Pulp Dental Podcast: Exploring Generational Perspectives, Innovation, and the Future

Hello everyone, and welcome to the very first episode of The Pulp. This is going to be our new podcast, which is hosted by three Andis with a passion for exploring the intersection of dentistry, business, culture, as well as all current events. I'm Ali, and I'm also joined by Dr. Andy Cot and Parsa Shahidi.

Our podcast has a unique backstory that connects us through the Harvard Endodontic program, where Parsa is currently a first-year endodontic resident, one of our young, bright students. Now, 30 years ago to date, I had the honor of being in his shoes as a student in the same program under Dr. Andy Cot's leadership. So, you can say that we've now come full circle, bringing together three generations of endodontists to share our perspectives on clinical and non-clinical aspects in dentistry, and also so much more.

Of course, after my graduation, Dr. Cot remained my mentor and later became a business partner, where we developed a robust line of endodontic products in endodontics over the past 20 years. Today, we're both retired from our previous company, Reendo, and are still active, however, in the field of innovation and education.

This first episode is going to be particularly special because we recorded right after attending and presenting at the Harvard Innovation Day yesterday. It was really an incredible event, celebrating the future of innovation in dentistry, as well as the fact that it gave us the perfect energy to launch this podcast.

Our goal with the podcast is to keep things dynamic and engaging. We'll dive into topics that resonate with dentists, healthcare professionals, and anyone curious about the overlap of science, business, and culture. This isn't really about teeth, as it is really about the larger picture and ideas that are shaping our profession and our world.

Since this is our very first episode, we would love to hear from you. So, what kind of topics are you into and want us to cover? Are there any clinical challenges that you're curious about? Trends in the industry that you'd like us to explore? Or even broader cultural or business topics? Let us know in the comments below and give us some feedback and constructive criticism. We hope to make The Pulp a regular series for you guys, so your input is really appreciated, as it will help us grow and improve as we go along.

Now, with all that said, let's jump into our very first episode. Thank you so much for being here, and let's get started.

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Welcome to The Pulp Podcast, where we take a deep dive into all things dentistry and non-dentistry. I'm joined here with my co-hosts, Dr. Andy Cot and Dr. Parsa Shahidi. Thank you so much for joining me.

My pleasure. Absolutely. This is unique for me. It's so exciting. And so, we're going to be calling this The Pulp Podcast. Is it because of the dental pulp, or is it because we're going to be beating ideas to a pulp?

I'm going to say the dental pulp.

The dental pulp. I love it. I think it's a little bit of both. It bridges the gap, right? A little bit of endodontics, a little bit of real world. I think the idea of three generations is really a wonderful idea because, as I've said to Ali a number of times, Parsa, one generation, you can make, I mean, that's the typical parent with the high school kid, right? But two generations are so amazing. And I'm north of 75. So, is there a maximum limit for a podcast age-wise?

But I remember asking my grandmother, and she, at the time, was 92, 93 years old. I said, "What was the most amazing thing that she had experienced in her lifetime?" She was born in the 1800s, and in a nanosecond, she answered, "It was the airplane." Wow. Think about that for that generation. They never could have imagined flying, not much less flying from, you know, New York City to Rio de Janeiro. So, I'm trying to figure out with my generation, not with his generation, but with your generation, what's the, what's the craziness?

See, that's going to be the one point to me. Is it, is it AI? Is it just the use of the home computer? And yesterday's Innovation Symposium that we all attended in part, participated in, that really blew me away. And I've done a lot of things, so I'm not easily blown away, as you know. But the quality of the presentations that you and your colleagues had as students, and the vision that you had, wasn't just about taking a simple little product and hoping some company would maybe sell it. You're talking about pre-seed round, A round, B round. It was so sophisticated. It was stunning to me. And as I said to Ali, when I woke up this morning, I was thinking, is it the access to information? Is it just the fact that there's five incredibly gifted individuals? Is it a combination of both? I don't really know.

Yeah, it was a great day. And I think it's a great subject to talk about. I mean, with what both you and Dr. Nas have done, setting, setting the stage, paving the path. I mean, it begs the question, what did you, what did you both think of yesterday? Dr. Nas, what did you think?

I thought it was amazing. It was a very great way of putting all of the, installing a new culture of innovation of the school. You know, the school's been going through, uh, transitions. Vic Will is the Dean now for a number of years, a few years now, and he's really done a transformation for the school and has put together a number of new ideas to really change the culture and, and not only increase the academic and research capability of our school, but also to really, uh, instill this culture of innovation. So, I think it's, it's been great putting this thing together yesterday. It was really impressive.

But what is innovation? Before, I mean, we were talking about Innovation Day and so on. What is innovation? And then probably we can take that up to what is dental innovation.

I think dental innovation is, without question, multifaceted. But I think one of the principal things to me, in my background, I've always looked at things in dentistry, dental products, dental techniques, is how can I make that easier to reach a greater majority of dentists?

Yeah, yeah, totally. And I think it's about, we talk a lot about this day-to-day in the endo clinic. But I think it's about convenience. And we touched on this the other night, uh, at the dinner before the Innovation Symposium. I think, um, when there is a need from the people to make something just a little bit more seamless, a little bit more fluid, save them time, save them money, the demand will kind of generate itself within dentistry, within medicine. But you asked the question, Dr. Nas, so what is innovation? To me, um, you have to be solving a problem that matters to somebody. To me, that's a definition of innovation.

How, how do you look at it? I mean, it starts with an idea, and that idea is solving a problem. So, for us, it is, you know, we, we go through a number of procedures, we're dealing with diseases. There are a number of steps in which the problems are posed. And the innovative mind is one that is open enough to see the problem, identify the problem, look at the current solutions, and then offer perhaps then new ones. That's why we've always said that the combination of curiosity, creativity, and critical thinking is important for anything innovative. And, um, it does start with a problem, and it always ends with, uh, I love that quote from, um, Linus Pauling, that was kind of talked about, is that, you know, the best way to come up with good ideas is to come up with lots of ideas and then throw out the bad ones. You know, sift away.

That's right. So, I ask you both, Dr. Nas, Dr. Cot, if, you know, giving advice to somebody younger, um, maybe they haven't decided what career path to go on. Is it dentistry? Is it medicine? Is it engineering? Is it, um, communications? If they find that they, you know, they really feel like they're an innovative person, they're an innovator at heart, would you, would you tell them to go down the path of dentistry?

For the young, young listeners out there, that's a really tough question. I think for me, never having children, and I've always thought about what a problem it is for parents. You have a young person, a young daughter, young son, and maybe you have your own frustrations, like, "I wish I was a physician," or "I wish I was an architect." How do you prevent yourself from layering that on top of your child? And, and I think for children to find themselves really takes some serious adult parenting to be able to do that. I think for people, whether I should go to dental school, engineering, I think one of the aspects is kind of passion-oriented. And, and I think when people talk about, well, we don't generally grow up as a young kid having an enormous passion about dentistry. But surprisingly, there are a number of people. My generation, when we applied to dental school, the question everybody asked, "How come you're applying to dental school?" Probably 50% had to relate, was related to orthodontic experiences. You know, I went to the orthodontist, there were like 12 people in the office and just one doctor. I thought that was pretty cool, the way they, you know, delegated authority. So, I, I think coming to that decision of why I'm going to go to dental school versus medical school or nursing school or something, that I think that's not an easy question.

Yeah. What do you think, Dr. Nas?

Well, in terms of deciding what to do, I'm, I'm, passion is important. But the real question is always for me being, how do you develop passion for something? And the idea's always been historically through Hollywood movies, is that you have a passion for something, and therefore you do it. It's kind of like, you know, passion comes first, and then you do it, right? I've always had the opposite philosophy in that I feel like passion can be developed through mastery. When you learn a field or in an area and you become an expert at it, and you become good at it, then you actually develop a passion for it because you then get good at it. But if you have passion for something and you start it and you don't really get good at it, it's very easy to lose that passion very quickly. So, I feel the mastery comes before passion, as far as I'm concerned. But I mean, obviously, I could be wrong.

Is that passion, or is that confidence? Confidence does help improve it. It's like a feedback loop, doesn't it? That, you know, passion, confidence through mastery increases passion. People like to do things that they're successful at, right? So, if you're a golfer and you're constantly four-putting on greens, all of a sudden your passion for golf decreases. And you can graph that. You can graph that. And I think it's about exposure. I mean, me, I, I kind of take a philosophy a little bit adjacent to what you guys say, but I, but I totally agree. I think the more you are exposed to things, I think you, you know, you get the chance to be either good or maybe bad at certain things. I mean, you're growing up, what are your favorite subjects? What are, what are your favorite sports? What are your hobbies? You tend to like the ones you're good at. And then I think, you know, being in the presence of philosophers here, Chris Williamson, he's a great modern-day philosopher. He talks about how people shouldn't necessarily be, um, you know, doing what they're passionate about because it may not yield their best lifestyle or best, you know, successful, their most successful outcome. But mostly, they should be doing things that they believe that they're best at because through that experience and through that, you know, through the trials and tribulations of any career path, you get to be at a point where you're so good at what you're doing, and then your life is ultimately fulfilled. And, I mean, it's a tough question, especially when it comes to, you know, telling young people what to do about dentistry and our career path.

Well, let me ask you, as the youngest person here, what is the future of dentistry, according to you? Where do you see it going?

That puts me on the spot. A tough question. No, because you guys, you guys have innovated. So, let me, let me, let me just give you a little bit of a circumferential thing here. Before I say that, I was so blown away yesterday by you and your colleagues. And I'm thinking again, what they're presenting, and I realized they were great graphics, and probably they were professionally done, but it was the thinking and the vision and this energy to take it through these rounds. It's not easy to do what you were doing. That is so out of the league of my generation. And I'm trying to think generationally. And I'm going to throw it to Ali. What, what is the genesis here that's resulting in having so many? How many people did you have? Think you had eight, maybe eight students?

