Protrusive Dental Podcast

Teaser:
We recognize that training our general dental colleagues on endo is paramount because we don’t want the option of implant to come in place of saving the natural tooth simply because of fear or the fact that they just don’t feel well enough trained to do the endo. So I believe as a dental community, the more we feel comfortable and proficient in endo, the more teeth we save and the better our patients are.

Jaz’s Introduction:
Is sodium hypochlorite still the best thing in irrigation? If it is, what percentage should we be using? This one might actually surprise you. Is there ever a time when to use chlorhexidine. Whatever irrigant we’re using, how can we improve its effectiveness?

Hello, I’m Jaz Gulati and welcome to the part two with Dr. Brett Gilbert. How awesome was he? Please do check it out if you haven’t already. We talked about elective endodontics or preemptive endodontics. I love the clarity and the passion in which he speaks with. And he definitely continues it on into this episode. He’s so knowledgeable, he’s so passionate about endodontics in general, but especially the innovation in irrigation.

Because after all, endodontic success is all about killing those bugs. And Brett has so much experience in trying all the different things out there. And towards the second half of this episode, he really talks about what are the innovations. What’s around the corner? What’s the next best thing in irrigation?

But then I also squeeze out of him the all important real world question, which is no matter what clinic you are in the world, how can you improve your irrigation? So we also talk about GP pumping right towards the end. This episode is eligible for CPD or CE credits. This one’s 0. 5 CE credits under the topic of 070 endodontics as Protrusive Education is a PACE approved provider. Make sure you’ve got the Protrusive Guidance app, so you can just answer the questions after this episode.

Dental Pearl
Every PDP episode, I give you a Protrusive Dental Pearl, and can you believe we already have 291 episodes? That’s across all the group functions and the interference casts. And combining all the stuff we do in the podcast, we’re almost at 300. We’ve also reached a really cool feat recently, whereby we now we’re ranked in the top 1% of podcasts worldwide in any genre. So I really want to thank you, the listener, the watcher for supporting Team Protrusive. Your support, your subscriptions, your wonderful engagement has meant so much to us and allowed us to create this content and bring on guests just like Brett and all the 200 plus guests we’ve had on. I want to thank all the guests who come on the show as well.

But before we join the main interview, let me give you today’s Protrusive Dental Pearl. How can you improve your endodontic access? Well, let me tell you the secret of improving anything in your dentistry. Any technique you want to improve in dentistry, you just have to do more of it. Now, what I don’t mean is every patient start accessing their first molar, trying to find MB2 just for the fun of it. That would be wrong, but here’s a really cool idea. As you know, every time I extract a molar, 95% of the time I will be sectioning that molar.

So for a lower molar, section around the middle to separate it into its mesial and distal root, and for an upper molar, more often than not, it’s separating it into its three roots. So I’m very pro sectioning, it’s kind to the bone, it makes your extractions easier. Makes extractions more predictable. I already have podcast episodes on this, and I also have sectioning school, my mini masterclass on Protrusive Guidance, if you want to learn more about sectioning.

But here’s how we can kill two birds with one stone. How can you improve your sectioning? Because when you start sectioning, the most difficult thing is getting that angulation of the bur correct, so that you cleanly cut through the fication or the root exactly where you want it. So how about this? The next time you’re going to do a molar extraction, How about you challenge yourself to first do an endodontic access?

The tooth’s coming out anyway, right? So how about with your bur, you go in for the kill. You get to the canals. What this will do is teach you about endodontic anatomy. It’ll teach you about where the canals live. And the more you do this, the more you’ll end up improving when you actually have to do a real access.

It’ll actually make you quicker as well. Because you have nothing to lose in that scenario because the tooth’s coming out anyway, you’re not going to be afraid to perforate. Because the point is, for sectioning, once you can see the canals, you know exactly where to section. When you see the pulpal floor, it makes the angulation of your section so much better.

So, now with the sectioning, you’ve improved your extractions, and now by the fact that you accessed it first, you’ve improved your sectioning, but you’ve also gained more experience in doing an endodontic access. So I hope you enjoy that pearl. Hopefully it’s applicable to you. Any limiting beliefs you have, oh I can’t do this in my clinic for x, y, and z, just do it.

