Transcription
Welcome to the Paul podcast where we talk about all things dentistry and non-dentistry from a generational perspective. I'm uh Alen. I'm joined by my co-host Dr. Parika Shahiti. Dr. Ankot is uh not with us today, but we have a special guest again today. So Parika, why don't you introduce our guest? We're really excited about this one. We're coming off of the AAE 2025 and we're so excited to have Dr. Steven Katz, who's the president, officially as of yesterday, of the American Association of Endodontics. We're so privileged to have you here in Boston. Thanks for being here.
Well, thank you so much. I'm very excited to be here with the two of you.
This is really exciting. Wow, so much to talk about. We had such a great time here in our hometown, right, Dr. Nasi?
Sure. It's great to have the AAE in our backyard. Maybe you should just choose Boston as a perpetual destination. I think it was like a record uh attendance, wasn't it?
It was a record attendance. Boston is always such a wonderful place to visit, and we're always so excited to come here. So it's been a great meeting. Thank you. You've been wonderful hosts, and we'll look forward to coming back again.
I hope so. Every year, like you said. Yeah, I mean, Boston has been historically like the mecca of dentistry and specifically endodontics, along with Philadelphia. The two big cities where, you know, between the schools, between Temple and Penn, and then here between BU, Harvard, and Tufts, we've really driven uh forward. And I think it is part of the reason why it is so well attended is because of the history of endodontics in these places. Not only is Boston a great city, but we've had this history too. But, you know, now as the new president and planning on leading the profession moving forward for the next year, in this podcast, we're really interested in ideas of leadership and innovation and entrepreneurship and all kinds of things we're going to be covering in future episodes as well. But as the new leader of this organization, what, first of all, what is your definition of leadership? Also, what are your plans for our endodontic group moving forward?
That's that's a really good, great question. Our association, our profession, is in a fabulous place right now. And although I have been been involved uh with executive leadership and on the board for several years, I take no credit. Uh, we've had some amazing leaders, and we have an unbelievable staff at the AAE. So for me, I just need to keep things moving in the right direction. Personally, a couple of things are really important to me. I'm I'm in private practice and I have been for 35 plus years now. And it's important that we serve all of our members. So we're seeing different practice models. Uh, we have some educational uh challenges right now, but we have to serve members at every level, in in every aspect of our profession. And and that includes private practitioners. And then the other item for me that's that's really important and crucial are the advocacy issues. So what can we do a little bit of a larger scale? I don't want to say a global scale because we have to pick and choose where our battles are and where we can afford to spend uh our efforts and and our resources. We do have the ability to influence uh on an advocacy standpoint from an advocacy standpoint. And and the AAE has taken the lead in that role. And I think that's crucially important, not only for us as endodontists, but as specialists and as dentists, and ultimately to protect our patients.
Terrific. I mean, obviously, I love we we'll probably get into this educational challenges uh facing the profession, as well as some of the advocacy roles of of Americans. But going back to leadership, what do you see actually, cuz I mean, this is now unrelated necessarily per se to AAE, but as a broader perspective, what do you see the role of a leader? Because we have a lot of young people here that are watching the podcast and interested in some of these conceptual things along with the details. What do you, what do you think? What, how do you...
The cost of leadership? You know, everybody's journey is different, obviously. Uh, I I started late. Uh, I became boarded late. I became involved at the AAE late. I I was in leadership roles on on a local level, but never on a national level. And so from a leadership standpoint, I I think it's, number one, you have to be involved. You know, you think of a leader like Napoleon, President Trump, whatever that is. We're we're we're not leaders like that. And and I don't think we want to be or or need to be leaders like that. It's not about telling people what to do. It's about it's organizing groups.
Yeah. Or it, not not only that, but but the ability to work together to form uh organizations that uh were stronger together. And and I think that's that's what my leadership role is, is is to utilize the folks around me to form coalitions to become a stronger, a stronger organization because of those relationships.
That is a terrific definition. Um, it is, you know, is getting people to cooperate together towards a greater vision. And to that extent, so what would be your vision? What do you uh think in the next five to ten years, the things that you will do over the next year as the president could affect? I mean, as you said, it could be just moving along the same path, but what is the path of the AAE overall? What is the greater vision that we're hoping to accomplish between the advocacy and education and the other things that you said?
Sure. Well, you know, I I think it really goes back to our our mission, our our purpose, and our values, right? So it's to promote the art and science of endodontics, to advocate for patient care. But for us, it's one step further than that. It's to advocate for specialty care, right? Right. So I mean, you know, everybody's entitled to care and access to care. And and and we as an organization, that's a big part of what we do. But I think that specialty care is crucial for us. So everybody may not have the ability to have specialty care, but they should be able to know about it and to know that it is available if they want it.
And so, Dr. Dr. Katz, how do you, I mean, we talk about leadership, and then obviously you're the person, you know, helping guide the ship and direct our our specialists and our residents and all of our communities. What, what, what can, you know, each endodontist do if they're in private practice? Or what can residents do? What can each of us as a piece of this endodontic pie do to better the specialty or profession? You know, what do you think is one small thing or a few things we can each do? You know, I, Dr. Perry, yesterday was talking about it yourself, all these things that make up this community, um, outside of, you know, let's say participating in the AAE on an organizational level, what can we each do to better that messaging?
