We are reviewing the spot play spotify reported this morning great earnings More so was the guidance. That was excellent. They said they were Ahead of Apple concerning all the podcasts that they're hosting so to me. This was a very good idea to get in on a dip it had this Amazing spike at the open see how this would trigger something that is crazy because you're opening higher than the Than the pre-market high and then it started spiking like this Everyone wants to get in and you see it was opening at you know around 270 and it jumped eight dollars so whoever was in that spike was a crazy play Saying that you know you buy let's say an option here to 70 you get super green here You need to be extremely quick to sell at the top because then it turned down on you But that's not the purpose of the The video what I want to show you is where I started to see that we were About to probably pop a little higher now I'll show you with the the option itself, but I was looking at the option prices when It was down here. It reached the top went down there reached the top again, and then it went down there I was like, okay. It's going to probably do that a Little bit at least we're going to catch some of it. Let me show you what it did and you understand what I mean Okay, now I was switched to the 270 calls for spot To show you exactly what I meant with the price action on the calls This is the one-minute chart on these calls You know just side note is Whoever got in here at four This went to 11 11 11 10 at the top during a one-minute candle So you have to be pretty quick to grab all this I'm gonna get in there and to get out at that point, but like I said, that's not the point of the Video what I want to show you is this here people that got in at in low four even not sorry a little under four and this is high six even seven and then same thing again and it goes up again So there's a very good potential. I know it's a little expensive to be at the bottom there but the price action was really really rewarding so This is the reason why I decided to go for seven. First of all for 70 was the upper limit there Making it in the money and then some would have been very lucrative would have paid would have paid well and The idea it was to buy from from the bottom. So we were looking for double bottom triple bottoms We're back on the actual chart here, and this is what I was saying we're looking at double triple bottoms and This is pretty much what I saw. This was the bottom of that wick another bottom there a little higher and When we dipped here to me this was the bullish sign it hit the 50 EMA and This is where we alerted on the 270 calls making Ways to move back to the 270 zone the idea was For us to take the bottom and move up Fortunately, that's not quite what happened and look at what happened. This is the top of the previous day and We did just a hair under now we had this Price activity that was very close by Sometimes what I really like to look what I really like to look for is not this price activity, but pre-market activity pre-market activity sometimes is the only thing available because let's say we are on a gap up or Something that is You know, we're higher than the three previous days. We have very little View of what happened the previous day. So sometimes when you look at Price activity from the the pre-market. Well, you see that this is exactly where we were so basically we were support from pre-market we bounce right on it and We took our first Exit on to 70 right there. I believe we were at 80% when we made it to this, you know, here's a top another top When you look at all this here, right? You see that this is pretty much it's reaching Where we stopped going up. So the idea is to grab some profits I took half out there and he percent and then We posed a few information and eventually I decided to move out when we reached the 275 this was my Total exit which was which was good for I believe 200 and something 232 percent at the top And it kept on going kept a freebie for As a runner, but the idea was to conclude the trade at 275 In 275 was struggling was really trying hard and I thought, you know, this is good enough And always remember look at the price that you pay or you paid for for your play. We paid a Price for the 270 right so you have to add 270 plus your premium this Will set your break-even point and This means that this was a 270 line it needs To be let's say you paid $3 for that. It needs to close at 273 At expiration to make sure that you become break-even so You know, it's Wednesday. We need to make sure that We are a little higher than 273 we were 275 and we're still 200 something percent If we were to close here at on Friday, obviously this this Profit would be a lot less. So the idea is to grab some along the way be happy with it and move on so just a recap What we looked for was a Very good play. We saw that the price activity on the premiums was very very good So the risk reward was there We got in on what we thought was a bottom and then it found support This was the first support and then we found support lower on the pre-market activity we bounce Took some profit on double top and then took the next profit the last profit we took Because I believe we took some along the way Took some as we were struggling to pass the 275. So I hope you guys are learning something and I hope to see you in chat. Thanks for watching


Hi, hi editor. It's the author so I'm so embarrassed about how many changes that needed I really hope it wasn't more work than you were expecting. Oh, don't stress It's because your book read so well. I decided to be more aggressive with the edits Okay


