Microscopes, Loupes and Diva Mode – PDP004

Jaz’s Introduction: Jaz, Why do you have this American dude doing introduction? That’s often a question I get. And the answer to why I have this American do doing is brilliant. Doesn’t sound really professional really good. I really like it myself. I’m blowing my own trumpet if you like for choosing this guy. Where did I find this American guy to do my podcast intro. So there’s amazing website called fiverr.com. That’s F-I-V-E- double R. There’s two Rs at the end. And the concept of this website when it initially began is for five US dollars or about at five pounds. You can get lots of different services. I’ve had logos made. I’ve had my introduction made for this podcast, you name it. There’s lots of artistic stuff out there. So check out fiverr.com and it’s not even been a minute wouldn’t this podcast and I’ve given your Protrusive Dental pearl number one there already. So it’s been a busy few weeks. For me I was in Dubai earlier this month on a course. The course was by a chap called Lukas Lassmann, Polish dentist, who basically teaches about full mouth rehabilitation concepts. He basically preaches the John Kois, the Kois school of thought, and I thought it’d be good to go to Dubai to get some sunshine, my wife as well, while attending this course. And that was really cool. I’m also doing the Dawson Academy from next month modules to be in May, so I’ll be sure to share my experiences with that. But last week, I was at Mahul Patel’s PrepEvo course. And that was amazing. We do a prep, let’s say for a full gold crown upper right six, and then it gets scanned in by you know, one of those prime scan, dentsply, [sironen] scanners, and instantly, it tells you how close your preparation is to the gold standard proper preparation, which they call the [Gold Particle]. And it was amazing to see instantly how good or otherwise your prep was. And then he teaches his protocol Mahul Patel. He teaches his protocol how to get better preps if you’d like and then we prep it again. And then we get scanned again. And instantly we see if we’ve gotten better or some people actually get worse because you know, it’s a new technique you’re learning, the average sort of score that a dentist gets out of 600 sort of preps that have been done possibly more is 18% Mahul told me. So 18% of the preparation is to within 0.1 millimeters of the Gold Particle. So I was quite shocke 24% first time around 40% in second time round, and I really benefited. I think my preps come Monday morning will always be better now from going in that course. So if we’re looking for a prep course, with someone who’s a great educator, I really recommend Mahul Patel’s PrepEvo course, do check that out. Today, of course, we have Neel Jaiswal, we’re talking about magnification, we’re talking about microscopes, loupes, all sorts, what I’ll do is I’ll just tell you which part of the podcast today sort of covers which topics. So the first 15 minutes or so is about the importance of magnification, and illumination. And if you’re looking to buy your first pair of loupes as a student perhaps, and the transition from loupes to microscope, the second third is about why buy a microscope? Is it affordable? Is it a return on investment? And something I share with you, which I think was quite funny, actually, is that diva mode, I created this find out what diva mode is okay, that’ll be in the second third of it. And the final third, it will be basically more specific microscope based advice about the what sort of lens cause you’re looking for. The advice on what to look for in a scope, should it have a fixed or reclinable head for example, secondhand scopes, because they are very affordable compared to let’s say a brand new scope, and how to get around the difficulties and photography during when you’re using a microscope. And it’s actually the whole point, the whole interview with Neel is littered with a really good communication gems, and Neel is a true gem as you’ll hear. The second Protrusive Dental pearl I want to give you today is when you’re doing your composites, let’s say you’re doing a posterior composite. I’m hoping everyone’s checking the occlusion so I check it with let’s say red aquatherm papers about 21 microns and I get them to buy together I take an intraoral camera photo of that and trying to replicate the marks later. But when you actually isolating your rubberdam and you’re trying to make the restoration, anatomically correct with good form, and with that will follow function. And often when you remove your rubberdam, check in occlusion a lot of time you’re beautiful and that moves being completely wiped away. So the tip I have for you to reduce the amount of adjustment that you need to do is let’s say you’re replacing a leaking carrier amalgam. You remove half the amalgam, okay, and you put your Williams probe inside and you measure the height of that amalgam and you know How much composite in you to fill there in sort of midsection. And then of course, you can add your cuspal inclines in. So the tip is to measure with a Williams probe once you’ve removed half the restoration, and that will give you a guide as to how much to build up your composite resin. So hope you’ve enjoyed that. And please enjoy this podcast. And I’ll see you after the interview just to summarize everything.

Main Interview:

[Jaz]
Okay, Neel, Neel Jaiswal, thank you so much for joining me today on the Protrusive Dental podcast. Really, really happy to have you on. Please, can you let the folks listening today, You know, tell us about yourself.

[Neel]
Hi there Jaz and yeah, thanks again for inviting man sort of been qualified 20 odd years normal wet fingered practitioner. And I have my own private practice in Hertfordshire.

[Jaz]
It’s a beautiful practice I went to a few weeks ago, it was gorgeous. And we’ll talk about your microscope shortly. Because that’s what today is about. But yeah, lovely practice. If anyone ever is in that pod sound, you know, it really is a standout practice.

