Podcasts about GP

According to public autopsy records, many people regarded as whistleblowers have died by s*icide.  Virginia Giuffre is one of Epstein's most outspoken victims who has spent her life fighting to bring Epstein and Ghislaine to justice.  At 17 years old she is photographed with “Prince” Andrew whose hand is wrapped around her waist.  By her late 20s she's best known for exposing that picture to the public and testifying to the trafficking she was subjected to by some of the world's elite.  Yet now, as of April 25th, 2025, Virginia Giuffre is dead. Leaving behind a manuscript titled “Nobody's Girl” detailing the 2 years she was trafficking by Epstein to limitlessly powerful people. Before her death she emails two confidants:  “In the event of my passing, I would like to ensure that “Nobody's Girl” is still released...” Sent April 1, 2025. April 25, 2025, Virginia Giuffre will be found dead. Her death ruled as a s*icide less than a month after her email and a few years after she made the following tweet on X:  “I am making it publicly known that in no way, shape, or form am I s*icidal. I have made this known to my therapist and GP– if something happens to me– in the sake of my family do not let this go away and help me protect them. Too many evil people want to see me quieted.”  Now, a lot can change in a few years, including someone's mental state. But with the Epstein case and files...  Everyone feels like a suspect.Everyone has money. Everyone has power. And everyone has a lot to lose.   Full show notes available at RottenMangoPodcast.com Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Steve has been a force in real estate since 2002, executing everything from raw land deals and bulk foreclosure packages to single-family flips, multifamily rentals, and large-scale land development. With nearly 4,000 units closed and over $1 billion in transactions, he's helped hundreds of investors build wealth across 18 states, currently operating in Utah, Texas, Arizona, Indiana, Alabama, and Idaho. A Brigham Young University graduate with a Master's in Real Estate from Georgetown, Steve pairs deep market expertise with a passion for helping others succeed. When he's not closing deals, he's enjoying time with his wife and four kids, usually around a barbeque, on the water, or out on the golf course or basketball court.   Here's some of the topics we covered:   GP'ing build-to-rent townhomes and the unexpected strategies fueling massive growth The commercial flex space arena everyone is scrambling to get into Shallow bay flex space broken down and why investors are suddenly obsessed The brutal reality of industrial flex space and the part nobody warns you about Steve's unforgettable REIT nightmare that still keeps him up at night Third-party property management horror stories that will make any investor cringe A wave of opportunity as distressed operators hit their breaking point How the Supreme Court vs. Trump's tariffs could send shockwaves through the country   To find out more about partnering or investing in a multifamily deal: Text Partner to 72345 or email Partner@RodKhleif.com    For more about Rod and his real estate investing journey go to www.rodkhleif.com   Please Review and Subscribe

Everyone loves a "we closed" post… but nobody talks about what actually happens next. Year one of operations is the most chaotic, most demanding, and least "passive" part of multifamily real estate — and most people have no idea what they're stepping into. In this episode, I break down the real work behind owning and operating apartments. Year one is where the property starts talking to you. Tenants, lenders, partners, vendors — everyone needs something. Problems you never saw in due diligence suddenly show up. Bills spike. Delinquency hits. Contractors ghost you. Utilities jump. And every weakness in your business plan gets exposed instantly. This is the part Instagram never shows. In this episode, we cover: – Why year one feels like a constant fire drill – The truth about older buildings and hidden issues – Delinquency, turnover, and the residents you "inherit" – The vendor and contractor chaos nobody warns you about – Cash flow pressure, tax deadlines, and insurance headaches – Weekly operator habits that keep a deal alive – Why year one determines the success of the entire hold period – What real operators do when the pain hits If you're in year one right now, you're not crazy — you're becoming an operator. If you're thinking about becoming a GP, listen with both ears open. And if you're an LP, this is why operators get paid what they get paid. Want tools, templates, or coaching to learn this game for real?

What happens when menopause meets chronic kidney disease? How do you know if it's your hormones, your kidneys or your medication talking? And what options are actually on the table if you're living with CKD, on dialysis or post-transplant?   In this special listener-led edition of Diary of a Kidney Warrior Podcast (in partnership with Kidney Care UK), host Dee Moore is joined again by menopause specialist Dr Vikram to answer questions sent directly from the Kidney Warrior community.   Together they unpack real-life concerns about: •Navigating menopause symptoms alongside CKD, dialysis or transplant •When HRT may or may not be suitable if you have kidney or liver disease •Non-hormonal options for hot flushes, night sweats, mood and sleep •Period changes on haemodialysis and after transplant •Bone health, osteoporosis risk and steroids •Fibroids, endometriosis, early menopause and hysterectomy in the context of CKD •How to advocate for yourself with your GP, renal team and menopause services   You'll also hear a powerful call from Dr Vikram for better research that truly includes women with CKD, especially those from ethnic minority backgrounds – and why your story and participation matter.  

Since the first IVF baby was born in 1978, there has been an exponential increase in the number of infants born using assisted reproductive technologies, or ART.  

Rosetta and Milly catch up with Lara Greaves for Political Commentary, and today they're chatting the latest policy announcement from The Labour Party - low-interest loans for family GP practices. Whakarongo mai nei!

Cristóbal Rosaleny, en La Tribu, para analizar todo lo que dio de sí el GP de Catar.See omnystudio.com/listener for privacy information.

Labour says some corporate owned GP clinics don't prioritise community needs. It announced a new cheap-loans policy to help GPs and nurses to buy or set up their own practices. Cecilia Robinson is the founder and co-chief executive at Tend Health and spoke to Ingrid Hipkiss.

We krijgen een zinderende apotheose in Abu Dhabi. Met nog één race te gaan maken Lando Norris, Max Verstappen en Oscar Piastri nog kans op de wereldtitel.  Verstappen won de GP van Qatar, mede dankzij een tactische fout van McLaren. Piastri eindigde als tweede, maar Norris liep met een vierde plaats meer schade op. We hebben een hele boel na te beschouwen en vooruit te blikken. En dat doen we dit keer met coureur en analist Jeroen Bleekemolen, oud-engineer Ernest Knoors en F1-verslaggever Louis Dekker.

According to public autopsy records, many people regarded as whistleblowers have died by s*icide.  Virginia Giuffre is one of Epstein's most outspoken victims who has spent her life fighting to bring Epstein and Ghislaine to justice.  At 17 years old she is photographed with “Prince” Andrew whose hand is wrapped around her waist.  By her late 20s she's best known for exposing that picture to the public and testifying to the trafficking she was subjected to by some of the world's elite.  Yet now, as of April 25th, 2025, Virginia Giuffre is dead. Leaving behind a manuscript titled “Nobody's Girl” detailing the 2 years she was trafficking by Epstein to limitlessly powerful people. Before her death she emails two confidants:  “In the event of my passing, I would like to ensure that “Nobody's Girl” is still released...” Sent April 1, 2025. April 25, 2025, Virginia Giuffre will be found dead. Her death ruled as a s*icide less than a month after her email and a few years after she made the following tweet on X:  “I am making it publicly known that in no way, shape, or form am I s*icidal. I have made this known to my therapist and GP– if something happens to me– in the sake of my family do not let this go away and help me protect them. Too many evil people want to see me quieted.”  Now, a lot can change in a few years, including someone's mental state. But with the Epstein case and files...  Everyone feels like a suspect.Everyone has money. Everyone has power. And everyone has a lot to lose.   Full show notes available at RottenMangoPodcast.com Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Iniziamo la puntata analizzando la sofferta vittoria dell'Inter a Pisa. Ne parliamo con Gianfelice Facchetti. Con Sandro Sabatini facciamo invece un punto più generale sul campionato: vincono Juve e Milan, attesa per Roma-Napoli.Entriamo nel dettaglio con Mario Ielpo: i Rossoneri di Allegri superano la Lazio e si proiettano momentaneamente in testa alla classifica. A San Siro però si è vissuto un finale pieno di polemiche per un possibile calcio di rigore non assegnato ai Biancocelesti. Sentiamo cosa ne pensa Angelo Bonfrisco.Ci spostiamo nella Capitale dove manca sempre meno al big match di giornata tra la Roma capolista e il Napoli di Conte. Cosa dobbiamo aspettarci da questa supersfida? Lo chiediamo a Massimo Caputi e a Max Gallo.Torniamo alle partite di ieri e insieme a Guido Vaciago analizziamo in particolare la vittoria della Juventus, con i Bianconeri che sono riusciti a rimontare il Cagliari.In coda con Umberto Zapelloni parliamo di Formula 1, con il GP del Qatar che è terminato da pochi minuti. Vince Verstappen, per il mondiale sarà decisiva la gara di Abu Dhabi.

Escucha la primera parte del derbi Sevilla-Betis, encuentro correspondiente a la 14ª jornada en Primera. Además, Racing-Eibar de Segunda. Primeras vueltas del GP de Catar de F1.

Cerramos conexiones con Montilivi donde el Real Madrid ha perdido el liderato tras empatar contra el Girona. Las opiniones de Fernando Morientes y Dani Senabre. Resto de partidos de la jornada y repaso al fútbol internacional. Crónica del GP de Catar de F1. Victoria de España en baloncesto

Escucha la segunda parte del derbi Sevilla-Betis, encuentro correspondiente a la 14ª jornada en Primera. Además, Racing-Eibar de Segunda. Últimas vueltas del GP de Catar de F1.

Analizamos el derbi sevillano que se ha llevado el Betis por el 0-2. Charlamos con Aitor Ruibal y con Alberto Moleiro tras el triunfo del Villarreal ante la Real Sociedad. Además, junto a Ponseti y De la Rosa desgranamos todas las claves del GP de Catar de Fórmula 1. Por último, entrevista con la atleta española María Pérez.

Labour says it will invest up to $25 million worth of low-interest loans to grow the number of locally owned GP clinics. The president of the Royal New Zealand College of General Practitioners, Dr Luke Bradford, spoke to Corin Dann.

Alemania y España empatan a cero en la ida de la final de la Liga de Naciones. El Getafe gana al Elche. Hablamos con Arambarri. Laporta contesta a Florentino Pérez. GP de Catar F1. #OasisdeLibertad. Noticias del derbi sevillano. Última hora del Barça y del Real Madrid #CampodelGas

In this episode, Danni discusses preparing for a sober December, offering insights and journaling prompts to help listeners navigate the holiday season without alcohol. She emphasises the importance of self-reflection, setting boundaries, and creating new traditions that don't involve drinking. Danni also shares personal experiences and advice on maintaining a regulated nervous system and staying connected to oneself during challenging times.For more resources such as coaching or to join the next HIQA challenge go towww.iquitalcohol.com.auFollow HIQA insta @howiquitalcohol Music for Podcast intro and outro written by Danni Carr performed by Mr CassidyIf you are struggling with physical dependancy on alcohol consider contacting a local AA meeting or a drug and alcohol therapist. Always consult a GP before stopping alcohol. Hosted on Acast. See acast.com/privacy for more information.

Previa del derbi sevillano entre Sevilla y Betis con Santi Ortega, Florencio Ordóñez y Francisco Toscano. Además, resto de la jornada de Primera, Segunda y fútbol internacional. Por último, análisis del GP de Catar de Fórmula 1, en donde Lando Norris puede ser campeón del Mundial.