E.J. I'd like to welcome all of our attendees tonight and thank you for taking time out of your Friday night during the holiday season. In just a moment I'll introduce our presenters but first some housekeeping. There will be an opportunity for questions during the presentations and one of our presenters Dr. Marou will be looking for hands raised in the audience. Discussion may involve more than one presenter. Please use the raised hand symbol at the bottom of your screen and they will recognize your questions. Also introduce yourself to the audience and mention your publication or association if possible. I'd like to especially thank Suzanne Pittman and the staff of the American College of Dentist for their assistance in making tonight's program possible. Next I'd like to introduce our three presenters. Dr. Mike Marou is a private practice orthodontist in Thousand Oaks, California. He currently serves as a webinar editor for the Journal of Clinical Orthodontics and recently retired from his directorship of the Student Professionalism and Ethics Association. Dr. Dan Hammer is a U.S. Navy oral and maxillofacial surgeon with fellowship training and oral head and neck oncologic and reconstructive surgery. He's currently full time faculty at the oral and maxillofacial surgery residency at the Naval Medical Center in San Diego where he's director of the division of oral head and neck oncology and reconstructive surgery and director of the Naval Medical Center in San Diego facial restorative surgery platform. One rounding out our stellar lineup tonight is Dr. Donna Hurwitz who has been in private practice for over 50 years, serves as a clinical instructor at University of California, San Francisco School of Dentistry for over 30 years and has served as president of the San Francisco Dental Society, a trustee for the California Dental Association and as an expert examiner for the California State Board of Dental Examiners. I'm going to take this opportunity to turn our program over to Dr. Mururu. Thank you, Mike. Awesome. Well, first off, thanks for having us. And you know, so Dan, Don and I have been on the phone quite a bit and email the last few days and I think we would all agree we have a very unique opportunity today. So we're going to have a little bit different of a format, almost a discussion. There's a lot of trends right now in dentistry where practitioners are accessing their information and the shift they're in. And so what we're going to do, format-wise, we're going to go through a series of questions and scenarios. Each one of us are going to take an opportunity to respond and then after the three of us have responded to whatever that question or scenario is, we'll take questions from the group. It would be nice if we can address each one of those individual questions as we hit them so that it's fresh in our minds and if a certain discussion piece needs to be drawn out longer, we have the time to do it and if it doesn't, we'll move right along. So without further ado, I'm going to move in. Now, I don't know if you've seen the title, we've changed the title of this presentation just a little bit from what Dr. Chambers had initially anticipated. But what we're calling this is dentist expectations for communication and learning within the dental profession. Last week, we talked a lot about social media and communication from doctor to patient. This is going to be from doctor to doctor and from doctor to expert within the profession. Where do we seek CE, who do we see as experts, things like that. So the first two questions that we're going to pose, Dan, Donna and I are going to go through this, but we just want to give you a little bit of where we're coming from, what stage in our careers we're at and where we seek information. So I'm going to pose this first to you, Donna, Dan, you can take over right afterwards, I'll finish, but here are the two questions. Where do you personally turn for information and knowledge within the profession and have you always accessed your information that way or have you seen a change in the way you've done it over, you know, the past few years? So Donna, to you. OK, I'm up. I have definitely seen a change and I should have seen it since my career has been very lengthy now. I will not be here and dismiss the advantages now of face to face communication and a one to one environment, but I have followed most of my career traditional ways as most baby boomers would have with following up lecturers, articles, authors of articles and learning who has credentials, taking them up on offers if I took a course to have a follow up question with the clinical problem. I would do the same thing with with articles. I kept up with my journals. So I did all of those things. But of course, over time, as computers made the scene in my life, things did change. And when I was when I was at school at UCSF as a clinical instructor, I started to learn more about this evidence based dentistry that the ADA was putting in the forefront as it always should have been. I started to learn more about statistics. I learned how difficult it is to research something. I'm a person who likes research. I actually like studying statistics. But I was amazed at how difficult it was to get answers that you could depend on. As an example, in an EBD group, we started at school. I had read an article that it was beneficial to disinfect cavity preparations that made sense to me. So I did that and I was spending time, a few dollars doing this with every operative case. But I was trying