[Neel]
When your your guys or people do come along. And we do have little chats and try and help dentists especially young adults. So you’re definitely welcome. So yeah, have a lovely private practice with a fantastic team. And really kind of what set me on that journey was going to Spear in Arizona having gone there quite a few times. And plus my mentors in this country. And then really from there just having this drive to want to do better and better work and seeing all this stuff on Facebook thinking how on earth are they doing it? And through various journeys, which I’m sure we’ll talk about, we ended up really becoming a you know, my practice, but me being a Microscope centered practice. In fact, I don’t use loupes, as we were just talking about earlier. And so yeah, BAMD does being which is the British Academy of Microscopic Dentistry is I’ve been for a few years. And alongside that I’ve been helping Dhru with the study clubs in England for Dentinal Tubules. And quite involved in a little car group that I run on Facebook.

[Jaz]
Turbine group?

[Neel]
Turbine. Yeah, we

[Jaz]
Know about this. Will link in the show notes. And if you’re into cars, and you know, your dentist, and Turbine would be an awesome name, and is a great group for people to connect about cars. So Neel has lots of things and lots of surprise. But he you know, he’s very passionate about all these things. And he’s amazing at all of them.

[Neel]
Well, definitely. I mean, one thing I really like to do is bring people together, whether it’s through education, through study clubs, and with turbine oil. It sounds gauche that we’re talking about cars, but should we do lots of events in current climates, I think dentistry we need to get together and build together. And that led me on really to starting an indemnity company with my business partner, Gary. And we are now running professional dental indemnity, which has been from strength to strength.

[Jaz]
But by the way, I mean, I this show is not sponsored by anything or anyone that if you want to sponsor me now, get in contact. But this year is not sponsored. And but I am a PDI member myself, and I’m just gonna give a shameless plug, when you’re filling in the actual form, it really does stand out how it’s different to conventional indemnities. It’s insurance based, and you actually get to write down exactly how many sessions,what percentage of which treatments that you do, and they give you a really bespoke quote, as much lower than someone you know, the dental protection, the daily use of the world. And I’d really think what Neel is trying to build up here is something quite extraordinary. So the more momentum we build with, or he builds with PDI, the more prospect and the future of our profession really improves in this country.

[Neel]
Well, thank you, Jaz, it’s really good to hear. But that’s it, you know, we are trying to change the landscape is a battle. And we can do it together as a collective. And it’s just a matter of growing now, really, and I think, as we said, it’s going from strength to strength and really pleased that you’ve had a good experience and hope everyone, our members spread the word. But yeah, so really, it’s all about doing great dentistry, having great communication and having great people around you and that’s how you grow.

[Jaz]
And so and then your journey obviously, let’s talk about your journey into magnification did you start because because one of the messages I get quite, you know, and I’m always happy to help younger dentists out is even just yesterday, someone Instagram was like, I’m looking to buy loupes, should I get 3.5 or 5x or whatever. And I think when I was in dental school, and I was a student, I was actually at one stage. I think it was the student of trumping UK loupes. Yeah, I was saw like a Sheffield mercy rep for them. So I got I gained some you know, good knowledge about the different types of loupes and stuff and got into it. So that’s the most common question people in dental school just out looking to buy their first pair. How did you get into it and then what would you advise based on your past experiences and then we’ll come on to the whole scope and where that comes in as well.

[Neel]
We’ll definitely as you know, Jaz that you can only treat what you can see. And if we’re now as in dentistry, where you know, the nice really nice thing about Facebook is we are showing our work and it is setting standards and we want those, you know, really beautiful margin. And, you know, we want our dentistry to look natural. So although people, especially when you’re younger, you think you’ve got pretty good eyes, but you really can’t be magnification, and hand in hand with that goes illumination. And now as you get a bit older, you really need magnification, you also really need more illumination. And also what you’ll find is, you know, when you’re young elastic, you can bend into all sorts of shapes. And, you know, people have terrible postures, and they get away with it when they’re young. But you’ve really got to start looking after your backs. And I know it sounds such a trivial thing. But people’s leaving dentistry because their neck and back.

[Jaz]
Oh absolutely, I think we all know someone who will numerous people who fall away, at least cut down to part time to save their back. But it’s funny because we see these, you know how every time there’s a course nowadays, and there’s photos of people trying to promote their course got photos of, you know, Phantom head working sort of stuff or if you just observe all these photos, and you just observe their posture. And this is them being you know, the Hawthorne effect, you know, you change your behavior when you’re being watched. So this is being them being watched by their, you know, tutors and professors, or whomever is teaching yet they’re still adopting that posture. So you can only think what’s going on, you know, in real wet fingered dentistry?

[Neel]
Well, on the battlefield, yeah. It’s crazy. It’s really ridiculous, you know, we really go the extra mile for our patients, and, you know, you get the patients can’t lay back and, you know, we’ll twist ourselves into all sorts of shapes, and I’ve damaged my health, doing things like that. And as you get older, you become a little bit more, you know, confident saying, Well, now I can’t do that. Because, you know, I don’t myself my neck to suffer, so you work around it, your economics improves, the layout of the surgery improves. But generally, I think actually, although the work is probably the most important thing, I’d argue health is probably even more important. And, you know, if you’re suffering with chronic pain and neck and back, and you can’t work and you having to retire, then a scope or loupes ergonomics, although it sounds like well, from the others think about it, this could make or break your career and your health,

[Jaz]
This could add years on, I mean, my principal [Amic Mahindra], he raised a really good point, he once said to me, how much money do we spend on equipment per year, you know, obviously, I’m an associate, but you know, just generally speaking, we spent a lot of money on equipment, okay, you are the most valuable asset that exists in the practice you your hands, you know, your body, you need to really invest in yourself and your health. And I think that ergonomics of it is such a huge part of that. When I initially ventured into loupes, the promise was that, you know, there’s going to really help my back and adopt good posture, which it did. But I mean, I think one thing that I’d like you to touch on, because, you know, your level of expertise on this will be beyond mine is that, you know, after years of wearing loupes now that the angle of declination of your neck, once you try a scope, and you then notice a difference that for me was the game changer?