Even if it just means you book an extra five minutes and that five minutes is what you spend on the access. Oh, and please use some good burs. It makes a huge difference to being efficient. Anyway, let’s join Dr. Brett Gilbert on how we can improve our endodontic irrigation.

Main Episode:
Irrigation! Okay, so I know you’re really hot on this. So the proper disinfecting protocols, let’s talk about where we are in 2024. Cause I was taught that sodium hypochlorite is the gold standard. So the first question is, is there anything better yet? Are we still relying on 3%, 5.25% wherever it is sodium hypochlorite?

[Brett]
We are, but what we’ve learned is a few things that are important to know, which is that the commercial store bought household bleach is not the way to go. And the reason is, is that what we’re dependent on for the antimicrobial bacteriology is to actually have free chlorine ion and the amount of free chlorine ion in bleach, it’s very unstable. It’s very fragile. We think of bleach as this noxious, hardcore substance, but it’s actually very fragile. It’s sensitive to air to light.

It can become contaminated. And even though it’s still, unfortunately, we’ll put a bleach stain on our beautiful new fig scrubs like you’re wearing there Jaz. It doesn’t mean that the free chlorine ion concentration is high. So we want you to be using a proprietary blend sold by a dental company where there are controls, there’s an expiration date.

And most importantly, what we found through our studies is that adding a surfactant to sodium hypochlorite really changes its effectiveness because surfactant lowers the surface tension of the solution, allowing it to flow into these crevices. We have to think, we think of the root canal as a vertical line, but it’s so much more.

And so we want to get penetration as much as possible. So for really not much more of an investment, we’d like to see you using some type of branded proprietary solution. And many, many dental companies sell these. So that would be the biggest change. Yes, sodium hypochlorite, but in the form where we can really control more of understanding that when we put it in the tooth, which is the most important part of the procedure, the chemical disinfection is the most important part.

And you would hate to be trying to do that with the solution that actually wasn’t very strong or active, even though you in your perceptible senses would have no way of knowing. So that would be the biggest thing is proprietary with surfactant.

[Jaz]
I was always taught with using these grocery store bleaches, which they used to back in the day. I mean, people still probably do now, but that was very popular back then. I know there’s a grocery chain here called Sainsbury’s, and apparently their bleach was what the endodontists used to go for, get a trolley full of 30 of them and go out. But one of my endodontist mentors taught me that, yes, apparently there’s lots of crystals and lots of other nasties in there that you don’t really need for your root canal. The whole thing about surfactants, is that already in the bottle or is this something that additionally you add.

[Brett]
Yeah, no, it’s part of it. It’s already pre mixed. And in fact, there’s even a solution from a company called Brass or that’s a one stop shop. So, you’re looking at organic debris removal and inorganic debris removal.

So you might be chloride is organic, right? It’s tissue. It’s bacteria. It’s biofilm. Then you need like an EDTA type material, which is going to be the inorganic, the dentine proteins, any harder substances that are removed from the walls. And so it’s always been this funny mix of the two. And now there’s actually a solution that’s all in one.

And so it’s becoming easier to be able to do this. I would say that one of the most important, there’s a ton of devices. I’d love to discuss if we’re going to get into it today, there’s been incredible explosion of technology in endodontic irrigation, but I think this is the most basic investment that each dentist needs to make is finding the right sort of proprietary stabilized solution that you can trust when you put it into the tooth.

[Jaz]
When I was a dental student, we used to use something like, 0.5% or 1% because that was like a safer amount as a dental student when you were learning. And then I learned that, okay, use something like 3% or 5%. And then if you use it heated, it actually makes it more effective and that kind of stuff.

What advice are you giving to general dentists out there? What percentage should they, now they’re, they’re converted. They’re like, oh yeah, Brett said you have to use a propriety, put down that Sainsbury’s bottle, go on the website or to an official endo supplier, buy the propriety stuff. But what percentage should they be putting in their basket?

[Brett]
Well, I know it’s going to be upsetting for, cause I know in Europe it’s taught differently, it’s very low percentages, but the way that I look at it personally is when you use a lower percentage, you really aren’t reducing or eliminating the risk of sodium hypochlorite accident.