to look into, as an example, am I spending my time wisely as the patient benefiting? I found that there was actually very few studies on that subject. And other things that I might have looked up, I found a plethora, really an overabundance of research. And when I began to take courses on statistics from people say like Michael Glick of ADA, who was my hero in the world on that, learning things that most studies have flaws. Today, after all I've done, I can frequently pick apart errors in methodology, sometimes patient selection. I've even done some consulting with articles with ADA, even though I don't have a PhD or any peer reviewed credentials like that. And I began to see how difficult it was to find out the truth. That's what we all want to do. That's what makes our profession and any profession fun and satisfying, finding out the truth and acting in that direction. So I know things are difficult. I know we need something faster. I know there's frustrations. I never finished figured out any answers other than to acknowledge that time is always limited. So you have to confine the time you spend on issues that really interest you, like that particular one interested me. Or when I go on medscape to keep up with medical information, I do their quizzes and I take their their weekly information at their end of the year, mistakes we all made. Don't do this anymore. I do all of that. But for something I need to spend an extraordinary amount of time, I will select something that affects my practice, my patients or my body or my loved ones. That's how I approach something. I have I'm very interested in Mike's information on how the Facebook works. Frankly, I I would see more positive about such an avenue than negative. That would just that is just my initial reaction as long as the participants. At knowledge, credentials, that's really what you want. You want credentials of somebody who's giving you advice, somebody who has credentials and who is experienced and also to take care that you have ability to follow up whatever is recommended. You know, to me, that's maybe the biggest risk as opposed to a long research project in which you have to go back and justify an outcome, whether there is one or not one or good, bad, whatever. Do you have that opportunity in an approach like the Facebook group? That concludes my remarks. Thank you. Awesome. Thank you, Mike and Richard for the introduction. Great to see everybody. I have some comments. So the first question is, where do you personally turn for information? Well, I'm going to kind of do it in reverse order because this has changed significantly. And so I've been in training for a very, very long time and I finally am done. And so I've had a huge change in where I go for information right now because I used to be part of structured education.  And I had mentors directly next to me who kind of shepherd me on where to go. So I was doing a lot more peer reviewed searches, etc. Now that I am not in training, to be totally honest, I get most my information right now from Instagram, I'd say about 90 percent of it in two forms. And I think the reason why it's changed is when I was going through my dental education, my residency, my fellowship, I need to learn foundational knowledge. I need to learn the evidence behind foundational knowledge. And now that I'm done, of course, I need to make sure that foundational knowledge stays there. But what interests me is the nuance. You know, like that was previous mentioned, what can I learn from other surgeons and other people with proper credentials that is going to enhance the outcome of my patient? That's really what I care about. So by going on Instagram, I can see a new technique being done in India by a surgeon and an outcome and I can directly message them. I usually hear back from them within the same day on the other side of the world. And we're discussing cases, you know, in a hippocomponent way. But, you know, like that's what I need, because what I think then is next week when I'm doing that case, using my foundational knowledge and traditional research methods, I can bring that to my patient. The other big change is the volume of information is just too much now. Like even from when I was a resident, I graduated in 2017. That wasn't a long time ago from residency. The amount I expect my residents to know right now is absolutely insane, even from when I graduated four years ago. So I think just acknowledging that the volume and it's not that people don't want to invest the time is that there's truly not enough time to read what you probably should. That's all we would be doing. And the last thing I want to talk about is why things have changed. Man, patients have gotten smart and very, very well read. And I mean, about 70 percent of my practice is oncology. And then the rest is reconstruction.  