From Scared to Confident in Oral Surgery – A Young Dentist’s Journey – IC049

[Jaz]
But today I speak to a young dentist, Aidan, who went from being scared to now being really confident. And he’s still a young dentist, about five years out, and he’s found himself in an environment where maybe 50 percent of his diary is extractions. And this is what he wanted. This is what he designed.

So listen to this interference cast today to explore Aidan’s journey. There’s a few little exodontia tips thrown in there and a really cool tip right at the end about how to actually get saline into your socket a really clever way, which I didn’t know about, and I think is going to blow your mind. So if you want to hear that tip, you have to go all the way to the end.

Hello, Protruserati, I’m Jaz Gulati, and welcome back to an interference cast. This is kind of like the non clinical arm of the podcast, although this is probably one of the most clinical ones that we’ve done. This one doesn’t have premium notes. It doesn’t have CPD, but this is a really warm episode when it comes to being inspired about someone’s journey and the steps they take and learning about how someone came to a decision.

Like I love something that Aidan says that he recognizes that he’s not the best at multitasking and he really enjoys the idea of having focus and oral surgery ended up becoming a focus of his and this young dentist is now pursuing an implant masters and how one thing leads to another. So this is a really cool journey to unpack.

So I hope you enjoy it. And if you gain something from this episode, don’t forget to hit that like button. If you’re watching on YouTube, if you’re listening on Spotify or Apple, thanks so much for always coming back, really appreciate it. Do make sure you are subscribed so you don’t miss an episode. It also helps Protrusive to grow. So I’d really appreciate that. Now let’s join the main episode.

[Aidan]
I feel a bit like an imposter today. I feel like I’ve not really, I’ve just done what I’ve loved and enjoyed, and I’ve not really felt there’s anything particularly that’s special about it.

[Jaz]
I disagree completely. Aidan, I think everyone’s got a unique story and you’re going to be amazed about how many young dentists will just get some ideas. So, I mean, let’s just say we’ve kicked off . Aidan? Yes. Welcome to the Protrusive Dental Podcast, my friend. How are you?

[Aidan]
Thanks, Jaz. Yeah, not too bad. Not too bad, how are you?

[Jaz]
Yes, great. And we just established that on Fridays, I do a bit of TMD work in a London clinic, but on this Friday, I’m admin, I’m protrusive, I’m writing to patients, I’m sorting out bits and bobs, and you are always non clinical on a Friday, is that right?

[Aidan]
At the moment, yes. Yeah, I’ve just started, or I’ve just signed up for this implant masters in September, so I took this Friday off just to allow me to do a pre work before that starts, because the clinical days for that are going to be probably Saturday, clinical day, I think, and then Friday is a sort of work day.

[Jaz]
Okay, well, let’s unpack your story. I want to discuss your story and how you niched into it and how you, how you are where you are, early on in your journey. So, tell us, where should we begin, Aidan?

[Aidan]
So, I went to university in Linfield, graduated 2019, so I’m fairly new to dentistry not being not be graduated that long as a lot of people that didn’t graduate with a huge amount of experience in oral surgery. That’s quite nervous going into it. And then went for an-

[Jaz]
Let’s just unpack that a second. Do you have a number? Like, how many teeth you would have extracted during dental school? Just nice to think about these things.

[Aidan]
I don’t have the exact number. I would have thought that the total number would have been about 40.

[Jaz]
How about surgicals?

[Aidan]
Oh, I think maybe one or two. And the question is that is, how much of that was me assisting? How much of that was me being the actual main lead in that case? I couldn’t answer that question. It would be, count them on hand. I think how many surgicals I’ve watched when I left university.

[Jaz]
Let’s remember that as the discussion develops and how you actually niche into it. Let’s just remember that at dental school, depending on where you are in the world, but a lot of the UK dental schools, we don’t get enough exposure, especially to the surgical element of it, raising flaps, sectioning teeth. Oh my goodness.

You know how much I bang on about sectioning teeth, right? And it’s something that I wish I learned earlier and earlier and earlier. It would have saved a lot of blushes in the clinic. And I’m sure we’ll talk about that as well. So, okay, fine. You qualified 2019 and I mean, obviously COVID around the corner. I’m sure you’re going to get to that.

[Aidan]
That was the thing. Yeah. So just about six months of dentistry. It was the first six months of FDs. So, when you’re just getting warmed up, I mean, just to start to feel comfortable. Yeah. About that. I mean, just as you start to feel comfortable, it was locked out.

And they were doing absolutely nothing for about six months time and massively. I mean, I remember doing my first one, but I think it was the last day before lockdown. I took out this upper canine tooth, the last extraction of my foundation unit. And it was the most nerve wracking thing because the nurse had called in sick and it was my educational supervisor.

There was no sleep for that day. And talk about performance anxiety, it was just an upper canine, which you don’t think anything of now. But back at the time, all I remember was feeling really uncomfortable.

[Jaz]
I think having someone, I mean, they’re very brilliant learning experiences. When you have someone over the shoulder watching you and critiquing every little step you do, it is daunting, but it is, when I’ve ever had it, the most powerful learning experience you could have. So I mean, even with that upper canine, did you get any feedback? Did you get any observation? Or was it just all very boring and smooth in the end?

[Aidan]
No, it wasn’t boring and smooth in the end. I was really struggling to get this tooth out. And luckily, my educational supervisor really got on really well with her, couldn’t falter at all. Would never say anything in front of a patient at all, it was all afterwards. But I just really struggled.