If you get 3% sodium hypochlorite out the end of the route, it’s going to cause a sodium hypochlorite accident as will 6%. And so what you do though, because we know that, again, as I mentioned, sodium hypochlorite is very unstable and it’s deactivated very, very quickly. So the higher concentration actually isn’t going to be that for very long.

So we recommend in my school of thought and where I learned and I think pretty much across the U. S. that the full strength is the best bet. And so most of these you’ll be able to find will be more of a 6% solution with surfactant. The material I mentioned, Triton, which is the all in one is actually two canisters within the same bottle.

And it’s actually 8% on one side. But once mixed, it’s actually 4% when it goes into the tooth. So there’s a lot to it, but my advice is, is if you’re trying to eliminate risk using a lower concentration, I don’t think it’s as effective as you think, but you are taking away some of the strength that you’re looking for to kill the bacteria and dissolve the tissue. So, my advice would be go full.

[Jaz]
Go hard or go home. But what about the use of chlorhexidine 2%? Like I’ve been in clinics before in the way in the past where they weren’t that well run. And then you look at the nurse and say, can I get some irrigation please? And then they give you Corsodyl 0.2%. And I’m thinking this is doing nothing. There’s no dissolving of the organic matter, et cetera. So where are we at now in terms of chlorhexidine? Is it something that we just need to just bin or is there still a place?

[Brett]
Well, it has a place as an additive. So for instance, if you’ve heard of Q mix or there’s a number of different product called smear off, it’s sort of the EDTA solutions for the inorganic debris removal. You’ll often see chlorhexidine included in there as an additive. There was a time in my early days where 2% chlorhexidine was in vogue in retreatment. But ultimately the research never really stood behind it as much as we thought, and so I don’t really ever use it anymore. And to your point, it would be ideal as an endodontic irrigant if it dissolved tissue, which it doesn’t.

And that’s why sodium hypochlorite remains the king because ultimately there’s nothing else that will dissolve tissue. And that is the most critical part of using endodontic irrigation. We have to get those bits and pieces out of there and you can’t just deliver it all out in mass. We really need the dissolution of it through solution.

[Jaz]
And when chlorhexidine is mixed with hypochlorite, is it true it makes a carcinogenic product that you should totally avoid that kind of stuff, right?

[Brett]
It does if you’re using just essentially the store bought bleach and just a regular chlorhexidine. If you’re using these proprietary blends, you can actually interact them without reaction. So that’s another advantage.

[Jaz]
I did not know that. Okay, fine. That’s very interesting. I definitely didn’t know that. Not that we’re recommending using CHX anyway, unless it’s an additive, as Brett said, but good to know. So now tell us about these new technologies. What is Dr. Brett Gilbert using in his clinic to maximize that disinfection and tell us about the evidence base. Is it established yet? Or is it up and coming? I would love to know what’s new and great in the world of disinfection.

[Brett]
Yes, let’s start on the most basic level, which is that at this point, probably the gold standard in terms of evidence is passive ultrasonic irrigation. So you put the irrigation solution in the tooth and you use some type of ultrasonic tip to activate it.

And by doing so, you’re hoping that you’re producing some cavitation. Cavitation is the implosion of a liquid molecule, and once it implodes, it has sort of this bombardment force against the wall. So you’re basically able to essentially hit the walls of the canal with the solution to get better penetration.

So you would use that in an in and out motion. Now, ultrasonic and sonic are different. Now, sonic activation is very common. The endo activator, my good friend, Cliff Ruddle developed this. It’s been an incredible seller and to your eyeball, you see it swirling and moving. And that is good. It’s better than nothing, but the studies would show ultrasonic activation to be better penetrating into lateral canals, apical anatomy.

So that’s sort of our basis point. If you can at least do ultrasonic activation with these proprietary solutions that I’m mentioning, you’re basically at the gold standard, but there’s been so much development in terms of the use of laser assisted endodontic irrigation.

Multisonic irrigation. So I’ve been very lucky in my career to have been able to test pretty much everything, you know? So if you look at what’s really kind of changed the paradigm of irrigation, it kind of created a new category. Very disruptively was the gentle wave, which many of you may have heard of.