Mhm. So that's a great question. And, you know, this is what I talked about yesterday in my speech. To become active is crucial. You said that. And that's really easy, right? So it's, you know, get active in your local organization. It doesn't have to be at the national level, but I mean, if you can, that'd be great. But just let people know that you're interested. But it it goes further than that. I I think the biggest priority right now is to educate. So when you get out, you need to give back. You need to come in a half day a week or or a day a week, right?
Absolutely. That's. You understand better than all. Yeah, right. So I think right now, because we do have a shortage of educators, that's crucial. And and as young endodontists, we need to ensure that the newer endodontists, the current residents, that they get the same fabulous education that you're getting. Okay? So that's number one. Number two, I think it's important to contribute to our foundation. Now, I understand that young endodontists maybe not are not necessarily in a position to do that because they have financial burdens. Education is expensive now. But somewhere along the line, I think most endodontists were incredibly fortunate, right? We we make, most of us make nice. And again, I think you need to give back. So that's important as well. I think it's important to get boarded, right? So becoming a diplomat of the American Association pushes our association forward from a lot of levels, but from an educational level. If outsiders look at us, they say, 35 or 50% of your members are boarded, or whatever it is. It's it's approaching 30% now. That's crucial because that says that we're interested in higher education. We're interested in making ourselves better. Okay? There's no board for general practitioners. They can become members of the AG or ICD or whatever that is. Being an AE, and you know, my journey was a little different. I practiced for 25 years before I became boarded. That was hard. But but but to your point, and I was going to ask, you know, this is a question for Dr. Katz and Dr. Nasi. You know, the education piece, we've talked about this a lot. Dr. and I say, you, you know, when you give all of us as residents advice on, you know, what to do life after residency, you always talk about, you know, spending time to give back in the form of education. And, you know, at the beginning, Dr. Katz, you talked a little bit about some educational challenges. I'm curious to know, you know, sort of what you meant by that. Is there, is there something that you think that is happening in our specialty or in dentistry as a whole that we need to address or get ahead of? How do you see that?
Currently, there is a shortage of educators. I think it it's across dentistry, but for sure it's in endodontics. Most residency programs and PDOAL programs as well have shortages of educators. So if you're fortunate enough at at Harvard to not have a lack of educators, you're really lucky. Um, as as I speak with people at our board or or out in in the field, most all programs have a shortage of educators. And so I think it's twofold. I think number one, many young endodontists have a lot of debt. They have financial burdens. So educators are not paid as much as private practitioners. So when you have that kind of debt, it's hard to make that decision. And and I've come across people and chatted with folks that say, you know what, I really want to teach, but I can't afford to. So that's one issue. And then the other issue is, and I think this has always been the case, is is the politics of education. You would know that much better than I. You know, I go in on a very part-time basis, and I don't have to deal with that, but my chairman has to deal with that, and I hear about it. And I think that's a little bit of a fight uh for a lot of people because you have to really want to be an educator and learn how to deal with some of those things. Personally, I don't know that I could do that on a full-time basis because, you know, you're you're kind of used to making your own decisions.
Yeah, it is a challenge. And when I graduated back in the '90s, my plan was to go into full-time education. But the limitation at the time was the reality that, you know, combination of student loans and the poor compensation at the educational level was what essentially forced me to go into practice. But I managed to find the right balance of still doing part-time teaching, which then helped. One, the practice kind of helps support the educational part. And that's what I try to teach these guys here as they graduate is that that idea of passing forward and giving back is so important because all of us, in a sense, when we were residents, we learned so many little nice tips and tricks from even those part-timers that came on. And in fact, from the part-timers that were out there in the trenches doing the hard work and had the clinical skills and the clinical expertise that they could give back. So that is an area that I've been really advocating to all of our graduates to come back and just give that a half a day a week or even half a day every other week. But it, it is something that the residents really benefit from.
And so to that extent, do you think the foundation, I know the foundation used to have an educator's grant and things like that. Do you think those are some of the ways we can solve this education problem? Because it is really a problem. And in fact, we at the school also were searching. We've had a couple of failed searches for full-time faculty and so on. And and we're in the process of it again right now. But, um, it is a challenge. So how do you think AAE can help?
It is a challenge. Um, yes, the foundation does have uh educator awards. I mean, more than one. There's part-time educator awards, there's full-time educator awards. So understand that, you know, the the foundation is a separate entity. That's not the same as the. So you should probably interview uh Dr. Toric, but I I'll give you my take on that. There are awards, and and it is helpful. But our foundation, and we're in a good place, is not large enough to have a huge effect on this issue. So we do have input, and I think we can move the needle a little bit, but not as much as as it needs to be moved.