It was quite warm and then there’s no palatal surface to grip onto. And I just remember thinking that, I’m not going to be able to do this. And it would get hot under the car and then managed to get out probably after about an hour or so.

[Jaz]
Wow.

[Aidan]
Yeah. pretty-

[Jaz]
By yourself or did you do ES after to jump in?

[Aidan]
Do you know what? I think it was by myself, but perhaps the point when I was just using WhatsApp just probably for about half an hour and the thing was, yeah, it was pretty, pretty stubborn. You know, it’s a single upper canine.

[Jaz]
They can be tough. I’ve been humbled by, yeah, there’s these patchy areas of ankylosis as Dr. Kwok explained to me when I was at Guy’s Hospital. When there’s little areas, the whole tooth isn’t, the whole root isn’t ankylosed, but there’s often these patchy areas of ankylosis and that can make your extraction very difficult. I’ve had a consultant at Guy’s, me, I was struggling with this canine, then the other SHO came, then the registrar came, then the consultant came and the end, he ended up having to remove this upper left canine, which is otherwise completely bog standard by drilling out the entire route. So my friend, we are not alone. I’m sure every dentist has a canine story.

[Aidan]
Yeah, definitely. Definitely. I think some of the buccal plate came up with it and that was that.

[Jaz]
And then that’s where it was enclosed.

[Aidan]
Yeah, yeah, yeah. And it was six months.

[Jaz]
What would you have done differently now? I know we’re jumping the gun a bit, but obviously we’ll, we’ll talk about how much you enjoy oral surgery now, but just think about the visualize that extraction, what would you have done differently now?

How would you approach it differently? Do you think it would have still taken an hour? What lessons could you pass on when it comes to an extraction that you’re struggling with?

[Aidan]
Would I have done anything different? I think I had the right approach. I just didn’t, at that time, probably have the muscle memory to know how much force you can apply.

And also as well, it’s getting that forcep down into the sulcus as much as you can, rather than sort of putting it supragingival, which ends up just, because of the levers on it, you just end up not putting as much force down the roof as you could do it, but you just moved up a millimetre or two millimetres up the roof. And so I don’t know if I changed anything.

[Jaz]
Something that I’ve always reflected on, I just want to reshare because this is a few oral surgery tips that we’ve shared on the podcast before, but just now on this topic, it’s always good to give the dentist quick wins while they’re on their commute. One thing I learned, like this is like a third degree thing, so someone taught someone who taught someone taught me kind of thing, right? So we don’t know who the original source is, but the six second rule, have you heard of this?

[Aidan]
What’s this? No, I’ve not heard of this.

[Jaz]
It could be any number of seconds, but when it was passed to me, it could have been Chinese whispers. It was six seconds. So basically, if you’re using a luxator, right, and it’s been six seconds, and nothing is really happening, change tactics, switch to something else, or get the forceps out, or change to a different instrument.

So, I mean, it doesn’t have to be six seconds. It’s not like the five second rule, with the food and stuff. It’s not that rigid, but it’s a mindset that, you know what, there’s only a certain time. If you’re not getting success, you need to now, I don’t know, put a purchase hole inside the tooth and use a different instrument or consider raising a flap or whatever it could be so that you’re not using the same tactic, insanity is the same thing over and over again, expecting a different result applied to oral surgery is that if you’re not getting a different result and it’s been a little bit of time, then maybe it’s worthwhile changing.

The other thing which I do with tricky teeth now, which I didn’t know about some years ago is imagine that canine, it probably didn’t have this, but imagine that canine did have a lateral incisor in front and a premolar behind just to chop the contacts off, right? Just drill, drill away the contacts to allow your Luxator to get better access. It is another consideration. Is that a trick that you use as well?

[Aidan]
No, it’s interesting you say that going back to the six second rule. I’ve never heard it said by that before, but that’s totally true because I know probably within the first three or four wiggles of a Luxator. What my plan is for it, and I’ve never put it like that before, but I was trying to describe it to my colleague the other day.

It’s either you’re going to get sort of a left and right movement, or an up and down movement, and if you get an up and down movement, yeah, kid, you’re in luck. If you get a left and right movement, then you know you’re going to have to change it slightly. So yeah, that’s really nice, nice to hear a to put like that.

But, yeah, contact point, really useful for orthodontic extractions, if you feel like a really tricky orthodontic extraction, because sometimes you get that five that’s politely placed. And you don’t really want to take it too far palatally. You can just chop off the contact point. You can take it a bit more buccal. When it would be pushing against the 6 and 8 and and 6 and 4, for example.

[Jaz]
And even just the forceps, I know you shouldn’t be rotating these teeth, but that little bit of a PDL trauma you can give, it just allows it to move without bumping into the adjacent teeth. And it gets rid of that resistance, which is pretty good.

But anyway, I just wanted an opportunity to bring in any sort of a pearl I could while we have you on the topic of oral surgery. But you were saying how we’re just digressing, That canine, you remember that, that the last thing you did before COVID happened. So then what happened over COVID?

[Aidan]
Just, it was all eCPD. We had, I had about a month or two months on reception where they got well and truly fed up on me. Cause I was not, I’m just not built for that sort of work. I’m very good at focusing on one thing. Do you get me to multitask? I’m absolutely used to sat in, my girlfriend will tell you that.