[Neel]
Well, you’ve definitely seen it yourself, you know, and as you said, once you’re aware of it, and it’s fun, even in the practice, you know, I take pictures of people’s posture, and I’m always pushing them a little bit here and there, and then you scan sit down and escape. And it’s almost gone from economy to business class. In economy all hunched up and bent over and twisted and no space. And suddenly, you know, you’ve elongated yourself, you get a little bit of distance from the patient, you’re not breathing all over them. I mean, just the health benefits of that. But also, I know it’s probably a weird thing to say. But I think mind and body follow each other a little bit. And if you spend, you know, eight hours a day bent over in a very negative position, you become a negative interest person.

[Jaz]
Oh, I’m a huge fan of that belief in I’ve read a few books whereby there’s something called forgot what it’s called, like, a power move. Like when you’re about to go into an interview you if you lift your body, your chest up, and you actually adopt a really positive superhero posture, that does wonders to your sort of confidence and your anxieties and your mindset. So I’m a huge fan of how the mind and body are connected,

[Neel]
I know. And so, with the scope at least you’ve got a chance to be upright, to have proper, not shallow breathing, to have circulation, to the air circulating, blood circulating, getting blood flow to your brain, and going home and smiling still and not shouting at your kids or whatever.

[Jaz]
This is the good sort of there’s still a concept now that we don’t have any evidence to support this. But it’s taking the findings of you know, the relationship between body posture and body language and everything else. So it’s sort of taken that across from one side to the other, I suppose, but you know, that it makes sense. So, when you’re now making suggestions, let’s say, I know where you know, we could this is completely unrehearsed we’re going to all these different tangents. But I want to draw it back to someone who’s young dentists getting their first loupes. What do you suggest?

[Neel]
Well, I would just you know anyone young especially for an associate you’re not going to invest in a microscope, at this stage of your career, you know, because microscopes have big, heavy, expensive, fixed object.

[Jaz]
But we’re gonna, I’m gonna touch on that as well, because I’ve been in touch with a few reps now. And some of these figures that are coming back to me, I read it know that they are actually that affordable. I always thought it was 40 50k Plus, but it’s like a 10th of that when you buy a secondhand, sure it might be a Chinese remake, but you know, it, they can do good service for a number of years. So we’re going to touch on that as well with the finances, the economics of loupes versus scope, because it’s not as skewed as I once thought it was. But yeah, back on the point young associate, you’re going to be getting most likely loupes. Okay, you know, let’s be real, we’re going to loupes. So what do you suggest?

[Neel]
When you’re in different practices, you move moving around, you’re still learning a craft, you’re still learning which speciality you may go into which that might change things. But yeah, gettin in to loupes really early on. And, you know, there are lots of good loupe manufacturers, and lots of very, you know, great expertise, and tend to be the loupes of manufacturers also tend to have a hand in microscopes as well. So, again, with dentistry, and with the whole thing, it’s all about relationships, whether it’s with the manufacturers, the suppliers, your reps, the patients, start building long term relationships with people. And you’ll be surprised how much help you get from people. So yes, I think you should you know, whether you’re a therapist, hygienist I’ve even seen dental nurses will loupes so

[Jaz]
Wow, I’ve never seen that before. That’s pretty cool.

[Neel]
A certain stage, you know, and again, the dentist wanted them to see what he’s seeing. And you know, and they’re doing, you know, point one millimeter kind of stuff to kind of help them with retraction cords or something

[Jaz]
Contact lense veneers

[Neel]
Fantastic. So, now, I definitely think you got to have loupes, and then people say, which ones do I go for, and there’s going to be an element to it ever, we’re all a bit different. So if some maybe go on price, and maybe go and quality, some may be go on own experience of other practices around them. I think really, first thing you have to do when you get loupes is make sure you’re sitting properly, because I had it with a friend of mine. And she thought these loupes just star she could see properly and all they would needed she needed more magnification or they needed the focal length to be different. But she was just used to that hunching over. So she got into a hunching over position that she normally sits in, puts the loupes and things. I don’t know these. So the first thing really, is get your posture sorted, figure out how you should sit, figure out what chair you should sit on. Get someone to check. And you know, when I was younger, we had really brilliant courses by [Alice Paul and Martin Amsoil]. And these guys, and we went along for a day. I think even in vt, we had some training about how to do four handed, how to do postural ergonomic.

[Jaz]
Yeah, he’s a big. Martin Amsoil. He’s quite well renowned in that field. I mean, I can’t I don’t see any more advertised courses anymore by him. I think they’d be great. But yeah, he’s certainly well known for that.