El deporte del viernes con Jesús Gallego: Fernando Alonso se acerca a los puestos de arriba en el GP de Catar, final de la Liga de las Naciones femenina Alemania-España, jornada 14 de liga con derbi sevillano, El Sanedrón con Raúl Pérez,  Mundial femenino de balonmano y de fútbol sala y más deporte.

Pascal Wagner interviews Bronson Hill, founder of Bronson Equity, about how LPs can invest confidently in today's noisy and divided market. Bronson shares how raising $50M+ across multifamily, oil & gas, and alternative real estate has shaped the way he vets operators, evaluates risk, and structures deals more conservatively after recent market challenges. He explains why understanding your true investment objective—cash flow, tax benefits, or equity growth—is the key to picking the right deal, and why due diligence should start with the market, then the operator, then the deal. Bronson also walks through his shift toward more control as a GP, including his Altadena modular housing redevelopment project after the California wildfires, and why debt funds and royalties are gaining traction with LPs seeking stability and monthly income. Bronson HillCurrent role: Founder & CEO, Bronson EquityBased in: Pasadena, CaliforniaSay hi to them at: Facebook: https://www.facebook.com/bronson.hill.37 | https://www.facebook.com/BronsonEquityLinkedIn: https://www.linkedin.com/in/bronsonhill | https://www.linkedin.com/company/bronson-equity/mycompanyYoutube: https://www.youtube.com/channel/UCc1KYJL8ZjF3GC3Wh5lYNfgInstagram: https://www.instagram.com/bronsondavidhillWebsite: https://bronsonequity.com Start earning passive income today at gsprei.com/bestever Alternative Fund IV is closing soon and SMK is giving Best Ever listeners exclusive access to their Founders' Shares, typically offered only to early investors. Visit smkcap.com/bec to learn more and download the full fund summary. Join us at Best Ever Conference 2026! Find more info at: https://www.besteverconference.com/  Join the Best Ever Community  The Best Ever Community is live and growing - and we want serious commercial real estate investors like you inside. It's free to join, but you must apply and meet the criteria.  Connect with top operators, LPs, GPs, and more, get real insights, and be part of a curated network built to help you grow. Apply now at⁠ ⁠⁠⁠www.bestevercommunity.com⁠⁠ Podcast production done by⁠ ⁠Outlier Audio⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

Andrew Mayne, Justin Robert Young, and Brian Brushwood kick off the episode with a discussion on the latest AI model updates, including Google’s Nano Banana and OpenAI’s GP 5.1. They explore the implications of AI personality and its impact on user experience. The conversation shifts to a group chat feature with ChatGPT, enhancing collaboration and […]

In this week's episode of The ADHD Women's Wellbeing Podcast, we're exploring the complex and often overlooked intersection of ADHD, hormones, and women's mental health, particularly during pivotal life transitions like perimenopause.I'm joined by Dr. Helen Wall, a GP and registered menopause specialist with the British Menopause Society. Helen is also a resident GP on BBC Breakfast, a columnist for Woman magazine, and public health clinical director in Greater Manchester. She therefore brings both clinical expertise and real-world empathy to bridge the gap between professional healthcare and accessible, compassionate advice to ensure women feel heard, understood, and properly supported.We explore why so many women feel dismissed or misdiagnosed when seeking help for emotional and physical symptoms related to hormone fluctuations, and touch on everything from progesterone sensitivity and HRT, to advocating for yourself at the GP, and the growing need for women's health education that takes neurodiversity seriously.I discuss the crossover of ADHD and hormones in my new book, The ADHD Women's Wellbeing Toolkit, which is now available. Grab your copy here!Key Takeaways:Why so many women with ADHD report mental health declines during perimenopause, including PMDD, anxiety, and mood disorders.The connection between hormonal sensitivity and neurodivergence, and why it's often overlooked by mainstream medicine.How stereotypes and stigma contribute to late ADHD diagnosis in women, especially in midlife.The shift in how menopause is being discussed and treated post-COVID.The dangers of a "one-size-fits-all" approach to HRT and why personalised prescriptions matter.Why clinicians must join the dots between long-term anxiety and depression and undiagnosed ADHD or hormonal issues.The growing importance of patient-led care and better GP education around menopause and neurodiversity.How to advocate for yourself at the doctor's office when your concerns have been dismissed.Timestamps:01:50 – ADHD & Hormonal Concerns04:00 – Perimenopause & Mental Health06:10 – Misconceptions About ADHD Hormones10:06 – ADHD in Women: The Hidden Struggles16:19 – Personalised HRT & Progesterone Sensitivity25:12 – Women's Health Advocacy in Practice31:21 – Self-Advocacy for Better TreatmentJoin the More Yourself Community - the doors are now open!More Yourself is a compassionate space for late-diagnosed ADHD women to connect, reflect, and come home to who they really are. Sign up here!Inside the More Yourself Membership, you'll be able to:Connect with like-minded women who understand you Learn from guest experts and practical toolsReceive compassionate prompts & gentle remindersEnjoy voice-note...

Contact us and share your opinionJoin Andy and Gandhi as they cover the impact of the budget, the BMA being out of GP negotiations and other plans for GPs by the DAUKAgendaWes Letter 27/11/25BMA lose exclusive negotiating role in GP contractBudget 25 - impact for GP?DAUK Your GP here for you campaignBMA set to lose exclusive GP contract negotiating role in Englandhttps://www.pulsetoday.co.uk/news/breaking-news/bma-set-to-lose-exclusive-gp-contract-negotiating-role-in-england/ Not our role to negotiate GP contract', says RCGPhttps://www.pulsetoday.co.uk/news/contract/not-our-role-to-negotiate-gp-contract-says-rcgp/ NHSE primary care director Dr Amanda Doyle: Patients deserve consistent online access - by Amanda Doylehttps://www.pulsetoday.co.uk/views/2025-26-contract/nhse-primary-care-director-dr-amanda-doyle-patients-deserve-consistent-online-access/ Budget 2025ContextLong waitLots of leaks and kite flyingNot least OBR leak on the dayhttps://www.nhsconfed.org/publications/autumn-budget-2025#:~:text=The%20overall%20budget%20for%20health,in%20the%20OBR's%20inflation%20projection. Wimslow practice videohttps://www.youtube.com/watch?v=1zNQN8VJLVI Medics Moneyhttps://www.youtube.com/watch?v=u0KEiv6cR8U Doctors demand new GP contract and £40-per-patient funding uplifthttps://www.pulsetoday.co.uk/news/contract/doctors-demand-new-gp-contract-and-40-per-patient-funding-uplift/Doctors' Association UK (DAUK) has demanded that the Government increase core GP funding per patient by £40 a year as part of a new ‘patient-centred' GP contract. The group's ‘Your GP, here for you' campaign proposes funding these changes by increasing per-patient funding by £40 a year to £209 – a move it says would bring the figure in line with inflation over the last decade. Advocate for a patient centred GP contracthttps://dauk.org/our-call-for-new-patient-centred-gp-contract/ Wes Letter 27/11/25Dear Colleagures… To GPs and bypassing the GPCFirstly, I want to say a heartfelt thank you to you and your teamsPatient satisfaction with general practice is improving, with 73.9% reporting a good overall experience, up from 67.4% in July 2024. This is a significant achievement, and the credit is all yours.Background to previous negotiation milestones with labour …We struck the first contract deal with the BMA GPCE in 4 years last year, backed by £1.1billion in 2025/26 (an 8.9% cash uplift), the biggest in over a decade.Within months of entering government, we invested an additional £82 million into the ARRS scheme and removed red tape to allow you to recruit over 2,500 extra GPs. I am now actively looking at ways I can introduce further flexibilities into the scheme to continue boosting GP employment.To ensure general practice is rewarded for the additional work you take on through advice and guidance, we have introduced a financial Boost your triage skills with our dynamic 5-session live webinar course, tailored for primary care clinicians. Led by Dr. Gandalf and Dr. Ed Pooley, this comprehensive training covers all facets of remote patient triage—digital, on-call, and more. Gain practical knowledge, exclusive tips, and direct access to our experts through open Q&A sessions. Elevate your ability to manage primary care challenges effec Subscribe and hear the latest EPIC episode. Join Dr Mike as he shares how to get started and fly using EMIS to make your life easier with this clinical systembit.ly/EMIScourse

ReferencesGuerra, DJ. 2025 Unpublished Lectures Accounts of Chemical Research2025 FEB Vol 58/Issue 5:714-731UBMB Life, 2011. 63(3): 175–182, MarchTelemann, GP. 1715. Various Career Sonatashttps://music.youtube.com/watch?v=C7lV9c0-C3k&si=qVZmMWNmbKliH_JDWilson et al. 1966 Pet Sounds LP Beach Boys.https://music.youtube.com/playlist?list=OLAK5uy_kSxA3IV3xpP1jCo4iNFKPLcaA8trAJGf0&si=6efnAJJyGdOrhg_P

In this week's episode, Dani continues her conversation with Dr Sarah Glynne, GP, menopause specialist, and co-author of the new paper “Menopausal Hormone Therapy for Breast Cancer Patients: What Is the Current Evidence?” - to explore one of the most frequently asked questions left after last week's episode: testosterone therapy after breast cancer.This is Part 2 of our special series following the publication of the new paper.In this episode, Dani and Dr Glynne discuss:What testosterone actually does for energy, mood, and libido.The studies we have so far - and how reliable they are.Whether testosterone can convert into oestrogen.How testing works and when it might be appropriate.Whether testosterone therapy can or should be used alongside endocrine treatments.The paper is here: https://journals.lww.com/menopausejournal/fulltext/9900/menopausal_hormone_therapy_for_breast_cancer.532.aspxThe Meno ABS trial: https://www.londonbreastcancer.com/meno-abc-trialFind Dr Glynne here https://www.clairemellon.co.uk/dr-sarah-glynneThe episode on testosterone with Dr Rebecca Glaser is Ep 56The episode with a patient on testosterone therapy is Ep 97Read all about HRT after breast cancer in Dani's book “Navigating Menopause After Cancer' in chapter 6: Buy it here: https://amzn.eu/d/0uLveeE Episode Highlights:00:00 Intro03:34 "Testosterone Use in Women"06:16 Testosterone Debate: Data vs. Choice10:38 Menopause Consultation & Treatment Approaches17:45 "Testosterone After Breast Cancer"21:21 Complexity of Menopause Treatment Conversations23:49 Vaginal OestrogenConnect with us:For more information and resources visit our website: www.menopauseandcancer.org Or follow us on Instagram @menopause_and_cancerJoin our Facebook group: www.facebook.com/groups/menopauseandcancerchathub

QUE RUEDE LA PELOTA!

Na 38ª edição da sétima temporada do podcast Na Ponta dos Dedos, Rafael Lopes e Luciano Burti conversam com Diogo Moreira, campeão mundial da Moto2 e confirmado na MotoGP em 2026. Além disso, tudo sobre o GP de Las Vegas de Fórmula 1 e a prévia do GP do Catar.