She’s sort of talking to you while you’re doing something, it doesn’t happen, yeah. But it did about six months, online. They were quite good, they had lectures all the time. So you never, just sat there, nothing for a day. And then it got to the point when I was applying for jobs. It was sort of the August mark, isn’t it?

Because your foundation year finished in September. So you left maybe a month or a month and a half before. And number one, it was really challenging to find anybody to take on a job because I felt like people were not sure what was happening with furlough, especially for people that are self-employed.

And I think you had to be working for a year, self-employed, but initially I don’t get to change, but initially I had to be working for a year, self-employed to get any of the benefits from that. I luckily, I applied for DCT anyway. I had absolutely no intention of doing that. I hated oral surgery. It was the one thing that made me hot under the collar.

I loved restorative university and yeah, applied for DCT. Back in, I think it was January or February that it cut off, so always keep your options open with that. You’ve got nothing to lose by applying for it. And then, luckily, I got Ipswich, which is where I grew up.

[Jaz]
And this is like a Maxfax, yeah?

[Aidan]
Yeah, Maxfax. I’d actually been treated by the consultant when I didn’t know. And, yeah, so I knew it quite well. It’s quite a small hospital.

[Jaz]
Let’s look at the motivations. Do you think your motivation was because you wanted to keep your options open for specialist training, or do you want it to actually, you’re generally interested in maxillofacial surgery or just surgery in general to upskill?

Or was it the fear of going into GDP land? I mean, that’s a common one. And I don’t want people to be afraid to admit that, for sure. That was a huge, that was a part of me. I actually wanted to be a restorative consultant at one stage. I knew I had to do the DCT, DCT2 that kind of stuff. But I had so many colleagues who like, as long as I’m in the hospital system, I don’t have to face the real world.

Do you think there was an element of that? Because obviously your story is like six months clinical, that’s it. You’ve had this pandemic, you’re feeling like you’re not very experienced. You’re feeling like you’re not very good. What’s that playing on your mind?

[Aidan]
I think not so much fear of going into practice. I think there’s probably a fear of all surgery that definitely contributed to that. I was really comfortable, even coming out of university, I was really comfortable with fixed restorative, especially. I had quite a lot of, well, yeah, the joke, I had quite a lot of crown preps on phantom heads. I think I’d done something bonkers, like two or three hundred crown preps at university on phantom heads.

And so I was really confident with that, but yeah, I completely helpless at oral surgery, just way too nervous. And I definitely applied for the MaxFax cause I wasn’t really interested in it, wasn’t really interested restorative or, I mean, restorative, not a DCT1 position anyway, I don’t think it’s a pretty much MaxFax cause the majority of it.

And so I definitely applied for that to try and be more comfortable with oral surgery. I think it was chance that I was pushed into it as well by COVID actually is the best thing I ever did, to be honest.

[Jaz]
Yeah, you hear though that Aiden because some people say that, Oh, I was just a pen pusher or I was assisting the whole time. I didn’t actually get to do anything. And that’s the nature of the beast. If you’re in a teaching hostel versus a district, you’re going to have a different experience. If you have a really open minded and really conscientious supervisor, even at DCT level, you can have a great experience versus someone who just sees you as a tool. Do you think your experience was because you were in the right place at the right time?

[Aidan]
Definitely, definitely. And going back last piece of advice I’d give actually is, and I didn’t know this, I chose it because of the Ipswich, but now I’ve realized the most important thing is the sort of hospital you’re in, because you have people in these big trauma centers, they shadow the most amazing stuff.

If you’re wanting to go to Maxfax, so if you know, that’s what you want to do. Then you’re going to see some amazing things and that experience will come later. But if you’re not sure like I was I wasn’t really interested in doing mantra particularly. What I really want to do is oral surgery or what I really want to be good at was all the surgery. Then I think going into a small hospital that doesn’t deal with the really complex cases and doesn’t have as many training positions. Then actually there’s no competition or a little competition for cases. So the middle grades are quite happy to say, you know what you take a pole arm, I’ll assist because for them, it’s an easy day.

[Jaz]
What was the coolest thing you got to do? I mean, this could be the number of extractions, or this could be a particular type that really gave you the confidence, or you managed to get rid of your fear. Any defining moments in that one year post that you had that, that really lifted you?

[Aidan]
Definitely my first wisdom tooth extraction for a proper surgical distal angular aid. And I came out and I thought, you know what? I can actually do that. And I took it both of them out. I would never have thought, after sort of going, well even going into that position, I would never have thought that I’d be able to do something like that and feel comfortable doing it as well.

And obviously a lot of that learning is coming.

[Jaz]
I had the same experience, Aidan, in Singapore when I was practicing there. And I’ve talked about this on a podcast before. When you were in Singapore, it is actually important for you to be able to remove wisdom teeth if you want to have a good salary, basically.

So in terms of income, you’re massively disadvantaged if you don’t do a wisdom tooth surgery. So I was like, okay, I’m the main breadwinner here. I need to learn how to do wisdom teeth kind of thing. And I was okay with extractions, but I was really keen to learn about wisdom teeth. And when I started to do them, and now I’ve got like a, my portfolio has got all these like OPG x rays of, or wisdom teeth that I’m proud of that I managed to take out.

So it’s a great feeling when you do your first few, it’s an amazing feeling. And then everyone has its own challenge. And when you start showing your colleagues who want to stay far away from wisdom teeth, you feel like, wow, you know what, this is a pretty cool thing to do.