Right. You know, to your point, and I have to give a shout out to the Ohio State University, of course. You know, I went to Northwestern. So that's. Well, I'm sorry for you. Oh, I may have to. Everything up and down at Ohio State. It is. Yeah, great school, but not much of a football player. That's true. Yeah, it's okay. Um, we had unbelievable educators. I mean, we, I mean, Ohio State has this tradition of having a great program, and and it, and it just continues. But as you said, we had great part-timers, right? And and none of them are compensated. Okay? They, it it was about giving back. And and I look to you again because it's about you and your colleagues. So you really need to give back. And and it's the guys that are in practice that you learn the most from. Yeah. I mean, listen, you learn research and and and all the didactics at school. That's why you're there. But if you want to go into practice and and you want to learn about the difficulties of patient care or or these complex cases, you look to the guys that are in practice, the guys and gals, I should say, that. And the other thing I was going to say is, and and I'm sure you've experienced this, when patients know that you teach. Oh, yeah. Well, what do you do on Wednesdays? I go to Harvard. And especially in this area because, I mean, you know, it's it's Harvard, right? You, it's different. You know, I go to West Virginia. Oh, that's great. You go to West Virginia. But it, you say, oh, I I teach at Harvard for a half day. Two week patients look at you a little differently. Am I right? Yeah. I mean, I think at any school, anytime you are doing that kind of leadership in education locally, whatever you are, you know, whether it's Ohio, you have Western Ohio State, you know, it is it is a terrific uh thing to just give back. I think uh it's appreciated. And I've I noticed that it's that you're referring sources and people that you work with, general dentists, restorative dentists, they do appreciate that to know that you are giving back and you are being a leader in the community. And that's something that should be marketed a little bit more strongly to your referring sources and dentists because dentistry is a team sport, right? I mean, if anybody thinks that they're just sitting in their own little castle, king of their own little castle, they're working. That's not how it works. You know, at every level of it, it is a professionalism and the collegiality working among a team group. That's what we depend on. We are the receivers in a game where we have quarterbacks and so on. And so it is so important to kind of be able to um to show that we are a part of the team. And I think that's probably the best way to do that. So I'm glad to see that AAE, along with the foundation, are working towards that front. I mean, I I have to say, like, we're we're really grateful for the faculty. And we we realize, I mean, you you said it, Dr. Katz, Dr. that we realized that they don't have to be here teaching us, and they could be more productive somewhere else. We wouldn't be where we are without without you guys. So we're we're grateful. I want to say that. So shout out to any educator, keep going. We really need you. We love you. But but it makes me think about the way education is taught a little bit. Obviously, financial limitations and and all these things, but it's so hard to get into endo residency. And so we have a lot of audience and folks listening, Dr. Cats, who would love to, love, love to be here and uh learn about endodontics in a residency program. And it makes me think about the model and the systems. Do you expect to see any major changes in the education model that we have from a residency perspective from a specialty, or pretty much uh trying to, you know, keep the status quo? What do you think will happen there?
First of all, I I would agree that there's a huge amount of interest in endo residencies now. And and that's really great, right? I mean, our specialty is in demand. Young dentists want to get involved and and become endodontists. So so that's terrific. The negative side of that is that there's a limited number of positions. So part of it goes back to the educators, okay? If you don't have educators to teach to residents, then you can't have programs or you can't expand your programs. So a lot of programs have one or two full-time faculty, so they may not be in a in a position to do that. A lot of programs may not have uh the physical ability to have more residents. Uh, some residencies are a couple, two or three per year. So, you know, you're not producing a lot of endodontists. Sure. This is what I will tell you, at every level of dentistry and endodontics, whether it be the DSOs, corporate, private practice, the message is the same. We need more endodontists. So from an organizational standpoint, we think about that. We talk about that. It's difficult to change some of those dynamics, but I think what you may see in the future is you may see some corporate influence in that regard. And I don't mean that in a bad way, but because of their financial situation, they have more money than we do. They have the ability to think outside of the box a little bit and maybe come up with some different ways to address that issue. And so, you know, and your audience knows, you know, the AAE, we're partners with everyone that's interested in partnering with us. So it could be a corporate model for practice, a DSO, or it could be a dental manufacturer. Sure. You know, we work really closely uh with our partners, and and we talk about all this all the time.
Yeah, where do you see the um, the role and of expansion of DSO models in dentistry as a whole, and particularly in endodontics, affect the nature of the profession down the line, five to ten years, let's say, and then beyond?
So I I think the DSO model is here to the DSO model is here to stay. I think there's a lot of reasons for that. Um, part of it is financial. A lot of younger endodontists don't have the desire or the financial wherewithal to buy a practice, or maybe they're just not interested. So I think that a a lot of endodontists either aren't interested or don't have the financial wherewithal to buy a private practice, and so the DSO model is here to stay. And and I'm not suggesting that uh it there's anything wrong with it. I think the ability to control patient care is what sets the models apart. So if you're in an organization where they mandate that you do ten root canals a day, that's not good. But if you're in an organization where they encourage you to practice professionally, and the DSOs that I know in endodontics that my friends have sold their practices to, that's what they tell me. Yeah, that they have the ability to control patient care, and that's crucial. So they're making the professional decisions. The DSO may be handling what happens out at the front desk. And I mean, think about all the positives. You know, they're buying for 150 practices, so they save money. From an AI standpoint, I know this is your expertise, but I was at a meeting, a a corporate type DSO meeting a couple of weeks ago, and they were talking about how AI can control every step of the process from when you call the patient and all the way through reading the image somewhere down the line, right? And and all of that makes dentistry more efficient. I mean, that's great. Totally. All of us are going to benefit from that. So I I think it's about having the ability to control patient care, to make those decisions. There's so many. I mean, just what we're coming off of the AE here, and you look around, and I think one really interesting things the DSOs offer is the luxury and the ability to remove that burden from a lot of young endodontists who don't want to deal with practice management operations, even more financial debt or financial burdens. And, you know, what they're offering is really incredible. And I think, you know, it makes you, you said, you know, DSOs are here to stay. You know, sometimes there's a stigma, right? You, where, where you're working, especially as a group of specialists, what's the value of care? What's the level of care? But it's, it's interesting to hear you, you know, sort of as our leader in this organization, keep such an open mind on this. I know Dr. So what do you think about the model?