This is from a company called Sonendo out of California. This is a closed system. So basically you build a little platform and then the handpiece fits right into that standard platform. And then basically you hit the gas and it’s an eight minute cycle. It’s cycle sodium hypochlorite, it cycles distilled water.

And by closing the system, it creates a situation where you’re able to essentially de-gas the solution. So if you think about if you had a glass of water and you wanted to propagate energy through it, any little bubble in the water, we know this from physics would dissipate some of that energy. And so what this console does is it actually pulls all the gas out.

So if you can imagine the inside of the tooth being filled with solution. But no bubbles at all. And now it has this energy, this broadband multisonic energy. And so it’s very disruptive to the walls. It creates a negative pressure so that it allows you to really get the solution down to the end of the route. And so it’s an eight minute cycle and there’s been some tremendous visual effects of that. Now, from a research standpoint-

[Jaz]
I mean, while are you talking, cause I’ve never heard this before. I’m Google imaging this. I’m looking at it. It’s looking like a big bulky machine, right?

[Brett]
Oh, it is. Yeah.

[Jaz]
It’s pretty sizable.

[Brett]
Yeah. It’s significantly. And it’s a costly machine. I mean, it’s getting towards six figures and even per procedure, they call it the procedure instruments are one use and they’re expensive. And so this did really change the game, but there are limitations to where it can be used.

If there’s any communication to the sinus, you have to be very careful. If there’s any type of decay or leakage under a margin. This will tear right through it. You really have to be very specific about where it’s used. But ultimately, as I mentioned, visually, you see some incredible cases with just sealer, just through three canals at the apical end and out lateral puffs, et cetera.

And a much of the research it’s out there is favorable, but we do have some question marks about the unbiasedness of it. Just being totally honest. I have some of my best friends who swear by it, who teach it and they get great results. And so that’s one option that really started this new game, but then lasers have sort of come into play.

And so laser activated irrigation. And by this, we mean that the laser energy is both able to sort of activate and stir up the solution, but also the laser energy can be absorbed by the water and dentine, creating an opportunity to really effectively debride and disinfect the dentine. And so, I’ve been lucky.

I’ve used the gentle wave. In my practice, I’ve had two different stints with it. I don’t have it right now. I have three different lasers in my practice right now. One which is Erbium YSGG. And with this Jaz, you actually have the solution in the tooth and it’s like a little fiber tip, maybe about a 21 at the tip, right?

Think of like a small hand file. And you take it down halfway. And as you activate, you bring the tip out at two millimeters per second. So basically it’s a eight second cycle. And then I go into the next canal and the next canal, refresh my solution, do it again. I can also use this with water.

So then I can take the tip closer to working length, again, withdraw, and it has what’s called a radial firing tip. So if you imagine like a cone coming out, almost like an inverted cone bur right? So as you’re in the canal, this radial cone is able to basically paint the walls with the laser energy.

So that’s one option. The next option is Erbium YAG. Now, what’s different about this one is again, solution goes into the tooth, but now the tip simply goes into the chamber. It’s about three to four millimeters off the floor, hit the gas, and there’s a tremendous impact that you can see through the microscope.

You can see a lot of this on my Instagram channel If anyone’s interested, I have a lot of videos related to this. So those are the two primary lasers that are available right now. We’re seeing really nice results the advantage. There really aren’t limitations to its use. Whether you have a sinus perforation, anything like that, we also find that we are having tremendous success doing endodontic surgery, as well as resorption repair with the lasers.

And these are technologies that are very versatile in the office. And so we’re very excited about that. Very recently, I’ve just test drove and actually it’s my last post right now. Another company came up with basically a little tip that goes down into the canal. It’s a 19 at the tip. Okay. And it actually drives saline.

So by driving it out at a certain speed out of the 19 tip, it creates a cavitation flow. And so now you have an opportunity to basically power wash inside the root canal. And the reason that this is unique is we’ve never been able to do this before because sodium hypochlorite is too risky. Even EDTA, we don’t want to drive that out of the end of the route, but by utilizing saline, we have an opportunity to have more velocity and more cavitation to sort of essentially power wash inside and I’m really impressed with the potential of it.

Again, if you look at the general dentist doing endo and you look at what your heart rate does, right? You look at the stress that comes because of the risks. And so if we did have a day and age where we could irrigate very passively with the sodium hypochlorite, not trying to drive it down.