Yeah. But is that what it is? Eight, eight student innovators? Explain this to the audience too.

That this Innovation Day involved giving a number of lectures and presentations involving, um, you know, experts in the field in terms of IP management and some of the legal leads, but then also had in the afternoon, um, product developers and people who have done things historically, as well as a number of student dental students who were in the kind of idea and innovation, uh, kind of field and had come up with ideas while in dental school. So, they kind of did a little pitch of their ideas. And that's what you're talking about being so impressive with their presentation of the ideas.

How did they, study while the genesis of them? Those people doing what you didn't do and I didn't do? Yeah, I couldn't have done it, to be honest. I was too busy at the school with the studying. What's amazing to me, I think part of the question, I mean, maybe it's a three-fold answer to me. Part of it is the ecosystem we're in. As it, like, you know, in the current day and age, the way that things are presented to us on social media, the way things are marketed, what's, what's sexy, what's attractive. Well, you know, being a tech, being an innovator, having that lifestyle is an attractive, um, path for a lot of young people. And so then when you're making a decision to go into medicine or dentistry or one of these professional fields, you try to find a way to bridge the gap. And so, you know, some people have different pathways. But I think that, that social media has played a big, big role in sort of the way that we think and the way that we want to, you know, we want our lives to look. So maybe my day-to-day in 10 years doesn't look like five or six days of clinical practice. It looks like two and a half days or three days of clinical practice and two days of full-time technology development. Who knows?

And, and I, the second part of it is, I think that, um, people who are innovators are, are wired to want to impact the world in a special way. I mean, we can, we can innovate in sort of all different categories, but if you want to, you can choose to impact the world on a global scale. So, for example, what you guys have done, uh, with innovating technologies in the endodontic field, 30 million cases. I mean, how does that make you feel? That's why you do it, right? And that's, that's a wonderful thing for all of us here. And I have a question. I'm going to ask you, and I know you're going to give me an honest answer. Do you like it when people tell you what to do?

I'm okay with that. Yeah. But I don't particularly like having people tell me what to do.

Interesting. So, you're seeing that that's the spirit of innovation, that idea of the contrary and independent minded. I mean, in a sense, that's the entrepreneur's mind. Is it? Never thought if you haven't planned it, it's like, if I'm going to crash, it's me, right? So, the thing for me, I, I think there is a part of the inherent personality that you want to do things your way, and you're confident in your intellect and your ability to get things done. I, I'm seeing that and saying that as a positive.

Yeah, yeah. That's interesting. I mean, people temperamentally gravitate towards different things based on how they, they, they are. So, that's kind of deterministic in some. I'm not talking about family people telling you what to do, but, but it's about sort of the question that you asked, Dr. Cot, is kind of like something that we discussed yesterday at the Harvard Innovation Day, which was, you know, are you an entrepreneur or an intrapreneur? So, are you going to, you know, we had a talk at the end, uh, about, do you, do you feel like you can be an asset to the team, and you, you are, you know, technically or clinically or in whatever capacity motivated and also talented and impactful, or do you really want to be the helm? Do you want to be the leader? And that's the question to me, you're asking. I, I feel when you look at the people like Elon Musk, and we talk about him all the time, I think he's willing to go to any extent to find a solution and a pathway because it has to be done his way. So, he doesn't like being told what to do. I mean, it's a great example, I think, right?

I like the helm. I'm assuming you like the helm. I, maybe a possible moderate about things. I don't know you as well as I know Dr. Nas, but I'm, I'm thinking that you're a person like, "See me at the helm." Meet me at the helm.

Well, I hope that's a good thing. I mean, the world needs a good balance. I mean, what, what do you both think is now having done a lot of that stuff and now trying to give back to our younger generation, to people like me? What do you think when you're trying to teach people who have ambition, but, you know, they, they need to be coachable? And I want to sort of play devil's advocate on myself. I hope that I'm coachable, but I think that's like an important thing. What, what do you think about that? Whether people are coachable or not?

So, you're saying, are people inherently able to do some things, or some things teachable to them?

Well, what I'm saying is, you know, certain people who, let's say, are innovators or entrepreneurs who like, you know, being in control, do you find them to typically be coachable or teachable? Let's say, I'll give them my opinion on that.

Yeah, having lived in Japan for nine years, the Japanese are really unique in being able to Japanize things. They'll take stuff from Western culture and they'll precipitate out what they want to take, and the rest of it they discard. They discard as garbage. Yeah. And I think when you have the old, "Do it this way, Parsa. Wait a second. It's great to be professional, great to be respectful, but a lot of the stuff you may have to throw out the window. But there may be one or two things that you could take." And I think there's, I think that's an attitude. Is when someone's offering you consult or help or advice, you don't feel guilty that you're not listening to everything they say, right? Take, take the one or two, as people like to say, "gems," pearls. Take the one or two pearls out of that conversation, be respectful, and make it work for you. Sure. That's a critical thing. And what Andy said is actually the do-saying is, you know, "When the student's ready, the teacher will appear." And it is very much possible that it is the case that these types of people, the entrepreneurs, as Andy said, they will listen to you, but they'll hear what they want to hear. Yeah. And you, that's, that's essentially that's the quintessential teenager's mind. It's true.

But yesterday, Dr. Fella, who who's a big visionary in our space, he talked about this graph of, you know, wisdom and energy. And I've had this conversation with my dad a lot of times because I really do value the wisdom and experiences people get. And I think, you know, what's a better, what's the best way to to learn anything? Experience. He talked about that. But, but, but I guess don't you find there to be more value in the experiences, for example, that you both have collected? Doesn't that supersede, let's say, as a young person, what I hope and what I think can happen because I've, you know, maybe I've never done it before? So, so maybe I take a couple pearls, but really I should be taking everything at face value because you've done it.

I think, I think the most applicable thing to different generations is interpersonal relationships, things like that. But technology changes. You know, so think about somebody who grew up only having a bicycle or or a horse. How, how can somebody then speaking about a car or something? There's so many differences. I think in when people are really well-intentioned giving advice, my experience as a person older than you, so much of my experience is so completely different than what you had. But in terms of human nature, in terms of conducting yourself, anticipating things, you know, setting a certain vision and working that minefield, which is humanity, that is kind of universal and applies. Sure. Talking about technology, things, there's very little that I can say to you that really is going to register on your radar. But talking about how to present, how to interact with people, how to structure things going forward, that part, which is not product-based, there's something to be gleaned from what I have to say. Yeah.

Yeah. Also, if I could add, you know, like the hero's journey, if you will, you know, in a Jungian way. You know, you don't have to have the exact same set, you don't have to have the exact journey, but there are applications of the broader concepts along the way that apply. That's why we like myths and we listen to stories from the past, is because there are lessons to be learned from all along. And for example, listening to Dr. Sam Lynch's journey yesterday, in terms of the trials and tribulations that he went through through getting his company finally, get through the FDA and all that. I mean, we may not go through that scale of a problem, right? But you're going to have challenges, and you're going to realize what he had to face, which was an extinction event for his company that depended on the vote of a single person. And, you know, it's just kind of, it puts things in perspective because all of us are going to have to face challenges, and we come to a point of making a decision as to, should we give up? Should we continue? Right? And it doesn't have to be the same scale. Sometimes it's just, you know, these are all microcosms or bigger pictures. And I said something yesterday which has really kind of affected my career path, and I was having lived in Asia, and especially particularly in Japan, remember when I said, "The more sophisticated something is, the more simple." Yes. I really believe that because if you're really trying the teeth me methodology or trying to have develop products that are going to be really successful, I think that's really a sound principle to go with. Yeah.

Uh, and I think, you know, people, I think there's a tendency, you see it in lecturing, you see it in some products, where people go and try to impress somebody. "I've got five different buttons doing 10 different things." I'd be much more impressed if you had one button doing 10 different things, right?

I, it's funny, my brother always tells me, "It's really easy to make things difficult, but really difficult to make things easy." Absolutely. And you, you both talked about it yesterday. There's the elegance and simplicity. But, you know, I think, I think for maybe, let's say, younger listeners out there who are thinking about dentistry or thinking about endodontics or any specialty in medicine, and what, what they're going to do, I think whoever controls the data controls the future. Which means that people with more wisdom, people with more experience, have that data, have that knowledge. When you look into the future of our field, do you feel that there's going to be a shift in the sense that the level of advancement for the next generation, or perhaps even my generation of innovators in this space, is going to supersede the rate that's ever happened before? So, every year, the number of new innovations and technologies that are coming out are going to be so much larger than ever before because of the access to technology we have? Or do you think it's really a, it's really a function of the people and their willingness to want to innovate?

So, to simplify the question, because it kind of, it was, it was a long one. Do you think that there will be more technology that is changing the field of endodontics or dentistry every year relative to 20 years ago?

That's a good question. I, I, I, I think the biggest concern for me is kind of losing focus of that it's patient-based. And what, what I mean by that is that certainly with the AAE and Endodontics, things the last three years have become very much on a, on a cycle, on a rush to new technologies, whether it's laser, whether it's ultrasound, sonics, all kinds of stuff. Everything's being driven by technology. Let's not forget, at the end of the day, we're working on a patient. And at what point is technology going to supersede that personal aspect of the, uh, of the doctor doing no harm and working and trying to do the best practices for the person sitting in the chair? So, what I'm trying to really figure out is, are we going to see more technicians? Are we going to see more dentists? I, I think everybody says, well, it's going to go the way of medicine, having more allied, you know, health technicians doing things. I'm not 100% certain about that. But I think getting a handle on how we use it. It's not just technology, it's material science. How we knew all this, how we basically take the new technology and somehow able to couple it with evidence-based principles. I'm not talking about old fism, right? I'm talking about true evidence-based principles. And right now, I have, I've seen very little, in my opinion, of combining that principle with latest technologies. And there's a bunch of new technologies. Somebody wise I know that's witty, uh, I often quote is, you know, she said, "Don't worship at the altar of technology." And I think that's really an important and impactful statement.