They've already Googled the new NCCN guidelines. I mean, these people come armed and I think there's a big difference now where they used to just come in and trust whatever the doctor says. And I think where patients have come now is trust but verify. And I feel that every clinic I have or even when I'm doing a third molar eval and I have a mother of the child that I'm doing the consult for and I bring up, do we have narcotics after third molars or not? That is a huge, huge thing. And parents are coming in very armed on is my kid going to get opioids or not afterwards and what the evidence is behind that. So I think that those are kind of the big three for me is the the speed, the volume and from a patient doctor relationship, just the accountability to be up on your knowledge. And when patients ask me questions, if I don't know that, then I know exactly where I'm going to go look that night. And I just have the humility to say, you know what, I haven't read that article. I'll look at it and follow up, you know, with you. So with that being said, I'll turn it over to Mike. Awesome. Thanks, Dan, and Dan as well. So the only thing that I would add to that, because I feel like especially Dan, you and I are in a similar boat. The orthodontic world right now is using Facebook more than it is using Instagram, I would say the dental world as well as the pediatric dental world is doing the same. And we'll talk about that in a minute. But one thing that I wanted to say a trend in my own life. So I graduated 2012 from residency. And what I would say, my sources are still the same. Journal articles, when I say list serves, things that come from the the ABO and other dental professional, either journals or publications. And then Facebook, so it was the same back then. But the order it used to be is I used to get the information first from a journal article, and then we would discuss it on social media. Now I feel like because the speed of information is so fast, I hear it on social media first and then I try and verify its accuracy on social media or in the journals, does that make sense? So before I used to get it in the journal and then work its way into social media, now it's completely reversed. And I hear that trend happening in a lot of places because it's immediate. I read something on Facebook, I'm like, wow, I really like the way that individual treated that case or I like that new technology or or whatever it might be. And then I go and then I'm and then I'm backtracking and say, OK, is there any data to support the me implementing this in my practice? And I would say that that's the trend and how it's changed for me. But what I want to do is I want to bring something about on the screen really quick, I'm going to share my screen with everybody. So bear with me here. OK, can everybody. There we go. OK, can everybody see this big flashy? Give me a thumbs up, Dan and Donna. Can you see my screen? OK. One of the things that's really interesting, that's changed over the years, I want to throw this example out there and we're going to backtrack and talk about it probably throughout the rest of this hour, hour and 20 minutes that we're here on the phone or on this call. But one of the things that we're seeing is these Facebook and Instagram groups. Let me show you the one that's that's most used within my passion of orthodontics. So you can see here, orthodontic pearls, they have 8000 members. And what's really neat. And I know a lot of you on this call are already using things like this. Dental nachos is one of the big general dental ones. They have 36000 members.  I mean, these numbers are they're starting to eclipse what organized dentistry is providing. I mean, just mass numbers of people. And what's interesting, and Dan mentioned this a minute ago, you know, we instead of having a conversation in, you know, within the US and Canada, all of a sudden I'm having conversations with with orthodontists in Korea and in Australia and China and in different places. And we're seeing new techniques and things that I don't know that I would have seen otherwise. So there's some positives. But let me show you what a day to day for me looks like, is every single day I am on this Facebook page. Every single morning I check it. So this is I mean, this is uploaded. This is live right now. Let's see when the last thing was posted. So somebody posted a case. If you look here, I'm going to circle it. Nine hours ago, this was posted. Posted a case. I don't I actually didn't read this one yet. But within nine hours, if you look here, there are 45 comments. Talking about the case. Giving thoughts and ideas how to make it better, answering any questions they had. Within a nine hour period, 45 other orthodontists chimed in and gave information. Scroll down further. This four hours ago, somebody had a question about this case right here. I haven't seen. OK, so nine, you know, nine comments. I know this individual, if we were just to look at what they ask, looking for some advice on treating this 12 year old boy, I won't go into the case, but they were looking for advice. Then you look down here in the comments, you can see me circling them. I mean, individuals are then telling them how to treat the case. Things that used to take me days, if not weeks, to either search it out on PubMed, read the articles and try and find the information or reach out to mentors, schedule a meeting, send over records and get advice is now happening in a matter of hours. If I have a huddle in the morning and I see a case is coming in that I have some questions about or I have an exam during the day, I can have an answer. I can have several answers to my question within a matter of hours. So that coupled with and I know Dan and I were talking about this a little bit earlier, this is having in pediatric dentistry. You can see this this head bar right here, M O P C. So this is this is the orthodontic pearls group. M O P C stands for the the mother of pearls conference. So they have started to hold their own conferences and they are selling out every single year. You go and it tends to be I mean, we're still seeing experts lecturing at these things, which is fantastic. But it's a little bit more, I would say, hip. There's a lot more going on. Everything from, you know, the lectures for, you know, delving into newer tech, things like that. Not only that, but how to run a business and then a lot more night life in these things. And it's really attracting, I would say, the younger or the newer grads in the group. So with that setting the stage, I'm going to stop sharing my screen and we're going to go back to discussing this. Let me see if I can get off of there. OK, so the question that I'm going to throw out first to to Donna and to Dan. Are you seeing these same trends? I know.   