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This is what we're yappin about in this 176th episode. GP's week (01:04) AD's week (04:56) Time to get angry at unhealthy folks that joke on the healthy and A bad friend to a blind woman in CALL IT OUT! (12:12) A man from Sweden has the world record for putting 81 matches in his nose. (28:30) You must resist this horrible Ai bear. (37:10) Quick bits where we talk real news real fast. (44:56) GP's review of Predator Badlands (52:44) We Call-A-Reminisce over College Dropout from Kanye West. (1:03:52) Positive Chakra (1:22:06) Yell outs before we head out. (1:24:50) #rate #comment #like #subscibe More things of the show, check out the linktree linktr.ee/Callitlikeidontseeit

Let's be honest – the occlusion after Aligner cases can be a little ‘off' (even after fixed appliances!) How do you know if your patient's occlusion after aligner treatment is acceptable or risky? What practical guidelines can general dentists follow to manage occlusion when orthodontic results aren't textbook-perfect? Jaz and Dr. Jesper Hatt explore the most common challenges dentists face, from ClinCheck errors and digital setup pitfalls to balancing aesthetics with functional occlusion. They also discuss key strategies to help you evaluate, guide, and optimize occlusion in your patients, because understanding what is acceptable and what needs intervention can make all the difference in long-term treatment stability and patient satisfaction. https://youtu.be/e74lUbyTCaA Watch PDP250 on YouTube Protrusive Dental Pearl: Harmony and Occlusal Compatibility Always ensure restorative anatomy suits the patient's natural occlusal scheme and age-related wear. If opposing teeth are flat and amalgam-filled, polished cuspal anatomy will be incompatible — flatten as needed to conform. Need to Read it? Check out the Full Episode Transcript below! Key Takeaways Common mistakes in ClinCheck planning often stem from occlusion issues. Effective communication and documentation are crucial in clinical support. Occlusion must be set correctly to ensure successful treatment outcomes. Understanding the patient’s profile is essential for effective orthodontics. Collaboration between GPs and orthodontists can enhance patient care. Retention of orthodontic results is a lifelong commitment. Aesthetic goals must align with functional occlusion in treatment planning. Informed consent is critical when discussing potential surgical interventions. The tongue plays a crucial role in orthodontic outcomes. Spacing cases should often be approached as restorative cases. Aligners can achieve precise spacing more effectively than fixed appliances. Enamel adjustments may be necessary for optimal occlusion post-treatment. Retention strategies must be tailored to individual patient needs. Case assessment is vital for determining treatment complexity. Highlights of this episode: 00:00 Teaser 00:59 Intro 02:53  Pearl – Harmony and Occlusal Compatibility 05:57 Dr. Jesper Hatt Introduction 07:34 Clinical Support Systems 10:18 Occlusion and Aligner Therapy 20:41 Bite Recording Considerations 25:32 Collaborative Approach in Orthodontics 30:31 Occlusal Goals vs. Aesthetic Goals 31:42 Midroll 35:03 Occlusal Goals vs. Aesthetic Goals 35:25 Challenges with Spacing Cases 42:19 Occlusion Checkpoints After Aligners 50:17 Considerations for Retention 54:55 Case Assessment and Treatment Planning 58:14 Key Lessons and Final Thoughts 01:00:19 Interconnectedness of Body and Teeth 01:02:48 Resources for Dentists and Case Support 01:04:40 Outro Free Aligner Case Support!Send your patient's case number and get a full assessment in 24 hours—easy, moderate, complex, or referral. Plus, access our 52-point planning protocol and 2-min photo course. No uploads, no cost. [Get Free Access Now] Learn more at alignerservice.com If you enjoyed this episode, don't miss: Do's and Don'ts of Aligners [STRAIGHTPRIL] – PDP071 #PDPMainEpisodes #OcclusionTMDandSplints #OrthoRestorative This episode is eligible for 1 CE credit via the quiz on Protrusive Guidance. This episode meets GDC Outcomes A and C. AGD Subject Code: 370 ORTHODONTICS (Functional orthodontic therapy) Aim: To provide general dentists with practical guidance for managing occlusion in aligner therapy, from bite capture to retention, including common pitfalls, functional considerations, and case selection. Dentists will be able to – Identify common errors in digital bite capture and occlusion setup. Understand the impact of anterior inclination and mandibular movement patterns on occlusal stability. Plan retention strategies appropriate for aligner and restorative cases. Click below for full episode transcript: Teaser: The one thing that we always check initially is the occlusion set correct by the aligner company. Because if the occlusion is not set correctly, everything else just doesn't matter because the teeth will move, but into a wrong position because the occlusion is off from the beginning. I don't know about you, but if half the orthodontists are afraid of controlling the root movements in extraction cases, as a GP, I would be terrified. Teaser:I don’t care if you just move from premolar to premolar or all the teeth. Orthodontics is orthodontics, so you will affect all the teeth during the treatment. The question’s just how much. Imagine going to a football stadium. The orthodontist will be able to find the football stadium.  If it’s a reasonable orthodontist, he’ll be able to find the section you’re going to sit in, and if he’s really, really, really good, he will be able to find the row that you’re going to sit in, but the exact spot where you are going to sit… he will never, ever be able to find that with orthodontics. Jaz’s Introduction: Hello, Protruserati. I’m Jaz Gulati. Welcome back to your favorite dental podcast. I’m joined today by our guest, Dr. Jesper Hatt. All this dentist does is help other dentists with their treatment plans for aligners. From speaking to him, I gather that he’s no longer practicing clinically and is full-time clinical support for colleagues for their aligner cases. So there’s a lot we can learn from someone who day in day out has to do so much treatment planning and speaking to GDPs about their cases, how they’re tracking, how they’re not tracking, complications, and then years of seeing again, okay, how well did that first set of aligners actually perform? What is predictable and what isn’t? And as well as asking what are the most common errors we make on our ClinChecks or treatment plan softwares. I really wanted to probe in further. I really want to ask him about clinical guidelines for occlusion after ortho. Sometimes we treat a case and whilst the aesthetics of that aligner case is beautiful, the occlusion is sometimes not as good. So let’s talk about what that actually means. What is a not-good occlusion? What is a good occlusion? And just to offer some guidelines for practitioners to follow because guess what? No orthodontist in the world is gonna ever get the occlusion correct through ortho. Therefore, we as GPs are never gonna get a perfect textbook occlusion, but we need to understand what is acceptable and what is a good guideline to follow. That’s exactly what we’ll present to you in this episode today. Dental PearlNow, this is a CE slash CPD eligible episode and as our main PDP episode, I’ll give you a Protrusive Dental Pearl. Today’s pearl is very much relevant to the theme of orthodontics and occlusion we’re discussing today, and it’s probably a pearl I’ve given to you already in the past somewhere down the line, but it’s so important and so key. I really want to just emphasize on it again. In fact, a colleague messaged me recently and it reminded me of this concept I’m about to explain. She sent me an image of a resin bonded bridge she did, which had failed. It was a lower incisor, and just a few days after bonding, it failed. And so this dentist is feeling a bit embarrassed and wanted my advice. Now, by the way, guys, if you message me for advice on Instagram, on Facebook, or something like that, it’s very hit and miss. Like my priorities in life are family, health, and everything that happens on Protrusive Guidance. Our network. If you message me outside that network, I may not see it. The team might, but I may not see it. It’s the only way that I can really maintain control and calm in my life. The reason for saying this, I don’t want anyone to be offended. I’m not ignoring anyone. It’s just the volume of messages I get year on year, they’re astronomical. And I don’t mind if you nudge me. If you messaged me something weeks or months ago and I haven’t replied, I probably haven’t seen it. Please do nudge me. And the best place to catch me on is Protrusive Guidance. If you DM me on Protrusive Guidance, home of the nicest and geekiest dentists in the world, that’s the only platform I will log in daily. That’s our baby, our community. Anyway, so I caught this Facebook message and it was up to me to help this colleague. And one observation I made is that the lower teeth were all worn. The upper teeth were really worn, but this resin bonded bridge pontic, it just looked like a perfect tooth. The patient was something like 77 or 80. So it really made me think that, okay, why are we putting something that looks like a 25-year-old’s tooth in a 77-year-old? But even forgetting age and stuff, you have to look at the adjacent teeth in the arch. Is your restoration harmonious with the other teeth in the arch, and of course is the restoration harmonious with what’s opposing it? Because it’s just not compatible. So part one of this pearl is make sure any restoration you do, whether it’s direct or indirect, is harmonious with the patient’s arch and with the opposing teeth and with their occlusal scheme. Because otherwise, if you get rubber dam on and you give your 75-year-old patient beautiful composite resin, it’s got all that cuspal fissure pattern and anatomy, and you take that rubber dam off and you notice that all the other teeth are flat and the opposing teeth are flat amalgams, guess what? You’re gonna be making your composite flat, whether you like it or not. You created a restoration that’s proud, right? That’s why you did not conform to the patient’s own arch or existing anatomical scheme. So the part B of this is the thing that I get very excited to talk about, right? So sometimes you have a worn dentition, but then you have one tooth that’s not worn at all. It’s like that in-standing lateral incisor, right? Think of an upper lateral incisor that’s a bit in-standing, and you see some wear on all the incisors, but that lateral incisor does not have any wear in it because it was never in the firing line. It was never in function. It was never in parafunction. Now, if you give this patient aligners or fixed appliances, you’re doing ortho and you’re now going to align this lateral incisor. So it’s now gonna eventually get into occlusion and it will be in the functional and parafunctional pathways of this patient. Do you really think you can just leave that incisor be? No. It’s not gonna be compatible with the adjacent teeth. It’s not going to be compatible with the opposing tooth and the occlusal scheme. So guess what? You have to get your bur out or your Sof-Lex disc out, and you have to bake in some years into that tooth. Or you have to build up all the other teeth if appropriate for that patient. You’ve just gotta think about it. And I hope that makes sense so you can stay out of trouble. You’re not gonna get chipping and you can consent your patient appropriately for enamel adjustment, which is something that we do talk about in this episode. I think you’re in for an absolute cracker. I hope you enjoy. I’ll catch you in the outro. Main Episode: Doctor Jesper Hatt, thank you so much for coming to Protrusive Dental Podcast. We met in Scandinavia, in Copenhagen. You delivered this wonderful lecture and it was so nice to connect with you then and to finally have you on the show. Tell us, how are you, where in the world are you, and tell us about yourself. [Jesper] Well, thank you for the invitation, first of all. Well, I’m a dentist. I used to practice in Denmark since I originally come from Denmark. My mother’s from Germany, and now I live in Switzerland and have stopped practicing dentistry since 2018. Now I only do consulting work and I help doctors around the world with making their aligner business successful. [Jaz] And this is like probably clinical advice, but also like strategic advice and positioning and that kinda stuff. Probably the whole shebang, right? [Jesper] Yeah. I mean, I have a team around me, so my wife’s a dentist as well, and I would say she’s the expert in Europe on clear aligners. She’s been working for, first of all, our practice. She’s a dentist too. She worked with me in the practice. We practiced together for 10 years. Then she became a clinical advisor for Allion Tech with responsibility for clinical support of Scandinavia. She was headhunted to ClearCorrect, worked in Basel while I was doing more and more consulting stuff in Denmark. So she was traveling back and forth, and I considered this to be a little bit challenging for our family. So I asked her, well, why don’t we just relocate to Switzerland since ClearCorrect is located there? And sure we did. And after two years she told me, I think clinical support, it’s okay. And I like to train the teams, but I’d really like to do more than that because she found out that doctors, they were able to book a spot sometime in the future, let’s say two weeks out in the future at a time that suited the doctors… no, not the doctors, ClearCorrect. Or Invisalign or whatever clear aligner company you use. So as a doctor, you’re able to block the spot and at that time you can have your 30 minutes one-on-one online with a clinical expert. And she said it’s always between the patients or administrative stuff. So they’re not really focused on their ClearCorrect or clear aligner patient. And so they forget half of what I tell them. I can see it in the setups they do. They end up having to call me again. It doesn’t work like that. I would like to help them. [Jaz] It’s a clunky pathway of mentorship. [Jesper] Yes. And so she wanted to change the way clinical support was built up. So we do it differently. We do it only in writing so people can remember what we are telling them. They can always go back in the note and see what’s been going on, what was the advice we gave them, and we offer this co-creation support where we take over most of the treatment planning of the ClearCorrect or Clear Aligner or Spark or Invisalign or Angel Aligner treatment planning. So we do all the digital planning for the doctor, deliver what we think would be right for the patient based on the feedback we initially got from the doctor. And then the doctor can come back and say, well, I’d like a little more space for some crowns in the front, or I would like the canines to be in a better position in order to achieve immediate post disclusion. And so we can go into this discussion back and forth and adjust the digital setup in a way that is more realistic and predictable and do it all for the doctors. So they, on an average, they spend four to six hours less chair time when they use that kind of service compared to if they do everything themselves. And on top of that, you can put your planning time. She was responsible for that and it works quite well. I still remember when we initially got on all these online calls and we would see fireworks in the background and confetti coming down from the top and all of that. [Jaz] Exactly. So excuse that little bit, but okay. So essentially what you’re doing is, for an aligner user myself, for example, you’re doing the ClinChecks, you are helping, supporting with the ClinChecks, the planning. And I’ve got a lot