It is very much layered. I mean, I always look at technology as, what is the value proposition? What is it that we are actually getting out of this thing? And it goes back to something I always often times talk to my son about, as like, you know, the, your biggest, uh, challenge in the world and the, you know, is going to be differentiating substance from style. And so many people are actually picking up technology just as an addition to style, or just like they want to be a part of it. It's a FOMO, it's like fear of missing out. What if other people are doing it and I don't have it? I want to buy this piece of technology because everybody else has it. And if I don't have it, my, you know, my patients or my referral sources are going to think that I'm inferior somehow, right? And that, to me, is really, you know, it's a form of accelerationism that causes you buying technology and increase, like, you know, hype up the value of different products without really any merit, because that's just, that's not real merit. The downside of that is that by investing into technology for the sake of technology, as opposed to technology for the sake of progress, which I always say, you know, change for the sake of change versus change for the sake of progress, is that you're increasing the cost of care. And that's the negative component of that. You're looking cool, you might be marketing yourself, but you're marketing yourself at a cost, at a patient. And I don't know if that's really ethically a viable place to be. I feel like we need to kind of focus on reducing the cost of care to what, you know, we talked about yesterday, minimal viable product, you know, that it's actually working for the patient, you're getting the results of what the patient wants. And often times, I feel like, you know, we put our own needs ahead of that of the patient. And that's when we end up going off track. I mean, I don't know, what, what, what do you guys, what, Dr. Nas?

That was exactly my next comment. Beat me to it. Uh, about about the access to care, the cost of care. When I graduated from the endodontic program, I used to do a newsletter for the, uh, University of Pennsylvania Endodontic Department called The File and Reamer. And, you know, I would, I would do all the photography, I'd write all the articles, do all that stuff. And then LD Cork, which is a division of Dentsply in Delaware, would actually publish it for free for us, which was wonderful. So, I had a version completely on microsurgery because at the time, Penn was light years ahead of other endodontic programs in terms of the whole microsurgery thing. So, I came back up to Boston to, uh, re, reinstitute my Massachusetts license, reactivate it. And I'm there with the individual who was the chief examiner, who was an oral surgeon. So, as I'm speaking to him and just kind of, you know, chatting, I show him the File and Reamer. Fully expecting that he's going to be incredibly impressed. So, he takes my newsletter and he throws it across the table. And he goes, "Why do you need to have a microscope to do an apico?" I mean, I've done apicos and things. And he goes, "What are you doing to the cost of care?" And I'm thinking, like, "Oh my gosh, I'm not going to get my license reactivated." And then he says, "Welcome back." I ended up over time developing a wonderful relationship with that man, Walter Glick. He was an amazing gentleman. But Walter, who was very involved with the GEND, that's, I believe, with Delta Dental. One of Walter's concerns, I think, is very legitimate. And that's what Ali and I are talking about. We're all for the good technology, good material science, but where does this ultimately end in terms of cost of treatment? And most importantly, access to care. As I said to you the other night, if you go to the ADA, yeah, and you take a look at how many people are not just partially edentulous, fully edentulous in this country over the age of 65, it's stunning. It's, you know, I don't know anybody who's completely edentulous, fully edentulous. You probably don't, and I'm expecting you don't either. But when you see the statistics, it's like, gosh, that's another part of America I'm totally not in touch with, right?

But, and I totally agree with what you guys are saying. But just, just one maybe counterpoint is, you know, to go back on what we learned from our family, "Don't do it, or do it right." Something that my dad always tells me. And so, the question is, what is right and what is wrong? And so, we talk about access to care, we talk about the cost. But if we know we can deliver better patient care through implementing XYZ technologies, but it drives the cost up, and this is a really great talking point here. Because in my perspective, whatever it takes to improve the patient outcome, improve the patient experience, improve patient care, I want to deliver my best ability to give that to my patients. Perhaps if it drives a price up, it's a price to pay for the better experience. What, what do you think about that?

What's the, uh, 10-year success rate in a really high-quality endodontic practice?

Now, over 90%.

Well, yeah, that's kind of a broad thing. We're looking for something more specific. What's the number?

Well, I mean, depending on the definition of success, you can't achieve 97, 95, 97% success rate.

So, what was the success rate of endodontics in 1978?

That's right. I mean, the 1978, which was based on a 1953 study, which is the Engle study, was 94%.

94 and a half percent. I think what Andy is basically getting at is that this, what you just said, is actually not what we're saying. The, what I said is that the value proposition, if something is better, then the technology is worth it, okay? The question here is, what is the value proposition? And also, what I mentioned between the difference between substance and style. Substance means that it's better. Style means that it is perceived as better, which is a different story, right? So, in order to know something is actually better, you really have to do, you know, some type of a long-term, uh, longitudinal, controlled, controlled across a few different institutions with adequate recall to find out if something is actually better or not. But today, because we live in an era where information is just propagated through social media, it's just enough to say something and said with enough confidence.

But, but Dr. Cot, I see, I see your point. I, I think that sometimes, I think with innovation and technology, especially with a new wave of technology, we don't know what we're missing. So, maybe while there's 95, 97% success rate, uh, in our, in our industry, and it's a great plug for endodontics, by the way, and to save teeth, but, and of course, we know the value of that. But I think sometimes along that, you know, there's a feedback loop. People don't know where their experience could be optimized. Right? So, for example, in the, in the spirit of talk about information, there might, you know, there might be a higher success rate in endodontics without any physical improvement in technology, but simply better communication with our patients. A lot of patients who might opt for implants might be better candidates for root canal therapy. And that 95% might go up to 98%. And I think that there's ways to innovate in technology that maybe is introducing new information and new ideologies that maybe never existed, you know, 20 years ago. Did anyone really think AI would get to this point in medicine? I, I don't believe that's the case. And I think it was hard to predict that. And, and I think that adds an element that maybe we never thought about. I mean, what, let's talk about that. What do you think about, you know, what AI and and computer software can do to our space?

To me, I think the big, let me just go back to my 50 plus years in dentistry. I, I've seen three big changes. The first big change I saw in dentistry was non-metallic dentistry. When I went to dental school, it was silicate, right? And when resins came out, and the first real commercial resin was Adaptic, and they had, you know, this red and blue dish that was a big, big deal. And then when Niel, Nua, Seil, which is the first light-cured resin material came out, that was startling. Like, "Don't look at the light, you'll never have any babies," that kind of thing, right? So, non-metallic dentistry was the first big change. The second big change to me were dental implants, particularly in edentulous people where years ago, we could put a couple of fixtures in, put a bar on it, now you had stability on your lower denture, you can make a full denture that you have to like, really try to get it out of a patient's head. If it loosens up, you can re-in. Maxillary edentulous is generally a pretty straightforward, but mandibular edentulous is a problem, particularly in terms of stability. But I thought implants were a Godsend. The third change, this is very personal to me, was the introduction of nickel-titanium rotary files. Because nickel-titanium rotary files, any system can give you shaping that we could only have dreamed about when we're doing hand filing cases. So, I've seen that. And in terms of kind of again, precipitating it down, just the endodontics, the biggest change for me in terms of technology, in terms of clinical, uh, performance, the biggest change to me was the crown-down. I think, I think Steve Montgomery's concept that we're doing it backwards, you know, taking a number 10 K file and fighting all the way to the end of the root instead of doing the, as opposed to doing a crown-down. Crown-down was just incredibly illuminating to endodontics. But in terms of technology, it's not the microscope. There are a lot of endodontists my age, or let's say younger, like 60, they're doing root canals, microscopes in the closet, and they're using loops, right? Obviously, people like Dr. Nas, younger people, they're using the microscope for everything. But they're still doing quality root canals, pulling the microscope over to the lab in a surgery when they need it. So, the thing to me that was the biggest change, I think in endodontic technology, is cone beam.

Yeah, I agree 100%. Cone beam changed the entire game in terms of what you can see, how accurate you can see it, how are you going to prevent just destroying a tooth when doing said root canal. Cone beam to me was the really big one.

Yeah. But, but, but to also go back to your point about, you know, changes in technology not just being qualitative, and therefore being legitimate for their application. I agree again, that's not the argument I'm making. I remember yesterday during the lecture with Andy, we were talking about the fact that all change or improvement can be quantified in terms of things being either better, and that's qualitative, higher success rate, or it could be faster, which actually means more efficient. And that also could mean more simpler, right? I mean, simpler is also another big improvement. Those are things that are important qualities that we want to have. So, if you're going to have a more efficient way of doing the same thing, given the same quality, the same, uh, success rate, that is that value proposition, right? And then the third one was to be less expensive, and less expensive. So, these three main factors are all, I'm not saying that the only way that you should manage or implement technology would have to make your quality of your work better. It could improve also your efficiency and simplicity of your operations, and also it could be make the overall rendering of care less expensive. These are all, but so that's why I said value. These are ways to justify that technology. What is the value you're getting out of the money you're spending, as opposed to the potential for it increasing the cost of care to the patient? And if that balances out, right?

Where do you think that balances?

I, I think it could be a generational perspective because I think maybe our, uh, minimum effective dose, or the minimum amount of improvement that we want to see through the use of technology, maybe a lower threshold than for example, you, Dr. Cot, you, Dr. Nas, because, you know, we're willing to give it a shot, and if it moves the needle 2, 3, 4, 5%, let's do it. Maybe other generations think, "Oh, well, I want to improve my workflow by 10, 15, 20%." And I think this is a huge, I, great discussion actually. The generational gap of that. What do you think? Why do you think that is? What is the source of that generational gap that is making you guys more optimistic? Should I say, maybe we're getting all the pessimistic ones? An is that what's? Yeah.