So I mean, my uh issue, as I have expressed previously on the AE connections, been the same way, is that it's a double-edged sword, like anything else, right? There is a positive and there's a negative. On the positive side, the things that you mentioned, the productivity growth and the efficiency and the potential for improving access to care, possibly reducing the cost of care. I mean, we'll have to see. And that leads to the second one, which is at the end of the day, it's a question of the profit margin on a procedure. And a procedure is done with a given profit margin. And as long as you're trying to keep the procedure the same and so on, the profit margin will will stay the same. You can gain a little bit by trying to reduce the overhead and so on. The question is, where does that profit margin go? Does it trickle down to the people that perform the procedure and are aiding to do the procedure, the auxiliary and the doctor, or will it trickle up to the executives and the corporate and the shareholders? And my experience of capitalism is that it does tend to trickle up more than it trickles down. And so I'm just wondering if the role of leadership in this particular situation would be to put in the proper mechanisms that helps control and keep the interest of the people that are performing the procedure as opposed to the people that are managing the procedure.
Yeah, that's a really good question. And and I'll be honest with you, I mean, that's not my expertise, right? I think, you know, from an organizational standpoint, we have to support every endodontist, wherever they are. And models are different, for sure. And and I think they will continue to be different. I don't know that I could answer your question. I will tell you something. We we were talking about, you know, thinking outside of the box and how do you solve this educational standpoint? So I'm going to throw this out there, and I didn't think of this idea, but it's a great idea, okay? The military model, right? M. The military model is, you go to dental school, they pay for it, you make a five-year commitment. You go to residency, they pay for it, you make another five-year commitment, whatever that is. The DSOs have the ability to do that because they have the funds that we don't have. Most people and/or organizations don't have. So what if a DSO said, "All right, I'll pay for your residency." How much? I mean, you know better than I do. I can tell you what the average is because I heard it this week. $312,000 for a dental student, not for a resident, for a dental student. So what if a DSO said, "I'm going to pay for your residency and you commit five years to me." Something to consider. Something to consider.
Well, I mean, certainly it is, as you said, it is like our military. The question then ends up being, who are you serving? You know, is that, is that really the crux of it? And, um, it is certainly, there's a lot of models for making education cheaper. I think there's a structural problem overall with our education that is not limited to endodontics. It just goes all the way up to the top of our educational system. I'm not sure if our education has evolved with time and it is as efficient as it could be, right? I mean, the cost of tuitions have gone up dramatically, whereas education, like, you know, what does it take to learn something, right? Why is the cost going up multiple folds that of inflation? I don't know. I mean, I don't have the answers. It's just the questions that that we see and we need to kind of address.
I think the educational institutions would tell you that the cost to educate a student is more than what they're actually paying. That if it costs $120,000, that if they think about how much they're paying the janitor and and heating the building and all that, it's more than that. Seems hard to believe, right?
It's not hard to believe. And and many schools are losing money in in in many ways. And I think part of that is because of the decisions they've made as organizations whereby they've kind of conflated the concept of education and entertainment of students combined. So the campuses are growing by having more facilities to, you know, to to entertain. That increases the cost of the institution overall. The overhead goes up. The administration has been growing uh to a great extent, to partially due to, you know, some self-imposed regulations as well as external regulations and so on. So I think the ancillary costs to education have gone up. The students are essentially supporting it by paying a higher tuition, right? Right. And the educators are not being compensated for it, right? The educators are not being compensated for it either. So it is, it's hard to believe because, you know, I totally get that. And I mean, it comes down to some statistics there, but the the truth is, you know, you think about the dental school model, residencies, the the the students are productive, so they're generating this revenue for the institutions. And so it's always kind of hard to believe my tuition plus whatever I'm producing for the institution is not enough, and that's why the tuition keeps going up. But it, it makes me think, you, you talk Dr. about all these external factors. So one big thing now is a lot of people get their information not just in school, but on social media, of course, right? These are things that that we all experience and deal with. What a great day to ask you this question. There's been so much happening with disinformation, misinformation, and our own specialty in endo being active on social media. You see all of these things. And I have to say, I think I, I almost find it personally offensive when I see claims like, you know, endodontic therapy or root canals cause cancer. It really angers me. And I think, you know, we talked about at the beginning, some of our duties or what, what are the jobs of each of us as endodontists across the country and the world? I think we need to to clarify those narratives. But I guess I'll open it up. What do you think about all of this misinformation about endo? What's going on?