Is that correct? I know you guys are on mute. Are you seeing these same trends? I'm seeing it in orthodontics and in other places. Tell me what's going on in your worlds. No, I appreciate the question. So OMFS has not really jumped on to the whole Facebook thing. But but Instagram has exploded. And actually, if you look at our most recent journal, there's an article about the influence of Instagram within oral and axiopatial surgery in the United States. Very similar to our plastic surgery colleagues who have been writing about this and actually doing good research on it for the past five years on patient education and outcomes with the increased social media presence. Because my profile on Instagram is 100 percent public. So patients can see it. Everybody can see it. There are no rules. People have full access to everything that I post. As far as pediatric dentistry, just speaking for Chrissy, and we mentioned earlier, she's really disappointed because this year she can't go to bourbon and baby teeth in Tennessee, which is the big pediatric dentist meeting now, instead of a PD, as far as continuing education. And you're right. The biggest reason I asked Chrissy before this talk, I said, obviously, she goes to both. But I said, why do you want to go to this bourbon and baby teeth? She said twofold. One, there's a huge focus on business and just like the business of dentistry and the business of pediatric dentistry. And it's not like a lecture style. It's like small case studies, people talking about their individual practices, how they dealt with staff, how they did it with these things. You can do real time feedback and there's not like a set agenda. It's just like and then there's also another thing called mommy dentist group. They have their own meeting. It's tens of thousands of people that are part of it. And Chrissy really wants to go to meetings where there are other female, you know, mom, you know, dentists who are small business owners so they can talk in their own space about the challenges of having kids being a small business owner and being a mom and she feels a lot more of a home in those different situations. And I think the reason this is changing is just and I interrupt. Let me throw this out. So has has your wife or Chrissy mentioned are these meetings? Are they pulling in more people than the APD or the ADA meetings or kind of tell me? I don't I don't think they're there yet. I mean, this is, you know, maybe a thousand people, which is significant. That's significant for sure. I don't I don't think they're. But this last comment on this, I think we're seeing the change of the practice type, right? So, you know, and this is huge in all of us, all of us has been super resistant to DSOs and getting bought up by everybody. But the new trend in all of us is sell your practice private equity because nobody can afford your practice right now. And it is like wildfire in all of us. Everybody is cashing in right now. Other practices, nobody selling to new grads because new grads can't afford it. So those days of having that one on one mentorship of the seller to the buyer, you know, dentist, no matter what the specialty is not happening. You're working for a DSO on your own. You got to go find your own C and mentorship. It's not built in anymore to the practice you're buying. So I see Richard as his hands up. So I'll pass it over to him.  And it seems like the the meetings coalesced no, they're no longer around a professional organization or region of the country. They're the common denominator here is that everyone in attendance is a member of the social media group. Am I right? Yeah. 100 percent. Donna, sorry, I keep going down. Oh, just to that point, that's another thing, because, you know, we'll talk more about organized dentistry later in this. But as a new grad, it is not easy to access the traditional channels of organized dentistry, especially in leadership.  You know, super long history with as the national leadership, everything, right? It's not as easy to get involved, you know, kind of when you get to a new area. She goes on mommy Dennis group. Now she's the head of San Diego for mommy Dennis group, coordinating 50 to 100, you know, mommy dentist to go do events. So I think that's that's true. It's not a geographic thing. It's it's the shared bond. Thank you, Dan. I'm going to I'm going to go to Donna and Richard will go to your question. So are you what are you seeing, Donna? Yes, a few things. First, I had no idea the trend had gone quite so exaggerated like you're describing. That is amazing. Obviously, there is a need for this. I did not do Instagram. I did. The precursor of that, I suppose, with some chat rooms that CDA had. But this it. It goes a long way toward your Facebook toward eliminating some of the biggest problems and trying to look up something like like you were saying in a different order that you go from some generalizations and then how you can apply it to a specific case. Now you're you're doing it the other way around. So you're introducing your own context right away. That's a tremendous advantage because everything you do, everything we