Well, let me just say one thing to say, understand where I'm coming from, uh, as my individual person in my age. I'm a person who has always strongly believed every generation's bigger, brighter, smarter, faster. You see it all the time in athletics, yeah? Okay. And you see it in other things too. And I think in, in technology, there's version one, you're, you're out of the blocks, it's working, you got it. But as you improve in it, and it comes version two or version three, generally it's smaller, better, and in many cases, cheaper. And prior to LORAN A, you used to do shore ranges. But LORAN A would skip offshore. And if you're 30, 40 miles out at sea, there's no signpost. So, LORAN A had some problems. LORAN C, when it came along, was so much more accurate, it was wonderful. But they were big boxes. All of a sudden, it got shrunk down to these little boxes, much, much cheaper, like one quarter of the cost. That gets blown away now, of course, by GPS. So, I, I do think there's something about the evolution of technology. And I think the most difficult part is getting out of the blocks. Yeah, getting it accepted. But I, I do think that if someone's an entrepreneur, taking things forward, I do think it's not just public pressure. I think it's kind of what maybe what you should try to achieve, developing products that ultimately, you don't want it to be this big with this price tag. You want it to be this big with a little bit less price tag that allows more people to use it. Yeah.

So, hold on. I don't want him to get off easy with this. He asked, he didn't answer my question yet. What is the, what is that generational gap? What is, what do you think is the impetus or the spirit behind behind?

It's a good question, Dr. Nas. But, and I think, at the beginning, Dr. Cot, you said something interesting, which was, you know, why is it that yesterday at the Harvard Innovation Symposium, we saw people more engaged, more technologically advanced? Where are they coming up with these things? And you talked about access to information. So, Dr. Nas, when you say, why do you think that, let's say, my generation might want to implement a technology when it only moves the needle 3, 4, 5% versus 10 or 20% as an example?

I think it's because we look at that ROI in a different way. Like, well, what do I need to do in order to actually try this technology and implement it? My access to information and technological skills are so, you know, immense that I have no, uh, I have not much to lose by actually trying to do this. And my pathway of getting things done is easier. So, if I want to implement a new form of, you know, um, software into my clinical workflow, it might take me an hour to actually read about it, learn all there is to know about it, how it can fix just the problems that I have, and then even download it. Versus 20 years ago, if I want to implement a new, uh, practice management, I won't say software, but a tool, I have to invite the rep. I have to have a sit-down meeting with him. I have to invite him to come from his hometown. The burden is higher. And so, in our generation, we look at things, well, there's not much to lose here. Let's give it a shot. And I, I mean, I think also when you couple that with in an environment with people who are, uh, you know, wired to try new things, you have that combination of like, kind of quick workflows, quick technology implementation. But, I mean, it's a good question to ask you both. When, as innovators in this space, which I think is often times dominated by people who are not willing to change, they're reluctant to change, how did you convince them that there is actually room to innovate when things were working well and things were working great? There's no need to change.

I, I think one of the things, if you're talking specifically kind of about what we did over the last 20, 21 years, Real World Endo, basically we led with education. So, just having a product come out and have a product is one thing, but if you lead with education of how you're going to be able to use this product, the multiple uses that you can get, maybe you didn't realize there was only one application, but there's four other ways you can use this product. I think leading by education has always been a staple of what we've tried to do at Real World Endo.

Yeah, it sure has been. I mean, as you said, though, I mean, the difference is information. Education is about sharing of information. And, um, so, you know, it's a concept of giving him a fish versus teach him how to fish. So, I think that was really the impetus behind it. Although I think nowadays, the, what I see also as a difference as you mentioned in generationally is the fact that we are increasingly accelerating into

In an Information Age, you guys are constantly being bombarded with information. I don't know if the competition is higher to that extent where you could make an argument that the incremental improvement in success, a couple of percentages here and there, is the, you know, athletic edge that people talk about. So having the edge in order to improve, I'm just thinking that the edge is more on the marketing side than on the, um, real side. I don't know.

You truly, yeah. And and so for me personally, the one thing that I always tried to do when I do a hands-on component, which is, uh, for those who are not endodontists, that's a big aspect of endodontics. And I think there's a whole different conversation about how effective can webinar-based CE be. Endodontics is a specialty where you can't see what you're doing, okay? And one of the things I'm, I'm, I'm telling, uh, people your age, Parker, is that when you're a referring dentist and you refer a dentist to the endodontist, when they come back, you know what the first question the general dentist always asks? What's that? Always. There's no exception. "How did you like Dr. Parker?" Or do, "Dr. Nasi, Dr. Kotch?" They don't say, "Where did Dr. Nasi fill? Where did the GA per end? Was it a millimeter shorter? The radiographic terminus?" No, that, that, that doesn't even enter into the equation. The equation always is, "How did you like Dr. Brown, Dr. Nasi, Dr. Kotch, whatever?" So there's very much a personal component to treating that. And and what I did for me, what I thought was an opportunity for me to separate, give me a little bit of a, a differential, I make the hands-on really personal. I, I sit down, I'm putting my finger, "Put your finger here," and I put my finger there. And as I mentioned to the group yesterday, no one leaves until you work with me one-on-one. You look at me eye to eye and do an endodontic procedure. Very few people do that. They have other things that they do, which is fine. But for me, that was kind of my calling card is that I'm taking it personal.

And, um, that's just the way it is. And I think one of the things that's also, that's why it was interesting for me when speaking to some of the presenters yesterday, uh, with Sam and with, uh, Dr. Griffin, when people criticize things and, and develop the product, it's personal. Yeah, right. It is, right. And so I, that's just, that's just part of the human nature aspect of it. But as a sidebar, the one thing with your generation that has amazed me working with some different people a couple years ago on some different, you know, kind of, you know, startup type of technology things, um, all those questions about wanting to pick my brain, I thought was very flattering. But I thought it was a lot of basically, right then, as I started to meet some people, well, your generation is really interesting. I think your generation really does want to learn from previous generations and it's making a decided effort doing that. So I'm really, really impressed with your generation that when they're speaking to people, it's not a BS thing. They actually really want to learn, "What's Andy? What's making your mind tick in the way it is ticking?" Yeah. Uh, I'm, I'm very impressed with that. That you guys really genuinely, I think as a generation, seem sincere. Although, I mean, I want, I want to, 'cause I have done videos on generalizations and things like that, want to say that the, you know, it's a bias sample too. Don't forget, we're at the Innovation Day, so we're having innovators. So I don't know if I speak for the whole of the generation, but the people I, obviously, I've met with trying to get ideas, trying to generate, but I, I like, I like that ability. I thought that was terrific. And again, I thought for the first, for the longest while, thought, "This is just some kind of story, some kind of BS." But I realized, "Gosh, these guys are actually genuinely interested." They're not going to listen to what I say, which is okay, but they're generally interested in listening to what I have to say. Yeah.

And, and I think it, it makes me think about, you know, you're talking about information and leading with education. Dr. Nasi, you asked us, "Why would our generation try things and try these technologies?" And, and I, I wanted to ask you a question, like, as an example, um, if, if you sent an email that was semi-important to you to someone in your exact age demographic, in your exact age demographic, Dr. Kotch, and in my age demographic, what is your expectation on response time? I think this question is pretty simple, and I think it speaks volumes to our, our, uh, technological obsession, right? So I'll let you answer it, and then maybe I can answer last for, for dramatic emphasis. But I'll let, let you guys go first.

I'm, I'm very disappointed in all generations in terms of their response on, um, your, your generation is a text generation. My generation is like, "Pick up the damn phone." Right? Right. And, and I don't think I'm the only person who feels that way. But for my generation, it is talking. It's like, as I mentioned yesterday, and I think maybe you had mentioned it, but some other people mentioned it, I said something about when you're working with a team or or even just one partner, when you meet in person, yeah, 1 plus 1 equals five. It's so much more productive than having a call or having even a Zoom event. Yeah, yeah. No, I like that. What do you think? To put a number on it, would you say if you sent them, you know, an email or a text where, where, you know, 30 minutes, two hours, a day, two days, a week, uh, within 24 hours? 24 hours. Okay. I guess I, I don't have expectations. I kind of realize that everybody's going to operate based on their own thing. There's people that have productivity rules and things follow that. I must say, how I myself have evolved. I used to be like, "It has, has to be responded within 3 minutes." So I'd be at a red light responding back to things. But I've calmed down a little bit since, I guess, because that's come at an expense on the family side of things, like, "The heck are you doing? We're at the dinner table."

My experience has been, the women text far much more than that. Men really? Yeah, I think that's true. But, but I think the reason I asked that question is because, you know, I think every generation should be judging itself. If I, you know, and I don't want to be, uh, judgmental of age groups, and I'm not, but I think like if I, if I am emailing or texting someone in my age generation, I know that they're, uh, probably going to see their phone because they're dependent on it or they're checking their email. So if I don't have a response then within an hour, I, I start to question, you know, how, how motivated are they? How, how, uh, dedicated are they to this task? And of course, things come up. But this is a generalization to say, you know, we really depend on technology to be efficient. And I think maybe that's a bad thing, right? So when I, when I talk to other generations, I talk to my dad about it, you know, I, I, I'm reminded about the beauty of patience. And I think that's maybe something our generation lacks. Um, you know, I, I actually prefer calling Dr. Kotch because you, you have a conversation. I'm all about that. But it's, it's immediate, right? Um, and so I don't know. What do you think about patience?

