Why do some Dentists find Dahl Distasteful? – PDP016

Jaz’s Introduction: Hello everyone. Welcome to Episode 16 of the Protrusive Dental podcast. It’s Jaz Gulati here. So Wow, what an episode with Michael Melkers I hope you enjoyed it. I really love recording it. And once again, it was a video podcast so you can see it on my Facebook page as well. But what can I say I am honored to have the Doctor Tif Qureshi on this podcast. I feel like the guests are getting better and better each time and it’s privileged people to interview these people. So Tif, the story of being with Tif is I went to his course in Sydney. Actually, I was living in Singapore at the time, and it was a great way to see Australia and I noticed that actually, Tif was teaching in Sydney and my wife let me go, so Sim thanks for letting me go. Now Tif is I’m gonna go ahead and say he is the most respectable person in UK dentistry. There we go. I said, if you don’t know about Tif Qureshi, then please join us for his fantastic two part episode. The amount of value he gives in the recording was so vast that I had to split it two episodes. So the way that the two episodes are split as follows. Part One of Dahl is basically talking about the importance of consistent photography, how Tif Qureshi carries out his consultations and what kind of communication he carries out with his ongoing patients in the run up to Dahl because what you’ll find out is that a lot of these Dahl cases, they’re not done as a treatment plan that’s presented to a patient and then they go ahead, it’s a conversation to have and you need to cultivate and discuss with the patient. So it’s some great tips in there. We talk about young associates moving around too much in terms of associate positions, we talk about how much you can learn from your follow ups, you know, you’re already probably familiar with a lot of his ideologies and philosophies which are just fantastic. We talked about in terms of Dahl itself, we talk about it, and I apologize in my last episode, if you listen to audio version about the fact that actually we do go in quite heavy into Dahl, we don’t actually talk about the history or the mechanics about the whole intrusion, joint repositioning to an extent we do. But it’s almost assumed that you know about Dahl technique already to a degree. And then I really grilling about the nuances, the nitty gritty after you done a couple of Dahl cases to actually improve your future Dahl cases. So I do apologize if you’re a bit earlier in your career, and you’re all bit unfamiliar with the Dahl technique. There’s plenty of good resources out there. In fact, I promise you on my blog, jaz.dental soon to be upgraded, by the way to Protrusive website, which I’ll tell you about that another time. I’ll be uploading that on like a PDF version, some good BDJ articles, which I found helpful when I was learning about Dahl, but obviously, you know, Tif’s course two-day course on Dahl Ortho-Restorative is the pinnacle of it all anyway, but he gives away a lot of his gems, because he’s such a generous person with his knowledge over these next two episodes. So part one, what we’ll be discussing is who is your ideal patient forDahl technique? Would you ever do Dahl in porcelain? The importance of Dahl as an interceptive treatment not to leave it too late for the patient to Dahl up because that’s really a full mouth rehab, what we can learn about full mouth rehabs by you know, doing the Dahl technique, and important once again, communicating, communicating with patients the right way, about the Dahl technique. So that’s what it’s going to be covered in part one today. For part two will go into much more depth in terms of which types of splints to use with Dahl before after, sort of the real nuances and the nitty gritty bits. And that’ll be in part two coming soon. So I hope you enjoy interview. And please, if you like it, you know, give me, Leave me a review on Google podcasts or iTunes or wherever you’re listening to. Give me any stars you want. My favorite number is five. So please, yeah, enjoy episode. And thanks so much for listening. As always.

Main Interview:

[Jaz]
I just want to say Firstly, congratulations for the massive prize, because I believe that the prize is named after the dentist that you admired a lot, right?

[Tif]
That’s correct, yes. But the tourists dog, I mean, it’s a massive prize to me, it’s probably doesn’t mean a lot to most dentists in the UK because, like It wasn’t that well known, I think a quarter of a dentist do know him and didn’t know him. But he’s not that well known in the wider community in the UK. But probably I would put them up there as one of the greatest dentists of all time based on not just his kind of clinical skills of which there was very apparent but really his perception and his kind of ethos in that. It was more about looking after people for a long period of time trying to do the most minimal treatment for the reasons of actually not just doing it for the sake of doing it minimally but because he cared about how things were five or 10 years down the line or 15 years down the line.

[Jaz]
Which is exactly your ethos and philosophy. So would you say he’s had the biggest influence in your clinical philosophy in your career?