[Aidan]
Yeah. Yeah. And to be able to be comfortable doing it, well and comfortable. And when you see it in the diary, you’re not nervous yet. You’re kind of excited to get stuck in really, and that was something I never thought I’d experience with oral surgery.

[Jaz]
An oral surgeon consultant once told me the following, actually, and what I’ll ask you about any plans you have to specialize in that kind of stuff later. But this specialist said to my colleague, Clifton, shout out to Clifton, who’s listening right now. Clifton was considering going down the oral surgery path, and this consultant at Sheffield, he was totally telling Clifton, don’t do it. He was like, look, when you first become a neurosurgeon, it’s cool.

You start doing these wisdom teeth and different angulations. And then he was trying to say that eventually it loses magic and you lose your, your, your mojo for it. And there’s only so much you can do. And really maxillofacial surgery is what you should be aiming for. Cause the sky’s the limit. And that’s what we were trying to say to him.

Now, obviously that was just his perspective as a restorative dentist who doesn’t do implants. I’m still learning. I’m still having fun every day. I don’t think that you need to keep doing every single thing and going to the next level. Always. You could, there’s a beauty in enjoying a skill that you’ve worked hard to attain.

Do you find that now it’s been some years and you’re doing wisdom teeth. Do you think you’ve lost that magic a bit? Are you now? Cause that look, you even mentioned you’re doing a master’s implant. So maybe you’ll look, you’re always chasing that next high when it comes to learning.

[Aidan]
Possibly. Yeah. Possibly. It was definitely a  little bit of that. I think what I love about the extractions is that you can book 45 minutes. For everyone, you know, you 45 minutes, if it’s an easy case, you can, 10 minutes and you’ve got 20 minutes to relax and enjoy the day, and if you, if it’s a difficult case 45 minutes, the next one might not.

So I think it allows you to have a more relaxed life, which then allows you to spend more time doing other things like planning other cases, for example, during the day, which you could be doing in that 20 minutes or so. So it’s definitely a means to an end for me. I wouldn’t say oral surgery is the end goal, particularly.

I like the fact that I’m, I’m confident at it now. Minor oral surgery, in a sense, sorry, I’m not an oral surgeon. But yeah, I like the fact that you’re confident with taking out teeth. But I do think, yeah, chase, definitely chase the neck, I think, implants next. Would you want to specialize in oral surgery?

I did want to specialize in the oral surgery originally. And then it got to the choice of doing DCT2. And I was like, Oh, I’m not 100 percent sure because I think the speciality training positions are very, very competitive. And what I didn’t want to do is go through all of that, then get rejected for a speciality position and then be back where I am now, but in two years time.

I wasn’t particularly bothered by hospital work. And I think if you’re wanting to do hospital work, then for sure it’s for you. But if you’re wanting to work in practice and you’re wanting to do minor oral surgery, you don’t have to be an oral surgeon for that. You don’t have to go through the special arts training for that.You can do that with BDS. BDS.

[Jaz]
Let’s talk about how you actually got here to have that confidence. Was it just the Ipswich post or what happened afterwards to lead you to where you are now in the kind of environment you’re in?

[Aidan]
So after the Ipswich post, I was quite confident doing oral surgery. I knew that was what I wanted to do. I wanted to fill most of my posts with that because I’m not very good multitasker, so I’m not very good when I’ve got back to back checkups, and there’s loads of things to think about. That’s not really what I’m very good at. When I’ve got an hour of a full mouth clearance, I can just focus on that.

That’s what I really enjoy doing. And so what I managed to get into a practice, which is actually quite heavily NHS As a very, in terms of NHS private split. It is geared towards NHS. The beauty of that is that it used to be a foundation training practice and a lot of the dentists have no interest in oral surgery.

They’d rather be turning to the line, they’d rather be doing restorative stuff. And so you get a lot of referrals from that sort of place. It doesn’t necessarily have to be the most high end, bougie private practice that you’re at. Sometimes, a mixed practice is actually a really good place to be, because you get a lot of people who are able to, who may be on the NHS waiting list for a reason to contractually, but actually if you’re there privately, as a provider privately, they can, if they want to, they can come in earlier and get it done at that practice. So you do get a lot of referrals from someone like that, but you might not necessarily have a pretty private practice.

[Jaz]
And that’s what you end up going for, you end up going for a position whereby you limited, you kind of limited yourself to, you weren’t doing check ups, you were limited to oral surgery.

[Aidan]
No, I do. I do general dentistry. I do general dentistry. Initially, I do four days. So initially I’ve not done an audit on it, but initially it was probably about half of my time doing extractions, half of my time doing general dentistry.

[Jaz]
That’s still amazing.

[Aidan]
Yeah, really good fun. Yeah, it might be sort of a day and a half. I’m not really done the math on it. But there’s a lot of it is oral surgery and it’s really important I keep, I try and keep some space open in the book so I can all that’s not always possible. So you get those emergency extraction appointments, which are really useful for patients to have in the book available for them.

And also, because I’d done six months of foundation dentistry, and then I’d done just pretty much oral surgery for a year with some minor sort of maxfax stuff like mandibles and stuff. I was then at the opposite problem where I was confident with the oral surgery, but I wasn’t confident, wasn’t too confident with the general dentistry.

And luckily, there’s a job at a practice where one of my friends actually from foundation year had worked as a foundation dentist and they didn’t take on any more foundation dentists. So the practice principal was just looking for a general dentist to come in and take over the book for the foundation dentist.