do, there's an element of uncertainty about it. Every case is different. So your context is both the problem and the answer of what you're trying to achieve most most of the time. And so you're bringing the context in with you and asking a wide swath of professionals for their advice. It is a faster way and it's. Well, it's faster than sometimes the more old fashioned traditional ways of having even mounted models and go and going in person and then putting something going after certain individual characteristics of the given case or analyzed. It's much more efficient. I still would like to know more about follow up. What you do about that and and how you how you. Present cases as they develop. Do you do that? As they go along, are you making progress in the treatment? So all of those things are followed up in some type of a timed sequence. Yeah, I think yes, would be the answer. And that's still I mean, if I'm understanding correctly, and it seems like yours, you're going to respond as well. But that it's still it's still the onus is on the individual, the individual practitioner, but they're able to to to be guided at certain stages and they they elect when that stage is. So if I need help at, you know, one phase of the treatment and not at the rest, I would only pose that question to the group then. Am I understanding that correctly or Dan chime in? Well, I agree with you. And I think to to further that is some people choose to do follow up on the questions posed and and everything. Some people do follow up with the primary references you know, on what was done. Well, that's how I took it. So yeah, I mean, there is follow up, but some people just take whatever information, then just run. And you don't you don't really hear anything more from them. Well, we'll talk about this a little bit later, but I think that's going to be one of the risks or one of the challenges that we face as a profession, that if if the source of the information is not is not evidence based, then where where does the patient end up in the long run? Right? I mean, I think that's going to be the key to the or that's going to be one of the takeaways here that, you know, I'm looking at a list of some of the strongest leaders in the profession on this on this group, that's going to be our that's going to be our call to action, I believe Donna and then Richard. Yes. Now, how do you handle, you know, that old joke you show seven dentists a case and you'll get eight different opinions? You know, surely you get a lot of different opinions. Well, now you're showing I just can't be a course on what you do with that. But just in general, how does that happen and how is that dealt with? So I'm going to I'm going to put that off till a little bit later because we have a section on that. But that's the biggest challenge is if you. So you said if you ask seven, you know, seven dentists, you're going to get seven different answers. But now what's happening is dental nachos or orthopreneurs or whatever it is. You ask 8000 people that question and like that girl had this morning, she had 45 responses in nine hours. So now now she's got 45 to sift through. How do you know which one is evidence based? How do you know which one's the best? All of that. I mean, I think that's the challenge. Richard, what are you going to say? Well, you know, I'm one of the senior citizens in this group tonight, but a couple questions. Are there is there such a thing as influencers in these groups and do some of the participants take on celebrity status? Absolutely. And just to show how crazy this has got. Last week in Vegas was the DIA meeting. Has anybody heard of the DIA meeting? No, the Dental Influencers Association. And I'm not even kidding. I am not even kidding. I was in Vegas last week and I have some buddies who went to it. One of them has a hundred and seventy five thousand followers on Instagram. Bloody Tooth Guy. He said he's out. He's out in New Jersey. One of my dear friends is his name is Vegas Max Face. And they have tens of thousands. And they literally it's a meeting now just for people on social media who are dentists to go meet other influencers to grow their followings and influence within a social media market. Now it could be Instagram, it could be, you know, and they actually have like courses and everything and they they invite influencers from other things. So maybe from like the hotel world or from whatever to come speak about being an influencer. So that's that can I ask you this, Dan? Do you feel like those dental influencers that that that those, you know, when they post, do the people reading it believe them more than they would your traditional experts because they're the influencer? I mean, I think the great question, the public believes them more. So if you put a post I put up and a post that Bloody Tooth Guy puts up with 175,000 followers, the public that look at his profile will believe everything he says over me because he has 175,000 followers. Interesting. I don't think that's true professional or professional because although I have much respect for Bloody Tooth Guy, he takes out teeth and takes a picture of his teeth, the teeth, and that's why he's famous. OK, we're like the circles I'm running in and the conversations I'm having. We kind of look at Bloody Tooth Guy and it's like, cool, good for the profession. Get it out there. But I'm not calling Bloody Tooth Guy about a pathology case. Right. So I think but the public definitely follows. Thank you.  