[Tif]
Yeah, without a doubt of all I’ve got, there’s a lot of dentists out there that I’ve watched and heard lecture and met and know them. And I admire them immensely. But I don’t think there’s anybody had quite an effect on me as watching the circle when I watched him for the first couple of times. And then I was very lucky to actually meet him. And then incredibly, he actually turned up on one of my courses in Stockholm back 10 years ago, I wasn’t actually expecting.

[Jaz]
Wow, that is really amazing. That is a really key lifting moment for you to have one of your, you know, mentors, when people you really look up to who comes to your lecture.

[Tif]
Absolutely terrifying as well, because in my presentation, there were some of my, you know, my pre aligned veneer cases, which really looked absolutely hopeless conservative, but to be fair, I mean, you know, he sat there is a student and listen to it all, and actually did some cases and believe it or not, I mentored him a little bit as well. So it was quite amazing, actually. So it’s a Yeah, I did. But he was humble enough to actually, with all the knowledge that he had to just sit there and listen and take on board what I had to say. And actually, that’s kind of where I suppose where this all came from. Because then with his kind of ethos, he knew what I was doing. And he kind of supported a lot of what I did, particularly in Norway, in Sweden, and there’s a guy, that guy that I actually won the prize with jointly, again, not well known here, but his name is [Eric Spencestud] [Jaz]
Oh, I think I’ve seen him on Facebook, he posts some good ABB cases as well. Right?

[Tif]
You’re right, that’s right. But Eric is actually really sparkers prodigy. And if you want to use a better term, I mean, he’s basically the person that circuit gave all his material to and he stepped in when he was unwell. And he really sort of is trying to continue that message on. And quite oddly, the reason I met Eric was because by 2013, I was meant to be doing a lecture where it was just myself smirk on stage. And we had a little bit of slight crossover. So that was like, for me a dream come true. But then unfortunately, Abushi became ill. And that’s obviously you know, he was suffering a little bit, he became a lot at that point. And Eric stepped in, and I was like, the upsetting Who’s this Eric guy, type of thing. But actually, I met Rick and literally from that day onwards, we’ve sort of clicked as, you know, extremely good friends, who, you know, we messaged and speak to each other and I said that dentistry about life in general pretty much every day about you know, where dentistry is, go and both of us have obviously been kind of been deeply influenced by circus. So yeah, to summarize, to win that award is a big deal for us. Definitely.

[Jaz]
And honestly, I can’t think of anyone better so you’re a man who says I’m gonna make you blush a little bit you’re a man who really doesn’t need to any might mean most of my listeners a ton of my listeners are from the UK young dentist and they all know who already Okay, so for those who are living under a rock, Tif is, if you don’t mind Tif, I didn’t ask you for introduction. I’m gonna make one up for you. That’s right through the eyes. And for the voice of me of me and you are the king or the other good. Maybe the Guru is not right term because I feel that term is won’t do justice. I think you’re just an amazing person and your niche area of Ortho-Restorative and how you really pushed minimal invasive dentistry is fantastic. You’re one of the nicest most humble most giving clinicians you’ve always got time for everyone, young dentists, everyone, you’re a master educator. And I know that because I’m pretty sure you gave two day keynote lecture in Scandinavia recently, right? Or is it always in New Zealand?

[Tif]
No, it was actually both the two days were were Norway. And there was one whole data very large audience and then another hands on day and then New Zealand was actually the year before where again, it was a whole day. And then I did two days in Australia, but that you know what, these things they come around and you take the opportunity when you can,

[Jaz]
No but Tif to to be able to speak for two whole days as a keynote speaker. Firstly, you have to be really engaging, which you totally are in if you’ve never been to one of the Tif’s course. And speaking opportunities are jumped at it. Really, I mean, I saw you in Sydney, if you remember.

[Tif]
Yes, of course.

[Jaz]
Okay, so I was living in Singapore at the time, right? And we were going to come back to the UK. And I thought, Okay, let’s go Australia. So while we’re there in Australia, I just noticed the dates have to happen to coincide and I didn’t want to wait another six months or a year to come and see you speak because you know, it was about the it was the Ortho-Restorative, the Dahl, hence why you know, which we’re going that’s what we’re talking about today Dahl and you know, I’m so glad I went and I’ve learned so much. I’ve gone through lots of Dahl cases which you can definitely get into nitty gritty of today. But I just want to emphasize Tif, you’re a fantastic educator, because you’re not only to put on a two day program and to really engaging but to have enough content to fill around seven hours per day, 14 hours. That is spectacular. And we know on Facebook, you have so many amazing follow up cases year after year after year. And I love how you present it two years, five years, 10 years, you’re very honest of this one’s with polishing, this one’s without polishing. So I think that is amazing what I also love about your cases Tif and I’m sorry if I’m calling any other dentists out here Instagram dentists, whatever, but I just don’t like it when dentists take one type of photo with a ring flash and then their final photos all the bounces and stuff okay, I’m not about that. I’ve noticed even though you’ve got bloody 15 years plus follow up, your lighting is always consistent and you’re never trying to hide anything. And that really in today’s era deserves so much kudos.

