Howard: So, it is just a huge honor to be sitting here in Melbourne Australia with my idol and mentor for probably 30 years, Geoffrey Knight. How are you doing?
Dr. Geoff: Terrific Howard.
Howard: Geoffrey Knight has a BDS Dental Degree, Master in Science MSC, MBA and a PHD. He is without a doubt the most famous dentist in Australia and I'd say probably the most famous dentist in New Zealand.
Dr. Geoff: It's a broad brush.
Howard: No! How many times have I lectured in Australia since 1995?
Dr. Geoff: Half a dozen?
Howard: I've come down here, I think this is the sixth or seventh time. So, I have breakfast, lunch and dinner with these guys. They idolize you and you've been doing this for a long time.
Dr. Geoff: I have been doing it for a while yeah.
Howard: How many countries have you lectured in?
Dr. Geoff: I haven’t counted.
Dr. Geoff: There's a few.
Howard: Geoff Knight is a general dentist and internationally noted dental speaker from Melbourne, Australia which is where I am right now, with special interests in Minimal Intervention Aesthetic Dentistry. He has pioneered protocols for the pharmacological management of dental caries and periodontal disease. He has introduced the concepts of tunnel restorations and co-curing to MID and developed a number of innovative aesthetic techniques for the placement of direct laminate veneers, direct resin bridges and occlusal rehabilitation using composite resins. He has consulted widely across the dental industry and is named on several patents. He is currently working with SDI, which is the largest dental company in Australia...
Dr. Geoff: That's correct yeah.
Howard: And the largest manufacturer of Amalgam, too aren’t they?
Dr. Geoff: Yep.
Howard: And PDS. What's PDS?
Dr. Geoff: Professional Dentist Supplies. That's what Paula is involved with.
Howard: That's Paula? Well come into the camera and say hi! Paula is a Dental Hygienist here in front of me.
Paula: Dental Hygienist
Howard: And what is the name of your company?
Paula: So, I work with Geoff Professional Dentist Supplies as a business development manager and also have my own tech whitening and dental hygiene studio on the morning (00:02:17 unclear). So, two hats on which is exciting.
Howard: Well. We're going to do a separate broadcast with you but if you want to sit here and join us?
Paula: No, I’m going to sneak back over there and Geoff can be the star.
Howard: Are you sure? You make us look so much better. If there's one good-looking one in the three of us. Apart from his broad clinical base he has been state president of his dental association and has extensive political and economic experience within the profession. He has been published in Quintessence International, Australian Dental Journal and Journal of Periodontal Research. He has produced a series of clinical videos and written numerous articles on aesthetic and adhesive dentistry that have been translated and published internationally in a number of languages. His recreational pursuits include mountaineering. I climbed the tallest mountain in Africa, Kilimanjaro and the last summer I lectured down here I said, "Geoff, I want to climb the tallest mountain in Australia. Mount Kosciuszko
Dr. Geoff: Mount Kosciuszko yeah.
Howard: A Polish name, right?
Dr. Geoff: That's right.
Howard: And that was so much fun. Thanks for taking me.
Dr. Geoff: That was a lot of fun.
Howard: I've got two out of the seven continents down. His recreational pursuits include mountaineering, an interest that has taken him to some of the highest peaks on several continents. You should hear the stories of when he climbed the highest peak in Antarctica. Ryan, we've got to do that. I think my next one I want to do is either Russia or Antarctica.
Dr. Geoff: Yeah.
Howard: And I'm going to save Everest until I’m cremated in a barn of ashes and I’m going to have Ryan carry me up there.
Dr. Geoff: Do it with a helicopter.
Howard: Disclosure: Geoff Knight is a technical consultant for SDI which is Strategic Defence Initiative that Star Wars, Ronald Reagan shooting down missiles with his lasers. And receives a royalty from the sale of Riva Star. Ok, gosh! There's so many things we could talk about. What are you most passionate about today? Caries?
Dr. Geoff: Well look, it's the change that is happening in dentistry. I was at IDS this year, out of probably the biggest dental trade display in the world. I think you can’t get around in a day and I think that about 75% of IDS was dedicated towards hi-tech traditional dentistry which means there was Cadcam, there was 3D printing, there was all sorts of radiological techniques with imaging and the surprising thing here is that the whole thing is based on the concept that the ongoing proliferation of tooth decay and the loss of teeth. So, the whole dental industry is pushing in that direction. Ok, that’s fine, but the model we have for restoring teeth these days means we have to remove the caries. Most dental schools now say you can leave the affected dentine and that dentin is what you call it I suppose. The affected dentin, which is...
Howard: Affected with an A?
Dr. Geoff: Affected with an A, but let me say dentine because I’m use to it. But the affected dentine which is the dentine that does the bacteria around the dentinal tubules but the fact is because they’re releasing acid they sort of made the dentine soft and traditionally we were taught to remove that. Now they say you can actually leave that dentine behind.
Howard: And what's that dentine called?
Dr. Geoff: That's called the affected dentine.
Dr. Geoff: And then there’s the infected dentine and that's the dentine where the bacteria actually in the dentine tubules...
Howard: For disclosure, Australians say dentine and drive on the wrong side of the road and Americans say dentin and drive on the right side of the road.
Dr. Geoff: You know that the American pronunciation is the pure English, don’t you?
Howard: It's pure English?
Dr. Geoff: Pure English because when the Pilgrim fathers came out to America, that's the way they spoke English and so there was a Faucet. Faucet's is a pure English word and then there was program which is spelt P-R-O-G-R-A-M and we spell it P-R-O-G-R-A-M-M-E and there was colour, C-O-L-O-U-R which we called it colour and that's the French influence.
Howard: Oh yeah.
Dr. Geoff: On the English language half, the Pilgrim fathers came out to America.
Howard: So, which is English and which is French? Aesthetic or Esthetic?
Dr. Geoff: The Americans speak real English; the English speak a French version of English because of the French influence on the English language. The Brits don’t like to hear that I might say.
Howard: So, some say aesthetic dentistry and some say esthetics dentistry.
Dr. Geoff: Some say aesthetics is French but esth is an English word.
Howard: So, are you a hygienist or a hygienist?
Dr. Geoff: I’m just speakin a particular way it’s too hard to change.
Howard: So, you're saying the infected dentine needs to be removed but the affected dentine...
Dr. Geoff: They still say the infected dentine needs to be removed you see, because even though they can’t differentiate between the affected and the infected, they still say the affected could be left behind, the infected has to be removed.
Howard: Even though there's no way clinically we can tell the difference?
Dr. Geoff: Well it’s a sort of colour I suppose, it's a different colour. Ok, if you believe that model, that means that basically that the tooth or the dentine pulp complex is the only tissue in the human body that doesn’t have a front line defence against bacterial invasion. Just think about it because most tissues when bacteria attack the body and try and get into the body has a defence mechanism which is able to go ahead and actually reduce the viability of the bacteria so the body can put a defensive barrier over it. For instance, if you've got burn or scar tissue, now the scar tissue falls over that burn, that's not skin but it's still keeping the bacteria out. Now, have you heard of arrested caries? Every dentist heard of arrested caries and yet arrested caries is dental scar tissue.
Howard: Explain what arrested caries is.
Dr. Geoff: Everyone seen an arrested caries, you usually find on the buccal segments of lower bicuspids or molars where there's been some sort of caries activity and then the person changes their lifestyle and they diet and that sort of soft carious dentine then hardens up as a black surface but you can’t scratch it. Ok, it's quite hard and that's keeping the bacteria out. That's because what happens is that the body is able to sort of overcome the environment, the body is able to overcome the bacterial attacking it and therefor it slowly puts calcium and phosphide ions in and you get saliva, you get (00:09:24 unclear) coming in from the mouth and therefor all sulphur salts are black and that's why arrested caries is black. Every dentist has seen it. Therefore, if what we should be doing is creating an environment that actually turns carious dentine into arrested caries and that's what I’m talking about the pharmacological management of caries. So, basically the model we have at the moment is amputation dentistry. That’s iatrogenic and it leads to all sorts of problems because you’re removing tooth structure which we know we could have arrested caries but we're removing tooth structure which we know we can arrest. What we do is as you have a cut on your hand you left it there it would eventually heal, is that right? But if you put a bit of iodine on that cut it's going to heal a lot faster.
