people will listen to this. And I think I really enjoyed talking to you. And people will listen to this and watch this and think, wow, I like this ‘Gos’ guy. I like the way he sees the world. Tell us how they can find you. Tell us a bit about your course. Is it online? Is it in person? How’s it going with COVID? and What? Why not?

[Mandeep]
Yes. So I mean, I’ve had quite a few gdps reach out to me via social media. So if anyone wants any advice on anything, just reach out and I would share, you know, anything. I’m quite open. And I just think, you know, part of my gripe with orthodontics, in general, is there’s a real lack of leadership, especially with GDP-Orthodontics. Yeah, so I think, you know, specialists need to take a little bit more of the lead we have, but we’re all busy trying to live our own lives, and we’re having contract issues. And this that the other, you know, so it’s, sometimes it’s the priorities quite low. But I think, you know, connecting with your colleagues is important. Yeah, treating them as colleagues, not competitors is really important. So I have that kind of attitude. So just reach out to me on Facebook or Instagram. I’m not on any other sort of.

[Jaz]
I’ll put the links in the show notes on protrusive.co.uk and also on the Facebook group. So I’ll put all that there to contact you. But your course, are you doing another one next year? Or is it all fully booked? Or is it? How is it with COVID? It just I don’t get it?

[Mandeep]
Yeah, so it was tough, you know, because I wrote it, it was intended to be under normal circumstances, you know, a real face to face, you know, course. But we’ve adapted it to be a bit more blended. So it’s delivered, you know, over 18 months, there’s quite a few lectures given over webinar. There’s a lot of online videos, which are just constantly updating, so loads of clinical videos, treatment discussions. So we’ve structured it in that way. And then obviously, there’s the practical components where we meet, we do a lot of typodont treatments, and there’s a clinical element as well, where over four sessions, they could come to the practice. And if they feel confident, either treat patients or so. So yeah, so which is why it’s just very small groups. Yeah. So it’s just I only take two groups on a year of eight. So if I take eight on in April, so in April, you know, I’ve got eight spaces, four I’ve already gone. And then I take on a second group in September. So we just do April, September, keep it small, you know, I’m never going to be like what are these big academies or big kind of, you know, teaching Institute’s or whatever, because I think to teach orthodontics properly, I think you need a mentor. You need that close contact with someone. And then also for me, I need to be contactable to all my delegates, you know, they can contact me and then I can respond straight away and just guide them through the process and I hugely enjoy it. And the reason we’ve been so I run it with my wife who’s all she’s got an MSc in orthodontics, and she was the inspiration behind it actually because you know she I won’t tell you where she did her MSC, but the you know, the process and the teaching was just horrendous in a way that it was very scientifically driven. There wasn’t much in terms of mentoring or treatment planning or practical skills, and I thought you can go you can get an MSc and you could literally not have any of those skills and still get one. But it’s just, I was like, right, I need to do my own, we need to do a course. Awesome, great together. So she helps me in a way that, you know, she thinks differently to me. So she knows she’ll say something like a practical aspect, or you need to teach him how to do this, this and this. Because you forget when said things are second nature to you, you forget how it was like when you didn’t know any of those things? Yeah, so she called me, She is a bit more fresh in that way and says, Look, I struggled with learning how to do this. So if you teach them how to do it this way, and be descriptive about this, they’ll learn x, y, and z.

[Jaz]
That reminded me of the first time I put power chain on I’m like, Wait, am I doing it? You know, and like, you know, you guys think what the hell is easy, but first time doing that any simple thing that you can think of, right? And it’s so great that you have that input for you know, from your wife. And it’s great, because it’s so easy, once you become efficient and proficient something to forget the struggles of the learner. And the learner will struggle with so much more basic things than you ever thought. And it’s nice to be grounded in a way and think I can simplify something, but actually make it exponentially more valuable.

[Mandeep]
Yeah, I completely agree with you, Jaz. And you know, within that eight, you know, within eight people, I’ll have three who are hugely experienced, who actually done other courses already, you know, so this might be like the, you know, another diploma that they’re doing just because, you know, they want whatever we’re offering. And then I’ll have you know, another three, that I’ve done nothing. And then everyone else sits in the middle. So it’s sometimes hard if you had a bigger group to tailor to all those things, to all those sorts of types of knowledge. But I think if you pitch things to the people who know nothing, and simplify it, even the people who think they know loads will get loads out of it. Yeah, so it’s just another way of doing it. So they might say oh, I’ve never thought about doing it like that. So you know and I’m full of you know, breaking things down clinically like trying to make things easy, I’ve shed any kind of pearl you know, like how to do certain things whether it’s attachments, IPR, putting retractors on or using this type of retract for this patient you know, just making things easy, clinically. How to put fixed retainer on right? So touted all those things, but also you know, in the real world how to keep your cost down, how to be efficient, clinically efficient, how to have protocols in place, how to then present cases to patients after a good concern. You know how to put the patient for..

[Jaz]
Your dream consent analogy is anything to go by that I’m sure you absolutely smashed that so nicely. I really enjoyed your teachings today, Gos, the way you explain things I really enjoyed it and I love the fact that you’re not afraid to become a little bit controversial because I think it’s gonna make for a really lovely I’m expecting loads of messages of ‘Oh my god, Gos just blew my mind’ because this is really fun chat. I mean, the wow an hour just flew right by. I really appreciate you coming on today. Gos, please send me the link for your course I can stick it on the protrusive show notes as well. So I don’t get bombarded by messages. I can just go on the website and click on find you as well.

[Mandeep]
Cheers, man. Thanks. There’s a few things here that you didn’t say. So you didn’t use the word, a myriad of uses.

[Jaz]
Really? I never knew said that. I say that?

[Mandeep]
You say that all the time.

[Jaz]
What?

[Mandeep]
You didn’t talk about people listening and cutting onions.

[Jaz]
Okay, yeah, yeah, fine. Yeah, that one I say a lot. I agree.

[Mandeep]
You say that a lot of gardening or cutting onions. I’m like, That’s such a Punjabi thing to say. One listener messaged me one time say I listened to you when I chopped my onions. I was like, this is a real thing. So that’s why I just I just imagined people just listening, chopping the onions all the time. That’s all you guys do. – Since you said that I now when I do chop onions. Hence the experience like you know, like justify your tears as you’re listening. You can justify your tears that you can justify, they’re crying because he was young. He wasn’t the movement of the inspiration of the podcast.

[Jaz]
Gos, thanks so much. Fun. No bust at the end as well. Thanks so much. And guys, check out Gosal on all the social platforms and I’ll stick the show notes on the website as well. Gos, thank you so much. Cheers, mate.

Jaz’s Outro: There we have it guys. I hope you enjoy that really entertaining content with Mandeep Gosal. Gos, thanks so much for coming on to make such a fun episode. I think I really appreciate exactly where you’re coming from and I really respect you as a specialist in terms of how you work alongside and how you educate general dentists, is really awesome. So, more power to you my friend, guys, thanks so much and next episode will be about retention, all about your your niggling queries in retention. In fact, on the Protrusive Dental community Facebook group. Some months ago when I was recording this episode, I asked you what you wanted to ask Dr. Angela Auluck, and you guys had sent me some questions through. So your questions will be answered and the most important things about making sure that retention is on point. So I’ll see you. Same time. Same place. Next week.