[Tif]
I have to say that’s probably just come down to laziness and like kind of stuff I try. I did try it. But I just thought more or less the fact that I mean, eventually I think over time you start you do actually look at the images more Honestly, I think what it is, is that, you know, I did play around, if you look at some of my images are a little bit different. Because if I did go from ring flash to [twin] [Jaz]
You might upgrade equipment, and I get that, but yeah, I know that you try and keep you’re not trying to like, you know, make one look not so nice. And the other one look, no, that’s exactly what my point.

[Tif]
You’re right. I do admire the guys that do that very well, because I mean, some of those pictures are beautiful. But to a certain degree, I think what I’m also trying to do is get people to focus on what you’re actually looking at not just to think, oh, what a beautiful picture. And actually, you know, I think what I’ve learned, and it comes back to what you said before that same people again, and again. It no one expects everything to look perfect, 5, 10, 15 years down the line. In fact, when it looks imperfect, you learn so much more from it, you see what I mean? Because it enables you to kind of get an expectation of how things are going to change. You know, this whole I think there’s you know, you could have a whole conversation on this whole before and after mentality is actually half the problem, what’s wrong with dentistry, but people are just focused on providing a service, here’s what you pay me, thank you, goodbye. And that’s the end of the relationship. That’s actually what I read. One of the things I learned it’s furka, it’s completely wrong. And that kind of method, that kind of attitude goes all the way through dentistry I find. It really is, it’s kind of it’s in there. I say, you know, it’s in specialism. And if you think about specialists, the way that they don’t just don’t ortho what generally other than perio, most specialists will do a very complex treatment, it’s done, goodbye. Okay. And that is not, I don’t think that’s the way the dentist should be. I think I’m not saying we don’t, you don’t have specialists. But I think that particularly nowadays, remote monitoring, all the things we can do, there should be so much more cross communication between people who are looking after a specialist created treatment or complex treatment, and the person actually carried it out. So I know slightly stray, the point being is that the photo, the reason for having long term photographs has really sort of made me understand that actually, that’s what dentistry should be about, it should be about a longer term relationship with the patient rather than this whole, you know, get 20% of the rich people through the door and sell them as much treatment that you can do. That’s just I did that for a while. And that is total, and I’ll be a bit rude total garbage. And it’s actually and I actually bought thing is borderline unethical, that whole kind of mentality of just no big ticket treatment, and then you just display basically just disregard the patient. I’m not saying that a lot of people do. But I do believe that in certain elements of dentistry, you know, work particularly smile driven dentistry, there is this kind of emphasis where you’re just always focusing on new patient, you know, it’s with a new patient.

[Jaz]
Yeah. There’s a whole massive market on Facebook all the time advertising, are you looking for new patients, 73 new patients in three days and all that sort of stuff

[Tif]
This is the thing I mean, I’m sure we’ll get into it. But I’ll tell you what, I actually don’t like to new patients. I don’t there’s reasons for it, I’m most of the work I do that you see, it’s all on patients, I’ve had a bit of a conversation going with for a few months, at least, or maybe a couple of years. But you know, that’s another reason why we’re talking about dahl. But it’s another reason why there’s so much dahl, because in reality, you will do far more dahl on patients that you know, and have had an ongoing conversation with compared to a patient you’ve never met before. Because dahl requires patients to kind of understand why you’re doing it, and what the benefits of it are.

[Jaz]
Absolutely And what I found is with all the Dahl cases, there’s only one Dahl case, which I saw present a treatment plan and she wanted to go ahead with it, I did it. But you’re right, most of the other Dahl cases I’ve done. In fact, all your Dahl cases has done, there’s been at least six months of communication. Now obviously, with my six months, it doesn’t compare to your years and years, we just thought the way it works out. And on that note, actually, I should really mention that, Tif, you’re one of the advocates of being in one place for a long time. And you already mentioned this, you know about long term follow ups and whatnot. And that’s really admirable. And I know one of the things I was asked you at the end is any tips for young dentists, I know that you always talk about this. And the value of being in one place for a long time is amazing in terms of how much you learn. But it’s actually having an interesting effect on me, Tif. Because every time I’ve been in a situation in my life since qualifying 2013, where I’ve had to leave a post because we’re moving Singapore or moving back. I’ve had your voice in my head, really be disappointed in me. You took the blame for this. So you’re having a great effect on it. You get you’re getting people associates, associates nowadays, you know, as a young associate, I can say it’s we’re moving around too much I think and I think what you teach to stay in one place to see a follow ups is just sensational.