Dr. Geoff: Because the Iodine sort of kills the bacteria and allows the body to get on with the process of healing. The iodine's is working with the body to actually heal it. Now, if you put pharmacological predicament on the caries and you kill the bacteria then you allow the body's natural healing process to go ahead and turn that carious infected dentin into arrested caries.
Howard: And what is the pharmacological agent?
Dr. Geoff: Well what I’ve been using is Silver Fluoride, Diamine Silver Fluoride.
Howard: And every time someone takes a two-year-old to a paediatric dentist and they’ve got six or seven cavities.
Dr. Geoff: They take them to general aesthetic.
Howard: They take them to general aesthetic...
Dr. Geoff: That's terrible.
Howard: It's a huge country so with that many people that make kids it seems like in the States at least one every three months dies.
Dr. Geoff: In Victoria, there’s four-thousand children. This is the state that I live in in Australia.
Howard: You call it a state or a province?
Dr Geoff: It's a state. Like America we have states.
Howard: And how many states do you have in Australia?
Dr. Geoff: We have seven states and one territory. Which is like the (00:11:49 unclear) I suppose.
Howard: And what does Canada have? Nine?
Dr. Geoff: Don’t ask me that, I've got no idea.
Howard: So, what were you going to say?
Dr. Geoff: So, there's four thousand children given general anaesthetics in Victoria per year. There's about four and a half million people and there's evidence coming out showing if you give a child under six a general anaesthetic it's dangerous and also it causes long-term brain damage.
Howard: General anaesthetic does?
Dr. Geoff: General anaesthetic does. General anaesthetic for old people and young people are pretty dangerous things.
Howard: Yeah, with the young people they don’t have the respiratory reserve.
Dr. Geoff: Yeah that's right! Young kids can actually lead to sort of brain damage.
Howard: Little kids can go from a 96% saturation rate to...
Dr. Geoff: I'm out of my field so.
Howard: Yeah but (00:12:39 unclear).
Dr. Geoff: There's a lot of evidence coming through now showing that's is a very dangerous thing.
Howard: And what do you say is old?
Dr. Geoff: About 80.
Howard: So, what would be the age too young and too old?
Dr. Geoff: Well probably people getting in their mid-eighties it becomes very dangerous or can become. You have an eighty-five-year-old, gets a general anaesthetic they're never quite the same afterwards.
Dr. Geoff: It affects their memory and that sort of thing.
Howard: Yeah, but every time this happens, and the media is intense because they never go in there and show that...
Dr. Geoff: I know that it's a statistic that the profession seems to push under the rug.
Howard: Do you know any of the statistics?
Dr. Geoff: I don’t know the statistics.
Howard: So, the point I’m making is that they’re always going to come out and say, journalism would say, "well if you put a million people under, someone's not going to come out.
Dr. Geoff: But children are more susceptible. Children and older adults are more susceptible.
Howard: And that's why...
Dr. Geoff: Well, the whole process of this Silver Diamine fluoride means that you don’t have to give the kid a shot, you don’t have to drill and the kid comes in, theye open their mouths, you paint the silver dyment fluoride on their teeth and that stops the caries. Ok? You may have to come back at a later day and put a restoration in there because you’re obviously going to get orthodontic problems if there's a gap there. But the food pack, you never see a kid in an emergency room with a food pack. That right?
Howard: In the emergency room with a what?
Dr. Geoff: With a food pack. Food stuck between their teeth. You get a lot of kids in the emergency room with dental abscesses.
Dr. Geoff: You see? So, that's the difference. So, there's two ways of doing it. You put the silver diamine fluoride on by itself and you've got to do it a couple of times a year, ok?
Howard: Is every six months enough?
Dr. Geoff: Sorry, probably put it on annually.
Howard: Once a year?
Dr Geoff: Probably once a year. Now, the thing is, when I did my PHD I was actually combining the silver fluoride with potassium iodide because there’s two issues with the silver fluoride is that, the restoration goes in place ok but because the silver flocculates out into the cavity then everything goes black and also the silver then reacts with sulphides in the mouth because you get silver sulphide forms and that's black. So, the problem is, you keep your teeth but the teeth go black and that's probably ok in pedodontics but you don’t get too many adults lining up for filling if their teeth are going to go black. The idea was, a friend of mine called Graham Craig who did his PH when I should’ve been doing PHD when I should’ve been doing mine and he did it on this silver fluoride, silver diamine fluoride and he said, "what I would’ve done if I had my time again was to put the silver fluoride on and put potassium iodide on because potassium iodide also, is a predicament and it reacts with the silver fluoride and it precipitates. It reacts with the silver iodide so any free silver ions that haven’t bound onto the collagen fibres and the dentine and reacts with the potassium iodide to form silver iodide which is a creamy white phosphatase and also the research I did shows the silver diamine fluoride reacting and the potassium iodide is more efficacious in reducing the viability of bacteria than silver fluoride by itself. So, you don’t get the staining and you get enhanced response but the difference here is that what you need to do with this technique, you need to actually cover it with a glass ionomer with cement. So, you actually put the silver fluoride on...
Howard: silver fluoride or silver diamine fluoride?
Dr. Geoff: Silver diamine fluoride. You put the silver diamine fluoride on and then you put the potassium iodide on immediately. The technique is basically (00:17:17 unclear). In fact, I've got a protocol here.
Howard: Why don’t you make an online CE course for Dentaltown on it?
Dr. Geoff: Yeah. I certainly can. Well, I've got the protocol here. When I finished the PHD, the chap I did it with Graham Craig, we tried to make this thing commercial ourselves and couldn’t. It was just too hard. Went to STOI, which is the biggest dental company in Australia, and they took it to market for us on this product called Riva Star.
Howard: So why don’t you make this online CE course?
Dr. Geoff: Yeah well, I’m very happy to do so. I’m not very good at this sort of thing.
Howard: Not very good at what sort of thing?
Dr. Geoff: Marketing. I’m a humbled (18:04 unclear).
Howard: Well it's so important.
Dr. Geoff: It comes in these little capsules.
Howard: So, this is the silver capsule? And does this have to be triturated?
Dr. Geoff: No, it's a liquid and you actually burst it with the silver brush like that... and you just brush on the teeth.
Howard: So, you take the silver brush and pop through there.
Dr. Geoff: Pop through there and paint it on. The silver diamine fluoride has got a lot of ammonium in it and therefor it's very volatile and therefore it’s necessary to have an individual presentation each time.
Howard: So, you put on the Silver Diamine Fluoride...
Dr. Geoff: Yeah, and then after that you actually take the green capsule.
Howard: It's the potassium Iodide...
Dr. Geoff: It's the potassium iodide.
Howard: And here's your instruction card.
Dr. Geoff: The instructions card is for desensitising because the TGA and the FDA haven’t approved it yet as an anti-caries agent although it's on the verge.
Howard: How hasn’t approved it?
Dr. Geoff: FDA and the TGA. The TGA is our equivalent to FDA in Australia.
Howard: In Australia?
Dr. Geoff: Yeah.
Howard: So, you can’t sell this?
Dr. Geoff: We can sell as a desensitising agent but dentists using it off instructions as it’s been using in the States at the same time. In fact, there's a product in the States...
Howard: Is anybody doing this in the States?
Dr. Geoff: Well they’re just selling the Silver Diamine Fluoride but the trouble is everything goes black. Nobody is selling the Potassium Iodide.
Howard: Have you talked to Ginette McClean?
Dr. Geoff: No, I haven’t. All I know is that the SDI, the company is trying very hard with the FDA. It's almost on the cusp of being accepted in the United States.
Howard: Can you write an article about using it as anti-caries?
Dr. Geoff: Yeah, I've got lots of articles.
Howard: Why don’t you put one in Dentaltown Magazine?