And I knew that was the right position for me because she was a trainer. She has that experience of working with people who are not that experienced. She’s a fantastic mentor. You can approach it with any case issues, always got time to discuss it with you. And I think that’s really important.

And that’s not something I particularly designed, but it works out really well. It’s something I definitely value now. And I’d say to somebody who’s looking for a job, to go into a practice where you’ve got somebody you’re used to teaching, who’s happy to help. And is really enthusiastic about dentistry as well.

[Jaz]
Makes a huge difference. The you, the mentor that you develop in the practice makes a huge difference. And also some dentists, young dentists, they fall into this trap where they go to work for this place ’cause there’s a big shot name on the door.

[Aidan]
Yeah.

[Jaz]
 That big shot name isn’t there when you are there. In fact, they’re away three to four days a week. They’re only there one two days a week. And actually they’re super busy that you don’t get that supervision or that time. And so just because you see the name in stars and lights doesn’t mean that they’re going to be there to mentor you.

[Aidan]
Yeah, for sure. And at that stage as well, when you’re just finished your foundation training, the mentor you need are not necessarily people that can do all of the complex implant all on four cases. It would be the mentor’s need is somebody that can tell you how to do a composite well, which is a whole different ballgame anyway.

[Jaz]
Or how to handle the disgruntled patient because they’ve been there before, or a patient who’s asking for a refund of their lower complete denture, and how do you handle that delicate scenario, or you have your first OAC, all these things.

[Aidan]
Yeah, there’s so much learning to do before you get to that stage where you need, where you know, you’re looking at the big shot names, as you call it, isn’t that?

[Jaz]
Are you working with this individual now, who’s in that same practice?

[Aidan]
So she’s the owner of the practice. She owns two practices. I work at both. I do predominantly half. I do one day at one, which is a predominantly private practice, to be honest. And then I do two, three days of the other one.

[Jaz]
Okay, so it’s a nice mix. So, as a percentage now, now that you’ve been a few years into it, how much of your day to day work is oral surgery? Exodontia?

[Aidan]
Probably, it’s difficult to say, I’d say probably one to two days a week. I haven’t got defined clinics. So it’s difficult to say because they’re sort of squeezing them on checkups.

[Jaz]
It’s a mishmash, whatever comes through. Yeah.

[Aidan]
Yeah. And that’s something I’ll work on as well. I mean, obviously different times of year, Christmas time, you’re going to get more extractions than sort of January for every time. It’s sort of more general dentistry and NHS checkups, that sort of thing.

Having to find clinics I need to work on because it made such a big difference. If you’re doing a lot of exodontics you can have all your stuff set up. And your poor nose isn’t running around trying to disinfect everything. Yeah, definitely more efficient. Yeah.

[Jaz]
And also it’s like compartmentalized. Yeah.

[Aidan]
Yeah. Yeah. And if you’re trying to learn as well, sometimes it’s good to have that back to back cases because you get you the swing of things. Whereas if you’ve got one in the diary, you’ve got that wisdom tooth, you’re a little bit nervous of, you put plenty of time for, you put yourself an hour and 15 minutes, an hour and a half for it.

Because you know, you want to make sure that you’re relaxed. You can’t, then you’re just thinking back to that all day. So sometimes it’s better to have back to back clinics, and then you would, by the time it gets to that difficult case, then you’re in the swing of things, you know?

[Jaz]
Yeah. It’s nice to be in the zone. I’m just going to just pick up on a few reflections. You’re the first guest on Protrusive to use the word bougie, so well done. That’s great. And I admire the fact that Aidan, you made a really, clever you, you said something really clever and I want to just highlight it to everyone. It shows a high level of emotional intelligence to me to be able to look at yourself and be so self aware that you realize that actually I’m not great at this.

And what you said is that, and it’s the second time you said it actually in this episode where whereby you mentioned about the whole multitasking thing. And when you are having today and you’re planning like eight different things, which is what we do as GDPs, right? GDP is the toughest job ever. Like, we’re planning all this, we’re looking at the periodontium, we’re looking at the tooth relatability index, we’re looking at radiographs, we’re looking at patient management. We’re looking at the vertical dimension, all that kind of stuff.

And you realize actually, maybe that’s not the, what you want to pour most of your energy into and you decided that, okay, I do have this passion for exodontia where you can focus into it, niche into it. And I think you grasp that.

And really you made your own fate and you made your own destiny by doing that. So what I would want for any young dentist listening here, or even if you’re an established dentist and you’re not in a good place at the moment, and you feel like you need to niche, then what are the lessons that we can pass to those listening right now to help them find their niche or also just pursue their niche?

Maybe they already know that they want to do composite bonding all day long. Maybe they already know that they want to do dentures all day long and that’s their real thing and they’re not a specialist but they’d like to just niche into it and have a kind of arrangement that you’ve done, well done to you for achieving it so young as well. I think that’s amazing. Well done. But what advice do you think we can pass on to others who want to have a taste of what you have?

[Aidan]
I think, and this is going to sound counter intuitive, I’m not saying focus on one thing or focus on what you’re good at because I think you should If you’re bad at something, you should put a lot of energy into, into something you’re bad at.

But you don’t necessarily be, need to be amazing at everything. I think you need to have a good baseline of everything. And then if you find something that you particularly enjoy, then just put a lot of time into that. And don’t worry if it takes you an hour and a half, even if it’s like a canine tooth, if I put it in for an hour and a half, it doesn’t matter. What matters is the fact that you’ve booked out, and you’re taking on that challenge and I think trying to do it yourself rather than passing it on to somebody else to do. Yeah.