of questions about that. The first question I’ll start with, which is off the script, but there’s probably a hundred different mistakes that could happen in a ClinCheck, right? But what is the most repeatable, predictable, common mistake that you’ll see when a new user sends a case to you to help them with their planning? What’s the most common mistake that you will see in a setup? [Jesper] Two things, actually. The one thing that we always check initially is the occlusion set correct by the aligner company. Because if the occlusion is not set correctly, everything else just doesn’t matter because the teeth will move but into a wrong position because the occlusion is off from the beginning. And so we always check that as the first part. How does this— [Jaz] So let’s talk about that ’cause that might be confusing for a younger colleague because they’re like, hey, hang on a minute. I scanned the bite left and right. What do you mean the occlusion is wrong? Because surely that gets carried through into what I see on the ClinCheck. So what do you think is the mechanism for this to happen? [Jesper] Two different reasons. I’m from a time when I graduated in 2003, so that was before digital dentistry. So when I went to the Pankey Institute and learned everything about functional occlusion and all of that stuff, I also found out that most of my patients, when I put silicone impression material between the teeth and asked the patients to bite together, they would always protrude a little bit unless I instructed them to bite hard on the posterior teeth. And when we got the scanners, when we put a scanner into the cheek and pull the cheek, most patients, when we asked them to bite together to do the intraoral scan of the bite, they also protruded a little bit, not much, but enough to set the bite wrong. So that is the one challenge when the technicians of the aligner companies put the models together. The other challenge is that some of the aligner companies, they let the technicians set the models. We always, as the first thing when we see a case, we always look at the photos, the clinical photos. And that’s why the clinical photos have to be of great quality. So we look at the clinical photos of the patient— [Jaz] And also in those clinical photos, Jesper, you have to coach them correctly to bite. You have to notice if they’re biting wrong even in the photos ’cause then it just duplicates the error. And that’s why good photography and actually being able to coach the patient is so imperative. [Jesper] Yes, that’s correct. But we compare the two and usually if we see a difference, we ask the doctor, is what we see in the photo correct, or is what we see on the digital models correct? And because we don’t like differences. So that would be the first step to look for. And what’s the second? The second thing is that when you look at the setup, the anterior teeth are usually—I’m trying to show you—the anterior teeth are very, very steep. Typically with aligners it’s a lot easier to tip the crowns. So when you have a class II patient, deviation one, where the anteriors are in a forward position, proclined, and you have a lot of space between the anteriors of the maxilla and the mandible, then the easiest thing on a digital setup is to just retrocline the anteriors of the upper to make them fit the lowers, which you could then procline a little bit, but usually you have very steep relationships between the two and this— [Jaz] So you’re more likely to restrict the envelope of function, functional interference anteriorly. You are obviously reducing the overjet, but you may end up reducing like a wall contact rather than an elegant, more open gate. [Jesper] Yes. And there’s another dimension to this because when we work with orthodontics, one of the most important things to look for is actually the profile of the patient. Because let’s say I’m trying to illustrate this now, so I hope you get a 90— [Jaz] So describe it for our audio listeners as well. So we’re looking at a profile view of Jesper. [Jesper] Yes. So I’m turning the side to the camera. I hope you can see my profile here. So let’s say I had flared anterior maxillary teeth and I wanted to retrocline them. It would have an effect on my upper lip, so the lip would fall backwards if I just retrocline everything. And every millimeter we move the anteriors in the maxilla in a posterior direction, we will have a potential lip drop of three millimeters. In addition, if we don’t get the nasolabial angulation correct, we risk the lower face will simply disappear in the face of the patient. So soft tissue plays a role here, so we cannot just retrocline the teeth. It looks great on the computer screen, but when it comes to reality, we’ll have a functional challenge. We’ll have a soft tissue support challenge, and in addition we’ll have long-term retention challenges as well. Because when you have a steep inclination, the anterior teeth in the mandible, they don’t have any kind of support. They will not be stopped by anything in the maxillary teeth, which you would if you had the right inclination between the teeth, which would be about 120 degrees. So why do aligner companies always set the teeth straight up and down in the anterior part? We wondered about this for years. We don’t have a strict answer. We don’t know exactly why it’s like this, but I have a hunch. I think there are two things to it. First of all, the easiest thing to do with aligners is to move the crown, so we can just tip the teeth. You take them back, you make a lot of IPR, and then you just tip them so they’re retroclined. Secondly, all aligner companies, they come from the United States. And in the United States there is a higher representation of class III patients. Now why is that important? All our patients can be put into two different categories in regards to how they move their mandible. They are the crocodiles that only open and close, like move up and down, and then we have the cows. And then we have the cows that move the mandible around, or the camels. I mean, every camel, if you’ve seen a camel chew, it’s just moving from side to side. [Jaz] Horses as well. Horses as well. [Jesper] They kind of do that. [Jaz] But I’m glad you didn’t say rats ’cause it’s more elegant to be a crocodile than a rat. [Jesper] Exactly. And I usually say we only tell the crocodiles. So why is this a challenge and why isn’t it a challenge with class III patients? Well, all real class III patients act like crocodiles, so they don’t move them side to side. From a functional perspective, it’s really not a problem having steep anterior inclination or steep relationships as long as you have a stable stop where the anteriors—so the anteriors will not elongate and create the red effect. So they just elongate until they hit the palate. If you can make a stop in the anterior part of the occlusion, then you’ll have some kind of stability with the class III patients. But with class II patients, we see a lot more cows. So they move the mandible from side to side and anterior and back and forth and all… they have the mandible going all kinds of places. And when they do that, we need some kind of anterior guidance to guide the mandible. I usually say the upper jaw creates the framework in which the mandible will move. So if the framework is too small, we fight the muscles. And whenever we fight the muscles, we lose because muscles always win. It doesn’t matter if it’s teeth, if it’s bone, if it’s joints, they all lose if they fight the muscles— [Jaz] As Peter Dawson would say, in the war between teeth and muscles or any system and muscles, the muscles always win. Absolutely. And the other analogy you remind me of is the maxilla being like a garage or “garage” from UK, like a garage. And the mandible being like the car, and if you’re really constrained, you’re gonna crash in and you’re gonna… everything will be in tatters. So that’s another great way to think about it. Okay. That’s very, very helpful. I’m gonna—’cause there’s so much I wanna cover. And I think you’ve really summed up nicely. But one thing just to finish on this aspect of that common mistake being that the upper anteriors are retroclined, really what you’re trying to say is we need to be looking at other modalities, other movements. So I’m thinking you’re saying extraction, if it’s suitable for the face, or distalisation. Are you thinking like that rather than the easier thing for the aligners, which is the retrocline. Am I going about it the right way? [Jesper] Depends on the patient. [Jaz] Of course. [Jesper] Rule of thumb: if you’re a GP, don’t ever touch extraction cases. Rule of thumb. Why? Because it is extremely challenging to move teeth parallel. So you will most—especially with aligners—I mean, I talk with a very respected orthodontist once and I asked him, well, what do you think about GPs treating extraction cases where they extract, you know, two premolars in the maxilla? And he said, well, I don’t know how to answer this. Let me just explain to you: half of my orthodontist colleagues, they are afraid of extraction cases. And I asked them why. Because it’s so hard to control the root movement. Now, I don’t know about you— [Jaz] With aligners. We’re specifically talking about aligners here, right? [Jesper] With all kinds of orthodontic appliances. [Jaz] Thank you. [Jesper] So now, I don’t know about you, but if half the orthodontists are afraid of controlling the root movements in extraction cases, as a GP, I would be terrified. And I am a GP. So I usually say, yeah, sometimes you will have so much crowding and so little space in the mandible, so there’s an incisor that is almost popped out by itself. In those cases, yes. Then you can do an extraction case. But when we’re talking about premolars that are going to be extracted, or if you want to close the space in the posterior part by translating a tooth into that open space, don’t. It’s just the easiest way to end up in a disaster because the only thing you’ll see is just teeth that tip into that space, and you’ll have a really hard time controlling the root movements, getting them corrected again. [Jaz] Well, thank you for offering that guideline. I think that’s very sage advice for those GPs doing aligners, to stay in your lane and just be… the best thing about being a GP, Jesper, is you get to cherry pick, right? There’s so many bad things about being a GP. Like you literally have to be kinda like a micro-specialist in everything in a way. And so sometimes it’s good to be like, you know what, I’ll keep this and I’ll send this out. And being selective and case selection is the crux of everything. So I’m really glad you mentioned that. I mean, we talked and touched already on so much occlusion. The next question I’m gonna ask you then is, like you said, a common error is the bite and how the bite appears on the ClinCheck or whichever software a dentist is using. Now, related to bite, vast majority of orthodontic cases are treated in the patient’s existing habitual occlusion, their maximum intercuspal position. Early on in my aligner journey, I had a patient who had an anterior crossbite. And because of that anterior crossbite, their jaw deviated. It was a displaced—the lower jaw displaced. And then I learned from that, that actually for that instance, perhaps I should not have used an MIP scan. I should have used more like centric relation or first point of contact scan before the displacement of the jaw happens. So that was like always in my mind. Sometimes we can and should be using an alternative TMJ position or a bite reference other than MIP. Firstly, what do you think about that kind of scenario and are there any other scenarios which you would suggest that we should not be using the patient’s habitual occlusion for their bite scan for planning orthodontics? [Jesper] Well, I mentioned that I was trained at the Pankey Institute, and when you start out right after—I mean, I spent 400 hours over there. Initially, I thought I was a little bit brainwashed by that because I thought every single patient should be in centric relation. Now, after having put more than 600 patients on the bite appliance first before I did anything, I started to see some patterns. And so today, I would say it’s not all patients that I would get into centric relation before I start treating the teeth. But when we talk about aligner therapy and orthodontic treatment, I think it’s beneficial if you can see the signs for those patients where you would say, hmm, something in the occlusion here could be a little bit risky. So let’s say there are wear facets on the molars. That will always trigger a red flag in my head. Let’s say there are crossbites or bite positions that kind of lock in the teeth. We talked about class III patients before, and I said if it’s a real skeletal-deviation class III patient, it’s a crocodile. But sometimes patients are not real class III skeletal deviation patients. They’re simply being forced into a class III due to the occlusion. That’s where the teeth fit together. So once you put aligners between the teeth and plastic covers the surfaces, suddenly the patients are able to move the jaws more freely and then they start to seat into centric. That may be okay. Usually it is okay. The challenge is consequences. So when you’re a GP and you suddenly see a patient moving to centric relation and you find out, whoa, on a horizontal level there’s a four- to six-millimeter difference between the initial starting point and where we are now, and maybe we create an eight-millimeter open bite in the anterior as well because they simply seat that much. And I mean, we have seen it. So is this a disaster? Well, it depends. If you have informed the patient well enough initially and said, well, you might have a lower jaw that moves into a different position when we start out, and if this new position is really, really off compared to where you are right now, you might end up needing maxillofacial surgery, then the patient’s prepared. But if they’re not prepared and you suddenly have to tell them, you know, I think we might need maxillofacial surgery… I can come up with a lot of patients in my head that would say, hey doctor, that was not part of my plan. And they will be really disappointed. And at that point there’s no turning back, so you can’t reverse. So I think if you are unsure, then you are sure. Then you should use some kind of deprogramming device or figure out where is centric relation on this patient. If there isn’t that much of a difference between maximum intercuspation and centric— [Jesper] Relation, I don’t care. Because once you start moving the teeth, I don’t care if you just move from premolar to premolar or all the teeth. Orthodontics is orthodontics, so you will affect all the teeth during the treatment. The question’s just how much. And sometimes it’s just by putting plastic between the teeth that you will see a change, not in the tooth position, but in the mandibular position. And I just think it’s nicer to know a little bit where this is going before you start. And the more you see of this—I mean, as I mentioned, after 600 bite appliances in the mouths of my patients, I started to see patterns. And sometimes in the end, after 20 years of practicing, I started to say, let’s just start, see where this ends. But I would always inform the patients: if it goes totally out of control, we might end up needing surgery, and there’s no way to avoid it if that happens. And if the patients were okay with that, we’d just start out. Because I mean, is it bad? No. I just start the orthodontic treatment and I set the teeth as they should be in the right framework. Sometimes the upper and the lower jaw don’t fit together. Well, send them to the surgeon and they will move either the upper or the lower jaw into the right position, and then we have