[Tif]
Yeah, if you’ve got to come back from Singapore to the UK, that’s acceptable. I totally get that. You know, that’s fine. It’s a life decision. But I think that you’re right. There are a lot of people who I think they kind of make their move around from practice to practice in areas actually aren’t that far away from each other. And I’m totally, What are you doing that? You know, I met one associate, I want to chat young chap, he met me in a course and you know, after a lecture, he said I really enjoyed that and but you can see he was down I could see he was explaining he’s had nine jobs in nine years. You’ve never seen your work. You know you basically had nine years of not really learning a lot, because the reality is, you know, I’ve learned and I say sort of beginning my lectures, I’ve done a lot of courses over the years. And I’ve watched a lot of lectures. But I’ve learned more from seeing my own cases than any course I’ve ever attended. And that is so important. Because to be able to face your own work, even when it looks rubbish is an absolutely key part of being a dentist, you know, and actually, when I looked at work that I encouraged the patient to pay for, you know, and I said, you know, we’re going to do this, I’m going to do that. And I came back and I looked at it, and there was a leaking margin on our composite that I’d done four or five years ago, when I looked at it partly because the other thing, and it may get into it, but I always use intraoral cameras for every single checkup, okay, it’s quite a rare thing to do. I look at dentists having draw cameras, but they don’t use them every checkup. And I take a picture of every single tooth, and it takes me lithium. But what that does is it helps sometimes, both the patient and I look at something that I did three or four years ago, and if there’s a league, you know, I look at not happy with that, I’m going to redo it. And you know what, just doing that, if you’re not happy with something, and you redo it, and it might cost you like 250 pounds, whatever of your time, the fact that you’ve done that is better marketing than any 1000s of pounds, you can spend on Instagram, trying to get a load of people through the door, because what you’re actually telling that patient is your primary focus is their health, their care, not money, you see my point?

[Jaz]
100%. And it’s something that I learned from actually [Tom Seeley] also does this and some of these great dentists like yourself, and [Tom Seeley] that when I went to shadow [Tom Seeley] once, you know, he’d come across some fantastic 9 out of 10 anterior composite, and because it wasn’t 10 out of 10, he wouldn’t force the patient, we say look, I think I can do a little bit better. If you have the time for me, I love to make it better for you. And that is your right that is the ultimate way to and he’s not doing it because he wants to market himself to it as he just generally wants to do an amazing job, I take a leaf from that and what from you’re saying. So that’s a great tip to if you see work that is not to your true standard, and you want to really fulfill your objective of making something beautiful, long lasting, then just replace it and the patient will you know, tell 100 people

[Tif]
Exactly. And then you know what, then the patients like you, they become friendly with you. And you know, and then then when they send someone in to see you that new patients very different to a new patient that you pulled in off Instagram or wherever. And I’m not saying that Instagram patients are terrible, blah, blah, blah. But what I’m saying is, you know, in my career, you know, a long career, I’ve noticed that the patients who get referred are so I found them so much easier to treat, it so much that you’re not having to win them over than somebody who’s just coming in and who’s just kind of you know, you get those kind of patients who are sort of trying out lots of different dentists and looking for price and that sort of stuff. And I’m very careful with those people. I don’t start treating them very quickly. Sometimes that might that but when it’s somebody that I know, I’m not saying that drop my defenses, but I found that over time, those people because their family and friends, you know, they’ve already they already love you. You see what I mean?

[Jaz]
Yeah, they trust you. And also it’s the family of friends or people who you also enjoy treating and who you also trust.

[Tif]
Exactly.

[Jaz]
You also great. You already like this patient, the patient already likes you just from their prior relationship with the other patient.