So eliminating the potential accident, be able to finish the job with saline in a powerful force, and then ultimately obituary with a material that would not ever have to be worried about extrusion. Now, I believe we open up endodontics to general dentist in a greater way where there’s not so much worry and risk.

And so there’s a lot of exciting things happening. I think as an endodontist, we recognize that, training our general dental colleagues on endo is paramount because we don’t want the option of implant to come in place of saving the natural tooth simply because of fear or the fact that they just don’t feel well enough trained to do the endo.

So I believe as a dental community, the more we feel comfortable and proficient in endo, the more teeth we save and the better our patients are. And there’s no question there are not enough endodontists in this world to even come close to eating the whole pie of endo. So it’s critical that we educate.

And that’s why I appreciate you having me on because I think your community obviously, or they’re advanced learners are looking to get better. And so exposing them to every discipline, especially the ones that most people would like to just punt, just, I don’t want to deal with this. I had a bad experience.

I had fear. So I have an online program called access endo. It’s a community I formed in 2019 where I really mentor dentists in endo. So that includes curriculum, but it also includes live coaching. And the best is like dentists send me their cases and I actually guide them through their cases.

And with the electronic medium online, I can actually be like you’re supervising, attending in your clinic. So I’m really putting myself out there to help dentists because I believe there’s a tremendous payoff for the dentist, for the patient and for all of us to see a more proficient level of endo across the board.

[Jaz]
That level of mentorship you described, it really is the pinnacle. Something that we’re setting up is called a Intaglio, Intaglio dental, whereby we’re going to make mentorship much easier because it’s difficult to find the right mentors. And I think it’s great. You’ve identified yourself as if anyone needs an endodontic mentorship, definitely check out Brett.

I’ll put all his links there. That sounds amazing. But one thing that we’re trialing basically is just like you said, having the system whereby they have a loop mounted camera or the scope camera is being fed into zoom and then you’re in their ear saying okay, yeah, that’s good, that’s good, okay, do this, try this now, and I know they use it in medicine, doing crazy surgeries from halfway across the world to get the best brains on board, and I think totally it needs to be tapped into in dentistry and sound. It’s amazing to hear you’re already doing that.

The question I have regarding going back to clinical is, we had an episode with Pasquale Venuti. He talked very interestingly about process based and being outcome based. And a lot of times we are like process based. The different steps and the different techniques and the fancy gadgets and stuff, whereas ultimately to have the outcome based evidence, unfortunately, there’s no shortcut.

We need to wait 10, 15 years to then look at the data and say, okay, yeah, this improved success rate in this scenario by 20% or 18%. What evidence base do we have? Is it too early? Is it too primitive? Or do we have any established evidence base on these novel techniques? Are they actually making a difference? Because we know that root canal treatment is actually quite predictable. How much of a difference is it actually making?

[Brett]
So it’s a great point. And the reality is, is we call this advanced disinfection protocols and we don’t have a lot of evidence. That’s the bottom line. I mean, we’ve had to rely on, which is eyeball evidence.

You know, what are we doing? We’re seeing more lateral canals filled with sealer, right? So I always say, when you look at sealer extrusion through little apical foramina, we know there’s multiple portals of exit. We know there’s lateral canals. And when you see the sealer, if nothing else, it’s a storyteller.

Hey, it’s a storyteller of anatomy. You now at the end of the procedure, like, wow, that’s why there’s this lateral vertical bone loss on this tooth because I had a lateral canal there that I can see now. You also know that in order to get sealer to go into these spaces. They have to have been cleared of debris because we know even on a level of smear layer, it’s going to block sealer from exiting out of a lateral canal and so the story is that yes, I use the laser.

I use the gentle wave and now I see the sealer. That’s pretty much what we have. We have had cases that we see heal tremendously fast. But we have had cases that we don’t see heal. And what’s important to realize is that the reason that we’re doing this is because we recognize that minimal preparation is key for dentine conservation. And most importantly, for all the dentists out there that are part of your community, recognizing that the pericervical dentine, the dentine, four millimeters above the CEJ and four to six millimeters below is the key dentine that supports the strength and fracture resistance of the tooth.