I like the beauty of patience. But let me just share a couple of things with you about growing older, okay? Um, when you're in your 60s, someone's 62, your lady is 63, 63 is 64, it's kind of like a chronological aging. But when you get into your 70s, uh, you can age like from 70 to 71, 71 to 72, 72 to 73 is like five years. So it all almost becomes like dog years. So it's, it's a very erratic, uh, it's, it's not a continual type of aging going to your 70s. One of the problems is, is you're talking about answering the phone within like, you know, I give an hour. First of all, finding the phone, right? A lot of people, you know, it's like, "Where did I put the phone?" Right? So as you get older, it's terrible. Those things start to creep in like, "What? Where did I put my phone?" And then, of course, eyesight is diminished. So where is it? Everything's black. Everybody, I, you know, the boxes are black, the suitcases are black, the sweat is black. So sometimes for people of my age, it really is a little bit of a challenge jumping on the phone. We don't carry the phone all the time. Uh, and I realized again, for me, this is my grandmother's airplane to me. It's amazing to me that we have grown and evolved into society where you have to have a phone. Yeah. If you don't have the cell phone on you, you're out of commission. You're out of commission. Yeah, that's a huge cultural change to make. Sure is.

And, and for better or worse, obviously, it's improved our communication, ability to communicate. But I feel like it points for over-communicating or, as you said, there is now a burden on your back in terms of response time. And that's not necessarily healthy, right? Because I mean, if you, and you know, if you spend too much time on this stuff, then then you become, you know, you end up having these digital addiction things. I managed to, you know, because I think I got on this very early on with the digital stuff and the social media and the sharing, and I had really, really intense habits of spending way too much time doing this stuff. Fairly quickly, I learned just through experience that this is not sustainable. It's not healthy. And it's probably not as productive. So my digital habits have changed dramatically over the past three to five years, I would say, probably the past five years. Hardly, you know, I just go on there, post, and don't do much else. I feel like it just opens up your time to do more productive thinking because digital media could be a place where you go on to either, you know, get a healthy diet and eat well, or go in there and just eat a bunch of junk food. I think the combination could, you know, making that decision as to which one you're going to consume is, you know, every one of us needs some kind of information diet. I think.

Are you by nature a binger?

Depends on the product. 'Cause I, I was in an elevator yesterday and there were two young women, and then one young woman said to the other woman, "What time did you go to bed last night?" "I got to bed at 4:00. I was binging Netflix." Right? So the girl was, was tired. So when you say, but when you were doing all this, your initial foray into all this social media, are you a kind of person? Are you a binger?

So I'm not impulsive in that sense of like, you know, having an addictive personality. No, I'm not. I could moderate it. But, but on Netflix side, if I do run into a, you know, a series and I have a problem with the fact, I mean, everyone's guilty. Oh my God. I mean, I, I could sit there and it could just like ruin a whole week of mine. And I could be till 3 in the morning. I don't even have Netflix. Oh, wow. For you, what I have, I have, uh, Hockey Central. So instead of, I guess I'm binging on ice hockey games. Right? No, that's also, that's, you know, that's part of it. I mean, I, I think though, you know, everything is good in moderation. You know, obviously, Dr. Nasi, you're, you're the radical moderate. But, but, but I think, but I think when we're bringing the conversation back a little bit to our profession, you know, when you talk to a lot of young people thinking about how do they make a name for themselves, how do they make a career successful in the space, how do they set themselves apart? You have no choice but to really think about social media and think about how you can truly represent yourself in the best way. And so, you know, I have a lot of colleagues, a lot of friends who, you know, want to make professional Instagrams, want to make a professional, you know, TikTok. And, you know, source subject, come, come tomorrow. But I, I think there's an inflection point happening where if you do not, uh, you know, have a presence on social media, if you don't actually, uh, use it to get some information, stay up to date with the most current events, you are really at a disadvantage. And I think our profession is one of those where that's a true reality. And I don't know how, you know, as specialists, we might have a, a larger referrer base than, um, someone who is on social media in the next, you know, year.

Let me ask a question. I, I think, and I think you'll probably agree, I think in terms of the print media, in terms of magazines, I, I think the magazine that over the last two decades was the best magazine for delivering endodontic technique articles, things that was probably Dentistry Today. Would you agree on that? For like a, for general kind of like a, you know, social type of a thing? Yeah, I mean, not very academic, but yeah, absolutely. Not academic, but, you know, product-related, new files, new operation techniques. Are you and your classmates, do you guys actually read much of the print media in terms of magazines?

Um, I, I don't want to generalize, but I think, but I think no. I think to be completely clear, no. I think that's what it is. It's about news absorption. And news, like, where are you getting your information? If I don't, you know, we were talking about X, you know, the other week with our co-residents and Dr. Nasi. And, you know, I, I really look at X, for example, as a way to absorb information and find things in real time. So we were saying, you know, I was walking down Boon Street and then I went into my apartment building and I heard a huge, you know, boom, bang. And I was like, you know, what's going on? Nobody knew it was going on. And, you know, the internet is not going to be populated with an article within a minute. So I went to X, I went to Twitter, and I searched up, you know, Boston or Boon Street, Massachusetts. Within 30 seconds, I was able to find a police department tweeting, you know, why, you know, a hype had burst. So immediately, I now have information to the most real-time data. And that's true with politics, with current events, geopolitics, with sports. Um, you know, I immediately after I watch a sports game, I go on there to see the analysis because everyone's putting their information there. So within our profession, I think that there is a disadvantage to not being a part of that community. And whether that's healthy or not is a another conversation.

So where do you, uh, and even your co-residents, where do you go for articles on Endo? Everything is internet-based, or do you actually, I mean, do you read the JOE or the International Endo Journal or Dentistry Today? What, what's kind of where's the access to, you know, different material for endodontics?

Well, I think a lot of our, you know, literature review and case review that we do, um, is based on the JOE and, sort of, some of the more reputable international journals. But all of that's online, on digital, so on our phone, our iPads, on our laptops. And, you know, we're able to, I think, probably absorb more information because it's quicker and a little bit more convenient to access things.

I don't know. Maybe, maybe this is a generational thing. Maybe I should, 'cause two generations is a gap. Maybe one generation. Do you find it easier to read stuff on your phone or your computer or in your hand?

So I did start by being very uncomfortable reading on the digital, you know, tablets and computers and things like that. But I must say, the convenience was so much, uh, more compelling that I think over time, I'm going to train myself to move away from the, you know, things that they have to carry around for that one specific thing into the digital consumption. It's just a little bit easier and more convenient, to be honest with you. But I still prefer, if I had a choice, that couldn't texture surface of it of something to read on that that makes it more organic. Solidify my dinosaur status. Um, but I'm still like a yellow pad person when I'm writing things. I, I write things on a yellow pad, then I'll put them on a computer. I, I, I just find something comfortable about the yellow pad and the pencil that works for me at this level. It's what I know.

There are three different generations, right? You got all of them. See, you got the yellow pad here, the iPad. That looks right to me. That's right. Exactly. So, but, but again, for me, the question is the inefficiency of kind of writing down on a paper and then entering. I was like, "Well, just, you know, maybe should bypass the middleman, just directly write into the tablet." So the comfortability factor to me is important because that's what drives creation in my mind. So like when I, for me, written many articles, a lot of different things, including a book. And the way I do that is I'll think about that for a fairly long period of time, and then I'll just sit down and just work like seven hours non-stop. Wow. Or I'll dictate. I'll dictate into a like 1978, circa 1978 cassette, right? And then I'll, I'll, I'll transcribe it out and then rewrite it, right? But I like thinking about something. Think all of a sudden it comes. You just go, "Well, there's something special about writing." And I think like growing up, you know, at my generation, I, I grew up not having social media and then having it immediately. I grew up where, you know, you had to go to the library to do certain things and then all of a sudden you never had to. But, you know, we took notes by hand through high school, through college. You know, as I, I said, in engineering and everything, you know, it's, you can't really do that on a computer. And I started to see people do on a computer. And in dental school, and now in residency, you really don't write anything. But, um, you know, to me, it's more about that. It's like about the idea of rebellion. How rebellious do we want to be? Do we want to keep our, our previous habits? Do we want to keep what we're comfortable with at the risk of being inefficient? So, you know, just something as simple as, uh, taking notes on your computer. Or for example, when, when both of you, when you, when you really, when you invented bioceramics, there was a serious level of probably rebellion. And I bet a lot of, honestly, the audience would want to know how you, how you dealt with that. And I, and I want to bring it back to Endo a little bit. I, I briefly mentioned that yesterday that among endodontists, any change that seems to make endodontics easier and quicker is viewed pretty negatively initially. It's like a threat. I, I understand this. People have a practice, they're looking at pay off loans. And I, I think that's been that way for many years in endodontics. Initially, it's seen as a threat. And, and especially something where, where doing it's not a single cone, it's hydraulic condensation. And hydraulic condensation works because of the endodontic synchronicity, which means the fit between the preparation and your master cone. There's hydraulic forces, uh, generated by that. And also, if you have a PDL hydrostatic, and it's those forces that drive your sealer three-dimensionally into the webs, fins, and that's theosis. But initially, when you hear something like that, obviously, I think, I think our fellow specialists are initially threatened by it.

Yeah, I mean, you, you know, there is always, um, um, a variety of reactions with a variety of motives, right? And some people could be just the fact that they're threatened. Other people, they want to have more evidence, or they kind of believe in what they believe in, and things outside of that requires, I guess, there is a middle ground because we're talking public health here. So it is important. So that's why you get the, you know, the highly motivated or the enthusiasts first, and then over time, you accumulate. If the product and the material is legit, then the science, which will hopefully bring us to the truth, will actually legitimize it over time. And then you will get the additional, um, engagement and participation. And the other thing in terms of marketing it, uh, for the bioceramics, we had the sealer, we had the putty stuff. And I was doing all these great cases with the, with the retrofill. Trying to have endodontists change their operation technique is really difficult. But what we knew with, with the BC was MTA is a good material, okay? The problem with MTA is the handling characteristics. So with the BC root repair material and a putty, that initial putty, we realized it doesn't have to be better than MTA, just has to be equally as good because our delivery is so much easier, right? So what, what the marketing decision made was, in terms of approaching the endodontist, first go down the route of a repair material and a retrofill material. Once they started to work with it and gain confidence, then you have a secondary compensation about using it as a sealer.