[Tif]
Exactly. And I think you know, I think this is the thing, we’re having this conversation about this now, how often are we hearing this in the you know, when you go to a dentist? Yeah, all you hear. And I know with all due respect to them, because a lot of great guys out there who are great gurus are getting new patients. And I think that some of the guys are amazing. But I don’t hear enough people talking about this subject. And actually, I think the effect it has on younger dentists who are not established is to make them feel under pressure that they’ve got to sort of somehow market themselves as a brand to then have all these new patients coming in. And that’s just not true. What you need to do you get back to what you said we need to do is to stay in one place, build trust, be honest, talk to people, tell them what’s going on, you know, do things right, and then it would take two or three years, potentially, but you’ll start to see these people coming back who actually trust you. And that’s really how that’s how we should be.

[Jaz]
And it just highlights again. But again, being in one place for a long time it has that you have the ability to do that by building rapport. And one more thing I mentioned is Zak Kara’s episode thinking comprehensive. One thing that Zak said in that episode, which always resonated with me is he’ll never treat a patient who can’t have a laugh with.

[Tif]
Yeah, I think he’s totally right. And actually, you know, that kind of sort of goes back to what I said about not jumping in too quick in that what I tend to do is, I mean, if someone’s coming in for quite comprehensive treatment, the bottom line is they’re going to probably need hygiene, a couple little minor things done anyway, what we’ve always done in our practice, we know you’ve got hygienist, it’s a great thing to send someone to an hygienist, sometimes you just have to travel to hygienist and just say, How did you find the patient, you know, because you can learn a lot from that actually, better be careful what I say here, but, you know what I mean, but the bottom line is that, actually, people need to visit the practice a few times, so you can really kind of get your head around them. I sometimes send patients off to the associate, they’ll do a refilling or something, something I don’t really do those. And again, I just do some simple stuff. And then before you really get into the big treatment, just make sure that this patient’s kind of on board with the whole kind of concept of the way everything works. And let’s face it, it’s just pleasant, a pleasant person to deal with someone you’re gonna have a laugh with. Exactly.

[Jaz]
Perfect. So that’s been one of the best intros I’ve ever done. Thanks. So much. Obviously, there’s so many gems in there. No, no, but this is awesome, I’m probably going to break this up into two episodes. So it’s the first part communication gems and life coaching, if you’d like for dentist, which is that’s what it was, it was full of great information. And so now, what I’m probably gonna have to skip is, look, the audience I pretend to listen to this podcast is already quite learned. I don’t doubt for a second they don’t know the core principles of Dahl so if anyone doesn’t know the core principles of Dahl, you know, localized tooth wear, obviously, Tif I’m happy to touch on it. But I don’t want to delve too much on the history, the lateral carefusion, the mechanics of that. I want to do more people who are actually case assessing, getting their hands dirty doing it, follow up, splint therapy, that’s the stuff on I’m going to. So for those dentists who actually want to learn a bit more about Dahl, I’m going to put some resources, PDFs dental update that sort of stuff in the blog post itself. So you can download that. So you know, if you want some background reading if you can but I really want to have Tif here, I really want to get to the things that I know you discuss it on your course and your two-day course, but things that other you wouldn’t necessarily be reading from that love day or anything. They’re the real nuances. So if you don’t mind can I just shoot you some questions?

[Tif]
Yeah, absolutely.

[Jaz]
So you know, if you senses which is the, who is the ideal patient for the let’s say, let’s call it the composite Dahl technique, because one the question on it later on, it could probably lead up to it is would you ever do Dahl in porcelain? So you go straight to porcelain? And then you want them Dahl in. So start off maybe by just saying, Who is the ideal patient? What percentage is time are you doing in composite? And then would you ever do it in porcelain?

[Tif]
So basically, I’d say the ideal patient is someone you already sort of mentioned, we localize anterior tooth wera, it’s also a patient, you’ve sort of known and been following who you explained to them about their anterior tooth wear they’ve got a localized anterior teeth wear and I’ll emphasize I think it’s important to say, but there’s no significant posterior wear, that’s key, because the point the way I look at it, it’s not it. And we know this is not true in every case. But in many cases, wear often start and localize anterior patient with anterior guidance, and then posterior wear can potentially follow not always we know that, but it can follow. So what I’m usually doing is looking in everyday checkup on every one of my patients, I’m always looking at their anterior tooth wear, tooth surface loss and the anterior guidance. And if I feel that their anterior guidance is starting to reduce, they’re starting to get close, they’re getting posterior contacts, and they’re starting to obviously, if they’re starting to, you know, occlude on sort of dentin, then that’s the type of patient who would be great for Dahl. Dahl, in my opinion, is actually an early interceptive treatment. It’s an and you’re saying, would I put Dahl Or would I do Dahl in patient straight in porcelain? You know what I have in the past, but the way I would look view is, if you had to do in porcelain, it’s probably too late. It’s not right. But by that time, it’s probably too late. Because it’s quite rare that the front teeth are that badly destroyed, and there’s no effect on the back teeth, do you see what I mean? Now, quite frankly, I mean, Dahl, the limits of Dahl are and the studies say about five mil is what and by the time you’ve already got five millimeters of anterior tooth surface loss, the post, there are cases where you get a huge amount of alveolar compensation and you still