it. No harm is done because we have done the initial work that the orthodontist would do. But I will say when I had these surgical patients—let’s say we just started out with aligners and we figured, I can’t control this enough. I need a surgeon to look at this—then I would send them off to an orthodontist, and the orthodontist and the surgeon would take over. Because then—I mean, surgical patients and kids—that’s the second group of patients besides the extraction cases that I would not treat as a GP. ‘Cause we simply don’t know enough about how to affect growth on kids. And when it comes to surgery, there’s so much that is… so much knowledge that we need to know and the collaboration with the surgeons that we’re not trained to handle. So I think that should be handled by the orthodontists as well. [Jaz] I think collaborative cases like that are definitely specialist in nature, and I think that’s a really good point. I think the point there was informed consent. The mistake is you don’t warn the patient or you do not do the correct screening. So again, I always encourage my guests—so Jesper, you included—that we may disagree, and that’s okay. That’s the beauty of dentistry. So something that I look for is: if the patient has a stable and repeatable maximum intercuspal position, things lock very well, and there’s a minimal slide—like I use my leaf gauge and the CR-CP is like a small number of leaves and the jaw hardly moves a little bit—then there’s no point of uncoupling them, removing that nice posterior coupling that they have just to chase this elusive joint position. Then you have to do so many more teeth. But when we have a breakdown in the system, which you kind of said, if there’s wear as one aspect, or we think that, okay, this patient’s occlusion is not really working for them, then we have an opportunity to do full-mouth rehabilitation in enamel. Because that’s what orthodontics is. And so that’s a point to consider. So I would encourage our GP colleagues to look at the case, look at the patient in front of you, and decide: is this a stable, repeatable occlusion that you would like to use as a baseline, or is there something wrong? Then consider referring out or considering—if you’re more advanced in occlusion studies—using an alternative position, not the patient’s own bite as a reference. So anything you wanna add to that or disagree with in that monologue I just said there? [Jesper] No, I think there’s one thing I’d like the listeners to consider. I see a lot of fighting between orthodontists and GPs, and I think it should be a collaboration instead. There’s a lot of orthodontists that are afraid of GPs taking over more and more aligner treatments, and they see a huge increase in the amount of cases that go wrong. Well, there’s a huge increase of patients being treated, so there will be more patients, just statistically, that will get into problems. Now, if the orthodontist is smart—in my opinion, that’s my opinion—they reach out to all their referring doctors and they tell them, look, come in. I will teach you which cases you can start with and which you should refer. Let’s start there. Start your aligner treatments. Start out, try stuff. I will be there to help you if you run into problems. So whenever you see a challenge, whenever there’s a problem, send the patient over to me and I’ll take over. But I will be there to help you if anything goes wrong. Now, the reason this is really, really a great business advice for the orthodontists is because once you teach the GPs around you to look for deviations from the normal, which would be the indication for orthodontics, the doctors start to diagnose and see a lot more patients needing orthodontics and prescribe it to the patients, or at least propose it to the patients. Which would initially not do much more than just increase the amount of aligner treatments. But over time, I tell you, all the orthodontists doing this, they are drowning in work. So I mean, they will literally be overflown by patients being referred by all the doctors, because suddenly all the other doctors around them start to diagnose orthodontically. They see the patients which they haven’t seen before. So I think this is—from a business perspective—a really, really great thing for the orthodontists to have a collaboration with this. And it’ll also help the GPs to feel more secure when they start treating their patients. And in the end, that will lead to more patients getting the right treatment they deserve. And I think that is the core. That is what’s so important for us to remember. That’s what we’re here for. I mean, yes, it’s nice to make money. We have to live. It’s nice with a great business, but what all dentists I know of are really striving for is to treat their patients to the best of their ability. And this helps them to do that. [Jaz] Ultimate benefactor of this collaborative approach is the patient. And I love that you said that. I think I want all orthodontists to listen to that soundbite and take it on board and be willing to help. Most of them I know are lovely orthodontists and they’re helping to teach their GPs and help them and in return they get lots of referrals. And I think that’s the best way to go. Let’s talk a little bit about occlusal goals we look for at the end of orthodontics. This is an interesting topic. I’m gonna start by saying that just two days ago I got a DM from one of the Protruserati, his name is Keith Curry—shout out to him on Instagram—and he just sent me a little message: “Jaz, do you sometimes find that when you’re doing alignment as a GP that it’s conflicting the orthodontic, the occlusal goal you’re trying to get?” And I knew what I was getting to. It’s that scenario whereby you have the kind of class II division 2, right? But they have anterior guidance. Now you align everything, okay, and now you completely lost anterior guidance. And so the way I told him is that, you know what, yes, this is happening all the time. Are we potentially at war between an aesthetic smile and a functional occlusion? And sometimes there’s a compromise. Sometimes you can have both. But that—to achieve both—needs either a specialist set of eyes or lots of auxiliary techniques or a lot more time than what GPs usually give for their cases. So first let’s touch on that. Do you also agree that sometimes there is a war between what will be aesthetic and what will be a nice functional occlusion? And then we’ll actually talk about, okay, what are some of the guidelines that we look for at the end of completing an aligner case? [Jesper] Great question and great observation. I would say I don’t think there’s a conflict because what I’ve learned is form follows function. So if you get the function right, aesthetics will always be great. Almost always. I mean, we have those crazy-shaped faces sometimes, but… so form follows function. The challenge here is that in adult patients, we cannot manipulate growth. So a skeletal deviation is a skeletal deviation, which means if we have a class II patient, it’s most likely that that patient has a skeletal deviation. I rarely see a dental deviation. It happens, but it’s really, really rare. So that means that in principle, all our class II and chronic class III patients are surgical patients. However, does that mean that we should treat all our class II and class III patients surgically? No, I don’t think so. But we have to consider that they are all compromise cases. So we need to figure a compromise. So initially, when I started out with my occlusal knowledge, I have to admit, I didn’t do the orthodontic treatment planning. I did it with Heller, and she would give me feedback and tell me, I think this is doable and this is probably a little bit challenging. If we do this instead, we can keep the teeth within the bony frame. We can keep them in a good occlusion. Then I would say, well, you have a flat curve of Spee. I’d like to have a little bit of curve. It’s called a curve of Spee and not the orthodontic flat curve of Spee. And then we would have a discussion back and forth about that. Then initially I would always want anterior coupling where the anterior teeth would touch each other. I have actually changed that concept in my mind and accepted the orthodontic way of thinking because most orthodontists will leave a little space in the anterior. So when you end the orthodontic treatment, you almost always have a little bit of space between the anterior teeth so they don’t touch each other. Why? Because no matter what, no matter how you retain the patient after treatment, there will still be some sort of relapse. And we don’t know where it’ll come or how, but it will come. Because the teeth will always be positioned in a balance between the push from the tongue and from the cheeks and the muscles surrounding the teeth. And that’s a dynamic that changes over the years. So I don’t see retention as a one- or two-year thing. It’s a lifelong thing. And the surrounding tissues will change the pressure and thereby the balance between the tongue and the cheeks and where the teeth would naturally settle into position. Now, that said, as I mentioned initially, if we fight the muscles, we’ll lose. So let’s say we have an anterior open bite. That will always create a tongue habit where the patient positions the tongue in the anterior teeth when they swallow because if they don’t, food and drink will just be splashed out between the teeth. They can’t swallow. It will just be pushed out of the mouth. [Jaz] So is that not like a secondary thing? Like that tongue habit is secondary to the AOB? So in those cases, if you correct the anterior open bite, theoretically should that tongue posture not self-correct? [Jesper] Well, we would like to think so, but it’s not always the case. And there’s several reasons to it. Because why are the teeth in the position? Is it because of the tongue or because of the tooth position? Now, spacing cases is one of those cases where you can really illustrate it really well. It looks really easy to treat these patients. If we take away all the soft tissue considerations on the profile photo, I mean, you can just retract the teeth and you close all the spaces—super easy. Tipping movements. It’s super easy orthodontically to move quickly. Very easy as well. However, you restrict the tongue and now we have a retention problem. So there are three things that can happen. You can bond a retainer on the lingual side or the palatal side of the teeth, upper, lower—just bond everything together—and after three months, you will have a diastema distal to the bonded retainer because the tongue simply pushes all the teeth in an anterior direction. [Jaz] I’ve also seen—and you’ve probably seen this as well—the patient’s tongue being so strong in these exact scenarios where the multiple spacing has been closed, which probably should have been a restorative plan rather than orthodontic plan, and the retainer wire snaps in half. [Jesper] Yes, from the tongue. [Jaz] That always fascinated me. [Jesper] Well, you’ll see debonding all the time, even though you sandblast and you follow all the bonding protocol. And debonding, breaking wires, diastemas in places where you think, how is that even possible? Or—and this is the worst part—or you induce sleep apnea on these patients because you simply restrict the space for the tongue. So they start snoring, and then they have a total different set of health issues afterwards. So spacing—I mean, this just illustrates the power of the tongue and why we should always be careful with spacing cases. I mean, spacing cases, in my opinion, are always to be considered ortho-restorative cases. Or you can consider, do you want to leave some space distal to the canines? Because there you can create an optical illusion with composites. Or do you want to distribute space equally between the teeth and place veneers or crowns or whatever. And this is one of those cases where I’d say aligners are just fabulous compared to fixed appliances. Because if you go to an orthodontist only using fixed appliances and you tell that orthodontist, please redistribute space in the anterior part of the maxilla and I want exactly 1.2 millimeters between every single tooth in the anterior segment, six years later he’s still not reached that goal because it just moves back and forth. Put aligners on: three months later, you have exactly—and I mean exactly—1.2 millimeters of space between each and every single tooth. When it comes to intrusion and extrusion, I would probably consider using fixed appliances rather than aligners if it’s more than three millimeters. So every orthodontic system—and aligners are just an orthodontic system—each system has its pros and cons, and we just have to consider which system is right for this patient that I have in my chair. But back to the tongue issue. What should we do? I mean, yes, there are two different schools. So if you have, let’s say, a tongue habit that needs to be treated, there are those that say we need to get rid of the tongue habit before we start to correct the teeth. And then there are those that say that doesn’t really work because there’s no room for the tongue. So we need to create room for the tongue first and then train the patient to stop the habit. Both schools and both philosophies are being followed out there. I have my preferred philosophy, but I will let the listener start to think about what they believe and follow their philosophy. Because there is nothing here that is right or wrong. And that is— [Jaz] I think the right answer, Jesper, is probably speak to that local orthodontist who’s gonna be helping you out and whatever they recommend—their religion—follow that one. Because then at least you have something to defend yourself. Like okay, I followed the way you said. Let’s fix it together now. [Jesper] That’s a great one. Yeah, exactly. [Jaz] Okay, well just touching up on the occlusion then, sometimes we do get left with like suboptimal occlusions. But to be able to define a suboptimal occlusion… let’s wrap this occlusion element up. When we are completing an orthodontic case—let’s talk aligners specifically—when the aligners come off and the fixed retainers come on, for example, and the patient’s now in retention, what are some of the occlusal checkpoints or guidelines that you advise checking for to make sure that, okay, now we have a reasonably okay occlusion and let things settle from here? For example, it would be, for me, a failure if the patient finishes their aligners and they’re only holding articulating paper on one side and not the other side. That’s for me a failure. Or if they’ve got a posterior open bite bilaterally. Okay, then we need to go refinement. We need to get things sorted. But then where do you draw the line? How extreme do you need to be? Do you need every single tooth in shim-stock foil contact? Because then we are getting really beyond that. We have to give the adaptation some wiggle room to happen. So I would love to know from your learning at Pankey, from your experience, what would you recommend is a good way for a GP to follow about, okay, it may not be perfect and you’ll probably never get perfect. And one of the orthodontists that taught me said he’s never, ever done a case that’s finished with a perfect occlusion ever. And he said that to me. [Jesper] So—and that’s exactly the point with orthodontics. I learned that imagine going to a football stadium. The orthodontist will be able to find the football stadium. If it’s a reasonable orthodontist, he’ll be able to find the section you’re going to sit in. And if he’s really, really, really good, he will be able to find the row that you’re going to sit in. But the exact spot where you are going to sit, he will never, ever be able to find that with orthodontics. And this is where settling comes in and a little