So, and, and from an emotional perspective, did, um, did you, at any point, feel, um, deterred or, you know, not as motivated when you originally thought about these ideas and developed these clinical innovations, and there was pushback or, you know, comments were made, or you thought maybe that the success rate at the beginning wasn't as high as you'd want it to be, and now obviously we see, you know, the success of it. So it's, it's a great ending. But how did you go about it at the beginning?

I, I'm pretty easy in terms of how I explain to people. I, I, this people, right? Know I take it personally. And I, and I, and I, and I give people the warning. I mean, uh, I understand people have a right to say, "I like blue," or "I like you." I'm okay with that. But when people start to make it an edge, and especially if endodontists are quoting stuff that came from competitive company salespeople, which is not true, you, as a specialist, should be at a higher standard. And you were with me one time in Hawaii with one individual, right? But I, I took that personally. And, and as I said yesterday, I, I don't seek confrontation, but I don't walk away from it, right? And, and I think one of the things, at least what that did for us in the beginning, it helped people realize, "Well, these people are serious about this." Yeah, Don Wright was serious. We think this is a great advancement for both specialists, general practitioners, all alike, and ultimately, the beneficiary is the patient. Um, but I think when you start to develop products, you're going to start to have that edge. And I think, as you know, as Dr. Griffin mentioned yesterday, with LightForce, that thing. So, I mean, it's the thing.

What about you?

Well, I mean, all change will face resistance because there are people who are resistant to change. So as a result, you're going to be ready for it. I did not take anything personally. I always give people the benefit of the doubt to the fact that, look, you know, people could have legitimate, um, concerns or legitimate questions, right? Especially if you, you're walking in there with an idea that makes sense, it's logical, it's rational, but you don't yet have the actual physical scientific proof. Yeah, then it's more about a kind of a promise based on your background knowledge of the chemistry of things and so on. And we were talking about that, like, you know, having understanding of the first principles. And when you go to school, it's if you know, I, we were making a legitimate, um, kind of in some ways, you know, a bet that based on this chemistry, this would be the ideal material based on predicates and based on the past. So, but we did not yet have a specific set of data proving it. So, um, you know, for me, that kind of concern at the beginning is true. But, and he's absolutely right, because what you will find is you'll find that people in competing, uh, you know, um, forums and different areas will try to smear it. It's the typical, the politics of things. Never, never any problem with somebody with a genuine difference of opinion. I think, and you probably think so also, Ali, it's pretty easy to differentiate who's genuine versus who's trying to be a wise, I'll use a nice term, wise guy.

I, I have to say, like, I, I also sometimes take it personally. I remember four or five years ago, um, we had a, you know, we had a booth at CES, Consumer Electronics Show. And someone saw our product line, and they were at a big company. And I won't say they're really, really honestly great company. And they said, you know, "It's, I, I can just do what you're doing, tweak a couple of things, and then my brand will speak for itself." And that really, uh, you know, angered me. I, I'll say. But I, I found it as motivation to continue to develop, continue to try to make a name in the market. But I think of what a lot of people might want to know from the story that you both share is, you know, was there a moment where you considered not, you know, bringing this to fruition with the bioceramics? Because it really changed dentistry. It changed endodontics. 50% of people roughly use it. Was there a moment where you thought, "We're not going to do this?"

Bioceramics was just part of the whole system. I mean, you have to realize, to me, I think if someone's developing an endodontic division or someone's developing an endodontic system, everything starts with the file, in my opinion, okay? And once you start with the file, and there were correlators, then you had different engines, we had ultrasonics, we could use regular gutta-percha. So it wasn't a life or death thing for us with, with bioceramics. But once we all understood from Dr. Yang, the V, the properties of it, was like, "My gosh, the salubrious properties associated with this. This is like the perfect endodontic sealer." So, for us, getting it out was, was obviously a little bit of a period where we had to go through the, the glass phase. But it, it wasn't so much that we were worried about it not coming out because there were other things that we could do. But what we were, I think we were all pleasantly surprised at how quickly people adapted to it. So I think those are the things. But the, to me, everything starts with the file. Yeah.

Well, all right. So let's talk a little bit now. Let's talk about something non-dental. Well, I, I just wanted to kind of finish up with one little thing on dentistry. It's kind of maybe non-dental, but it's kind of about continuing education. And my thing, having been in the education business, as I said yesterday, for quite a few years, with your generation and your colleagues, what's the best way to reach your group in terms of continuing education? Is it totally? Is it, is it web-based? Is it, is it a webinar? Is it, is it Instagram? Is it, what, what's the best way that you and your friends look, look for and get CE?

Yeah, it's a great question because I think, access to the information is the most important part. So I think, while there is a demand for in-person and, you know, the traditional ways that, you know, you guys pioneered a lot of that stuff in Endo, I, I think that being able to access that content from anywhere, anytime, is probably the most important headline, right? So, you know, maybe I went to a CE course and I, uh, six months ago in Palm Beach, Florida, but I want to come back, uh, to Boston in practice and I want to remember what Dr. Nasi and Dr. Kotch told me. I want to be able to access that information in real time with this thing, with my phone. So I think finding a way to bridge the gap for real-time, you know, recall that information, access to it. So if we have a CE course, uh, I do it in person. It, I hope that it's recorded and I can, you know, maybe there's an app, right? Maybe there's a Real World Endo app that I can, uh, go back and watch that on. And maybe I can engage with the person I'm, uh, learning from. So if you guys teach me a course, um, you know, on the app that you've developed or on a platform that you're on, I can actually message you and talk about a case that I'm having trouble with and get real expertise, uh, within endodontics.

Let's say, have you been doing that fairly routinely with other aspects of dentistry? Frankly, not so much. I, I have to say, like, you know, obviously being in a specialty program, residency, you're trying to, you're already learning sort of the newest, most cutting-edge stuff. But I, from what I understand, there just really isn't a 24/7 engagement mechanism with people teaching the CE courses. And I think part of that is the economy of the CE. I mean, you both will talk to this point. I think there's a whole industry around this. And I, I have a feeling that that might take away from the sort of the economics of that world. I mean, what do you guys think?

Well, let me just give you my opinion on this. Is that during the pandemic, endodontists worked through the pandemic. And there were many general dentists who discovered doing endodontics on the emergency patient for the patients. One of the things that came out of that was the fact that yes, there were more people doing Endo. The divisions that were selling endo products for different companies, their gross revenue went down, but they probably imagine maybe seven, 8%, maybe a little bit higher. But they crushed all the expenses. You know, many sales people got furloughed, released, whatever. So what happened? The companies that were involved in the business of endodontics were making enormous net margins during the pandemic. Wow. Pandemic. So are wonderful people are getting back to normal. But in my feeling, the companies are not so quick to give up the jumbo net margin. And one of the things where I see it, I have a lot of different friends doing CE for different companies. They've kind of all been pushed aside, like, you know, "We don't need to pay for Dr. So-and-so to go to Madison, Wisconsin, or San Antonio, Texas." And we most assuredly don't need to take Dr. X out to Ruth's Chris for a steak dinner. I've seen companies cutting back on their expenses to CE programs. And with the idea that we're going to do everything through the web right now. For me, I think a lot of things can be delivered through the web very effectively. I understand the encyclopedic nature of things like that, where you watch it for 20 minutes, you go out, you come back later that night, you watch the next 40 minutes. But I think there's an element of in-person CE courses, particularly in endodontics, that's required. Because unless you guys can give me another example, I think it's the only specialty in dentistry where you really can't see what you're doing. Yeah.

But, but I, so there's a lot of tactile feel. That's right. So it has to be kind of in person. I mean, I remember when you, you made us look, you in the eye, and then do the three-stroke approach with you and Dr. Nasi's methodology. But I have a question too, that that regarding CE, how does someone actually break into, you know, being successful in the CE world? What does it take?

Let me do the first part because my approach was different than your approach was, which is multimedia online. I wrote a gazillion articles, okay? And one of the things that I did is I wrote all kinds of journals. And one of the things you're going to find out, and it's changed in those years, if you wrote an article that was well received, you had free reign to get other articles published. That eventually morphed into the category where we're not publishing your article unless you can give us $10,000 for an advertising page. Wow. But back in, you know, the late 1990s, early 2000s, everybody was looking for articles. I even got to the point where I had, I had monthly columns in like economic magazines. So the whole thing that I tried to do was a blitzkrieg. And it was purposely done. Get the name out, get publicity for Real World Endo. And any print media I could write an article, and I was doing many, many.

What was the reason for that?

So that a lot of people would know that you were, yes, okay, that we were doing CE. And that was, that was the whole initial purpose of Real World Endo in the beginning was CE. And we evolved all the time. But Dr. Nasi had a very different approach. And so that's why when you combined my print approach with his multimedia approach, it was pretty effective.

Yeah, I mean, it also has to do with what your main motive is. I mean, what are you driven by? What is the drive for you to want to do that? Providing CE or just sharing information? I mean, nowadays, previously, you didn't have the ability. Had as Annie just said, you had to kind of write a whole article and then you, you had gatekeepers at journals and magazines that would either hold you up or, uh, had to, um, make decisions based on their own set of biases. And now today, it's an open world and you can share information across all kinds of social media. So there are no more restrictions. Whether you want to provide CE, then the question really becomes, the question of what is the motive for that? In terms of financially speaking, I'm not sure if education per se is financially on par in any way with actual clinical work, right? So as an endodontist, you spend, you know, you, or any specialist, or even, or dentist, or so on, doing clinical procedures, far more lucrative, if you will, kind of a thing. So it has to be an element of passion, or in some ways, you're trying to educate people in some other way, or could be a multiple type of stream of income in which case, that enough isn't, that's not, yeah, the amount of work goes into it. So it has to be a certain impetus for you to do it. For us, it was a part of also helping the, um, the innovation and the ideas that we had to kind of be able to show people how to use these things, right? So it kind of dovetailed with that. Yeah. Uh, but in so far as just sharing information digitally, and I do agree that, you know, things are moving online, but Annie is right, because it is difficult, since it is a very abstract procedure, to just think in abstractions. It's, we're not like physicists here, we're talking about like, you know, quantum mechanics, sitting, sitting down, talking about a world that we'll never see. We still end up going clinically in there and have to achieve a result based on tactile feedback, based on taking that conceptual information and then translating into physical work. Um, there has to be a hands-on component to it, right? Uh, otherwise, it's never really complete. Yeah.