[Jaz]
So five mils anteriorly is basically how much you’re building up. So the posterior that’d be around about maybe, depending on the ratio, you know, 1.5:3, depending on what, it’s not always 3:1, obviously is a rough one. But would you say that’s how much it opening up at the back?

[Tif]
Yeah. I mean, if you really think of it equilibly and you think of the jaw, like a hinge, you know, obviously and actually even then, as you go closer further to the back, you’re a bit maybe an equal one and a half to two mil, and then each segment at the back has actually only got a mil or so to move. So it’s not like you’ve got two mil of actual movement of each segment. So it’s so actually you often find that he do move five mil at the front will create about two roughly at the back ish, it depends on the patient’s , or the other sort of stuff as well. But I mean, that’s kind of fine. But if it’s beyond five mil, you know, if they want beyond five mil and we’ve got then we’ve also got wear on the posterior teeth. That’s significant, then really that’s it that you’re getting to full mouth [territory] [Jaz]
And that’s something I took away from your course, Tif. So if you’ve got a basically how to make it tangible, if you’ve got exposed dentin posteriorly and you’re just doing this beautiful dahl buildups anteriorly, giving them anterior guidance, but you still got exposed dentine posteriorly and those teeth probably will benefit from restoration, which is exactly my right and that’s your point. Actually, that patient is a full mouth rehab case rather than you know, Mr. boat for dahl technique.

[Tif]
Exactly. But the interesting thing is the technique that I use on the front teeth the way I build the teeth up, and I’ll use that same technique on a full mouth case, but the slight the way I do it, and the way I do it is I build a thought those the anterior is up again and there are soft temporize, the back teeth to stop those teeth from moving and then through the process. We then have these buildups on the anterior soft temporaries on the back teeth to stop the moving and then I effectively wait for the jaw to deprogram and I’ll go through my whole usual full mouth process from that point. So you can use the same bonding technique, but the key point, as you rightly said is if you’ve got wear on the back teeth, you don’t want those teeth to move. You need to hold those in them in position

[Jaz]
Because you want the space so you don’t have to hack them down anymore. And that’s exactly but then interesting point you raised there is when you don’t want the posteriors to sort of move in those cases where you’re doing more of a full mouth rehabilitation in those cases, I think is good because the whole principle of full mouth rehab is you want to establish the anterior guidance first. Anyway, you are doing that anyway by doing your doll you’re establishing anterior guidance and with the dahl i think is a great exercise for learning occlusion because you’re then adjusting. You’re using your articulating papers, you’re getting the you’re creating the correct smoothly anterior guidance is a great way to directly learn occlusion I suppose, the principles of anterior guidance because dahl, the basis of dahl is on that. Would you agree with that?

[Tif]
Absolutely. Right. And that’s the thing because you’re actually using on patients at an early stage who aren’t you know, these aren’t big TMD patients, these aren’t patient is smashed all that back teeth part. And this is kind of me, one of the questions that we were sort of thinking about here was, you know, why do people not appreciate it and one of the biggest problems is a lot I think a lot of people use dahl on the wrong patients when it’s too late. And dahl is really for patients that you’ve had a relationship with you they understand what’s going on, and to actually say to imagine to brand new patient who’s got a bit of wear on the lower anterior teeth, imagine trying to say to them, right, I need to build your anterior teeth out to improve your anterior guidance and disclude your posterior blah, blah, blah.

Jaz’s Outro: So thanks so much for listening to part one. Stay tuned for part two, which be coming out soon. Have a little break for me for a while. I mean, isn’t Tif Qureshi is just a pleasure to listen to. He’s just full of so much knowledge and information. So thanks so much as always Tif. Look forward to part two. And once again, thank you so much for listening all the way to the end. And please, just like I said, last time, check out occlusion2020.com, which is the occlusion course by Dr. Michael milkers, which I’m proudly sponsoring. Tickets are flying for that which is so great to see. And like I said before, I’m determined to make this the best to date seminar program on anything let alone occlusion in Europe for 2020. So please come and join us for occlusion and lamb chops.