You should be angry. Okay? And I think as scientists, we all should be angry because it's misinformation. But I mean, you know, that's not a scientific source. It's bunk. It's garbage. There's no research behind it, or the research is 140 years old, right? So we know as scientists that it's, it's not accurate. It's not true. So the question is, I think this is the real question, is how do we get that message to our patients, to the public, right? And and and I'll tell you how we do that. We do that through our association. Our association has been come so strong from a marketing communications department. It's unbelievable what the AAE does for the private practitioner, the educator, any endodontist, from a misinformation, disinformation, promotional standpoint. We have toolkits. We have a brand new toolkit coming out specifically to combat misinformation. Okay? I'm glad you asked me because it's like, that's on the top of my head, like, what do I need to share with you? Yeah, and that's number one. You know, from a promotional standpoint, I mean, we have a couple of campaigns that we've, we've had for several years now. We have uh Save Your Tooth Month, which is every May. And and we do a lot of promotion. We go out and we visit the news stations. Uh, I'll go and I'll spend a day in New York making some uh informational videos and things that'll that'll reach all kinds of news channels all over the country. And then we have Root Canal Awareness Week, which is all part of that. So so from a promotional standpoint, we're really strong. But I want to share you some of these numbers. In 2024, our campaigns generated 200 plus million media impressions. Wow. I mean, we're, we're getting a lot of mileage from these campaign uh campaigns. We had 3500 plus media placements, okay? We were in Time magazine, we're in the New York Times, we were in People magazine. So we're really getting our message out there. 2 million people plus visited AAE websites, not the scientific part of it, but patient-facing websites. Our top performing page, what is a root canal, number one Google search result for key queries with 834,000 unique visitors. Digital ad campaign, 22 million impressions. So the AAE is aware of what we need to do to keep our message at the top, and they're doing it. We're now utilizing, as I mentioned to before, uh, Chat, uh, GPT Plus, sure, which allows members to go in, have access to some of this AI information as well. It's a lot to deal with. And I think, like you said, I think the answer has to be, at least in my humble opinion, I'd love to hear your take, Dr. Nasi, as well, is this information, the speed at which it travels, is because of the nature of social media and the access to information. And so we need to combat that in the same on the same platforms and same mechanisms. And I, you know, I talked to a lot of my friends who are in the medical space or other dental specialties, and they realize the value of endodontic therapy, of root canal therapy. And, you know, so the sort of the educated individuals are so aware. I think our job is to get it to the people who are not medical or dentally inclined. You know, that's going to be something that we have to take on. Is I think in my generation, that's going to be the burden that we have to carry. And I wonder if that, you know, goes back to the profitability, you know, implants versus endo. I know that's a whole other conversation, but I think it starts with that. What, what do you think, Dr. Nasi, about this whole misinformation?
Well, I mean, certainly, yeah. I mean, people are always motivated by their own set of motives. So it's true when you talk to many of these people that are peddling fear of root canal therapy, then they come back and say, well, I have this special, and this specific root implant that I have for you is a special implant. It's non-metallic. It's zirconia, which is a zirconium is a metal. So they just, you know, it is, it's an economy. Everybody, you know, people get into this economy. And so to that extent, I feel like the misinformation campaign, as you just said, so beautifully in terms of what AAE is doing about it, can best really be addressed with more good information. That's really the only thing you can do about it. Because misinformation in the modern medium will spread faster than good information. So the volume of good information has to be disproportionate to the misinformation to compensate for its pervasive effect. So to that extent, I think working with probably the larger media channels, and even on the social media, as you said, working with people that have on the medical side of things are interfacing with the general public to just raise awareness about this procedure is important, right? And and every one of us has the ability to do that. It doesn't have to be me that goes into the news station. You could go on your channels, and you could go on your channels, and the AAE provides the tools to do that, right? So and and I think we do all need to do that.
Yeah, that I think that's a critical part of it because at the end of it, whether it's, you know, individuals in their practices working, whether it's DSO, whether it's in the school, all of this ends into the integrity and safety and the belief in the procedure, right? Whether it's done by specialists, whether it's done by, you know, restorative dentists, non-specialists, it still has the procedure has to be viable first. And then from that, everything else kind of reverse engineer it from that. And that's why it's so important to make sure we focus on the integrity of the procedure.
Transitioning after that, I was going to say, we're lucky because we live in an ecosystem and in a time where there's a lot of access to health information on, you know, channels like ours, but, you know, across the medical space, and people talk about dentistry a lot, and people talk about root canal therapy a lot because it's the number one thing people think about, well, I have to go to the dentist or the specialist, and I, they think about a root canal. And we're lucky because we get to be a part of the narrative. And, you know, I, you, you said that too, Dr. because I am angry to hear that. I go on social media and I have people that I love, you know, Dr. Huberman's and the Peter Attias of the world, and I, I, I'm so happy to have you here today with Dr. Nasi, the you legendary individuals to say root canals don't cause cancer. So I'm happy to, I'm happy to talk about that. And we were just touching on this topic, but there's a, I think there's a billion-dollar elephant in the room, and that's implants. Sure. Oh my gosh, what a, what a big topic to to dive into. But, you know, one thing that we always talk about is this uh conversation of saving teeth, placing implants. And I think that's probably the most frequent question that patients ask is, should I save this or should I just go for an implant? This whole concept has dominated the narrative. What's your take?