You know, and the reason I ask is because I see a lot of colleagues in my generation really, really more motivated than ever to be a part of the CE community because, well, first of all, there's a lot of engagement. You meet a lot of people. You're, uh, educating, hopefully, a lot of people. But also because it's a scalable thing. And I thought that was sort of maybe part of the motivation is that you get to really, uh, you know, it's a form of teaching, but in a way that's maybe more professional or even financially lucrative. Do you think that there's, um, you know, maybe too much CE happening? It's kind of been watered down, and there's not enough barriers at this point?

That's a good question. I, I think probably the answer to that is yes, okay? Um, and I think one of the, I think the biggest problem with CE is that I think the clinicians kind of lost control of it. Yeah, right. And companies started dictating things, right? And like all the different articles I wrote, I wrote it like you were sitting at a table with me. And a number of times, I would write an article and I would write, "Wait, I see a hand raised." So if I was introducing a new concept, I would literally write, "Wait, I see a hand raised." It wasn't written from the point, "I'm trying to impress you here with this article." It's kind of like, again, making it like a format, just like this conversation today. But where it changed was it got out of the, I think it got out of the control of the endodontist and ended up in the hands of the companies.

Yeah, for sure. There is, there is a crisis, as far as I'm concerned, in medical education, in education, you know, as a whole, I guess, across the board, kid through 12 and, and beyond, and even after, uh, graduation from either medical school or dental school. And the CE we get, I think part of that where we went wrong is when we decided that there is such a thing as a free lunch, that you can go to a program and get like, you know, you don't want to pay for the education. And then that there is CE, so you don't realize is the effort that goes into creating that is then provided by somebody else who's actually probably the sponsor, if you will, right? So that's the challenge of it. You know, when our organizations, you know, American Association of Endodontists or ADA or any of these other places, in annual meetings, have all of these CE programs, and the speaker is not really actually paid or do anything. That payment is coming through a different entity. And, and, um, that is where the bias enters the system. Clearly, there are guidelines for no bias or commercialism and things like that, but those are fairly loose and hardly enforced. So I think we really, as a body, have to come to a point of making a decision as to what matters. The fact that we're getting free education, or the fact that we're getting unbiased education, right? And as long as we don't make that decision, we're going to be going through the motions and probably get CE that you could then use towards renewing your license, right? But are we really getting real education? And that is really what it comes down to. And I mean, I don't have the answer for that. But I think at some point, if you have educational platforms in which we are, people are actually, you know, becoming members and paying for it, that seems to be a system in which it's supported by unbiased. The schools, which of course for so many years were the leaders in CE, it's really a challenge for schools to run dental continuing education. And if you speak to all the big meetings, their their problem is getting young people, young dentists, to come to the meetings, right? So the whole, the whole thing has really, really changed. It's become far more difficult. Schools, many of the schools that still run CE departments, those CE departments are on, are basically on their own body, meaning they have to generate enough revenue to pay for their department. Yeah, that's, that's really tough for CE departments to do. And I think part of the reason could be, you know, when you go through the dental school, medical school process, and the residency process, you're talking about, you know, for private institutions, $70, $80, $90, $100, $120 grand a year. And so you come out, and you might have this chip on your shoulder, I don't, I don't want to go right back and pay $2,000 or $1,500 for a day, um, to just brush up my skills. Um, and I think then the question is, you know, are the CE courses really designed for the general, uh, practitioner market, or are they specialty specific? And of course, there are differences. But I think, you know, what it seems like is, is mostly, let's say, specialist, um, coaching the general dentist on things that, you know, they're trying to add to their repertoire, their bag of tricks, um, so that they can serve more patients and they can, you know, perhaps be more profitable. Um, but I think this idea of the business and the economy of CE is such a hot topic. And I think people really want to know, you know, how do I really stand out in that field? And I, I guess a question for you both is, what can, what can somebody do to stand out as a, as a leader in the CE field, um, if they're really passionate about teaching and, uh, reaching more people?

There's an endodontist, I'm not going to mention this individual's name, but I, I've mentioned this with Ali one time. This person said to me, they have, they have an institute. And it mentioned, "You build it, and they don't come." So even the high-profile key opinion leaders in endo, and perio, and implantology, if they're putting money into institutes, there's no guarantee. Wow. That they're going to be having a full house. So, I have a lot of respect for the people running these institutes. I think for endodontists, for endodontists looking for CE, maybe that's the preferred way to go is to one of these institutes versus your typical run-of-the-mill, you know, endodontic course at the Greater New York, or Endodontics at the Yankee Dental Conference, right? Um, many years ago, uh, I had the opportunity to really build this endodontic CE thing for TUSC Dental. And I had about 25 people lecturing. We were doing, started to do a lot of courses. And every summer, we would have a summer get-together out in Oklahoma on this big lake. And it was a lot of fun. And when I would speak to the guys, I would say to them, "Listen, if you think you're going to come to lecture and make money, you're mistaken, right? If you want to come be part of something and have fun, you know, welcome to the club. But if you're thinking about it, you're going to make money from lecturing, you're much better off staying at home in your practice in New York or New Jersey and doing more endo, right?" So I think this whole concept of building CE and it's scalable and making money off of it, I think that's become more and more difficult in my opinion.

Yeah, I mean, there are many, many channels now. So again, the CE is a very specific thing. The other thing is education. They're two separate items, right? Do you see them as two separate things?

Well, I mean, you know, education is about sharing information that has some specific value that is going to help you change in a positive direction, right? So that's real education. So, uh, CE is something that hopefully you'll get educated on and will go towards your license renewal, right? Right. I mean, so you have to do it. Yeah. I mean, for me, the idea was like, you know, what, what I used to do with the shorter videos, I thought shorter videos were the way to go because people wanted to consume information in less short, more efficient type of bites. Um, now it's become like so short, it's like one minute. It's like, how do you even say anything in a minute, right? But, but it's like a pendulum is swinging back towards this longer podcast too. So I don't know where things are going. But, um, I think, uh, either way you do it, my idea was that, look, go get your CE somewhere else. Come here to get your education because it's, you know, one thing is CE has to be regimented. It has to be specific length of time. It has to be, uh, this and that, whereas your education is more directed towards, um, you know, it's learning something as efficiently as possible. I mean, why would you want to have to, because CE requirements is for you to spend 45 minutes to talk about something, yeah, uh, to get one CE, at least 45 minutes to an hour, um, but we have to drag.

It subject on for that long, it just makes no sense. Yeah, I guess it's an important point because I, I, I think a lot of people after they leave the ecosystem of the education environment, so, you know, after residency or after school, unless they're sort of tapped in or, uh, involved in teaching in some capacity, they're not necessarily staying on the cutting edge of the research, the knowledge, the technology, um, the communication. And I think this is probably the only way that they can get access to that and also stay in the loop. I mean, how important is it for when you, you as a patient, when you see your doctor, you want them to be, you know, considering all of the possible options. You want them to have the cutting edge information. And I think CE is really the mechanism to do that. And that's why I think philosophically our generation is so interested in it because, you know, it's our way to stay in the know all the time, in real time. So that's sort of the genesis of the conversation.

I said there are a couple of different endodontists running institutes. I think they all do a really good job. Yeah, but part of that's working, piggybacking off of their reputations. Yeah. Uh, uh, that's fine, but it's not, it's not easy, uh, running an institute for anybody either in prosthodontics, endo, or implants. Yeah, yeah.

The other thing with the education of the CE is what we learn actually before we need the CE, which is in schools, right? So you're in school right now. Yeah. Do you think at the graduate level and then also at the undergraduate level, what are, are you learning enough? You think it's a good, it's a good question. Don't forget, I'm your teacher, so we have to. Yeah, yeah, yeah. It's, uh, I have to be careful. He's my direct attendant. So, so I think as a resident, it's clear when you come from, you know, we, when, by the way, in terms of terminology, I think undergraduate we call college, right? And then dental school, professional school, medical school, whatever you want to call it, and then residency. So, I, I think there's a stark difference when you enter residency at the specialty level and you think you have a pretty decent idea and understanding of endodontics. When you, when you get to residency and then the first three to six months, you realize, holy cow, this was, you know, I didn't even know anything. I didn't really know the tip of the iceberg. So there's a huge, huge level of advancement. I think that speaks to, you know, what specialists do. But, you know, the question is, in the dental school level, Dr. Kotch, you talk about this. I think it's, you know, we learn a lot of fundamentally important things. I think the bigger question is like the caseload, how many cases are we really absorbing? I mean, I see that as maybe the bottleneck. How, how do you feel?

I think the biggest problem in endodontics. I think all post-doctoral programs do a good job. Some may be more, uh, putting more emphasis on surgery, some may put more emphasis on literature review, but they're all doing a good job training graduates. I think where there's an enormous discrepancy is on undergraduate and endodontic education in dental schools. Um, uh, for the last few years, I've been all over the country and the average to me is basically one to two, generally two canals, not two teeth, two canals. And also this thing has developed where you're having dental students split teeth like, Ali, you do the buccal, I do the palatal canal. That's crazy to me. Also, uh, I'm found out to my utter disappointment, uh, when I'm doing hands-on and I literally ask young people, when did you graduate from dental school? How many cases did you do? And sometimes people say, well, I, I did like two cases. Then we do the hands-on and 20 minutes later, they realize, well, Dr. Kotch is pretty chill. And they come up to me and they say, you know, Dr. Kotch, you know, when I said I did, I did two cases at dental school, I said, well, they weren't clinical cases, they were only typodont. I never did a clinical canal. This is probably almost 15% of the, uh, 15% of the students that I see. And these hands-on, that's patently wrong. I'm not upset because, oh my God, they're not going to be future endodontists. That's not the point. What I'm upset about is that if you're in one of these schools that's doing very little endodontics on the undergraduate level, you don't know where endodontics fits into the overall treatment plan. Like, you know, all he knows, I know what endodontics can do for your patients, what endodontics cannot do for your patients. That's really, uh, critical, especially when you're formulating your treatment plan.