[Jaz]
Brilliant. I think that’s good. And making that allocated time. And I think a lot of colleagues, they are in a type of environment. It’s all about environment. You’re in an environment where you feel as though you’re constantly rushed and you’re not able to do the things the way that you want to do them. So you can’t even build your portfolio because you can’t, you’re embarrassed that you can’t, you don’t have time to rubberdam on, but you know that to the kind of level you want to do, you want to be able doing rubber dam, you’re creating your anatomy, but you can’t do it because you’re constantly rushing and running behind.

And so to know that, okay, you know what, this is going to be my fun case, my passion case of the week. Instead of booking the half an hour, which I usually book, I’m going to book an hour. And you know what? Me and my nurse, we’re going to have fun. We’re going to take photos and I’m going to learn something and I’m going to really deliver every bit of my soul into this restoration or into this crown or into this extraction, whatever it is.

And that can be the first step in trying to regain the passion or trying to generate new passions. And then if you do that more and more and become slick and you have that portfolio built up, then I think the top advice that I would probably give just from speaking to so many colleagues, just like you Aidan, is there’s usually a voice.

Holding you back. There’s usually a fear of letting go of the income that you have at the moment or the stability that you have at the moment and to really shake things up and say, you know what, I’m now going to go from four days to two days in this practice so that I can pursue a new opportunity in that’s pretty much set up for me to do the kind of dentistry I want to do. And that takes massive action. We talked about this on podcast before. It takes a lot of guts, but most people I speak to, they always say I have no regrets. I only wish I did it sooner.

[Aidan]
Yeah, definitely.

[Jaz]
Well, how do you think you’ve. found yourself here, four or five years out of dental school in this position. What qualities do you think you had that allowed you to fall into it? Do you think, how much of it was luck? How much of it was actually your determination and grit?

[Aidan]
That’s a difficult one without sounding, uh-

[Jaz]
Go for it. Don’t worry. That wasn’t the thing. We’re amongst friends here.

[Aidan]
Yeah. I mean, luck is a massive part of it. Having said that you need to put yourself in a position to be lucky. If you don’t apply to that DCT position because you want to do DCT or you don’t like oral surgery. And you can’t really get lucky when you found a position that just allows you to do extractions and you end up in the wrong hospital. Yeah, I think I have been very lucky, for sure. But I also think that I do try and put myself out there a lot.

[Jaz]
I think you make your own luck, Aidan. I’m waiting for you to say, you make your own luck, you know. The harder I work, the luckier I get. Have you heard that one?

[Aidan]
Yeah, the golfer said that, wasn’t it?

[Jaz]
That’s it. Exactly. People shouldn’t think that, oh, yeah, you got the absolute job and everything just fell into place. You still have to make decisions. You still have to take risks. You still have to have these experiences and reflect on them. So I think, credit to you, Aidan, for doing it that way. Any final remarks?

[Aidan]
No, you said about left [inaudble] to young dentists, and I was thinking about that. And number one, I’d say is loupes. And number two is I’d say sectioning. So I do everything under loupes now, even extractions, and I’ve got six point, I think it’s 6. 8 loupes or 4, so six times and it’s the refractive ones.

And I do every extraction under those now, but even that’s, to me, that’s not enough now. I was looking at the more, more zoomed in ones. And I think since using those, especially for oral surgery, you think, oh, maybe I don’t need loupes for oral surgery, or maybe I need the smaller versions. But no, I think the higher magnification you get even for that is important.

I think that I have far fewer, so I only got moved recently, actually. I was, I moved up 12 months ago. I was thinking, oh, do I go in for the light, the less zoomed in ones, the three times, or do I go for the magnified ones and that, glad I went in for the magnified ones because I think since using those, and-

[Jaz]
These are what you said, 5X, right? 5X?

[Aidan]
I think it’s 5. 7 on the lens. And since I’ve been using those, so many less patients coming back with post op pain because I’m no longer-

[Jaz]
Interesting.

[Aidan]
When I’m looking at where I’m placing the good luxator. Good luxator is king for me. When I’m looking at where I’m placing that luxator, how many times are you putting it in a socket? Because the nurse is a little bit too afraid to go right in there with the suction. To find that little tip of root and you’re putting that luxator in rather than creating space with the luxator You’re finding it. You can find it a lot easier.

[Jaz]
Yes.

[Aidan]
With loupes on. So I’m the creative and going to the I think it’s the eight times for all surgery.

[Jaz]
Aidan, I think you had a one more lesson about photographing.

[Aidan]
Yeah, if you try to get the one thing that’s helped me last year, I’ve been doing more implant extractions. So where you want to preserve as much bone as possible which obviously sectioning is so useful for and I did one I think I did two and they got six or four months later when the implant went in the implantologist turned around and said well, why did you do that?

Because I think they you know, it was a big infection as well. I’m not sure it was entirely my fault, but I think what I’ve started to do now, which is really helpful when you’re doing extractions because implants are becoming so popular. It’s really easy. If you’re not going to do a major socket preservation which you’ll think we eventually might have an involved in the future, but isn’t quite ready yet.

Always try and section it, or try and take a tooth out as atraumatically as possible, and take a photograph of the socket after you do it. And ideally what I want to see when I do an extraction, even for a molar tooth, is literally three perfect little round circles with the bone, with that sort of Mercedes Benz symbol on the bone and the gums around it looking really, really healthy. I mean, yeah, that’s definitely helped me get better.