Sure. Great question. So things have changed a lot in the last several years, Dr. Nasi will tell you that, you know, several years ago, the folks that were placing implants would tell you they were 100% successful. Not that anything could be 100% successful, but that's what we would hear. We would hear that you'd put an implant in and and that was the end of the story. Nobody even told the patient they needed to brush it. Just put it in and it's going to last forever. Well, you know, fast forward 20 years, and and now there's a lot of research that shows that implants aren't 100% successful. In fact, they're way less successful than that. You know, somewhere in the what, upper 80s to low 90s, which isn't any different than the success rate of endodontic therapy. You know, the other thing that we're learning is that every implant develops peri-mucositis or peri-implantitis, almost every one of them, right? So again, nobody shared that message at the beginning. But I'm finding from a on a personal level, like in my practice, like the periodontists that I work with, they're saving more teeth. I mean, they're doing root resections again, and he sections, and and they're doing what they can to save teeth because they know that the patient is better off with their own tooth. And it, there may come a time when the patient needs an implant, but they're doing whatever they can to kind of push that down the line. There's a graph that I'm sure you've seen that O Peters did, right? That save your tooth of the life cycle of a tooth. And I think the whole idea is is to push that to the right, to to hang on to the tooth as long as we can. And I kind of look at it from a medical standpoint. It's like if you go to an orthopedic surgeon and you're 50 years old and you know your hip's starting to bother you, most orthopedic surgeons with integrity will tell you, you know, come back in 10 years, come back in 15 years because if they put a hip in when you're 50 and they have to put another one in when you're 70, the success rates just plummet. It's way, way more complicated. And it's true with implants too. So if an implant fails, and and they do fail, Yeah, then down the road, it's way more complicated. Success rates are way less with a second implant. So I I think the whole idea, and this is what we promote from an organizational standpoint, as you can imagine, is that you need to save your tooth as long as you can. Nothing functions like a natural tooth. It's absolutely. Yeah. It's all about holding on to it as long as you can.
Yeah, nothing is as natural as your natural tooth. I guess the u. And I think that's, I mean, the best analogy is the orthopedic medicine, um, kind of wisdom from experience that look, you just want to try to ride your own natural tissues for as long as you can until you can't. And then that's where, uh, surgery comes in. And it, it's kind of is the same. It's the oldest adage that I often times say is that, you know, medicine or healthcare is the slowest way to die. The same way as dentistry is the slowest way to lose your tooth or your teeth, if you will. So, you know, all we're doing is just essentially postponing the inevitable. But there is something to be said about the nature of our own tissues, and uh, there's a certain element of that that is, you know, we still haven't been able to top. And you're right, that issue of the Derk's study back in 2016, in terms of the incidence of peri-implantitis in the Swedish population, that's just staggering to know. And I think, as you said, 20 years back, we were told that look, implants are 100% successful. But the pendulum is swinging back. And I think the key, like everything else in life, is finding that, you know, medium, kind of optimal level in which we choose to save teeth that are savable for as long as possible, or up for that given patient's capability and possibility and their desire, and then replace them with implants or dentures or whatever is best for that patient, given the the the option. And to that extent, I feel like we do need, and I've been kind of proposing that for a while, for our school, maybe to put together a symposium of sorts on saving teeth, which is like, what is really the evidence out there that shows the indications? What, what are the specific indications for saving teeth, and when should we remove them? And I think we are kind of lacking that. So if we can't do it at our school, maybe we should do something at the AE, even. And, yeah, and and the AE did have a symposium uh several years back where uh we had a joint conference with prosthodontists and the periodontists, and we got together, and and that's what it was about. And and even back then, this was 10, 12 years ago, um, we talked about that. Uh, it's, I don't want to say that it's in the works because we're not that far along, but we have talked about having another joint symposium. There certainly is interest in it. And and at the organization, you know, we understand that. And, you know, listen, our goal is to serve you, to serve our members. So if that's the message we get, then that's what we're going to work on. Yeah, that that one was the other one was about the success of implants versus the success of root canal therapy. But this is like, for me, I'm saying like, indications for saving teeth versus, you know, not saving them. It's a good idea. Be and, you know, like you made a good point, Dr. Nasi, and Dr. Katz, you touched on this earlier, you know, I think like, you, you said, like, we look at the, the perio and oral surgery colleagues, or the pros colleagues, the high level of integrity, they want to save natural, they want to save your natural teeth. So they're not pushing this treatment. I I think the key is the messaging with the implants was the fact that there was access to this technology, or this, the this surgical equipment that we could actually replace your tooth with something prosthetic. And we know we have the the equipment to do it. We have the technology to it to do it. And now I think we can use the same messaging and same mentality in our space, right? With microscopes, we saw, I mean, look at the microscopes we saw this week at a, look at the CBCT technology, look at the biomimetic materials, the bioceramic materials. We have all all these tools in our toolbox to even extend or, you know, give a few years back to someone's natural dentition. That's amazing. And I think that's the same thing that we have to do from a messaging perspective to to our patient, um, that the folks in in implantology were doing several years ago, as you mentioned. And I, I wonder if that will help. And and that maybe that's the reason that the pendulum has swung back because people are realizing that with all of these tools and capabilities, we can actually do a lot more than we ever thought was possible. But, you know, I'm sure the AE is, you know, on top of it. You shared those, those metrics, that's really incredible. And I'm excited. And as practitioners, we know that, you know, when the patient goes into the perio office or the oral surgery office and they say, "I want to save my tooth." That's very different than when the patient goes in and says, you know, "What do you think, doc?" Right? So that's part of our job, all of our jobs, and our job at the association is to get that message out. Is that yes, you can save your tooth. You don't have to put an implant in. The success levels are just as high. And let's do whatever we can to hold on to your tooth as long as you can. And so when patients come in and and give that same message, that's when things change. I think.