bit of enamel adjustments. [Jaz] I’m so glad you said that. I’m so glad you mentioned enamel adjustment. That’s a very dirty word, but I agree with that. And here’s what I teach on my occlusion courses: what we do with aligners essentially is we’re tampering with the lock. Let’s say the upper jaw is the lock. It’s the still one. We’re tampering with the key, which is the lower jaw—the one that moves—we tamper with the key and the lock, and we expect them both to fit together at the end without having to shave the key and to modify the lock. So for years I was doing aligners without enamel adjustment ’cause my eyes were not open. My mind was not open to this. And as I learned, and now I use digital measuring of occlusion stuff and I seldom can finish a case to get a decent—for my criteria, which is higher than it used to be, and my own stat—is part of my own growth that’s happened over time is that I just think it’s an important skill that GPs are not taught and they should be. It’s all about finishing that case. And I think, I agree with you that some adjustment goes a long way. We’re not massacring enamel. It’s little tweaks to get that. [Jesper] Exactly. I like the sound there because sometimes you hear that “ahh,” it doesn’t really sound right, but “tsst,” that’s better. [Jaz] That’s the one. You know, it reminds me of that lecture you did in Copenhagen. You did this cool thing—which I’ve never seen anyone do before. You sat with one leg over the other and you said, okay guys, bite together. Everyone bit together. And then you swapped the legs so the other leg was over the other and bite together. And then you said, okay, whose occlusion felt different? And about a third of the audience put their hand up, I think. Tell us about that for a second. [Jesper] Well, just promise me we go back to the final part because there are some things we should consider. [Jaz] Let’s save this as a secret thing at the end for incentive for everyone to listen to the end—how the leg position changes your occlusion. Let’s talk about the more important thing. I digressed. [Jesper] Let’s talk about the occlusal goals because I think it’s important. I mean, if you do enamel adjustments in the end—so when we finish the treatment, when we come to the last aligner in the treatment plan—I think we should start by breaking things down to the simplest way possible. Start by asking the patient: are you satisfied with the way the teeth look? Yes or no? If she’s satisfied, great. How do you feel about the occlusion? “Well, it fits okay.” Great. Now the patient is happy. There’s nothing she wants to—or he wants to—change. Then you look at the occlusion. Now, it is important to remember that what we see on the computer screen, on the aligner planning tools, will never, ever correspond 100% to what we see in the mouth of the patient. And there are several reasons for that. But one of the things that we have found to be really interesting is that if you take that last step and you say, okay, the occlusion doesn’t fit exactly as on the screen, but it’s kind of there… if you use that last step and you don’t do a re-scan for a retainer, but you use the last step of the aligner treatment as your reference for your aligner retainer… We sometimes see that over six months, if the patient wears that aligner 22 hours a day for another three to six months, the teeth will settle more and more into the aligner and create an occlusion that looks more and more like what you see on the screen. Which to me just tells me that the biology doesn’t necessarily follow the plan everywhere in the tempo that we set throughout the aligner plan. But over time, at the last step, if it’s just minor adjustments, the teeth will actually move into that position if we use the last stage as a reference for the retainer. Now, if we do a scan at that point and use that as a reference for creating an aligner retainer, then we just keep the teeth in that position. Now, if the teeth are a little bit more off— [Jaz] I’m just gonna recap that, Jesper, ’cause I understood what you said there, but I want you to just make sure I fully understood it. When we request, for example, Align, the Vivera retainer, it gives you an option: “I will submit a new scan” or “use the last step.” And actually I seldom use that, but now I realize you’re right. It makes sense. But then on the one hand, if the occlusion is—if the aesthetics are good and the patient’s occlusion feels good, what is your own judgment to decide whether we’re still going to allow for some more settling and occlusal changes to happen over a year using the Vivera retainers based on the ClinCheck last-aligner profile, rather than, okay, let’s just retain to this position? What is making you do the extra work, extra monitoring? [Jesper] To me, it’s not extra monitoring. It’s just basic. I mean, it’s just part of my protocol. I follow the patients. And honestly, to me, it’s just time-saving to just use the last step in the aligner. Because I mean, if the plan is right and if the teeth have been tracking well, they should be in that position. Why do I then need to re-scan for Vivera retainers or for other kinds of retainers? Now, if the occlusion is a little bit more off—and in a minute you’ll probably ask me when do I see which is which, and I can’t really tell you; it’s about experience—but that’s the beauty of this. If I see there’s a little bit more deviation and I like some teeth, the occlusion isn’t really good on one side compared to the other side, I would rather have a bonded retainer from first premolar to first premolar in the mandible, combined with a Hawley or Begg or something like that retainer for the upper. And you can order them with an acrylic plate covering some of the anterior teeth so they keep that position, but that allows the teeth to settle. And over three months you should see some kind of improvement. If you don’t see enough improvement and let’s say you still have a tendency for a kind of an open bite on one side, you can always add some cross elastics, put some buttons on the upper, on the lower, instruct the patient to use these, and then in three months you will have the occlusion you want. Now, once that is established—you have that kind of occlusion—you need to keep the teeth there for at least six months before you do some kind of equilibration or enamel adjustment. Because if you do the enamel adjustment right after you have reached your final destination for the teeth, the teeth will still settle and move. So you do the equilibration, two weeks later everything looks off again. You do the equilibration, two weeks later things have changed again. So I prefer to wait six months before I do the final equilibration. Now, in this equation what we’ve been talking about here, it goes from very simple to more and more complex. And then we have to consider, well, did I expand the mandible posterior segment? If so, I can’t just use a bonded retainer on the lower and I need to add something to keep the teeth out there in combination with whatever I want in the upper. Do I want to keep the Begg retainer or the Hawley, or do I want to change to something differently? So these kinds of considerations have to be there from the beginning of the treatment because, I mean, it costs additional money to order a Begg retainer compared to just an aligner. [Jaz] A Begg retainer is the same as Hawley? [Jesper] Well, no. It has a little different design. [Jaz] Oh, a Begg as in B-E-G-G? [Jesper] Yes. [Jaz] Yeah, got it. Got it. Okay. [Jesper] And then in Denmark we use the Jensen retainer, which is a Danish invention, which goes from canine to canine or from first premolar to first premolar but with a different type of wire which keeps the teeth more in place compared to a round wire. So there are different variations. The most important part here is it allows the posterior teeth to settle so they can move, which they can’t in an aligner to the same degree at least. Now, this is all really nice in teeth that only need to be moved into the right position, but most of our patients are adult patients, or they should at least be adult patients. Most of my patients were more than 30 years old. So if you have a patient with anterior crowding and you move the teeth into the right position where the teeth should be, the teeth are in the right position, but they still look ugly because they have been worn anteriorly by the position they were in when they were crooked. So when we position them, we still need to do some restorative work. Then what? We still need to retain those teeth. The patient wants to be finished now as fast as possible, so we can’t wait the six months to make the final touches. So we have to figure out: what do we do? And then we have to think of some kind of retention strategy to keep the teeth in place during that restorative procedure. And I mean, at the end of an aligner treatment or any orthodontic treatment, two days is enough to have relapse in some patients. Some patients it’s not a problem. The teeth are just there to stay in the same position for three months, and then they start to move a little bit around. But other patients—I mean, you just have to look away and then go back to the teeth and they’re in a different position. You can’t know what kind of patient you have in your chair right now. So you have to consider the way you plan your restorative procedure in regards to how you retain the teeth during that phase. So if you want to do anterior composites or veneers, do it all at once. Put in a bonded retainer, scan, and get your aligner retainer as fast as possible. Or use a Begg or a Hawley or something like that that’s a little bit more flexible. If you want to do crowns, then we have a whole different challenge and then we have to consider how do we then retain the teeth. [Jaz] Okay. Well I think that was lovely. I think that gives us some thoughts and ideas of planning sequence of retention, which is the ultimate thing to consider when it comes to occlusion. Okay, yeah, you get the occlusion, but how do you retain it? But in many cases, as the patient’s wearing aligners, the occlusion is embedding in and is fine. And you take off the aligners, the patient’s happy with how it looks. They bite together. It feels good. You are happy that yes, both sides of the mouth are biting together. Now, it might not be that every single contact is shim-hold, but you got, let’s say, within 20 microns, 40 microns, okay? Then some bedding happens. In that kind of scenario, would you be happy to say, okay, I’m gonna scan your teeth as they are because I’m happy with the occlusion, the occlusal goals are good, and they’re near enough the ClinCheck, and go for the retainers to that position? Or is your default preference as a clinician to go for the Vivera or equivalent based on the last aligner, on the ClinCheck projection? [Jesper] I would still go for the last aligner because I think the planning I’ve done is probably a little bit more precise than what I see clinically. However, I still expect that I will have to do a little bit of enamel reshaping at the end after six months, but that’s okay. I mean, the changes are so small, so you can still use the last aligner or the Vivera retainer that you already have ordered. So it’s not that much of a problem. [Jaz] Which goes back to your previous point: if it’s a big deviation, then you’ve gotta look at the alternative ways, whether you’re gonna go for refinement or you’re gonna allow some occlusal settling with a Hawley and a lower fixed-retainer combination, or the elastics like you said. Okay. Just so we’re coming to the end of the podcast—and I really enjoyed our time—I would like to delve deep into just a final thing, which is a little checklist, a helpful checklist for case assessment that you have for GDPs. [Jesper] Yeah, thank you. First of all, one of the big challenges in a GP practice is being able to take a full series of clinical photos in two minutes without assistance. I think most dentists struggle with that, but that is a foundational prerequisite to any aligner treatment. Once you have the photos, I would sit down with the photos and I would consider six different steps. One: is this a patient that I could treat restoratively only? Because that would be the simplest for me to do. Next, moving up in complexity: would be, do I need periodontal crown lengthening? Or next step would be: do I need to change the vertical dimension, or is there something about centric relation that I should consider? Moving up a little bit on the complexity: are there missing teeth? Do I need to replace teeth with implants? Next step would be orthodontics. So this is step five. The next most complex case we can treat is actually an aligner case—orthodontics in general. And the last part would be: are the teeth actually in the right position in the face of the patient, or do I need surgery to correct the jaw position? So these six steps, I think they’re helpful to follow to just think, how can I break this case down into more easy, digestible bits and pieces to figure out what kind of patient I have in front of me? Now, if you consider it to be an orthodontic case or ortho-restorative case, here comes the challenge: case selection. How do you figure out is this an easy, moderate, complex, or referral case? And here’s the trick: do 500 to 1000 treatment plans or treatments with clear aligners. And then you know. But until then, you really don’t. This is where you should rely on someone you can trust who can help you do the initial case selection. Because you can have two identical patients—one is easy and one is super complex—but they look the same. So it’s really nice if you have done less than 500 cases to have someone who can help you with the case selection. And I don’t say this to sell anything, because we don’t charge for that. Because it’s so essential that we don’t do something that is wrong or gives us a lot of challenges and headaches in the practice. I mean, the practice runs really fast and lean-oriented, so we need to make things digestible, easy to work with. And I think that’s really important. [Jaz] It goes full circle to what we said before about having that referral network, staying in your lane, knowing when to refer out, cherry-picking—it all goes back full circle with that. And not even orthodontics, but restorative dentistry—case selection is just imperative in everything we do. [Jesper] Yes. And there is—we always get the question when we do courses and we do consulting—can’t you just show me a couple of cases that are easy to start with? And it works with implants, kind of. But with orthodontics where we move—I mean, we affect all the teeth—it’s just not possible. I know the aligner companies want to show you some where you say, you can only just do these kinds of cases and they are really easy. The fact is they’re not. But they want to sell their aligners. [Jaz] I get it. They are until they’re not. It’s like that famous thing, right? Everyone’s got a plan until they get punched in the face. So yeah, it can seemingly be easy, but then a complication happens and it’s really about understanding what complications to expect, screening for them, and how you handle that. But thanks so much. Tell us—yeah, go on, sorry. [Jesper] There are three things I’d like to end on here. So, first of all, we’ve been talking together for about an hour about a topic that, if you want to take postgraduate education, it takes three years to become an orthodontist. And there is a reason it takes three to four years. However, I want to encourage the listener to think about this: Mercedes has never, ever excused last year’s model. Meaning that they always strive for perfection. So if we go into the practice and we do the very best we can every single day, there is no way we can go back and excuse what we