[Jaz]
Almost, almost untouched gums, right?

[Aidan]
Literally. Yeah. Yeah. Almost as if like somebody’s just taking those three rigs and just pull them straight out without any trauma. And also irrigating as well. Because I think especially when you’re trying to get good extractions, you’re using like say, so you’re creating a lot of basically dead bone around that extraction site and that’s what’s going to bring a lot of patients back with post op pain.

Either they’re going to convey we’re getting white stuff coming to the socket. There’s a little bit of tooth left behind, which doesn’t look great. So always we use our eye washers. So a little canister is about this big and I just get an excavator and an eye wash after every, every extraction it’s been a little bit traumatic or if there’s a curb root and there’s a little bit of bone that could have broken off is I just irrigate the socket with a, with a saline solution.

[Jaz]
So this saline is like a eye wash saline. Yeah.

[Aidan]
Yeah. I’ll have to give you the exact link to it, Jaz. It’s the implantologist used it and I have, I saw it in the cupboards and I thought, well, that’s really useful. A lot of this.

[Jaz]
This is very, I mean, is it like, and you just squeeze like a little plastic device, you just squeeze into it, or how do you deliver the saline into the socket?

[Aidan]
So it used to be the saline from the packets, and I’d use a straight hand piece, and I’d just take the nozzle off, and I’d rub it, so the saline goes, washes everything out. But these saline solutions come in little plastic containers about this large. And they’ve got a dropper on the end. So, because they’re designed to squirt in your eye. So you don’t need to put them in any other instrument, syringe or anything. You just need to-

[Jaz]
So it’s like grab and go. You just grab the eyewash and you just squeeze it. And did you get enough flow into the socket?

[Aidan]
100%, yeah. So put it right in the socket. Get the nurse to take off the surgical suction, put on the normal suction, right next to the socket. And you just squeeze it in and just pulse it in the socket. And then you can also, if you want to do half and then debride it a bit with an excavator and then put the other half in. And you’d be surprised about the amount of just loose fragments that come to the surface.

[Jaz]
This is amazing. I love this. In the restorative circles, we use like glycerin or KY jellies, what people use. And then I found this Italian dentist, got me onto using ultrasound gel. And then I found this specific brand of ultrasound gel on Amazon, which I use called anagel, not anal gel. Anagel, right? And I squeeze it and it’s a lovely little delivery to squeeze it on the teeth, spread it round and cure your composite.

This is like, that level of tip right here. Yeah, I love this. I’m so glad we recorded this bit. So using, like, I can just imagine it now. You’re going to have to send me a link later so I can share it with everyone. But this, this eyewash to use as a grab and go, instantly usable, dispensable, sorry, saline irrigation for your sockets. This is amazing. Thank you so much.

[Aidan]
Yeah, no problem. And the only thing to be careful is that you have to make sure after you do it you get a good blood clot together. Because obviously you’ve washed out all that blood. So just make sure you get a good blood clot.

[Jaz]
So how do you do that? What does that look like? What’s the next step after you wash it out? How do you get a good blood clot?

[Aidan]
So usually you don’t need to do anything. Usually you just need to put a gauze in and it will bleed by itself. Because obviously you’ve excavated as well. You’ve sort of scraped away a lot of the loose stuff, but that process then actually start the bleeding again, just to look in the socket.

[Jaz]
Sometimes curating the internal wall of the bony wall that can induce the bleeding that you need if in doubt.

[Aidan]
Yeah, exactly. Exactly, and just making sure when you do that you don’t create more fragments. So just, just nice and gentle when you do that. Yeah.

[Jaz]
Right, I can’t wait to share this with everyone, we got a new Anagel level pro hack here of using the eyewash, I love it, thanks so much Aidan. Magnification is like a drug, when you get it, you want more and more and more, and it never stops. One of my principals, Hap, he showed me some videos of him doing extractions under a microscope. This is like a lower molar under a microscope.

[Aidan]
I’ve seen these American guys and they do extractions under rubber dam. These are split down.

[Jaz]
Yeah.

[Aidan]
It’s bonkers, bonkers.

[Jaz]
But I totally echo that I use for all my extractions. I use loupes. And I think the next tip you’re going to give us about sectioning and if you’re going to be sectioning then, it’s like we’re doing a crown prep in a way you want to be precise in a way and therefore loupes and a good light, great light source and magnification are essential.

And so I work with colleagues who are in oral surgery and they’re like, no, no, I don’t need loupes. I don’t need loupes because what we do is so macro. It’s not micro, but I’m totally in agreement with you, Aidan. I think it really enhances even for orthodontics, for those placing brackets, use loupes, it gives you more precision.

[Aidan]
So, so yeah. And sectioning teeth is a must at top. I’m more nervous about taking out a tooth that I have in section now than a tooth that I have, if I see a molar tooth it’s getting sections.

[Jaz]
As a percentage, standard upper molar, huge amalgam, root canal, fairly straight ish roots though, would you always try to give it a wiggle, give it a go first without sectioning, or are you just going in with the section?

[Aidan]
That’s a difficult question because it all depends on the roots. So sometimes you see the buccal, it means you’re wrapping just a buccal are fused. So in those cases, you can sometimes, if they’re very conical, then obviously sectioning is not going to work. So for molars that are able to be sectioned, so any molar now with a divergent buccal, root, or a separate buccal root should I say, I won’t try without it.