[Neel]
Well, he I don’t think he’s doing anymore. He’s got a couple of videos on Tubules, which are a good start. And actually, the guru now for me is a lovely lady called Jacqueline Boss, who’s Dutch physiotherapist. He’s worked with tons of dentists. And we did a global of kind of Skype sort of thing in with lots of dentists from Mexico and Russia and myself. And after hearing for about an hour or two, I just thought, you know, I need to get her over. So we nearly brought her over, we nearly did course. Just we had some slight issue with aid at closing one of their offices, which we’re currently using, when they were relocating. So it never quite worked out. But with still, you know, it’s gonna

[Jaz]
Watch this space, you never know if it comes out. I’ll put like a reminder onto the page or something. So watch out for that

[Neel]
Well after dental stress yesterday, and I think we’re going to do something. So going back to getting off tangent, excuse me,

[Jaz]
but this is the beauty of it. The beauty of where our thoughts and conversations leaders, but yeah, you’re saying fix your posture,

[Neel]
Get your posture, right. And then literally, you know, you’ve just got to try three or four of the lead manufacturers, and really look for what’s comfortable, you know, everyone’s got different size heads, everyone’s got different heights of torso. So kind of what works for you. What do you feel you know, it’s going to work in your hand, what’s convenient to you? What’s your price point? And definitely the students you get a much better deal. So really, the sooner you get them the better

[Jaz]
What stage of your career Did you buy your first loupes and which ones where they?

[Neel]
Surgitel. And it was probably this second year after vt.

[Jaz]
Okay. So Surgitel is very respected brand, obviously, I mean, mine was a bit different. I was a student so I didn’t have Surgitel money. I had more like the Chinese remake money and. My recommendation is okay. If you’re a student and you’re a normal student, ie, you know, the Bank of Mum or Dad, you know won’t be there to buy 5000 pound worth loupes for you. I would I think to get a 600 pound range of let’s say TTL Loupes, through the lens loupes , okay? And use them throughout, you know, two three years of your clinical sort of period of your dental school to get used to loupes. And then when you know, lets you first second paycheck just do it go invest in a decent pair of loupes I personally use 5x by Xenosys Korean company, I think Bryant are the suppliers for those, Bryant dental. But there’s loads out there. The only reason I bought that one is because the sort of the headgear that comes through is the only one that fits on my turban. So that’s, that was a big, game changer for me. So that’s what worked for me buying a cheap set, firstly, but not overly cheap, because I did actually dabble in the 60 pound eBay one and they just break apart something around the 600 pound range, I think the OptiLOUPE is a good brand to go for. And this is just worked for me. And then eventually you want to get a premium one out there. But now I’m in that transition now where to the presses are working, I’ve got a scope, I’m using that more and more. And I’m actually thinking about the third clinic and as an associate, I’m thinking of getting a microscope in that’s how much I’m loving now using microscope something, it’s transitioned. And I think this is the sort of, I think, the evolution of my education.

[Neel]
Exactly. You know, you sort of, you know, it’s like when you get a bicycle, you know, you start off with training wheels and tricycle and then you get used to that, and then you realize it’s human nature, we always want to see more, have better stuff. You know, improve dentistry.

[Jaz]
Magnification is like a drug you just want more and more honestly, like five times now is just not enough for me. I feel like I can’t see anything but even five times now, you know, I don’t know how even used to use three times loupes. I mean, I’m alone when I switch back three times now, as I can’t see, I would refuse to work without loupes now. That’s point blank.

[Neel]
Well, yeah, I mean, how many associates friends do we have, who carry the loupes around or, you know, all the different practices. And, you know, I remember one lady saying, Oh, she forgot them, and she had to drive an hour, just to go back and get them again.

[Jaz]
That’s and by the way, whenever we say loupes, we do mean loupes in light, you know, not loupes in isolation. I think that’s given here, whenever me and Neel are saying loupes, we actually mean the whole set of loupes and light because light is more important than loupe.

[Neel]
I mean, absolutely, Jaz, you know, if you know the to go hand in hand, really because, you know, unfortunately, we have to work after seven, it’s really dark in the mouth, you end up even with loupes not being able to see so then you strain more to try and get closer. You know, you get the nurses way. So again, illumination is a must and having a good overhead light as well. You know, I’ve got a nice a thick led thing. You know, just put everything you can get it illuminated.

[Jaz]
See. I stopped using my headlight now because my I’m so content with my loupes light but you know, that’s a good recommendation, you might find that combination works for you. So experiment, you know, figure out what works best in your surgery, with your conditions, with your light, with your loupes, and just get as much light in there as possible.

[Neel]
Maybe your nurse she’s not got that illuminate

[Jaz]
Yeah, that’s very selfish. [overlapping conversation] Okay, fair enough. Good point, point raise, and I think you win there. The next thing on a just to touch on is the statement, okay? That microscope is not a return on investment, you won’t make that money back, it’s not going to make you more profitable. Discuss.

[Neel]
It depends how you feel, you could say that about a scanner, you could say about a CT scanner, you could say about getting a nice a lecture versus, you know, a salon chair, you know, so everything we do with you got to kind of look at the overall picture. Now, for me, in private practice, I want to do the best job I can, I want to look after patients. And I also want them to appreciate what we do for them as well. So looking at the whole process of the patient comes in, you have a nice waiting room, you have friendly staff, he smile, you run on time, that’s all part of the process. But when they come into the surgery, and you may have a scanner, you may have a lovely surgery, you may have a comfortable chair, you may have digital x rays, and they go, Oh, wow, well, or they may have come from a really high in practice already. And they go well, this is normal for me. And then you pull out the scope. And you say, I’m just you may not have seen this before. It’s a microscope that allows me to see, you know, normally work between x6 and x12 magnification is the picture on the screen. And it just makes sure that we spot things clearly. And I’ve had patients in the pub because well in Philips, it’s an old Roman village, and I overheard someone saying, Oh, you can go to my dentist. “He’s, you know, I’m sure it’s gonna be for cheaper than what you’re paying.” And the patient went “But does he have a microscope?”