Ellen Kamhi talks with Dr. Torkil Færø, a GP and emergency physician, documentary filmmaker, author, and photographer. Dr. Færø found that using wearables is an excellent way to track and regulate your nervous system and physiology.  In his new book, THE PULSE CURE, Dr. Færø teaches everyone how to take charge of your own health with measurable actions! This is the first book that teaches how to use wearables to track heart rate variability and gives a practical and holistic plan to improve overall health.  https://thepulsecure.com/

Jonas Salsicha foi o convidado do podcast desta semana. Faixa preta de MuayThai e Kickboxing, ele conquistou o título do GP da divisão até 70kg no K-1 World Max 2025: Final Round. Durante o papo, o lutador paulista falou sobre o início da sua trajetórias nas artes marciais e detalhou a experiência de participar de um dos maiores torneios de Kickboxing do mundo.

In this week's episode I interview Em about her pregnancy during lockdown. She was induced at 41 weeks and laboured for a long time alone in the maternity ward before she was transferred to the birthing suite where she experienced the cascade of intervention and birthed her baby boy via vacuum delivery. Em was four months postpartum when she disclosed her sadness to her GP and was subsequently diagnosed with PND and PTSD. Three days later she walked into the Perinatal Mental Health Unit at Mitcham Private Hospital. It was a life changing experience for her and she shares her story in the hope that she can spread the word about the essential postpartum support resources that are available (even if they are notoriously difficult to find). Hosted on Acast. See acast.com/privacy for more information.

Dr. Victor Martel, a general dentist practicing in Florida, is back on the Everyday Oral Surgery podcast with Dr. Stucki for another round of expert insight. This time, he's here to talk about comprehensive treatment planning and how surgeons can work with the GP to provide excellent patient care. Tune in as Dr. Martel defines comprehensive treatment planning and big-picture dentistry, explores how it can grow your practice, and unpacks the key barriers that hold clinicians back from putting it into action. Dr. Martel deep dives into grand rounds and how they fit into this conversation, shares a key frustration he sees with All-on-X cases, and breaks down his initial comprehensive patient exam, including what he calls the ‘tour of the mouth' at the second visit. He emphasizes the critical role of communication between GPs and specialists, and underscores the need for clinicians to invest in educating themselves and their teams on comprehensive treatment planning. Don't miss this insightful episode and a powerful reminder that when we work together and keep the big picture in mind, that's where the magic happens!Key Points From This Episode:Welcoming back Dr. Vic Martel, a general dentist practicing in FL.How Dr. Martel defines comprehensive treatment planning: big-picture dentistry.Where generalists fail (even at the very first visit).How comprehensive treatment planning can grow your practice.We look at the barriers holding clinicians back from doing comprehensive planning. Looking at patients from a comprehensive standpoint, and his definition of holistic dentistry. Why he believes first-time patients should not be brought to the practice for a cleaning first. His thoughts on how a specialist could help a general dentist comprehensively plan.We deep dive into grand rounds and how they fit into this conversation. Dr. Martel shares a pet peeve: all-on-X cases.A tour of their mouth: a breakdown of how he structures a comprehensive dental exam and what makes it effective.He explains the permission statement.Why it's essential to include specialists in the communication of the comprehensive plan. The main summary take-home point Dr. Martel wants listeners to walk away with: learn to comprehensively plan treatment.Where to learn more about Dr. Martel and his courses.Links Mentioned in Today's Episode:Dr. Victor Martel on LinkedIn — https://www.linkedin.com/in/victor-martel-dmd-91431922 Dr. Victor Martel on Instagram — https://www.instagram.com/drvicmartel/ Dr. Victor Martel Email — martelacademy@gmail.comMartel Academy — https://www.martelacademy.com/ The Dawson Academy — https://thedawsonacademy.com/ Everyday Oral Surgery Website — https://www.everydayoralsurgery.com/ Everyday Oral Surgery on Instagram — https://www.instagram.com/everydayoralsurgery/ Everyday Oral Surgery on Facebook — https://www.facebook.com/EverydayOralSurgery/Dr. Grant Stucki Email — grantstucki@gmail.comDr. Grant Stucki Phone — 720-441-6059

In April 2025, we bought a small 6-unit property for $400K, put $68K into CapEx, tightened operations, filled every unit, and had it under contract at $650K within five months. We were days away from closing. Buyers locked in. No renegotiation. Clean inspection. A true home run. And then… two days before closing… a 17-year-old driver crashed into one of our tenant's cars, launching it straight into our standalone studio apartment. The entire facade caved in. The tenant had to vacate. And the deal we had lined up fell apart instantly. In this episode, I walk you guys through everything that happened — the lender delays, the accident, the insurance process, the missed deadlines, the backup buyers that vanished, and the financial pressure we're now navigating. This is the real side of multifamily that nobody posts about. We talk about: – How the accident killed the sale – Why insurance and permits slowed everything down – The cash flow and holding-cost punch we're dealing with – The impact on our partners' liquidity – How time destroys IRR in a flip scenario – What we're doing next to stabilize, re-lease, and relist – Why operators earn their keep in moments like this If you're thinking about becoming a GP, or you already operate deals, this is a must-listen. This is the part of multifamily nobody glamorizes — and it's exactly why you need the right systems, the right expectations, and the right team. Want tools, templates, or to work with me?