Yeah, I think at the end of the day, so like the reason implants grew so fast, so quickly was because they were the companies were charging, you know, $400 to $500 for an implant device that cost them a couple bucks to make, right? So the profit margin was so high that the marketing push was possible. And so they essentially saturated the
airway with this what turned out to be later on a misinformation that as we just discussed as 100% successful. That I had people tell me at that time, I remember in the '90s, they said that, "Look, I believe that implants are even better than your own teeth. That you should even pull all your teeth and replace them with implants." This was, this was researchers that were doing work on this stuff. So it just goes to show that, you know, our enthusiasm sometimes supersedes reality and wisdom of experience. And let's not forget who did that research, that early research, right? It was all done by the implant companies. Yeah, right. Right. Yeah. So what do you think the message was going to be? Very much so.
So where do you, so let's, we've talked about leadership and the broader things on the on the political side of the spectrum. On the clinical side, where do you see the profession moving? What is your own, as a clinician, because you've been practicing for a long, uh, time as well, you have that wisdom of experience, where do you see our profession is moving towards? Have we really had really true improvement in what we do as root therapy? What should be our priorities moving forward for the profession, clinically, in our practice lifetimes? Things have changed a lot in my, for sure. I mean, I learned with stainless steel files. I, I hand filed everything, right? We developed our own radiographs, no microscopes, uh, certainly no cone beams. So now we have rotary files, we have better materials. We have better materials from a sealing standpoint. So things have changed drastically. Have the numbers changed? I don't know. Uh, at the AE, we, we are doing some outcome studies, so we're looking at that. I mean, it would be great to say, yeah, 30 years later, due to all the materials we have, we have moved the needle, like our outcomes are higher. But we don't know the answer to that yet. But it doesn't mean we shouldn't strive for perfection, right? There's going to be a certain number of teeth that always fail, whether it's two or 3% or whatever that is. There's cracked teeth, there's periodontally involved teeth, all of that stuff. So we're never going to be at 100%, but it shouldn't mean that we don't strive to do better. And I'm not talking about research, because I know again, the research doesn't indicate this, but I have to feel that the way I practice now is better. Do I have less flare-ups? Or are my procedures shorter? Are my patients happier? Yeah, maybe. So that, that has a value and that translates to better patient care. Sure. What the, if the numbers are different, I'm, I'm not convinced.
Moving forward, personally, you ask me as a clinician, I think that it's adjunctive irrigation, adjunctive cleaning. So whether that means, you know, the GentleWave or lasers, I'm not sure. I mean, again, I would like to see what ultimately the research shows. I can't help but think that if the canal is cleaner, it's going to be more successful. So I, I see. So that's one of the ways I think from a technological standpoint will improve things. I think AI and and again, this is your expertise, it's not my expertise, but you know, the ability to look at mountains of data and then to compare it to your radiograph and, you know, have the suggestion that, you know, maybe that's not a ridiculous cyst, maybe you need to send this patient to a pathologist or or whatever that looks like. I mean, that's here now, right? But certainly we'll see more of that in the future. So I think AI is going to affect the way we practice, I mean, more than it already has now.
My feeling in in the future, and again, I've taken my AE hat off. Yeah. Yeah. Um, is that there may come a time where a robot does the endo. You know, we'll make the diagnosis, we'll probably get the patient numb, and then you'll put one of the navigating systems on the tooth, right? We've all seen them, right? And it'll draw an, it'll drill an access opening. And and I think that's okay because that doesn't eliminate us. That makes us more important because we're going to have to make the diagnosis. And and I could see a role for a dental specialist. It's, it's funny and I, I want to hear your thoughts. Dr. I'm very curious. You made some great points. Dr. Cass, uh, Dr. Peter Deman, a super super well-known longevity AI expert. He's a physician. He says AI will not replace the doctors or the people, but it will replace the people not using it. You know, we, there are companies doing robotic, a lot of, we talk about this all the time. There, there are that use AI and other imaging modalities to do these things remotely. Um, but I like to believe, maybe in my naive, humble opinion, that we're in a specialty that requires so much knowledge, tactile capability, know-how, wisdom, expertise, that we're far, far removed from from the procedural aspect being replaced by that. But I think in the next five years, in the whole medical space, as a the general rule of thumb, it'll be illegal or unethical to not use AI in our day-to-day practice. Yeah, I mean, it's, it's very possible. There's no question about it. And and I think the key is that, you know, autopilot did not eliminate pilots, right? I mean, we still need to have that kind of human interaction. Uh, it's just going to help address some of the human frailties and erroneousness that can happen to all of us from time to time. It's just going to help address some of those issues. And there's no question about it. I think AI is going to be a big factor. And I, I, I hope that we're going to be able to capitalize on that. But with endodontics as a procedure, I think by the time robotics is going to replace us in many ways, I think there's no other thing left for anyone to do because it is such a precise, complicated, and yet, you know, microscopic kind of a procedure that I feel like at that point, like everything else is basically going to be robotics and AI as well. So hopefully there's going to be some type of a, you know, universal income or something we can all sit home and enjoy or something, right?
Irrigation was an interesting one. I mean, Dr. Nasa, we, you talk about all the time. So Dr. Katz, you said irrigation. There could be some interesting, uh, advances. Where do you think we're deficient right now in the ir irrigation space? I mean, that's a, it's a question you brought up. Some of these other adjuncts that are improving our irrigation, and there's no question about it. Everything that can improve the irrigation is going to just by the transitive properties of logic, going to help overall, since that is the, you know, stumbling block, the rate-limiting step, the main source of failure, addressing the biofilm, right? So to me, though, it is a bargain of cost-benefit as well, because we're not working in a vacuum of costs, right? I mean, everything we do that increases the cost ends up getting trickled down to the patient, which will then increase the overall cost of care, which will then reduce access to care. To me, the main issue is that how do we balance out the marginal improvements in potential success compared to the marginal decrease in access to care by increasing the cost of care? And at what point do we reach that equilibrium in which we are helping people, but then not as a result of helping them, we're not preventing them from saving their teeth, right? Because if that cost goes up, sure, dramatically. Same thing with education, right? We were just talking about that. It's like the consequences of a higher tuition education has decreased the ability to get people to come and teach at institutions. So I feel like all these vectors are pushing into different directions and finding that right equilibrium is essentially what we should do as opposed to just jump on every technology bandwagon and kind of like, you know, this thing helps, yeah, of course it helps you, but at what cost? Sure. And to what benefit? And what is the evidence? I think until you can really show that it's more effective, that it alters your numbers, it's just for the wealthy, for those that can afford it, right? Because if you're charging patients extra for it, you have to be able to show them that there is a a benefit to that. You know, ultimately, does your cost get spread out amongst all your patients? So maybe you don't have to charge them extra to do it. I mean, maybe I don't know. But I, but I think there has to be a benefit to it. You have to be able to say to them, "Listen, I'm going to charge you extra $100 to use this, but this will increase the success rate by 5%."
Potentially, from from an education standpoint, you said something interesting because Dr. Rosado said the other day that there's oral surgery programs that are longer, some are five years, I guess, and some are a couple, three years, or six years, whatever it is. He said the longer programs, they're not all being filled because the dentists, the younger dentists, they'd rather go to a program where they're not spending $150,000 more money. So the cost of education is certainly going to affect who has access to and who chooses to go into that level of debt. So it, it is a big thing. Yeah. It's funny because how all of these things intermingle with the broader overall world and global affairs is that as inflation increases the costs of things, then people are limited in terms of what they can do because they have to. This is, you know, in biology, we call that the Red Queen phenomenon. You got to keep running just to stay in place, right? So people then stop getting into these areas where they can invest more into their education, maybe the arts, other things that are not as well compensated. So this is where the society starts to streamline towards just this process of, you know, but that's a whole different topic, I guess. It's interesting. It's interesting. And I think this is a big message and a big takeaway, maybe from the conversation today, is that we need to push the specialty forward. Technology is a big part of that. But you've always said, are we evolving? You know, are we innovating? Are we evolving for the sake of just saying that we're doing it, or is it really pushing the needle forward? One of the first things I learned from Dr. Nasa, and you, you've always said this, you've always said, is that technology, is that innovation going to give more people that access to care, or is it just icing on top? And this is a big question. I think in the next 10, 20 years in our space. Yeah. We'll find out. I mean, endo is a dynamic, uh, field in many ways, although it's been static in other ways, you know, but, uh, it is still, I mean, healthcare, so it's a good thing that it's conservative in many ways. People don't want to have change. It's not like software, you know, at the end of the day, you're dealing with patients, so the safety and efficacy of everything we do has to be validated before someone gets hurt. And I think in that way, it's a good thing that we're, you know, our growth and progress is controlled in many ways. So that, that, that's important. But, you know, I, we know, uh, Dr. Cats, that, uh, you are in the middle of the AAE meeting and you have a lot of, uh, meetings and things going on, but we really, really appreciate you joining us today and spend a little bit of time so that we can share the message of the AAE with the u with our viewers. Is there anything you want to say at the end as a message for from the AAE?
Sure. Um, well, thank you for having me. It's, it's really been a pleasure to chat with both of you this morning and and we appreciate the opportunity. I think the message from the AAE is that we're working for you. There's a lot of organizations that may say that, but there's no evidence that they really are. And many organizations in dentistry, in particular, are struggling right now. But the AAE is not struggling. Our our members, for the most part, are busy. Uh, the numbers are showing that we are actually seeing, as specialists, we're seeing a higher percentage of patients than every other specialty. So more patients are seeking out endodontists for endodontic care. And that's what we're all about. And so I feel incredibly proud to be able to say how strong we are right now and that we're moving in the right direction, and we're going to continue to move in the right direction. The other thing I would tell you is that we are open for comments, for questions. As an executive committee, we discuss these things all the time. We have a combination of educators and practitioners, so every aspect of endodontics is relevant to us. And as a board, it's the same thing. We have a great mix. And so if, if you or your friends or whomever you said you'd like to see a symposium about when we should save a tooth, so present it and we'll look at it and we'll do what we can. If, if endodontists want that, we're going to do that. If you have problems you need to talk to somebody about and you think that we can help you, you know, call me. It's, we're, we're really available for you. So that, I think that's an important message.
That's awesome. Really excited about you and Dr. Perry. We're looking forward to a great year and hopefully around this time next year, we can talk again and and dive into all that's been done. So thank you. That'd be great. And we, we'll get a feedback as to what was the experience like going through it. Right, right, right. That would be great. I would love that. Absolutely would love to have you back again. And thank you so much. It was a pleasure. And our guest, Dr. Steven Katz, the president of, uh, American Association. And if you are a patient or a colleague, make sure you visit AE.org or to get more information about the procedure and everything. My co-host, Dr. Paridi, thank you. Findmyendodontist.com. That's where your patients can find access to specialty endodontic care. Findmyendodontist.com. Terrific. Is it? You heard it. See you in the next video. [Music]