Yeah, I mean, what do you think, U, as a, well, first, first of all, I want to say that I, I, uh, I like that idea of sharing. Is that called tag team? Am I? Pretty efficient, you know, four people, four canals, we can distribute. Exactly right. It's like a bunch of hyenas sharing your kill. I'll leave the MB2s for you and I'll, I'll do the palatal. That's patently wrong for the bill of tuition that somebody is paying for these young men and women, right? They should be, you know, at least do a couple of clinical cases to get a sense of what endo can do. Yeah, absolutely. And I think the lack of that kind of educational awareness about what endo is and what it can do is what results into that vacuum of knowledge being filled with implants. Yes, people coming in and saying, oh, endo doesn't work, implants have 100% success rate. Let's pull every tooth with a lesion, therefore, because it's not going to work and an implant would be better, right? So the only antidote to that type of misinformation is more good information. And that good information is really having a knowledge of the overall prognosis of endodontic treatment. What are the mechanisms for failure? What are the, um, what are, you know, what are the variables that you're going to have to consider? And who should do what? You know, as an undergraduate, case selection is really where you're going to seal your success rate within endodontics, right? It's a highly skill-based procedure. Clearly, there is a technique and a mechanism to go through to do it. So, um, you need to acquire that knowledge through skill. You know, I mean, any skill, we were talking earlier on about these things, skill, as we know, is a kind of, we're talking about passion, but the way you develop his skills by putting together this concept of knowledge, you know, desire, which is that passion, and then practice. The confidence of these three factors creates a skill because you need to have the passion, which is the energy that you're going to use to acquire the knowledge that then through practice, you're going to hone in and get better at. Yeah, and as long as you're not getting that, that knowledge, it's just going to get filled with a lot of other misinformation.

Yeah. Did you, do you feel like you got enough of that in, in your undergraduate? Um, yeah, I think dental school did a great job of, of helping us understand the philosophies behind and, and sort of the methodology of, let's say, pulpal therapy or all the, all the practice in endo. But I think it comes back to, um, the, the way that people, you know, dental students are thinking about treatment planning. So I think they think about, okay, like, can I, can I save this tooth in particular? Can I, or, uh, does it have to be extracted and place an implant? And I think the, even the, you know, the most world-renowned people in implants will talk about the value of saving your teeth. And I think that's a testament to, you know, the science behind it. And I, I don't know if, um, you know, there's been a way to, um, simplify the endodontic procedure protocol outside of obviously your innovations, but like with implants, you think about it, well, if I, if I can extract this, this tooth, I can design a guide and that process is actually a little bit more, um, seamless to me and a little bit, a little bit, I have more support on my side. But, you know, if I'm, uh, trying to tackle an MB2 in a calcified case on my own as a general dentist, I'm, I'm alone. I'm, I'm referring that. So I think the, it's about the willingness to learn. And I don't know if, um, that's there right now. I think it's more about the motivation to even try it.

Um, many years ago, uh, during the Chicago Midwinter, uh, I sat down with a good friend of mine. He was a couple years behind me at Penn, very, very famous periodontist. So I said to him, would you be willing to anoint, that was the term I used, anoint, real-world endo and endo sequence as your endodontic file system of choice? He said, absolutely, no problem. I said, well, that's wonderful, but I think I'd like to show you how it works, right? So it took him less than five minutes to all of a sudden get entirely what we're doing. He's working, he, he's working, he's filing, he, all of a sudden, he starts to fit the cone. He goes, this is just like doing an implant. Everything matched. It was precision-based. The endodontics. So that was the whole purpose. It's like PR 102, everything's matching. So I think when dental schools don't understand that doing an endodontic procedure can be as relatively straightforward as, quote, placing an implant, they just haven't done enough homework.

Yeah, yeah. The other question I have, and I don't have an answer, is how much money is coming to dental schools from implant companies? And is that affecting the curriculum? I don't, I don't know because I don't, I don't. It's a tough, it's a tough question. We, we, um, we certainly see it. I think all of us on a day-to-day. I mean, um, maybe the international companies, some of the globally recognized brands definitely have a foothold on the sponsorships behind a lot of the things that dental students and residents and even practitioners use. But, you know, I don't know how to evade that. And, and again, the question is, do you think that there, it's a problem of, are there enough cases that are viable? Probably not, right? Because we don't have, seem to have any limitations on patients in our, you know, residency clinic. I think there's enough cases.

With Ali's residents, I had a rule is that before you could take an undergraduate's case to do a root canal on, like if it was a surgical case, broken instrument, short radius, curvage, a crazy patient, but before the resident could take the undergraduate's case, they had to find a replacement case. Oh, okay. Right. And when I did that, they all started chirping like The Simpsons, right? And, and I said to them, there was like, there's no discussion here. And my answer was, they also pay tuition. And do you know how long it takes an endodontic resident to find a replacement case? What? 15 minutes? Right? That's, that's right. In terms of finding cases, one of the things that we did, and we did this, uh, at the program, and also we had done this many years ago at Penn. The cases are in the panorex, right? And so if you have an endodontic resident, I was lucky because, you know, we had, again, Harvard's lucky because you have a three-year resident, you have four or five third-year residents. They can walk around a clinic as well as a second year, look at the panorexes and realize, oh my God, you've got two big lesions here on necrotic teeth. The way to make that work is that since day two after the dental first dental school was created, every dental student is worried about satisfying the prosthetic requirements to graduate. Right? So what happens? They get a case and they hide it. Okay? And in many cases, it becomes kind of ethnic based. All the Korean students share cases among the Korean students, the Persian students among the Persian students, the Taiwanese, right? That's kind of like that's the way it, that's just the fact. Okay. What they have to do is, if you're in an endodontic department, you have to reassure the undergraduate students that if they have a case in their chart for a patient that they're working on, you have to basically guarantee that student that case is coming back to them. Right? You need this patient to graduate with your three-unit bridge, but wait a second, there's three other root canals that need to be done, right? So what it does, it takes a little bit of effort on behalf of the endodontic department, right, to make sure that their residents and there's an assurance to the undergraduate students like, no, we're not stealing your patient, you're getting the patient back, you're going to be able to do what you need to do, but you also have a couple of root canals.

Right. I, I, I think, and, and maybe to, you know, as we near the end here, wait, by the way, when I was talking about Persian students, you guys look guilty. Yeah. You know, but that goes on in every school. Just, that's just the fact. Yeah. I, I was going to say, as, you know, we talk about this and we near the end, the, um, the, the positive of this, and the, I think the uplifting part is it's more competitive. I mean, negative in some ways, it's, it's more competitive than ever to get into endodontics, which tells us, um, you know, there's a huge demand for it. People want to be a part of this, people want to save teeth. And, you know, at the end of the day, um, the profession means a lot to, to, to a lot of people. And I think at least that makes us feel good, right? So, yeah, it's really difficult to get. For many years, it was about a little bit less than 2%. That was the, the, that's crazy. Yeah. No, it is. I mean, endo is a, um, is a field. It's a very old field that is having a reawakening. People are looking at beginning to realize that the promised land of the implants were not quite as 100% success as they were promised. And that there's nothing really better than your own natural teeth. So, you know, in future episodes, we should definitely talk about some of the other challenges of, you know, holistic to to endo about saving teeth, you know, people that are on the holistic side of things and they say endo is an issue. And, um, many other factors, both good and bad. So I think this was a very good first kind of a podcast. What do you think? What's your feedback?

I, I, I'm incredibly excited about this because three generations is a big difference. Absolutely. Absolutely. Ali's working with his son and working with this, so he, he kind of understands this. But for me, going back two steps, it's really a different mindset. Yeah. Um, and again, as I said to you an hour ago, I do honestly believe every generation, bigger, brighter, smarter, faster. That's humanity. That's the goal, right? But, but it's, it's interesting, just with your group, especially at the school, how you drawing, you know, again, take what you need to take, kind of modify it, have it work to your advantage. And I think that's incredibly exciting.

Yeah. And I think one of our goals with this, uh, podcast and to the, to the people listening for future episodes, we want to really break down barriers. We want to understand, uh, you know, we want to talk about trends that are happening in real time and in the news cycle, what's true, what's not, what's important to know about dentistry, how does it relate to the oral systemic, how does that correlation happen, why is it important to care about it, understanding the business of dentistry, the business of endodontics, um, you know, giving advice to people who are coming into this profession, and also, you know, learning from you, how can people flourish in this profession? And I think that's, that's what people really want to hear. And that's what we're here to do. That's right. So for the first one, pretty good. And we're going to hopefully improve on it. Once a month, we're going to try to do this. If it does end up being more popular, we could hopefully maybe increase the meetings. So I can, I say it's in the can? Well, it's not yet. You have to do all, all your magical editing. The K, right? You mean we're done? We're done. Oh, yeah. Yeah. No, it's good. No, no, no. So terrific. Well, thank you very much for inviting. Thank you so much. This was awesome. Thank you both for co-hosting it. And, uh, that's it for the first episode. See you in the next.

[Music]

One bright smile and his wisdom spins facts and style.

Parsa dives deep with a touch of flair.

Through generations of dental care,

Root canals and life beyond the chair.

Culture and politics, we dare to share.

From MERS to moments that shape our day,

We drill down deep in every way.

Turning pulp into gold with every word.