And to be honest, like, I generally just work around the margin with a luxator for maybe a second or two seconds. Let’s say, you know, straight away and then I’ll section it straight away. I just think it’s not worth it. I think patients enjoy it as well. Well, they don’t enjoy it, but they don’t not enjoy it.

I think it’s much more comfortable for them. It feels like a filling and then a bit of pressure. Whereas if you’ve got a difficult moment, you’re out of section, then you’re putting speed. The head’s wiggling about in the chair. It’s just not nice for a patient when you’ve got to get the nurse to hold Because they’re keeping still. So I think it’s much more comfortable for the patient.

[Jaz]
Gosh, yeah, that hasn’t happened in a long time. It’s been years since I’ve seen that. Because I’m doing so much sectioning. I’m totally in agreement with you, Aidan.

Interjection:
Hey guys, it’s Jaz. Just interjecting with this important message. If you are struggling with sectioning, like if you want to see some amazing 4K, high quality footage of me walking you through each and every facet of how to section a molar and how to become more confident and make your extractions more predictable.

Then you need Sectioning School. This is one of my masterclasses that’s included in the Ultimate Education Plan on Protrusive Guidance, which is our platform. You can even try this plan for a week to make sure you love it, and I’m sure you will. And of course, you’ve got the entire community of Protrusive Guidance, our tribe, the Protruserati, to bounce ideas off and to find a place in the home of the nicest and geekiest dentist in the world. Head over to protrusive. app and choose the Ultimate Education Plan to get instant access to Sectioning School. Let’s join this episode again.

[Jaz]
But people, Protruserati, you used to be saying about the power of sectioning, that’s amazing, Aidan I’m so glad, you said that you started this episode saying that, yeah, there’s imposter syndrome, and I get that, I get crippling imposter syndrome time and time again, but what you have to say is that you have a journey that I’m sure is going to inspire people to think differently, make a change, reconsider their options.

Maybe they’re disqualified and they’re thinking, Oh, you know what? This gives me something to think about when I’m at that crossroads, making a decision. And just because someone sucks at oral surgery and they’re afraid of it doesn’t mean that can’t flourish into a kind of career that you have now, which ironically niched into it and you enjoy it so much. And now you’re doing an implant masters soon. So more power to you, my friend.

[Aidan]
Thank you. That’s my own choice.

[Jaz]
But no, thank you so much. It’s always great to extract stories and there’s always so much in it. So you can never connect the dots looking forward, you can only connect the dots looking back, and the whole time that you had in the hospital with Ipswich, the mentor that you had in practice, the practice that you chose, even though it wasn’t the bougie, fancy clinic in a way, it still gave you the opportunities to do the kind of stuff. Which the other dentist didn’t want to do, which just fuels that passion of yours.

[Aidan]
Yeah, yeah, definitely.

[Jaz]
Amazing. Aidan, just before you go, you will have inspired a generation of young dentists who are thinking about their next steps, and sometimes it’s nice to have someone to reach out to. Even if someone wants to say, hey Aidan, thanks for taking the time to record that episode with Jaz, it really helped.

Or, Aidan, I’m stuck between, do you know anything about this hospital versus that hospital or any advice that they might want to seek from you? What’s the best way to seek out? I know you have an Instagram with photography, you’re an avid photographer, so tell us about how best to reach out with you.

[Aidan]
Yeah, so I don’t have a professional Instagram for my work, I have a personal Instagram that I use on public now, so I think Jaz he’s going to put a link to that. Sorry, Jaz.

[Jaz]
Yeah, but what’s, just to say I’ll put a link to it, but what’s your handle?

[Aidan]
Aidan full stop. yate. So a-I-D-A-N and then full stop. And then Y-A-T-E-S.

[Jaz]
Amazing. So if you want give some love to Aidan or pick his brain then, or just admire his photography, check out Aidan and Aidan. Please do if you can join Protrusive Guidance is free community access and people on there are always sharing tips and advice. And it’d be great to have you on there, especially as you start your master’s journey. then do consider joining that as well. Perfect. Did you look at that? Perfect. So, tell you what guys, Protruserati, go on, if you want to send a question to Aidan, DM him on Protrusive Guidance. Send him some love there. That’s a cool way to do it. Amazing. Thanks so much, mate. I’ll see you on Protrusive Guidance.

Well, there we have it, guys. Do you remember the very beginning of this episode, the beginning of the interview with Aidan? He felt like a massive imposter. And you know what? This, this affects us all. I get crippled by imposter syndrome. But you know who doesn’t get imposter syndrome? The true imposters.

So I think imposter syndrome is, is part of the journey. And I just wanted to reassure Aidan. Aidan, you did a fantastic job. I’m sure we agree. To share his journey, I think we gained a lot in terms of perspective. And of course, there are a few clinical gems thrown in as well. So Aidan, thanks so much for being vulnerable, sharing your story.

We absolutely loved it. This episode isn’t eligible for CPD, but we have hundreds of hours CPD on protrusive guidance and the best way to DM me, DM Aidan and liaise with all of us is on our little platform, head over to www. protrusive. app and join the community. If you have no budget and you want to join for free and learn from each other, then that’s totally cool.

And if ever in the future you want to get certificates, the CPD certificates for the episodes that we do, that’s the premium plan. And if you want to access all the master classes, that’s on the ultimate educational plan. But if you want to just catch the vibe of the Protruserati and gain a lot of value for free, then just join the community access plan.

I’ll see you on there. See you same time, same place next week. Bye for now.