[Jaz]
Wow, that is powerful.

[Neel]
That it’s a little things. Yes, it’s a lot of money. But actually if you’re going to be in a practice, you’re going to look after a community of patients, you want to do your best for them. So firstly, do it for yourself, you know

[Jaz]
Do it for your back. Do it for your health

[Neel]
Do it for your back. Do it for your, actually I’d,

[Jaz]
You might be able to work more years and make more money.

[Neel]
Exactly.

[Jaz]
Just speaking out loud.

[Neel]
Well, there’s so many things, you know, you’re going to be healthier, you’re going to take more pride in your work, you’re gonna feel better about yourself, because actually, I’ve done some beautiful work in the past, you can say I can say that. And it’s not because I’m any good. It’s because I had illumination and magnification. And the patient will pick up, they’ll pick up on all sorts things I might pick up on the handsoup on the toilet they’ll pick up on the scope,

[Jaz]
Neel you say that, that patients will pick up, but I think it’s you as well, because I think there’s a way to communicate these things, you might have really good stuff. But if you don’t highlight it, it doesn’t actually get ingrained in their mind. So what you taught me when I came see you a few weeks ago at your clinic, was that the way you actually say, Oh, this is a microscope, you know, sometimes people will just pull out the scope and the patient’s got their eyes close,d mouth open, and you’re using a scope. And they might not even realize that there’s a big whopping machinery was being used, you know, if you say there’s a motion, I can see between six and 20 times bigger. You know, don’t be intimidated by it’s got bright light and just introduce him to him. And then they’ll when they go to a different dentist in future and they haven’t got microscope that’s when the value really generate. So you have to almost sing and shout about the beautiful technology that you’ve invested in. So I think there’s a communication point.

[Neel]
Well, you know, people spend so much on their Instagram and Facebook and trying to market patients but actually nothing beats word of mouth. And you create, as you know, we all know raving fans, you know, we’ve known this since Paddy Lund, you know, 15 years ago. So create raving fans create, you know, you look after your patient, but, you know, when you go to a car showroom, sorry to get back to cars, they don’t just say, there’s BMW, there you go, sir. They get actually, here’s a BMW, it’s got night vision, it’s got radar assist, it’s got this and it’s got this and you feel better value, I’m getting a car with all the features, I’m going to use them, it’s going to help me drive, that will help me be safe, that kind of practice. If I you know, fundamentally dentistry, it’s about confidence that patients, you can be a winner in all these cases where the works been rushed, but they’ve loved the dentist, you know. So it’s about trust, it’s about relationships. And if you’re adding to that relationship with the value, so things to do, basically, when you and your nurse are talking, just make sure your nurse picks you up a little bit, you know, not incorrectly, not dishonestly, but if you’ve done great work, and then nurses are saying that’s really lovely prep. There’s no harm, but they are Neil, that’s a really lovely prep for that.

[Jaz]
That’s a really good one. The other one, I do it. The other thing I do, and I think is I’m educating my nurse constantly, okay, so when I tell her, I’m using this wedge instead of that wedge, because I’ll find the teeth will separate a little bit more without distorting the matrix band, the patient doesn’t know what you’re saying, and that they’re like this jargon to them, but they know that I’m sort of thinking out loud, and I’m really going to the attention to detail. So at the same time, when nurses picking up this knowledge, she gets to learn why I’m making certain decisions. And then this just keeps them interesting. But you know, the patient see that, wow, this guy’s you know, just a little filling And this guy’s taking so much care and attention,

[Neel]
They’ll pick up on the vibe, on what you’re saying the tone, the professionalism. And also, when you want to tie a patient in to a practice, you don’t just tie in yourself, because you might have a good day, a bad day, you know, isn’t a big drop, but if they love you, they love the nurse and love the reception and love the practice. You could have an off day, you know, run a bit late, something could happen, but they still got investment in all over the people. And the other thing I do is when you know we’ve finished the film we’ve done through post operative instructions and we’re escorting the guests back to the reception. I just turn around say thank you Joan, thank you Ramona, Thank you.. No, I’ll thank the nurse and

[Jaz]
I noticed that you’re very good at doing that as well. That’s very good.

[Neel]
And that gives them the audio cue for the patient the patient and gets Oh yeah, thank you as well and it just reinforced that actually you’ve had a service you know it’s not you’re here under duress and we’ve you know assaulted you in your service you know?

[Jaz]
Absolutely. The other communication tip I have is since we’re now talking about is I like to call this i’m sure someone’s maybe written about this but if they haven’t I’m going to claim this one okay. I’m gonna call it “diva mode” So going diva mode means right your nurse hands you let’s call it she hands you a wedge. Right? You pick this wedge up and you don’t like this wedge and say like “I don’t like this wedge. Okay, give me the best wedge you have, give me the other one. I want it to be perfect.” I think that really adds value is on a patient wow you know this guy is so picky he’s so in you know in trol they’re making this perfect phrase that I call that diva mode. So if you haven’t had that before, that’s my invention Diva mode. Go diva mode now and again.