This week we welcomed theologian and GP member Kat Armas to share about her brilliant new book, Liturgies for Resisting Empire. After the sermon Kat is joined by GP Lead Pastor Josh Scott for a conversation about our response to empire.⛪️ To learn more about who we are and what we do, visit https://gracepointe.net/about-us

Verstappen dominated the GP in the ‘Entertainment Capital of the World’ reminding us again of his truly special talent, the kind that will ultimately have us drawing parallels with Michael Schumacher and Ayrton Senna. But Max’s 69th career win wasn’t the biggest talking point in Las Vegas it was the disqualification of BOTH McLarens after failing a post race tech inspection! Matt Hickey from Codesports is back on the pod for an easy listening convo with Rusty that unpacks the lot. How could McLaren get it so wrong at such a critical time? And what does it mean with two GP’s and a sprint race remaining? Their disqualification elevates Kimi Antonelli to the podium and he did with a drive that was absolutely worthy of some silverware. Ferrari’s form wasn’t great and Liam Lawson’s lap one move reignited the Aussie vs Kiwi sporting rivalry. Plus a bold prediction as the sport moves back to the Middle East for the final two rounds of the season. Head to Rusty's Facebook, Twitter or Instagram and give us your feedback and let us know who you want to hear from on Rusty's GarageSee omnystudio.com/listener for privacy information.

Dr. Sheila Samaddar, a GP, shares how aligners have been a huge benefit to her practice, but she's also candid about the challenges. She walks us through the key things every GP should know before diving into clear aligner therapy, plus some of her favorite products and tools that help her get the best results. Dr. Samaddar is internationally recognized and published by Invisalign for Top Case results annually for the last several years, as well as having a Top 10 case with the American Academy of Clear Aligners.

Con Manolo Lama. Las consecuencias de los mensajes de Florentino Pérez en la Asamblea y del mal partido, después, frente al Elche. Previa de los partidos de Liga de Campeones. En directo: Espanyol-Sevilla. Resaca de la final de la Copa Davis y del GP de Las Vegas en F1

Black men are dying of cancer in silence. So we took a room full of dads, sons and survivors and built the most honest conversation they've ever had.This episode was recorded at Macmillan's Open House, a home built to feel like the houses that raised us: soft light, old portraits, kettle on the stove, carpet holding the memories of every step. Into that house we brought a live conversation on men, fatherhood and grief.Marvyn Harrison is joined by:– Ibrahim Kamara, whose dad died of cancer on his birthday while he was locked alone in a Covid hotel– Paul Campbell, who was denied treatment, diagnosed in the same year as his brother and sister, and watched his father die from prostate cancer– Host and facilitator Ruben Christian, unpacking identity, masculinity and the cost of being “the strong one”Inside this episode:– The Black dad who had to fight his GP just to get tested– Why three siblings were all diagnosed with cancer in the same year– How a father hid his diagnosis from ten children and made one son carry the secret alone– Men explaining what grief actually feels like inside the body– The quiet ways race, culture and masculinity shape how we ignore symptoms– What good men actually need from their partners, friends and community– Why checkups aren't a verdict, they're a lifeline and a second chanceThe episode closes with “White Smiles”, an original song written about a dream of a father who finally returns smiling, with new teeth and no pain. Listen grounded, eyes closed if you can.If you love a Black man, live with one, are raising one or are one, this is the episode you send. Hosted on Acast. See acast.com/privacy for more information.

Get access to metatrends 10+ years before anyone else - https://qr.diamandis.com/metatrends    Salim Ismail is the founder of OpenExO Dave Blundin is the founder & GP of Link Ventures Dr. Alexander Wissner-Gross is a computer scientist and founder of Reified – My companies: Apply to Dave's and my new fund:https://qr.diamandis.com/linkventureslanding      Go to Blitzy to book a free demo and start building today: https://qr.diamandis.com/blitzy   Grab dinner with MOONSHOT listeners: https://moonshots.dnnr.io/ _ Connect with Peter: X Instagram Connect with Dave: X LinkedIn Connect with Salim: X Join Salim's Workshop to build your ExO  Connect with Alex Website LinkedIn X Email Listen to MOONSHOTS: Apple YouTube – *Recorded on November 21th, 2025 *The views expressed by me and all guests are personal opinions and do not constitute Financial, Medical, or Legal advice. Learn more about your ad choices. Visit megaphone.fm/adchoices

Episode replay, and oldie but a goodie. In this episode Ash Grunwald focus on the first three fundamentals we use in our coaching to help people quit to change your self image and belief systems. These are the first three things we will talk about in our upcoming webinar on How To Quit Alcohol and creating daily habits that will transform your life. This does not just have to apply to alcohol, the system is also useful for over eating, smoking, low self esteem. It is about rewriting and reprogramming your brain through gratitude practise, I am's, visualisation, and daily habits. For more resources such as coaching or to join the next HIQA challenge go towww.iquitalcohol.com.auFollow HIQA insta @howiquitalcohol Music for Podcast intro and outro written by Danni Carr performed by Mr CassidyIf you are struggling with physical dependancy on alcohol consider contacting a local AA meeting or a drug and alcohol therapist. Always consult a GP before stopping alcohol. Hosted on Acast. See acast.com/privacy for more information.

Matt Faircloth interviews Christian Macellari, Head of Acquisitions and CIO at RSN Property Group, about how their team has grown more than 20% in the past 15–16 months by staying disciplined, data-driven, and relentless in sourcing opportunities. Christian explains how RSN underwrites roughly 400 deals a year to close just a few, why top-down market conviction matters before drilling into individual assets, and how their team blends off-market outreach, broker relationships, and distressed-debt conversations to secure deals. He also breaks down RSN's buy box, when they'll consider heavy-lift opportunities, and why Chicago is the market he “loves to hate.” Christian and Matt wrap by discussing JV/co-GP equity structures and how operators can realistically partner with larger institutional groups. Christian MacellariCurrent role: Chief Investment Officer & Head of Acquisitions, RSN Property GroupBased in: (Not explicitly stated in transcript)Say hi to them at: https://rsnpropertygroup.com | LinkedIn Alternative Fund IV is closing soon and SMK is giving Best Ever listeners exclusive access to their Founders' Shares, typically offered only to early investors. Visit smkcap.com/bec to learn more and download the full fund summary. Join us at Best Ever Conference 2026! Find more info at: https://www.besteverconference.com/  Join the Best Ever Community  The Best Ever Community is live and growing - and we want serious commercial real estate investors like you inside. It's free to join, but you must apply and meet the criteria.  Connect with top operators, LPs, GPs, and more, get real insights, and be part of a curated network built to help you grow. Apply now at⁠ ⁠⁠⁠www.bestevercommunity.com⁠⁠ Podcast production done by⁠ ⁠Outlier Audio⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

Disclaimer: This is a sponsored episode. Not advice. Educational purposes only. Not an endorsement for or against. Results not vetted. Views of the guests do not represent those of the host or show.  

Today I interview Jo, a mother of two and GP who brings so much knowledge and advice to her story. She says that being a mother has definitely made her a better GP although she admits that so many of her expectations of parenthood were thrown out the window when she became a mum. She feels strongly about safe co-sleeping (she shares a lot of evidence around this) as well as extended breastfeeding and the societal pressures that often prompt early weaning. Lighthearted and joyful, Jo shares all the details of her two physiological births and the skills she embraced from to actively relax while her body actively birthed.You can learn more about The Birth Class here. Hosted on Acast. See acast.com/privacy for more information.

GP opens on the Grizzlies blasting the Sacramento Kings last night 137-96 to end their 5 game losing streak with strong performances from Zach Edey, Vince Williams Jr, Cedric Coward and Santi Aldama(21:00) Jessica Benson joins to continue the Grizzlies discussion(57:00) Memphis MBB battles vs #1 Purdue in close loss/will play Wake Forest today in consolation game, Lane Kiffin saga continues, Baylor AD steps down, Texans beat Bills on TNF, and Wicked For Good is set to have huge box office weekend(1:42:00) GP's Carry Out with what we're watching this weekend 

If you want us to build a MOONSHOT Summit, email my team: moonshots@diamandis.com  Get access to metatrends 10+ years before anyone else - https://qr.diamandis.com/metatrends   Salim Ismail is the founder of OpenExO Dave Blundin is the founder & GP of Link Ventures Dr. Alexander Wissner-Gross is a computer scientist and founder of Reified – My companies: Apply to Dave's and my new fund:https://qr.diamandis.com/linkventureslanding      Go to Blitzy to book a free demo and start building today: https://qr.diamandis.com/blitzy   Grab dinner with MOONSHOT listeners: https://moonshots.dnnr.io/ _ Connect with Peter: X Instagram Connect with Dave: X LinkedIn Connect with Salim: X Join Salim's Workshop to build your ExO  Connect with Alex Website LinkedIn X Email Listen to MOONSHOTS: Apple YouTube – *Recorded on November 19, 2025 *The views expressed by me and all guests are personal opinions and do not constitute Financial, Medical, or Legal advice. Learn more about your ad choices. Visit megaphone.fm/adchoices

GP opens on the Grizzlies looking to snap their 5 game losing streak tonight vs the lowly Sacramento Kings(15:00) Mike Wallace joins to continue the Grizzlies discussion(36:10) Memphis MBB takes on #1 Purdue in the Bahamas, big top 5 matchup in college hoops last night, Lane Kiffin/coaching carousel, MLB coming to Netflix, movie rentals are back!(1:08:55) GP's Carry Out 

READ: Norlander on UConn's win over BYU - https://www.cbssports.com/college-basketball/news/uconn-byu-score-results-aj-dybantsa-dan-hurley-silas-demary-kennard-davis-keba-keita/ Parrish and Norlander recap the weekend in college basketball. The No. 1 team in the AP Poll escapes a loss in Birmingham, plus a great game between UConn and BYU in Boston. All that and plenty more from the weekend in college hoops. 0:00 Intro! #moreofus 1:00 Houston holds on to beat Auburn 73-72 16:30 UConn beats BYU 86-84, AJ Dybantsa scores 25 points + Silas Demary Jr. was awesome 29:29 Weekend Whiparound Time! 29:50 Arizona 69, UCLA 65 (Kareem could write columns for GP) 37:54 Gonzaga 77, Arizona State 65 38:30 Michigan 67, TCU 63 42:45 Buzz Williams, Josh Pastner get wins against former schools + a Memphis crisis 54:00 More weekend action 1:05:30 Massive freshman performances 1:07:15 Looking ahead - Champions Classic on Tuesday  Theme song: “Timothy Leary,” written, performed and courtesy of Guster Eye on College Basketball is available for free on the Audacy app as well as Apple Podcasts, Spotify and wherever else you listen to podcasts. Follow our team: @EyeonCBBPodcast @GaryParrishCBS @MattNorlander @Boone @DavidWCobb @TheJMULL_ Visit the ⁠betting arena on CBSSports.com⁠ for all the latest in ⁠sportsbook reviews⁠ and ⁠sportsbook promos⁠ for ⁠betting on college basketball⁠. You can listen to us on your smart speakers! Simply say, “Alexa, play the latest episode of the Eye on College Basketball podcast,” or “Hey, Google, play the latest episode of the Eye on College Basketball podcast.” Email the show for any reason whatsoever: ShoutstoCBS@gmail.com Visit Eye on College Basketball's YouTube channel: ⁠https://www.youtube.com/channel/UCeFb_xyBgOekQPZYC7Ijilw⁠ For more college hoops coverage, visit ⁠https://www.cbssports.com/college-basketball/⁠ To hear more from the CBS Sports Podcast Network, visit ⁠https://www.cbssports.com/podcasts/ To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoices