Stop Making Love to the Tooth: A Recap of My Q&A with Dr. Nachos

Recently, I had the privilege of sitting down with Dr. Paul Goodman (a.k.a. Dr. Nacho) of Dental Nachos for an endo FAQ session. We chatted about work-life balance, dental technology, case selection, and more!

It’s a good opportunity to get answers to a wide range of questions you may not even know you had—like you’re picking my brain for bits of endo knowledge.

You can watch a recording of the full webinar with Dental Nachos here:

Or, you can check out some of the highlights from our conversation below! 

Don’t Sweat the Small Stuff

Dr. Nacho of Dental Nachos: “Tell our audience about your work schedule and how that’s transformed over your career.”

Dr. Sonia Chopra: “I got really fast at endo. I started working in my practice fifteen years ago, working five days a week like most people. But I’ve gotten super efficient and I really value my time, and so I’ve allowed myself to produce the same amount in five days a month as opposed to five days a week.”

Dr. Nacho: “So, efficiency and speed. We all remember that feeling of sweating on the outside, crying on the inside of a dental school root canal. So talk in general about efficiency and speed with endo.”

Dr. Sonia Chopra. “I think that a lot of people overcomplicate endo. We’re just overanalyzing things. We think that, ‘Things should be in this exact recipe, and if this doesn’t happen, I can’t move on to this next step.’ And I’ve been watching dentists at E-School LIVE—my live-patient hands-on course—I watch them do the root canal and I see people ‘make love’ to the tooth.”

Dr. Nacho: “Tell us what that means. It’s an 8:40 PM webinar, PG-13, here we are—Sonia Chopra, tell us what that means.”

People are so strict and rigid with their rules for endo that that lack of flexibility doesn’t allow them to adapt to the tooth. So what I see is that people are like I need to take step one to completion and then and only then can I go to step 2. The truth is when you get stuck on step 1, you have to do a little bit of step 2 so you can go back and finish step 1.

Dr. Sonia Chopra: “So what I mean is that I can see them agonizing over adhering to strict and rigid rules that don’t allow them to adapt to the tooth. They try to take step one to completion, thinking then—and only then—can they move on to step two. I’m like, ‘Okay, just stop right there. I’m going to have you do something else for a minute.’ Sometimes you have to move to the next step in order to come back to finish the first step. It’s something that makes sense when you kind of build on top of one topic to the next when you’re talking about endo.

“Another area where I see people waste time is that I’ll see them pick up a master cone, try to measure it, and then put it in to do their cone fit, and they’ll struggle. They’ll just waste minutes just trying to measure that cone to 19 millimeters and then stick it in the tooth, and really all they need to do is pick it up and drop it in the tooth. There are these little tiny things that make your procedure go so long—like playing with an apex locator to try to make it exact—that you don’t need to get so hung up on. With more trust within the procedure, you can make things go way faster.”

Make the Most of Dental Technology

Dr. Nacho: “I’m not as good of a meme maker as dental school pros, but I have a very funny meme, Sonia, of the front desk talking to a new dentist, and it says ‘MB2, did they find it yet?’ That seems to come up a number of times. MB2—talk about some of those challenges.”

Dr. Sonia Chopra: “The MB2 is like the holy grail of endo. Everybody wants to find it, and people really struggle with it. There are some hard truths about the MB2, but there’s a way to make it easier—or at least trust yourself to say, ‘Hey, this #3 or #14 is for me, but this one over here is not.’ So, if you’re using a cone beam, you can really be smart with your cone beam. There are a lot of strategies that you can put into play to make sure that you don’t get into a tooth like a maxillary first molar and say, ‘Oh, I’m going to have to refer this mid-treatment.’

“It’s not necessary to have one, but if you do have one and you’re already using it for things like implants, you want to utilize it for this, too. It will help you with your risk assessment. It’s going to help you really understand canal anatomy, whether it’s a maxillary first molar or maybe it’s a premolar. It’s going to be useful, and you’re going to say, ‘Yeah, I feel comfortable doing that,’ or ‘No, I don’t feel comfortable doing this one,’ and it is going to save you chair time. 

“The number one thing I want dentists to learn is how to really protect their chair time. And that’s where you get really productive. We want the root canals to bring you joy. We don’t want them to cause you stress. It’s okay to punt the ones that you’re not comfortable with, but this is going to give you the confidence on how to really manage these types of teeth.”

Build Relationships With Specialists

Dr. Nacho: “Give us some general best practices or awareness on working with referrals and how best to communicate.”

Dr. Sonia Chopra: “So, I love relationships when I work with dentists, I really want to know them—I don’t want to just know them. I think it’s really nice if you can actually sit down over dinner, which I feel like some people really hate these days. They don’t want to waste their time with the specialist, but that’s where we get to know you. That’s where friendships are made, and when that happens, that relationship happens. You develop this ease of talking to each other and communicating with each other and extending help to one another. 

“It’s okay if you want to do your own endo—we need you! There are 15 million root canals done every year. It’s like a crazy amount. And that would mean that every specialist out there—because there are only a few thousand—they would need to do 20 root canals a day each in order to handle all of that. So, we need your help, and I think that it’s the relationship that’s important. When we can all work together, that’s when everybody wins.”

Choose Cases That Boost Your Confidence

Dr. Nacho: “Tell us how dentists listening in can improve their case selection to stay sane and keep their patients sane.”

Dr. Sonia Chopra: “Case selection is key, because that can also impact your confidence. If you start something that maybe was a little bit too much for you, you’re going to think you suck, and I don’t want anyone to think that they suck. So, case selection is very key, not just for your patient but also your confidence. 

So, maybe it’s the patient behavior, maybe they are a gagger. Or maybe it’s a #2 and they open very little. Or maybe they have no pulp chamber. Punt that case! There are so many ways, not even using the cone beam, that you can do case selection and save yourself some heartache. If you can bang out two crowns faster than that molar root canal, bang out the two crowns!”

Thanks for reading, friends! If you liked this endo FAQ with Dental Nachos and want to improve your own endo skills, the best recommendation I can make is to enroll in E-School, my mini residency in endodontics!

– Sonia