If your access is too big, it’s going to put more force on that pericervical dentine, we actually find that the preparation and the taper of that preparation doesn’t impact the fracture resistance as much as how big you open the orifice.

So being aware that we want to conserve the dentine. And so what these advanced technologies do Jaz is they allow us to keep the prep small, but still get the cleaning down inside there. And that’s what we’re after. Do we have the evidence of outcome? We don’t. I wish we did. We’re spending an awful lot of money over here around the world and in endo on these devices because we so want to improve.

We want to get better outcomes. We want to save teeth, but ultimately it takes time. So you have some that put their necks out there first. I’m one of them for whatever reason. I’ve always felt like someone has to try this for the sake of everyone else, even though at times it feels a little risky, but ultimately I think we’re at a point now where we are going to start to see some more studies, but like I said, if you look at the gold standard from evidence or outcome, it’s the passive ultrasonic activation that has the most evidence and that would be a great starting point because it’s not expensive to institute into your practice and your protocol, but ultimately you can have evidence based understanding that it’s definitely better than needle irrigation alone. No question.

[Jaz]
Well, you’re definitely a pioneer and that’s absolutely clear from speaking to you. An old fashioned technique that I still do is GP pumping. Your thoughts on dentist GP pumping. And therefore, can you also give us some guidelines how best to do it? I remember one dentist, old school dentist who taught me to dip the master GP cone, just the tip of it in some chloroform, just a tiny bit.

And then take it to the end and then they’ll kind of make the shape of the apical foramina and then use that to GP pump. I was like a little bit concerned about doing that, but what is a good safe protocol, a good safe way to do GP pumping and just describe for our younger colleagues what that actually is.

[Brett]
Yeah, so again, so GP pumping is just manual agitation again, just trying to get the solution to flow a little bit more. Obviously, that’s going to have very little impact in comparison to an ultrasonic energy coming through it. The custom cone, dipping into chloroform. Obviously, the last thing we really want to do is introduce chloroform to the apical end where it can escape.

And as I mentioned before, It’s not the Gutta-Percha we’re hoping to seal. It’s the sealer. So to me that, although I was taught the same way, I don’t think that that holds a lot of weight. In fact, I think we really want to just have chloroform be out of our operatory in general. Why bring something noxious and carcinogenic to our patient’s mouth?

Yeah. So at a very minimum, doing some type of gutter percha agitation of the solution. But as I said, if you’re here, if you’re listening, if you’re interested in endo, you can buy an ultrasonic activation tip that goes on an ultrasonic unit, very inexpensive and ultimately gives you a much better flow and activation of that solution.

[Jaz]
Can you recommend a brand?

[Brett]
Yeah, so there’s one Vista Apex out of the us. They have a handheld unit called the Endo Ultra, so that’s just like a single unit. But if you’re using an ultrasonic and if you learn endo from any endodontist, you’re gonna learn that an ultrasonic tip for uncovering canals.

Finding your preps is so key. You want to find MB2, you want to be able to kind of be thorough and finding the canals. And so something like there’s a tip called Irrisafe, from a company called Acteon that also is very inexpensive. It can be used 50 times it’s autoclavable and on an ultrasonic, you can see if you go in and out, it creates that cavitation. So those would be two suggestions. Just top of mind.

[Jaz]
Amazing. Brett, that was absolutely fantastic. I’m so, so happy to have you. I’m so thankful to Tom Levine from the community once again for connecting us. Please tell us how can we learn more from you? So obviously you’ve got on the cusp podcast for those who’d like to have mentorship and identify you as someone.

And I have to say, Brett, I really appreciate educators like you. And I think everyone else as well. My community going to love you because we love direct. We love direct answers. Here’s how it is. You’re also very balanced, but you’re also just no fluff. You give us the answers and we absolutely love that. So I know everyone’s going to love you. So how can they learn more from you?

[Brett]
Yeah. So again, my access endo community, you can find me at accessendo. org. You can message me on Instagram, but we have a great community. You can take a free training and just sort of get a really great training on different aspects.