Unknown Speaker
We’ve changed it a little bit because it was really greatest respect. I had actually, I’m sure my endodontist, well endodontists are a different breed of dentists as we know that They’re very special people, very precise. And you know, a good one is very anal. So we had our endodontists are saying, Oh, no, I don’t want that one, that don’t like that one, find me

[Jaz]
They’ll upset because I won’t get the quality that I want or something to that effect, you know,

[Neel]
I think I’d probably say, you know, doing that. So that’s a really great one wedge, and that works really well, most of the time. And actually, for our lovely patients, you know, David, whatever, because he’s got this unusual anatomy, I will get a much better job if we have this wedge. And could we have that? So you don’t denigrate what you’ve got to say that Actually does brilliant.

[Jaz]
Well, of course, you are so smooth. Oh, my God

[Neel]
The practice we have is great. We don’t have the stuff that we just actually done. And you don’t want to do it. Actually, you know, you’re absolutely right. That’s a fantastic wedge that we use for most of the time. And as you know, we have such amazing products here. But actually, we have been, you know, the contracts we are we’d have a choice. And actually that wedge for you would be much better. So I wouldn’t denigrate any.

[Jaz]
So the take home message everyone is don’t go diva. Go diva light, the light mode will be amazing.

[Neel]
I know what you’re saying. You’re trying to get across that point of excellence.

[Jaz]
Yeah you increase the value of what you’re doing. And you’re really demonstrating that you really care. And I know the people you know out there. Excellent dentists who really care and sometimes need to show it to the patient. So Neel before we digress too much. couple more questions. So to get back on track, it’s so communication pearls there, that is what features to look for in a scope because I was in the market for a scope. Before I realized I probably have to delay by year for finances. And I was offered one without a I think it was called it. It was a fixed head. It was a fixation. Yeah, there was no inclinable head. And I saw I asked you for your opinion. And for someone who’s like a restorative dentist like me, it’s no good, you need to be able to incline that head. So can you tell us about which features are absolutely mandatory? And, you know, if they don’t have it, then it’s not really worth investment, Can you give us any enlightened on that?

[Neel]
Well, I think generally, if someone’s buying the scope for somebody else, like a principal is buying a ticket for an endodontist, they probably don’t do the same due diligence as if they were using it themselves. So I think it’s only fair that when you look at the scope, you think, would I be able to use this. Now endodontist generally don’t need as many features, let’s say because they’re basically 1/3 of the canal, they kind of gain on muscle memory, and you know, skill. But for any restorative type dentist and I do you know, as I said most for my work with the scope, even all my exams, my kids exams, everything. So for me, I really want that flexibility that I can use it in all situations. So the scope itself has to obviously have a great lens. And there are different and lens qualities. And if you can look through that, you know, go to the show and look through three or four or go to your friends practices and look through a few, you’ll see the lens quality. So that’s a must. Illumination is led versus xenon. Xenon’s brighter, a bit more yellowy, and the bulbs are quite expensive. But if you want the really bright light, maybe you’re getting a little bit older, maybe you’ve got a lot of cameras and magnification and other things going on on the scope. Xenon is good. But wherever they really in terms of cost LED lights are really cheap. They’re bright illumination they last a long time. So an LED light is good. You want some ability to take pictures, you know as you’re building up your portfolio as you’re showing patients so whether it’s a beam splitter that can take an SLR whether it’s got a built in camera, some of the older cameras aren’t so good as you know things change the new Zeiss extaro got an amazing camera but technology changes

[Jaz]
Don’t get me started on the Zeiss extaro Oh my God, I mean, literally, that’s a dream if anyone hasn’t seen or heard of the Zeiss xR Oh, that’s e-x-t-a-r-o Zeiss. It’s got this function this light the fluorescence mode, which it makes like you know when you’re like out in like a UV rave nightclub, and your composites go like fluorescence, they’ve got a different color, you can actually see that in the chair. And then all the flash of composite that you can see, you can see calculus, plaque that just blew me away. And also the the light actually, the normal sort of white bright light doesn’t cure composite. So these are just two of the features I know about the extaro after using it, it just blew me away.

[Neel]
I know. It’s fantastic. And that’s definitely one for if you you know, you’re starting a practice they’re going to be there 10, 15 years, you know, you put the investment in and I think we’re going to one of my friends

[Jaz]
That’s about 70k you know that’s that’s good but all in I know what. When you add in VAT, and then all that all those sort of specs and stuff. Yeah, maybe that’s okay. Probably not as much 70 but it’s a hefty investment. But you know, I asked one of the reps and you’re looking at roughly about monthly payments of about 700 pounds is just just to give people a little taster. That’s why I use this device.

[Neel]
Well, definitely that’s the real choice. I mean, they used to have the size per worker which is even more expensive. But and that was 70 grand. So actually, they’ve come down in price. And it’s become better as most things do. But generally, you want the adjustability, you want good light, you want things like various scope, you want

[Jaz]
What’s various scope?

[Neel]
So basically, you’ve got a few things, I mean that I don’t want to talk too much about this particular device. And we’re going to be fair to global and caps and things. But generally, different manufacturers have different terminology. And what they’re basically saying is, how does the lens move? How does you know the positioning? Will it tilt? Will it turn? What magnification depth can you go to zoom? Is it if you know, a fixed lens? Can it click so there’s all sorts of different things. I’m afraid I can’t give you the magic answer just straight away. But you know, anyone looking for escape, they want to email me or, you know, give me a call,

[Jaz]
or go on the BAMD Facebook page. And you know, post your question or message or just post question because someone else probably thinking the same thing. And there’s so many great, amazing international dentist on that. BAMD Facebook page would be just happy that someone else is joining that little niche club of microscope using dentists. And they’ll be happy to help you. So post any questions. I mean, the take home messages, you do need a bit of expert advice when you’re buying a scope, which is such a big investment. And you know, things like is the head is incliniable, the lighting, the ability take photos, these are all really important considerations to look into.

[Neel]
If I can just interrupt, Jaz, the thing is people you know, like yourself, you were saying, Oh, I found a scope and it’s a secondhand one. Just be a little bit wary if it’s a one that’s already more mounted, which is actually the best way it costs you a couple of grand to get that off the wall delivered to you without the lens being upset and then remounted. And I’ve seen people who’ve gone, tried to save some money, bought a used scope, and they could have got a decent quality new scope for what they paid in terms of transportation. Easier if

[Jaz]
Yeah, those extra fees, they can

[Neel]
You’d be surprised. I’m not. So I think with the, you know, the freestanding ones, obviously easier to move a position problem and they tend to be for endodontics. You know, once a week they get dragged out. But problem with those is one they’ve got bulky footplate. And two, you’re not going to use it again, as you know yourself. If it’s in the cupboard, you think I won’t get it out. If you’ve got it wall mounted in front of you, you’ll use it. So just be a little bit wary of use scopes or add, you know, if it’s a starter scope, then you think, Okay, this is what I’m going to do, then I’m going to sell it three years, and this is the plan, but just be aware of hidden costs of transportation, and the manufacturers don’t really want to help you move it because they take a such a liability if the lens distorts, you can say Oh, and it’s through travel and you know, it’s a precious item, these things and, yeah,

[Jaz]
See I know, I never would have thought that

[Neel]
and probably three or four grands worth. Three or four grand extra to transport and mount and deliver.

[Jaz]
So last one last thing, then is already when I’m taking photos, which I take loads of photos with my you know, 5x loupes, they’re really long, to telescopic if you’d like, it’s not as easy take photos with my loupes on sometimes I usually just try and keep my loupes on while I’m taking photos, okay, it’s a bit of a hassle. But with the scope, you know, unless you’ve got a really great system of the camera being integrated into the scope, you have to I have to move my scope out the way and then you know, take photos. So you may need to make these things easier. You know, photo taking should be easier, you should have your camera ready anytime you want to use right. Anything that will slow you down or be a hindrance will reduce you, will lead to you taking less photos. So any tips for getting over that hurdle, basically, of how difficult it can be from transitioning away from this microscope. Getting a camera is just a hassle, basically. And we all know that microscope photography, although it can be good. It’s really difficult to master.

[Neel]
Yeah, I think I mean, lots of people have difficulty with taking pictures and images. And again, when you’re setting one up, make sure you get spare cables built into the wall, make sure you get it mounted to a big TV screen. So you know the things that you’ve really got to get set up. And it’s all in the planning. But generally a scope will give you a great still images. But actually I would sometimes I’ve got a beautiful intraoral camera which one is it’s, I can’t remember the name, start to three grand it’s quite expensive Iris and you get beautiful images from that. So I will keep the scope there. Just pick up the iris takes me three seconds. Okay, that’s a good one. So I’ll sometimes just use the iris and the iris is such an amazing camera. It’s a bit of a sight. It’s so expensive, and if it needs repairing ask about the state. So there’s probably other ones around but that wins the awards every time and when you see the images. And to me again you think well it’s a return on investment but the amount of time the intraoral camera where I’ve got a picture of the crack or I’ve got picture the tooth patient comes back six months later though that tooth we did is hurting and you go well actually I did the one next to it and here’s a picture and blah, blah, blah, or something flares that

[Jaz]
I mean, we cannot, we can just go on and on about photography, that’d be a whole different. I mean, this is so important. But that’s why it’s important to if you’re thinking about loupes and scopes, also think about how you’re going to factor the photography into it. Because I think those dentists who are even thinking or investing in loupes and scopes, you care about what you do, okay? You want to be proud of the work that you generate, therefore, you probably aren’t taking photos of your work. So they all go hand in hand, that means to have a little plan of how you’re going to be able to see more, but also photograph more,

[Jaz]
But definitely use your scope, get a great intraoral camera, and get your SLR and getting this trained on the SLR so that you know how to take them.

[Jaz]
That’s exactly one way to lead to is essentially, if you’re the one who’s doing all of it, and if you’re having to move the scope away, and then pick up the camera, if it just moves go away, and the nurse is ready to take a photo and she knows what she’s doing. Or he or she you know, it’s that is I think the way to go?

[Neel]
I definitely think look, you know, nurses are very competent, capable people, they, you know, let’s face it, they don’t do it for the money, they do it for the love to help people. to care, to be part of a team. And you can nurture that and you can reward them. And you know, you’ll know when you’ve got a great nurse, and it becomes a partnership, and we’re talking about Martin earlier and hand in hand with Martin his nurse, long standing nurse, Sally, and, you know, they’re a team and you know, when you do have a great dental nurse, you know, get them involved, if you say and talk to them, and tell them what you’re doing, nurture them. And, you know, again, it’s a chance for you as a dentist to make a huge difference to someone’s lives. So, look after your nurses respect them, they’ll respect you, and they will want you to succeed. It’s amazing how you know, they have that nurturing element to them, they want you to do well. So you know, create that relationship, you get them to doing the cameras, you know, get them doing the impressions getting taken the X rays, thanking them in front of the patient, you know, these are all things that really, you might think, you know, they actually come back to you tenfold. So, you know,

[Jaz]
Neel, that’s amazing to take home messages, get your nurse to take photos, or make them look much life much easier, whether you use loupes or microscope in having that help. And you just gave us so much more than just, you know, loupes versus microscope today, you gave us amazing communication pearls. And I think everyone listening today would really benefit. So thank you so much, Neel, for today’s podcast

[Neel]
I think we’re probably gonna have to do another one on scopes.

[Jaz]
Now, this is exactly what I wanted, like an introduction, I want people to not dismiss microscopes, I think it’s so easy to be a few years qualified or been using some loupes for a few years. And then thinking automatically, okay, which loupes should I now upgrade to? But actually, I want to put this out there actually, you can, you know, consider using a microscope more and more, and that will do wonders for your posture and your dentistry. So I’m just basically, I’m very pro loupes, but actually, no, I’m pro magnification. Okay. And I want people who are the set in their ways about loupes to really get out of their comfort zone and consider microscope that will just, you know, just be a massive game changer

[Neel]
You know, there’s a bit of a learning curve with a bit of cast, same suit for the

[Jaz]
I was scared. I’m so scared of the microscope. I mean, I’m getting better now, basically. But that little thing in the corner, which I use to hand things on, but now I’m actually using it more and more. And it definitely is scary. Even when I bought my 5x loupes, and then was an upgrade from 3x. I just spent all this money. And for two weeks, I was scared to use it because it was just out of my comfort zone. And then when I started using it and you know, after the hurdle about the first week getting used to it, now I’m like, you know, I’m constantly glued to it. It’s the same thing with the scope, you need to book a little bit longer for your patients to start doing some exams. Like, I’m just amazed to do two pediatric exams with microscope. That’s a great tip, I think and just go out and use the scope and I promise you, you will love it.

[Neel]
And definitely, you know, think of it’s part of your career, you know, it’s part of your life, part of your health, part of your patient care. And you know, it straightaway you become a different. I mean, I felt when I went to Spear or when I get to Pankey, Dawson, Kois, immediately even just by turning into course, I’m doing nothing different. I am now in a different echelon of dentist, not that I’m any good. Not that I’m bright but I spent the time invested in that, and I’ve become better. And the same as scope you are immediately in a different category of dentists. People use scopes, we know who they are, I know they are. They’re great friends of mine, they all use scopes. And they’re straightaway they’re elevated into that next Echelon. So if you want to get ahead you know if you want to be one of the top dentists, doing great work and proud of your work and helping patients. I honestly thought you needed to get a scope.

[Jaz]
Absolutely and when I think of dentist that use scopes Okay, I mean, I do hold them in high regard because if I’m referring a patient to okay there’s a there’s a guy in Hong Kong a dentist, a really cool dentist in Hong Kong right who loves using the scope. He has a scope for his hygienist. Okay, so his hygienist using a scope, right? And then he emailed me saying, “Listen, you know, you’re part of the operations manager, BAMD, if I’m ever looking to refer any patients to England, because I have some Patients often traveled to England and then the might need a dentist, is it okay if I refer to you because obviously, the fact that you use a scope tells me that you’re a good dentist” you see what I mean? It’s like that, it raises your the value of that clinician. Because if they’re using the scope, you know, they’re really care about.

[Neel]
You probably if you’ve got loupes and someone hasn’t got loupes, you probably think I’m probably the best dentist, not the normal best dentist. Not that I know more and yes, but you’re everything naturally. They don’t use loupes, you not saying you look down on them, but you kind of think you’re not using loops. And that’s how I, you know, that’s how we should feel about my people not using microscopes. And there’s definitely a place loupes where

[Jaz]
I agree, once you join that club, you do then start looking out for other dentists who use a microscope, and then you sort of keep it within that little circle. It’s just, it is what it is. I’m sorry, guys.

[Neel]
I mean, you know, look at [Monder upon McClelland or Tony Druckmann,] or, you know, all these guys, you know, Hap, Hap Gill. Top guys do beautiful work, care about what they do. Very, you know, decent guys who are humble, they just want to do the best work and they want to look after themselves and their patients. So definitely, look, it’s a big learning curve. But we’re here to help. We’re here to give you advice. We’re here to help you with ergonomics. And again, as we’ve seen from today, we can help you with a whole practice environment, you know, and pass on our knowledge that we’ve learned through our own mistakes. And really, it’s a holistic approach to dentistry.

[Jaz]
Thank you so much, Neil, for joining me today.

[Neel]
My pleasure, Jaz, you take care and have a great day.

Jaz’s Outro: Thank you guys for listening. I hope you enjoyed that interview with Neel Jaiswal. If you did enjoy it, please subscribe on iTunes or Google podcasts or wherever you listen to it. Please like the Protrusive Dental podcast Facebook page. So I can keep tabs on people who are interested in my content, gone website, jaz.dental to download any show notes, my future shows. I’ve also got something for students coming up. It’s called How to Ace your dental exams. I’ve got Prateek Biyani coming on that so that’d be great to catch up with him as well. And I’ll catch you the next one. Thank you.