Dr. Geoff: I certainly will.
Howard: And then make an online CE course.
Dr. Geoff: I’m very happy to do that yeah, alright. But I said, if you want the protocol.
Howard: Because the reason I’m very concerned about this is that, I’ve got grandkids. I've got a five-year-old granddaughter Taylor.
Dr. Geoff: Then don’t have a general anaesthetic.
Howard: The paediatric dentists, it's so controversial in the dental aspects but God damn, I don’t my two-year-old grandchild being put under a GA and it’s just high risk and I want to tell you another deal. For all you guys out there who think that’s scare mongering or whatever, I know a dentist who's a dental anaesthesiologist who went to dental school, got a dental degree, went on got his two-year board certified dental anaesthesiologist and his wife made him quit. He was going around to paediatric dental offices and doing GA's and he kept waking up in the middle of the night screaming because he kept having nightmares that he was losing a two-year-old.
Dr. Geoff: Losing those kids yeah.
Howard: and after two or three years his wife said, "it's not worth it. I don’t care, you can’t do this anymore". And he quit doing it and he just became a general dentist.
Dr. Geoff: But there’s not a lot of interest amongst the paediatric dentists to stop doing general anaesthetics.
Howard: There is not a lot of interest?
Dr. Geoff: Well it doesn’t seem to be here in Australia.
Howard: And why do you think that is? The money is the answer and what's the question?
Dr. Geoff: I don’t want to say that.
Howard: Well come on, you’ve been around the block. What do you think it is?
Dr. Geoff: Well it seems to me that there’s certainly an easy way to manage it and you know...
Howard: Now it's Dentistry Uncensored, come on. Shit! Punch them between the legs!
Dr. Geoff: Well, I think there’s a lot of paediatric dentists that think this technique applies the fiscal sphincter.
Howard: Say that again.
Dr. Geoff: Applies a fiscal sphincter.
Howard: Applies a fiscal sphincter?
Dr. Geoff: Yeah.
Howard: Because they don’t get the money?
Dr. Geoff: Well look, I had a friend of my wife. Her grandson in Sydney was told he needed a general anaesthetic for her son and it was going to be $3,000.00 or something but they came down. I said, "come down to Melbourne". I had the kid and the kid's saying "where's the needle? Where's the needle?" and he was terrified of injections as well as the general anaesthetic. Spent a bit of time talking to him. Just painted the stuff on, put the glass-on with cement on top. Kid was in the chair for half an hour. No anaesthetic, kid walks out no problems. If you come back and sort of re-entry into these lesions, six months later then the caries dentine is as hard as a rock.
Howard: Now is this mostly a paediatric dentistry product or?
Dr. Geoff: Well I use it for everything. I mainly use it for root canals. The fact is that I've not had a root canal fail since I've been using this material and I sort of redo root canals. I find that I use to send root canals, it really is amazing. What it does is you can get a bar film on a surface that's been treated with silver fluoride potassium iodide and that information, if you go to my website, it's published on that. I've got all the articles on there.
Howard: So, what do you mean you’re not doing a root canal?
Dr. Geoff: What you do before you operate. It's an adjunct not an alternative before you operate. You just put the silver fluoride in the pulp chamber and go with a ray mat to half a millimetre of the apex and you put potassium iodide in half a millimetre of the apex then you wash it out, couple of paper points in then you operate. The fact is that you’re lining the entire lining of the root canal with silver iodide and you can’t get a biofilm on a surface with being treated with silver potassium iodide.
Howard: So, have you had any endodontists agree with this?
Dr. Geoff: I've got a periodontist which are interested but the fact is again, there's not a lot of interest in the profession.
Howard: By endodontists?
Dr. Geoff: Doesn’t seem to be. I mean I try and talk to them very enthusiastically and they’re not terribly enthusiastic about it.
Howard: Well, Dentaltown is a very vibrant community. If you posted that on Dentaltown under endodontist I guarantee you many of the endodontists would engage you and try it.
Dr. Geoff: Yeah. I've got a friend who's a retired ENT surgeon and went to interstate and had some root canals done and came back and said, "you dentists are so expensive". This is coming from an ENT surgeon mind you. You do these root canals and they don’t work and I've got to get myself on a course of antibiotics every three months. I said, "Peter, you want to be the laboratory dog". He looked at me and said, "I’ll be the laboratory dog". So, came to the office, took out the old root canal with an engine reamer and rinsed it out, flushed it out with water, didn’t use any sodium hypochlorite. I put the silver fluoride up there, potassium iodide up there and just put a glass on with cement dressing on it.
Howard: What did the op trigger with?
Dr. Geoff: I didn’t. I just left it. He's the laboratory dog you see, so all I did was put a GP point up there in case it ossified and I couldn’t redo it again. Now, I did this in` 2007 and since then he hasn’t had any antibiotics and there’s trabeculation growing around where the root canal was.
Howard: Let me tell you, I know that people in the United States thinks that everything starts and ends in the United States but it was the Australians who... Americans were surgically removing all the ulcers.
Dr. Geoff: That's right.
Howard: That’s a bacterium.
Dr. Geoff: Yeah.
Howard: And the Americans didn’t listen to him for ten years and now they’re doing it again down here with faecal marrow transplants.
Dr. Geoff: Yeah. I’m pretty happy about that.
Howard: They're blasting people with all this chemotherapy and radiation and people laying around lifeless and it was down here in Australia where they realized a human is only a trillion cells. They've got ten trillion microorganisms, parasites, fungi, bacteria in the stomach lining and you’re killing all that and these guys are laying around lifeless, so they’ll go get a sibling and they’ll start having them poop in the deal and then give them an enema to repopulate their deal and people are noticeably springing back to life.
Dr. Geoff: That's right yeah. Well I think there’s more living cells on a human that aren’t human.
Howard: Yeah, ten to one.
Dr. Geoff: Yeah that’s right.
Howard: Yeah, it’s like something crazy. Like 95% of all the DNA in your body do not come from your mom and dad.
Dr. Geoff: Yeah that's pretty scary.
Howard: Yeah and with my children, half of their DNA is alien. I think that’s odd. Strange Ryan! So, very interesting but I think that if you would post this under endodontics, you’ll get some endodontists looking into it.
Dr. Geoff: The whole thing is, it's got amazing applications in the developing economies too.
Dr. Geoff: I go up every year to Istanbul.
Howard: I know you do.
Dr. Geoff: And the first year I went up I took the silver fluoride with me and the other dentists didn’t want to know it and thought what's that stuff and I was painting it on kids’ teeth. Went up the next year a week after the crowd went up there and they said, "we've seen some really strange things up here. We've seen these sorts of large carious lesions but their absolutely rock hard and we just can’t scratch them". He said, "what's going on?" and I said, "that's the silver fluoride". So that was the thing and now they can’t do without it and I came up and mentored a young hygienist to actually use this. In two days, she saw one hundred and twenty-one children and treated two hundred and fifty-seven carious lesions. Now you see how this fits into public health dentistry.
Howard: And it's in East Timor
Dr. Geoff: It's in East Timor.
Howard: And this is why I’ve always schooled the dentists on Dentaltown because they don’t realise that the whole world is watching these conversations and I’ve been in several countries in Africa where they’re reading on Dentaltown where amalgam is bad.
Dr. Geoff: Yeah.
Howard: So, they’re trying to do direct composites but they don’t have high speed suction and I watched this dentist in Africa and he drilled out the composite and the woman stopped every couple of minutes, the patient, and rinsed out with water and spit in a bucket.
Dr. Geoff: Right.
Howard: So, he acid etches and then he puts on the primer and then she sits up, rinses, spits in a bucket and then goes back, put on the bonding agent and then he cures it, then she sits up, rinses, spits in a bucket then he adds the composite and cures it, then spends like thirty minutes, doing this amazing polish and I’m like, "this is a disaster". So, there's two million dentists and five hundred thousand that practice like you do in Australia and we do in the United States and Canada and Western Europe but there’s a million five hundred thousand dentists in Africa, Asia and Latin America that there's market segmentation and procedures and when you try to sit there and say the whole world is going to have one standard of dentistry, it's not very publicly outlined. Like explain the difference in East Timor and Melbourne?
Dr. Geoff: Well, it's the same sort of thing. You spit in a bucket.
Howard: And how many people live there in East Timor?
Dr. Geoff: Probably 600,000. But there are no dentists at all. There's two or three dentists for the whole community.
Howard: So, 600,000 people.
Dr. Geoff: So, what happens,East Timor it's a lovely country but they suffer there with this uprising. They got their independence and then Indonesia came through and there were a lot of people were killed and so it's a recovering economy. You’ve got a farming community where people are digging yams and growing yams sort of thing and the road comes in and that's fantastic because the first thing that goes in is a healthcare clinic because tuberculosis is an epidemic in East Timor. Everybody gets treated for tuberculosis and that's great and the next thing comes and it's a school, and that's terrific. And the next thing that comes in is the mobile telephone tower so everyone's on a cell phone. Where they get their cell phones from I don’t know but the government gives them money. So, we've got a cell phone but the next thing that comes is the flour and the white sugar and that’s how when I was a dental student, they say I use to give rats caries and of course the kids and the adults teeth just fall apart. Can you imagine it takes six months to grow a crop of jams? You just go down to the little shop that buys a bag of flour and a bag of sugar and just and just make dampers and of course, diabetics are on the rise, dental caries is just out of control.
Howard: That's what they did in Arizona, so Arizona before World War II, there was no commercial air-conditioner. So, the state was mostly American-Indian reservation.
Dr. Geoff: Right.
Howard: And so, then after World War II they commercially made available a swamp cooler and they have a bunch of military bases out there and six million World War II vets were coming in and out of there. So, they liked Phoenix.
Dr. Geoff: Right.
Howard: So, the city started building but the first thing they did is, they took the river water away from the Indians and channelled it into the Phoenix and Tucson and all that stuff, in exchange for giving them welfare. So, they took them from farming to eating processed foods.
Dr. Geoff: Yeah.
Howard: And it's just diabetes and caries.
Dr. Geoff: Well that's the trouble they have in a lot of indigenous communities when they get the benefits of Western civilization.
Howard: Yeah. What were those benefits again?
Dr. Geoff: Diabetes and caries.
Howard: Diabetes, obesity, caries. So, let’s get an online CE course on this. If you have some sample kits or whatever, you should post under endodontics and post on...
Dr. Geoff: Well look, if anyone is interested in trying this, apparently the way it works is that even though it hasn’t been approved by the FDA, I can send a sample over as a dentist to another dentist for clinical evaluation. So, you’re not breaking any rules.
Howard: And how do they contact you?
Dr. Geoff: Well, contact me on the internet or my email address is firstname.lastname@example.org. Don’t forget to put the au on it because if you just go dentalk.com it goes to a dental laboratory in Thailand. They've got the .com
Howard: dentalk.com.au. And they use for Austria?
Dr. Geoff: For Australia.
Howard: Oh ok, I thought we were in Austria. I think my plane made a wrong turn. You also have another website www.profdent.com.
Dr. Geoff: Yeah.
Howard: What's the difference between dentalk.com.au?
Dr. Geoff: Well the Profdent is a little manufacturing company I have. We make a number of things like bleaching products and for dentists we make alcohol and mouthwashes and hand pieces, that sort of thing.
Howard: So, let me finish up with the silver diamine fluoride. There's no question that Japan and Australia and New Zealand...
Dr. Geoff: The Japanese invented it.
Dr. Geoff: Silver Diamine fluoride. At the end of the second world war, the Japanese took on all the benefits of western civilization which included the western diet and their teeth started falling apart and the Japanese government just didn’t have a means of dealing with this but they knew that people who painted their teeth with heavy metallic salts, actually stopped caries. It was a process called "Uma guru" I think, where a woman got married and she painted her teeth with these silver teeth went black and the samurai did the same thing. So, when they whipped your head off you couldn’t see the smile on their face I suspect but they also knew that if you actually did this, it stopped caries. So, the Japanese government looked at a series of metal salts and saforide being sold in the States. I think it was still available for 20-25 years.
Howard: Saporide? How do you spell it?
Dr. Geoff: Yeah, it's Diamine Silver Fluoride. I think Marita sell it.
Howard: Gene Marita?
Dr. Geoff: Yeah.
Howard: The Japanese company?
Dr. Geoff: Yeah. S-A-F-O-R-I-D-E. The only problem was that it used to turn teeth black and this is the good thing about this Riva Star is that it actually turns teeth...
Howard: And what was the Japanese tradition where they wanted the black teeth?
Dr. Geoff: Oh, it was like a social status.
Howard: They still have that?
Dr. Geoff: I’m not sure. There aren’t too many samurai running around at the moment.
Howard: But we were in Tokyo. Ryan and I were in Tokyo not very long ago and there still is underground... Did you remember seeing that Ryan? That there were some beautiful women with black teeth.
Dr. Geoff: It's a cultural thing in Japan, basically that's fine.
Howard: My favourite culture is Buddhism because they worship a short, fat, bald guy with a big belly. That's the culture I try to promote the most. I want everybody to think that a bald guy with a big belly and a smile on his face is God. I mean, can we promote that more?
Dr. Geoff: I’m very happy to do that for you.
Howard: But what I was going with is the fact that the Americans had a really great restorative filling when I got out of school called the Amalgam. It was metal, it was all anti-bacterial, half mercury, the other half is silver, Zinc, copper, tin. All anti-bacterial that lasted thirty years and we replaced it with a direct composite which is an art plastic and is lasting about six and a half years.
Dr. Geoff: Yeah and releases hormones. Turns boys into girls and that sort of things.
Howard: But in Japan and Australia and New Zealand, you guys use a lot more glass ionomer.
Dr. Geoff: Yeah, we use glass ionomer. See the thing is...
Howard: Why do you think the Americans use (00:38:25 unclear).
Dr. Geoff: Well let me ask you a question, ok? We talked earlier about the fact is that you can leave the dental schools now agree, that you can leave affected dentine but not infected dentine and we talked about that. So, therefore if composite resin was there to restore a carious lesion then sure the manufacturers would say on their spiel this is the bond strength of this dentine bonding agent to affected dentine. What's the bond strength of affected dentine? Dentine bonding agent to affected dentine?
Dr. Geoff: Well, very small you see, and the fact that you can tell where your infected caries is but you can’t tell the interface between infected and affected and you can’t tell the interface between affected and sound dentine. It's just by feel. So, if you’re restoring a tooth, you’re restoring a carious lesion for a composite resin, what you've got to do is you’ve got to remove all the infected dentine and all the affected dentine and just to make sure that you've got to get some sound dentine away from it so you're taking away all this tissue which is basically iatrogenic amputation of reminerizable tissue. It's bizarre! If you use a glass ionomer cement, you see the glass ionomer cement pump out when you mix it up it's got quite a low PH of about 1.5 to 2, and therefore it just sort of dissolves the outer layer of the apatite crystals and then what happens then is that when you decide you get in solution then you actually use the apatite when it actually sets to PH 7, doesn’t shrink. So, you’ve got all these sort of 1% fluoride release. Now, 1% fluoride release is about 5 500 [00:40:27 unclear]. So therefor if you've got 2 000 (40:30 unclear) you'll kill strep mutans, one of the main bugs that cause caries. So, you can leave a thin layer of infected dentine so you can leave all the affected dentine and the sound dentine underneath. So basically, it's about a millimetre of tissue you can leave and the glass ionomers with cement will form a biological seal. You get calcium phosphate irons percolating up through the dentinal tubules. You get the fluoride coming out from the glass ionomer cement and calcium, depending on the product and what happens then is that you kill the bacteria so you get a thin layer of dental scar tissue of arrested caries, where you leave the caries behind but all the affected dentine with is carbonated apatite. When a tooth forms it’s all sorts of carbonated apatite or freshly ruptured tooth has got a remineralisation and demineralisation PH of 5.5, but once it actually forms into a fluorapatite, it’s got remineralisation demineralisation PH of 4.5, so that's one PH drop lower which means it's ten times more effective. So, what you’re doing is you restore a tooth with glass-on with cement and you leave the affected dentine behind. Your turning the affected dentine from a carbonated apatite into a fluorapatite and therefore its ten times more effective against caries. So, you’ve got a caries resistant base on the base of your restoration. If you restore a tooth with composite resin, particularly if you’ve got subgingival preparation on the floor of approximal box, where all the dentinal tubules are running that way and it's percolating out fluid, what sort of bond strength are you going to get with the dentine bonding agent on dentinal tubular fluid? Whereas with the glass ionomer with cement is a water based material which will bond to a wetted surface. Every way you look at. Dentists in Australia really can’t quite understand why this is overwhelming with rejecting the glass-on cement in the United States.
Howard: But where is it accepted? Japan, Australia?
Dr. Geoff: Not Japan. Japan is driven by their health care system I believe. I think a lot of the dentistry in Japan, they do these stainless-steel inlays because that's what the healthcare system pays for. Maybe different now but that's how it used to be like.
Howard: So where is glass ionomer mostly used?
Dr. Geoff: Well, it's used in Australia, New Zealand and Europe, Britain. It’s used a lot in the UK. It's used a lot in Scandinavia. Not so much in Germany. It’s the European tend to follow the American model, as does South America. The fact is that you asked in the States what’s the most common lecture you'd like to hear, they talk about post-op sensitivity. Australians don’t have post-op sensitivity because they use glass ionomer base. The trick is to do a sandwich. The glass ionomer with cement has got a lot of biomimetic properties and those biomimetic properties it actually helps heal a tooth that works with a tooth, not on the tooth but the fact is, it doesn’t have the strength and so therefore if you go put a composite resin overlay on top of glass ionomer with cement, that's the ideal restoration as John McClean, who was a very famous English dentist said, that you replace the dentine with the glass ionomer with cement and you replace the enamel composite resin.
Howard: And he's from the UK?
Dr. Geoff: He's dead now but he said that thirty years ago and Graham Mount who was one of the great proponents of glass ionomer with cement here in Australia.
Howard: Graham Mount?
Dr. Geoff: Graham Mount yeah. He was again, one of the reasons why glass ionomer with cement became so popular in Australia.
Howard: And would you credit Graham [00:44:35 unclear] for New Zealand?
Dr. Geoff: Oh, Graham Miller and I came after Graham Mount. Graham Mount set the stage in Australia and New Zealand and Graham and I picked up the baton and ran with it.
Howard: So, Graham Mount...
Dr. Geoff: Well Graham well made it. There's been a lot of people like Graham Craig.
Howard: United States had Graham Cracker. The Gram Cracker?
Dr. Geoff: The cracker?
Howard: Did you know that was a medication?
Dr. Geoff: What's it?
Howard: Yeah it was made by a doctor, it was Dr Graham and he made the Gram cracker for people who had upset stomachs. I’m serious.
Dr. Geoff: Right, ok.
Howard: It was originally a medication.
Dr. Geoff: Right, ok. That's a bit of information.
Howard: But truthful and funny.
Dr. Geoff: One of the fascinations of dentistry in different parts of the world you get this...
Howard: Well I love that the most. I think the greatest education that I've had in my life. I don’t know if it was actually college or in the evening reading books. I think it was more international travel because when you’re born in a tribe you swallow and believe the religion, food ,cultures and customs.
Dr. Geoff: Yeah, you’re right.
Howard: And when you start going around the world you say, "ok everybody has a toilet but everybody makes it slightly different. Everybody has a window but everything is just slightly different". And I love the fact that dentistry that's it’s the little nuances and that's why I love my favourite meeting is an STI meeting and Cologne you're talking about. IDS, International Dental show.
Dr. Geoff: International dental show or something.
Howard: International Dental Show, it’s in Cologne, Germany every year.
Dr. Geoff: That is so big.
Howard: Over one hundred thousand dentists come.
Dr. Geoff: And you can’t walk around in the time of the show. You can walk around it but you can’t visit every stand.
Howard: If you were just walking like you were walking to the park, you could not walk by every booth in five days.
Dr. Geoff: Yeah.
Howard: And you'll stop and these dentists could be from Pakistan, Turkey, India, everywhere. Every single country on earth and you listen to them and it's just amazing how the human mind sees everything. You’re looking at the same mouth... By the way those bugs you said streptococcus mutans. The research is showing that by the time you get four millimetres down into a cavity, there are no streptococcus mutans and then that layer their discovering new bacteria every three months.
Dr. Geoff: Oh yeah sure. It's very complicated but you need the strep mutans (47:20 unclear), they’re the ones that initiate and create environment. We get these more complex bacteria actually coming in and again, propagating the disease.
Howard: And the reimbursement is huge because if they only pay you for drilling, filling and billing and there's no procedure to pay for prevention, that definitely changes the outcome.
Dr. Geoff: Drilling and filling is working on the teeth. It's an iatrogenic amputation model but this pharmacological caries management is working with the teeth to help the teeth to help the teeth do what they can do anyway and that is remineralize and form the infected dentine or the caries dentine forms arrested caries which is dental scar tissue and the affected dentine actually goes from carbonated apatite to fluorapatite which is ten times more as recent of further tooth decay. That's why the glass ionomer with cement is such a superior restorative material to use in composite resin. Composite resin is alright to replace existing restorations. It's when you see a technique where a dentist shows how to do a good composite resin. They never show it treating caries, they also take an old filling out, an old restoration out, put a new one in. Have you noticed that? They never show you how to treat a caries lesion, just think about it. It's always, is taking out an old filling because the manufacturers know that it gets very tricky when you start using a composite resin on a carious lesion because you’ve got to take out all the infected and affected and some of the sound dentine. So, you're making a huge iatrogenic hole in that tooth.
Howard: So, what is the status of water fluoridation in Australia?
Dr. Geoff: Pretty good. Most of the capital cities are fluoridated except for Queensland and Brisbane and that's a political thing. You have governors and we have premiers that run our states and in Queensland there’s a lady called Anna Blythe and the state was in big financial trouble and she found out that if they fluoridated the water supply then the public health dental service would save $200 million over three years because of the fluoridation of the water supply and she just did it. All the loret bags and the nutters started screaming and yelling saying it was forced medication and all that sort of stuff that goes on. Basically, Australia's pretty good.
Howard: It's amazing what the advent of social media and you see large number of dentists on social media. It's amazing how many Millennial dentists are not buying into water fluoridation. Why do you think some of the younger dentists that are under thirty...?
Dr. Geoff: Look, one of the big problems here in Melbourne, a dental degree now costs $300,000.00. Well pretty close to $300,000.00. Now, the government gives you a loan but you've got to pay the loan back. Ok, so these kids graduate with a $300,000.00 debt, 7 years it takes and then they’ve got to go to a practice. So, the trouble is when you go out into the big wide world, now everything looks like an implant or a crown or a breach because they try to cover this huge debt they’ve got and so there’s a lot of social dislocation. I think that's not entirely ethical of the universities because we have five new universities in Australia in the last seven or eight years, so apart from the old Sand Stone universities in each of the states we've got five new universities. So, they’re turning out more and more dentists which is a problem. And the other thing is it's the old people like me that have the cavities. Generation X doesn’t have cavities. There are plenty of cavities out there in the public sector but the middle class that could afford to use to go to a private dentist. My kids don’t have any cavities and my friends' kids don’t have any cavities and I talked to patients. "I know my kids don’t have any cavities" but some of them will come in, they’ve got a root canal or they’ve got a filling that's broken or they’ve got to have something replaced. So, in fifteen years’ time when the baby boomers have left the (unclear 52:09 unclear) there’s not going to be a lot of work around and not in the private sector. I suspect it's the same in the US?
Howard: The dentist is really... He just crawling along. It doesn’t seem like a dentist anymore is just to create jobs for the universities. Create jobs for all the people selling all the high expensive equipment.
Dr. Geoff: Yeah.
Howard: And create jobs for all of the staff. A graduating dentist has a target on his back. He's got to feed academia, he's got to feed all the big equipment manufacturers, he's got to employ five, six, seven people, it's an economic burden.
Dr. Geoff: And they’re still graduating with this amputation iatrogenic model which is then feeding into the dental industry where you’ve got to go to IDS and 70% of the displays are talking about restoring teeth or doing implants. So, the whole thing it's churning it on but the whole thing is predicated on the continuation of caries and tooth loss. It's like the whole thing is being hijacked by technology and industry and the dentists are just being sucked along in the process.
Howard: So, you have another product. So, you have two websites. You have www.dentalk.com.au but you have www.profdent.com.au and that is what you were showing me.
Dr. Geoff: One of the things that fascinated me as a dentist is that there’s a big demand for bleaching. I do a lot of bleaching in the practice and I use to really hate taking the pressure. We can’t get our assistants to do it. Our dental assistants.
Dr. Geoff: Well, the government won’t let us do it.
Howard: Wow, how will the government catch you?
Dr. Geoff: Don’t go there.
Howard: Don’t go there?
Dr. Geoff: Don’t go there.
Howard: Remember the law is just suggestions?
Dr. Geoff: No, no! We make this thing called now because you say to a patient "would you like to bleach your teeth?". They say yes. I say, "would you like to do it now?"
Howard: Oh now!
Dr. Geoff: You see, that's what it is. So, what it is...
Howard: Upside down it looks like ‘moo’.
Dr. Geoff: That's right.
Howard: I’m reading ‘moo’.
Dr. Geoff: So, what you’ve got, you’ve got a universal trade. So, the low has got lower on it so it can’t be confused and the up has got upper on it and it's a very viscous gel and you get the gel and you can see how viscous it is.
Howard: So, what is it? Carbamide peroxide?
Dr. Geoff: Straight carbamide peroxide.
Dr. Geoff: We’ve got 16% and 10%.
Howard: 16% and 10%? And which one do you recommend?
Dr. Geoff: Well if people react to the 16%, you give them 10%. 10% Doesn’t cause any problems. We sell other bleaching products and the 10% is more popular amongst dentists because they give it to patients and the patients aren’t going to give them any angst where 16% works faster but basically they’re going to get sensitivity.
Howard: You know what I tell my patients? I tell them that if someone brushes and flosses every morning and every night and they have zero gingivitis, 16% is always fine and that everybody that I know that has sensitivity is because they have bleeding gums, they’re not daily flossers, and I believe that when you start soaking your teeth in carbamide peroxide, it really starts curing and gingivitis rapidly. If they say, "well, it's stinging and sensitive", I just say, "well, come on do you really floss every morning and night?" They go "no".
Dr. Geoff: You don’t need to floss every morning and night.
Howard: Well, if you have any bleeding and you get the 16% bleach agent, that's the sting.
Dr. Geoff: But the thing is that the flossing... The only reason that you’re flossing is to get the endo proximal plaque out between your teeth. So, the saliva can wash though and take away the acid and toxins. If you say to someone "you’ve got to floss every day" they will say, "well I can’t floss every day", so they don’t do it at all. They say you’ve got a built-in meter. If you floss and you spit out blood, you're not doing it enough but if you floss and you don’t spit out blood that probably means you need to do it two or three times a week, then that's fine because it takes that long for the bacteria to produce the [00:56:58 unclear].
Howard: And don’t you think it should be legal to have red toothpaste? I can’t believe how many...
Dr. Geoff: They use to sell a cochineal toothpaste. They still do, don’t they?
Howard: They sell what?
Dr. Geoff: A toothpaste that was...
Howard: Close Up is red.
Dr. Geoff: Yeah
Howard: I mean the toothpaste is red so you can’t have red toothpaste. You need white toothpaste and a white sink to see blood.
Dr. Geoff: You see the cochineal use to actually stain the gums pink and therefor it makes the teeth look really white but when I was a young graduate I was selling this cochineal toothpaste with cochineal in it which make the gums go bright red and the teeth would go bright white.
Howard: So, if they go to your website www.profdent.com.au they can order these premade so they no longer have to take alginates or rep models? And how much are these pre-made trays?
Dr. Geoff: Well, we sell them to dentists, the kits to dentists for AUD $98 which is probably about $70.
Howard: So that comes with the trays and one too with gel?
Dr. Geoff: Yeah, 30 ml of gel.
Dr. Geoff: Yeah.
Howard: That’s the only metric that Americans knows is millilitres. How many kilometres is a marathon?
Dr. Geoff: Forty-six
Dr. Geoff: Sorry, forty-two.
Dr. Geoff: Yeah. Forty-two kilometres.
Howard: Well I love this part, I mean for $70 you get the upper and lower. Who's making your trays for you?
Dr. Geoff: A company in Melbourne makes it. The moulds are made in China but they actually bake them here in Melbourne.
Howard: And are you selling any of them in the United States?
Dr. Geoff: No, I don’t sell anything in the United States. We're just trying to get her off the ground here in Australia.
Howard: You should post that on Dentaltown under tooth cleaning.
Dr. Geoff: People say to me “Doctor, can we talk about whitening?” And I say “would you like to do it now?” He says “we can”. I say “well that’ll be good” So, the fact is I charge $180 for it. It’s Australia so you’re making the cost of prophylaxis basically for nothing. So, as if someone comes in for a check-up and a prophylaxis you get for the price of… you actually get a margin for check-up might get two prophylaxis and that makes it...
Dr. Geoff: That makes I sort of a very, very… say after a kid finishes a set of orthodontic treatment. So, well the orthodontist is going to say “Well just give them a kit.” Now, you’ve got such lovely straight teeth now here’s an opportunity to make them white. And instead of making special trays, etc., etc. they just give them that and off the kid goes. So, it’s a niche product in the industry. It’s not going to take away from professional bleaching.
Howard: And why not?
Dr. Geoff: Because dentists still like the margin they get from professional bleaching I think.
Howard: Do you think the bleaching light does anything?
Dr. Geoff: That’s one of the biggest… My friend Ray Bertolotti, got the bleach, and he bleached every second tooth and he got the light on it and after 20 minutes he said he had a zebra smile. White teeth, dark teeth, white teeth, dark teeth. Three days later, back to where it was before, ok. All the bleaching light does is dehydrate the teeth. That’s been well documented.
Howard: Yeah, and you know the only company that I really know that was ethical enough not to sell the bleaching light, you know which one?
Dr. Geoff: What?
Howard: Dan Fischer of Ultradent. He said I cannot sell the light when all the research says it does nothing. And, that hurt his sales. And, he sells opalescence and you know, all these like “I know it doesn’t work but the patients want the light”. And he was like “You’re a doctor” So, you’re going to say ok I’m going to use the light because the patient wants one.
Dr. Geoff: We’re under these pressures… everything in our society these days, people want it now, and they want immediately, they want it for free, and they don’t want it to hurt.
Howard: I have a friend he’s a podiatrist. And he says, when I’m removing a bunion, he says I’ll put you to sleep, he’s like take out the 15 blade, I reflect, I remove the bunion but when he goes, when he says “laser surgery” on the foot, the phone just starts ringing off the hook. He says ‘I can take a 15 blade and make the incision in 1 second but laser I’m cutting along and I’m cutting along- he says half the time. To tell you the truth, I just start using and put it down and take a 15 blade and do it’ but it says… so for him, the laser foot surgery, huge marketing.
Dr. Geoff: And also it makes your operatori smell like a Korean barbecue.
Howard: A Korean barbecue?
Dr. Geoff: Yeah.
Howard: I’ve never smelled a Korean barbecue.
Dr. Geoff: We’ve got a very multi cultural society here in Melbourne. So, there’s a lot of Korean… you go around it’s got a very particular smell.
Howard: And what glass ionomer where you using with this? Who makes your glass ionomer?
Dr. Geoff: Well, I’m using the SDI. There are three really very good glass ionomers in the market. There’s GC.
Howard: Which is General Chemical?
Dr. Geoff: I don’t know. GC Fir.
Howard: But doesn’t the GC stand for General Chemical?
Dr. Geoff: I’m not sure. They call it GC. I mean, SDI stands for Southern Dental Industries and they just call it SDI. So, you’ve got GC, you’ve got SDI, and you’ve got 3M. And they make the… they’re the big sort of…
Howard: I think GC is General Chemical, and they move their headquarters from Tokyo to Switzerland.
Dr. Geoff: No, no, no. Mr. Macow moved his headquarters in Tokyo. He moved from Tokyo to Switzerland. He was the owner but the company is still in Tokyo.
Dr. Geoff: He moved himself.
Howard: To where? Switzerland?
Dr. Geoff: Switzerland, yeah.
Howard: So, did you think he did that for tax purposes?
Dr. Geoff: Oh no, I wouldn’t suggest Mr. Macow would do that. He’s a really nice person.
Howard: Can you get him to come on my show and podcast?
Dr. Geoff: Yeah, he would do that.
Howard: Can you email him?
Dr. Geoff: You email him yeah.
Howard: You email him and CC me.
Dr. Geoff: No, no. You email him. Don’t get me to email him, you email him.
Howard:: Can you get me his email address and his name later?
Dr. Geoff: I’m sure I can find it for you. Yeah, I mean I got to get through the right channels but yeah I mean he’s a really interesting man. Sort of took it, end of the war, Japan was in terrible trouble and he’s taken this company and it’s one of the biggest, probably one of the most successful dental companies in the world.
Howard:: Yeah, and what’s his name?
Dr. Geoff: Mr. Macow. M-A-C-O-W I think.
Howard:: Mr. M-A-C-O-W?
Dr. Geoff: I think Macow. Was pronounced Macow but it’s probably spelt… It’s a Japanese…
Howard:: And who’s’ the CEO… I forgot his name, I had lunch with him at SDI.
Dr. Geoff: Jeff Chi… Oh no, Samantha his daughter now. Samantha Chitum.
Howard: did he retire?
Dr. Geoff: Jeff is still… he’s still the chairman of the company… non-executive chairman.
Howard: Does he still go to work every day or…
Dr. Geoff: He still has to work but Samantha does the knots and bolts now. But Jeff’s the non-executive chairman. He just sits on the board meetings and gives us all his blessings.
Howard: Well, tell Samantha that I want to podcast her.
Dr. Geoff: Certainly, I’m sure she’d be happy to do that.
Howard: And also, I think it’d be a great marketing story because now half the dentists come out of school are women and she might be one of the few women.
Dr. Geoff: She’s a very switched on young lady she’s got an MBA, and all the stuff you need to… and she’s very much hands-on.
Howard: She’s here in Melbourne. Yeah, last time I was in here we all went to lunch.
Dr. Geoff: She’s up in the snow at the moment but she’s…
Howard: Up in the snow? Where’s the snow?
Dr Geoffrey Knight: No, no Mount Bulla, we’ve got a ski resort..
Howard: That’s where we climbed Kosciuszko?
Dr. Geoff: That’s another one but the closer one is about 120 miles away out of Melbourne.
Howard: Well, is there anything else that you want to talk about?
Dr. Geoff: I think that’s about it yeah. I really enjoyed as always.
Howard: Yeah, what you were telling me, you said that there’s no way we can talk for an hour and we went over an hour.
Dr. Geoff: Did we? I did say that. I didn’t think we would.
Howard: That’s when you said when we were climbing mount…
Dr. Geoff: We went to climb Kosciuszko, we sat in the car for sort of 4 hours on the first day and you slept going up to Sydney. I think so we didn’t talk all that much. But it was just a very nice experience. And thank you for the opportunity of being over to talk to you tonight too.
Howard: Hey, thanks I love to go around the world, and hear from the legends around the world.
Dr. Geoff: I’m hardly a legend.
Howard: I know you’re a humble man but you’re a legend here. You’re a legend in the minds of every Australian dentist I know, and
Dr. Geoff: You get a polarized response.
Howard: Well everyone respects you. It doesn’t matter if you agree or disagree, definitely listen and respect everything you’re saying, and again my pet peeve on this is that. America seems to be killing a child with general sedation, at least, every three months. I mean, look at this. If you go to Dentaltown, and we have 50 categories, and one of the categories is pediatric dentistry, so, we’ll go to pediatric dentistry, and look at some of the names of these deals. That dentist in Texas that was charged.
Dr. Geoff: I mean it’s certainly alternative to general anesthetics for children, it’s not about that. You can also treat for fissure protection, but they don’t call it fissure sealing they call it fissure protection. If the kid’s got a small endo proximal lesion, what you do is you do actually put phosphoric acid on the teeth to clean it.
Howard: Look at this thread. Another death, and this thread is 7 pages long. I mean every time you turn around, there’s another one. Another death, another death, I mean. Megyn Kelly reports on sedation deaths. So, have you heard of Megyn Kelly? She’s a big famous journalist, and she did a whole story on kids dying at the dentist. And the thing is that you shouldn’t die from having a cavity when you’re 2 years old, and some of my mentors like my mentor which I really wish you would meet, Janet Mclean who’s a pediatric dentist in Phoenix, Arizona where I lived. She made the cover of the New York times talking about that. One in two use a silver diamond fluoride this is someone you should put your product on her hands. She’s got articles on Dentaltown but I think you guys should meet.
Dr. Geoff: Alright
Howard: So, thank you for all you do for dentistry, alright.
Dr. Geoff: Well it’s a high five isn’t it?
Dr. Geoff: Hello, my name is Geoff Knight and I’m a General Dental Practitioner from Melbourne. Dental implants play an important role in restorative dentistry. However, over the years, many patients have asked me if there are simpler, less invasive, and less costly alternatives. Following bridging technique has unique anchoring system within the enamel of the abutment tooth resulting in a minimally invasive, less costly procedure that provides patients with the same aesthetic and functional outcomes as a dental implant.
This young woman had been uncomfortably wearing a plastic denture for many years and was seeking a more secure replacement. A small restoration which was moved from the mesial of the abutment tooth and incorporated into a T preparation, prepared 2/3 of the way across the lingual surface towards the distal, and about 1.5 mm deep. Mostly, it would be enamel. This graph shows the 3 principles of tooth preparation. Prepare enamel to a depth of about 1.5 mm. The anti-rotation T design stabilizes the pontic and the retainer in three directions, a slightly increased width and depth of the preparation at the margin to enable thickening of the retainer in this area and improve the strength of the bridge at the isthmus. A triple tray impression technique is employed. Heavy body impression paste is placed into the upper and lower sections of the tray and light bodied impression paste over the abutment area. The patient is then asked to close in the centric position once the tray has been inserted. Remove the tray once the impression paste has set. Observe the outline of the preparation within the abutment tooth, about 1.5mm. Shade taking is achieved by photographing a vita shade guide against the abutment tooth and emailing the photograph to the ceramist for color matching. A temporary dressing is placed into the preparation prior to returning the denture and dismissing the patient for ten working days until the prosthesis is ready for insertion.
At the insertion visit, after removal of denture the temporary dressing is carefully removed with a high speed fissure bur. The abutment tooth is then etched for 5 seconds with 37% phosphoric acid and thoroughly washed and dried. The bridge is next tried into the preparation to ensure the good fit of the retainer and that there’s a correct color match of the pontic. The Mylar strip is next inserted on the distal surface of the abutment tooth and a small amount of resin-modified glass ionomer cement is placed into the preparation and on the proximal surface. A small amount of resin-modified glass ionomer cement is placed upon the retainer with no incisors it is sometimes advisable to place a white opaque over the fitting surface the retainer to block out any metal shine through on the labial surface of the abutment tooth. After the bridge has been inserted and gently placed into position, another small increment of resin-modified glass ionomer cement is placed over the retainer followed by small amount of composite resin. Composite resin is further placed into the jaw in between the retainer and the pontic, and a perio probe is used to remove any excess cement from the gingival margin of the proximal surface. The mylar strip is then gently folded over the lingual surface of the retainer and pontic and the patient is asked to close firmly into centric occlusion to achieve the correct positioning of the bridge.
Steps for inserting the indirect internally retained bridge are summarized as follows: Firstly, etch the preparation for 5 seconds, wash and dry. Next, insert a suitable resin-modified glass ionomer cement into the preparation, next, insert the retainer and the pontic, next, cover the retainer with a small amount of composite resin, next, overlay the retainer and the pontic with the mylar strip and have the patient close firmly in centric occlusion. Next, photo cure the labial section for 10 seconds, ask the patient to open, and the photo cure the lingual surface for a further for 10 seconds. Labial contouring is achieved with a [inaudible 1:13:51] tungsten carbide bur underwater spray, the occlusion is then checked in centric, lateral and protrusive movements, and adjusted with a high speed diamond bur under water spray, check the occlusion again and carry out the final contouring with a slow speed diamond sphere to ensure there are no interference on the lingual surface. The bridge is also finally finished using a rubber cup on both the lingual and labial aspects of the tooth.
Proximal surface of the adjacent tooth is checked with dental floss and also to assure that there is no debris on the pontic or against the proximal surface of the abutment. This minimally invasive bridge easily matches the aesthetics of a dental implant. With less clinical time, and laboratory phase involved to make this bridge, dentists can now offer their patient a comparable clinical outcome to a dental implant the substantial savings involve cost and the time involved.
Direct fiber reinforced bridges are a minimally invasive, efficient, and low cost alternative to replacing missing teeth. Every patient presents with a unique clinical challenge, and I’ve specifically chosen these patients to show the wide range of treatment options available with this technique.
The direct fiber reinforced bridge creates happy patients, is a sound practice builder. The upper left canine is a fiber reinforced resin crown, it’ll be used as an abutment tooth, trichloroacetic acid chemically cauterizes the gingival tissues stopping [1:15:34]. An antidote solution with sodium bicarbonate is kept on hand when TCA is being applied. An access cavity is prepared to just over 1.5 mm deep and 1mm wide in the mesial aspect of the abutment tooth. A carbon fiber post, composite post is tried with the preparation proper to the cementation. Fuji bond LC is placed in the cavity and over the post. A fiber reinforced composite resin is placed into the preparation. The carbon fiber post is carefully moved into position with the preparation to form the central core of the pontic. Preparation is light cured for 20 seconds. After cementing the post, Fuji bond is again smeared over the exposed post and a white tint placed to opaque out the black carbon rod. Spot cure for 5 seconds. An increment of New Light F is placed on the carbon rod and kept with [inaudible 1:17:20] around it to form the outer layer in the reinforced core. Cure for 20 seconds. Resin bond is placed over lingual surface of the pontic and abutment tooth and increment of New Life F is placed over lingual. A resin impregnated section of ribbond fiber is placed on the copper resin. The preparation is photo cured for 20 seconds.
A microfill resin is next placed over the lingual surface to cover the fibers. Prior to photo curing a 3cm square section of freezer bag is placed on the uncured resin and the patient asked to close. The facial aspect is spot cured prior to opening and curing the lingual surfaces for a further 20 seconds. The lingual surfaces will only require a slight adjustment to clear the bite. A Triodent sectional matrix is inserted on the pontic core with a concave servers against the abutment. This will form a contour for the gingival floor, stabilizing the matrix with a finger, an increment of capitulated 32 LC is injected under the core and adapted with a plastic instrument. Still holding the matrix in place, the resin-modified glass ionomer cement is photo cured for 20 seconds. Resin-modified glass ionomer cements present a better tissue surface than resin. And micro but is used to place resin bond over the facial surface. An increment of [inaudible 1:19:57] microfluorescent is puddled unto the pontic of the water carver and the matrix is gently pushed into the gingival margins. The area is spot cured for 5 seconds. Bonding resin is placed again. An increment of body shade microfill resin is placed on the pontic and contoured into shape with a water carver. A small amount of white tint is placed into the resin and characterized unto the surface. Spot cure for 5 seconds. The lingual aspect of to the sectional matrix is – away from the pontic. Paper point is gently wedged interproximally in the mylar strip inserted. Position lingually between the pontic and the matrix. With the mylar strip secured, bonding resin is placed over the preparation. An increment incisor shape microfill resin is placed proximal and worked over the incisal edge and unto the lingual matrix. The strip is folded over the facial surface to facilitate the formation of the proximal margin.After spot curing for 5 seconds, the facial and lingual margins are each cured for further 20 seconds. After placing the bonding resin, the proximal area between the abutment and the pontic is formed using increment of incisal shade and formed with a water carver. The whole restoration is now photocured for 20 seconds.
Matrix band is moved with a pair of pliers followed by the paper point prior to finishing. A 12 fluted tungsten carbide bur is used for initial survival contouring. Marked reduction of facial incisal surfaces is carried out the [inaudible 1:23:05]. Lingual contouring is achieved using a high-speed round diamond bur. Lingual contour would be minimal due to prior occlusal adaptation. Final contouring is carried out with a small [inaudible 1:23:46] disc. When the disc is reversed, it can be used for contouring the proximal surfaces of the bridge. Final occlusal adjustments are carried out with articulating paper registering centric, protrusive and lateral movements. It’s essential that all the occlusal interferences are identified and completely removed. A high-speed pear shaped dome provides initial facial contouring. Polishing instruments with a silicon rubber wheel on both facial and lingual surfaces. Proximal finishing is carried out with flexible abrasive strips. Dental floss confirms the absence of any roughness on the proximal and gingival surfaces. A final polish is carried out with a small, fine, soft flex disc. The lingual view shows the reinforcing fiber. Facial view shows the natural contours and gingival adaptation that can be achieved using this construction technique.
I’ve been providing these direct resin bridges now for over 25 years. While nothing worked 100% of the time on 100% of the people, there are many patients that had been very happy to have received one. They are great way to build your practice and a challenge that will enhance your enjoyment as a dental practitioner. If you’d like more information about this technique, there are other videos in the series. I can be contacted on the following email and numbers or check out the website. Thanks for watching the video.
Riva Star, silver fluoride and potassium iodide. Over in the tooth to gain access to the caries, isolate the cavity with either rubber dams or cotton rolls. Remove superficial debris on the surface layer caries with an excavator using a number 3 round slow speed bur. Remove the carious dentine at the dentin-enamel junction and cavity floor. So, as to encircle the caries with sound dentine. Apply [inaudible 1:26:53] 37% phosphoric acid for 5 seconds and wash away with copious amounts of water. Dry, but do not desiccate the preparation. Pierce the floor cover over the gray silver fluoride reservoir using the gray brush. Rotate the brush to push the foil to the side to the reservoir, bend over the brush, and remove the brush from the reservoir. Apply the silver fluoride solution liberally over the cavity preparation. Commence sodium iodide application immediately following silver fluoride application. Pierce the foil over the green potassium iodide reservoir using the green brush. Rotate the brush to push the foil to the sides of the reservoir. Bend over the brush and remove brush from the reservoir. Apply potassium iodide solution liberally over the cavity preparation. Continue applying the potassium iodide solution until the white precipitate solution clears from the preparation. Immediately following potassium iodide application, flush the cavity with water, dry but do not desiccate the preparation. Place a suitable matrix system prior to restoration placement, insert Riva SC or Riva SCHV into the preparation up to the level of the dentin-enamel junction. Prepare a resin modified GIC bonding agent, Riva bond LC. Impregnate the bond into the brush, and commence condensing the glass ionomer cement. Prior to setting the Riva SC, place a suitable composite resin, ice into the preparation, and condense the cavity to slightly overfill the preparation. Light cure the restoration for 40 seconds to enable the exothermic setting reaction of the composite resin to help set the Riva SC. Contour and poise the restoration with suitable rotary instruments completed restoration prior to occlusal adjustments.