And then at the end, learn a little bit more about joining our community. Really, really want everyone to tune into on the cusp. It would be so honored to have you. This is different than what we’re talking about here. This is really for clinicians about clinicians, but it’s about sharing the journey, the human journey, and the ideas that as more of us share about our journey and how we’ve managed stress and how we’ve dealt with burnout and how we sort of do daily practices to keep ourselves going and healthy because I believe when you are doing work on yourself, you’re investing your time during your day to work on yourself as a human. That human walks into the operatory and is a better doctor and that better doctor provides better treatment.

If you’re bringing the weight of the world and stress and sadness and trauma into the operatory with you, you’re not going to be as good of a doctor and neither will be your treatment. So on the cusp is about tuning in, hearing these amazing stories and journeys and having something resonate with you. Something someone says that becomes that instigation to say, you know what? I’m actually more interested in finding fulfillment in life than a full bank account, a fancy car and a big house.

Because as youngsters, we choose this profession. We don’t know anything about anything. We don’t even know who we are, but we make an investment of time, money, and energy that is so tremendous that you really can’t turn around and walk back out. So why don’t we learn from others journeys of how they’ve managed this stressful, burdensome profession, where, as you mentioned from the jump, we sometimes take everything so personally, that’s what my podcast is about.

It’s about finding fulfillment in life and doing it while still bridging the gap as this clinician who cares, but also has this other side as a human to make sure that when you come home from work, you’re not so dead tired that you can’t talk to your family. You have nothing to offer. You’re just dead. And I’d rather see you come home and be still ready to interact with the kids.

Do something that your spouse asked you to, because you might work all day long and take care of a million people, but when you get home, you haven’t done anything for them. And so the goal of this podcast is to get you feeling more fulfilled in your life so that you can be a fuller person. Everywhere you go and ultimately find that healthy balance between the stress of work and the joys of being alive because it’s a short period of time and I’m trying to make the most of it. So that’s what the podcast is about.

[Jaz]
Absolutely beautiful. I’ll definitely put the show links on YouTube and on the podcast below. So please guys check it out. I think that we all need this. We also have coming up in December on our podcast, dentist life, work life balance. So I’ll be sure to bring you on again to just go. Cause there’s so much we talk about and I’d love to explore this further. Brett, thank you so much for giving up a time to really enhance us in our endo, our irrigation protocols, our judgment on preemptive endo and giving us that lift that we all need. You are absolutely brilliant at doing that. Thank you.

[Brett]
Thank you. And I want to acknowledge you. The podcast is awesome. You’re doing a great service. You bring great energy to the show and that’s what you need, right? You want energy so that the information is absorbed. It’s something that actually excites you and gets you feeling excited. So I feel pumped after being here with you, Jaz. So I’m ready to get back in the clinic tomorrow and get after it.

[Jaz]
Amazing. Thank you so much.

Jaz’s Outro:
Well, there we have it guys. Thank you so much for listening all the way to the end. The future of endodontics is very exciting. And don’t you just love the human side of Brett? And the mission that he’s on. So to support that, I’m going to put all the show links to Accessendo and his community on there. He’s obviously a fantastic mentor to have, and I’m very grateful for him sharing his time with us over this two part episode.

Now, if this is the first one you’re listening to, please do go back an episode. You missed a really good one on elective endodontics. And of course, if you’re on our community, Protrusive Guidance, answer the questions, get your CE certificate. And if you’re not part of the Protrusive community yet, if you identify yourself as a nice and geeky dentist, this is a home for you.

Head to www. protrusive. app, make an account, and then you can check us out on iOS or Android. It’s all singing, all dancing app we have. I think you’ll be quite impressed. We also host monthly webinars live, sometimes me, sometimes I’ve got a guest on, in addition to what we do on the podcast. If you do want to get CE, there are paid plans available, and they’re the ones that support the podcast.

So if you’re gaining great value from the podcast, please do show your support by signing up as a premium member or for the ultimate educational plan if you want access to things like sectioning school. I want to thank the team as always. Thank you Erika for doing fantastic production. Thank you to Mari, our CE Queen.

Thank you to Nav and Krissel for making sure everything is quality controlled and scientifically correct. This podcast would not exist without the team. And thank you to the listener, once again, for listening all the way to the end. Hit that subscribe button. I’ll catch you same time, same place next week. Bye for now.