Thank you. So I'm listening to two specialists who I consider to be young. Thank you. Who know how to evaluate the validity of information. That's part of your training. Right. You have a foundation of knowledge that allows you to apply the basic fundamentals. It allows you to evaluate the information that you're pulling off social media. When I talk to young dentists, general dentists, they tell me they have not been taught those skills in dental school. Right. So they're getting their information from social media. And they're choosing the sites that have the most followers. I worry that they don't have the ability to discriminate. So they're going to they're not going to listen to Dan Hammer. I don't think I think they're going to listen to the influencer with the most followers. Your comments, please. I I'm going to I saw Dan nodding his head. I am seeing the same trends. Remember, so I just left speed a few weeks ago. And so I've been working hand in hand with students for, you know, for more than 10 years and I was a student prior to that. So I would agree with that. I actually I Jerry, I see your hand up and I'm going to come to that. Dick and I and I'm not losing what you said because we're circling back here. Lance, I'm going to take your question, but I want to ask you a question as well. So I'm sure everybody on here knows Lance Rucker, but you're in you're in in B.C. You're in Canada. Are you seeing these same things happening in Canada as we're seeing in the US? What would you think, Mike? I would assume yes. Yes, you assume correctly. OK, I would like to say that at least several institutions in this Regency that I have dealt closely with and and across the continent do include materials that attempt to help students qualify material that is evidence based. Right. That being said, I'll go back to Dick's question because I think it's it's the appropriate question. And I'm probably even more concerned than Dick is about it. Can I can I interrupt? So I, Becca, will you pull up your screen for me? We have the outgoing president of the Student Professionalism Ethics Association with us today. And I just texted her. You can see her down here. And I and I and I posed her this question. I asked if she'd be willing to address it. I mean, can you can you answer Dick's question? I mean, what do you she's at USC in Southern California?  What do you see? Well, this is actually really funny listening to this conversation because Facebook and our generation is kind of obsolete. There's no one really on Facebook, but Instagram. Absolutely. I can't tell you how many times I've seen something on Instagram. I'm like, wow, I didn't know you could do it like that. And then I'll text either you or Eric and say, have you ever done an injection like this? And Eric's like, oh, God, please don't ever do that. So I'm lucky that I have sorry about that. I'm lucky that I have mentors that are able to kind of help me through that. But I would say that most of my class is not that lucky. I also would agree that if somebody has more followers, more students will tend to listen to whatever they're saying. Most of us can usually tell by their work when you look at it.  And so we kind of like, OK, their work isn't legit. But sometimes we will see things and I don't know whether it's right or not. So if a patient were to ask me something, I would go to PubMed. But if I was just trying to look and see what's the most current, usually Instagram. So so that's you. But what about so are you but when it comes to your classmates, are you agreeing with Dick's concern that the majority of your classmates might be looking elsewhere other than the literature? The first my first response to that is, yes, I do think that. But when I when I dive a little deeper, the majority of my class, I would think no, when a patient were to ask them questions, they would dive into the literature. Absolutely. But there would be a few, obviously, minorities in that group that would tell them whatever. But that they would have been done that anyway. So I do still think that relevant literature is still popular amongst most of us. Good. Hopefully it stays that way. Yeah. Thank you so much, Jerry, I'm going to move I'm going to move to you. Well, thank you, doctors. I'm Jerry Sabery and I'm just an old broken down cowboy dentist in Boulder, Colorado. I'm thankful that I'm retired. I still have the fire. Just a couple of comments that I've been listening to, especially with Dr. Hammer about the just tidal wave of information. This is a brief quote from Dr. Peter Denson, who's, I think, an internist at the University of Iowa, says it is estimated that doubling time of medical knowledge in 1950 was 50 years in 1987, years in 2010, 3.5. In 2020, it is projected to be 0.2 years, just 73 days. Students who begin medical school in the autumn of 2010 will experience approximately three doublings in knowledge by the time they complete the minimum length of training, which is seven years needed to practice medicine. Students who graduated in 2020 will experience four doublings in knowledge. What is learned in the first three years of medical school will just will just be 6 percent of what is known at the end of a decade from 2010 to 2020. So knowledge is expanding faster than our ability to assimilate it. The reason I say that is I've generally been considered the zenith of hallucinatory reasoning. But I noticed that when when I was taught how to review the literature, it was it was eyeopening to me and about two percent of the literature could be known as quality literature. What I'm wondering, especially in a town that I'm in, is what role will I play in filtering down all of this? And Dr. Rucker knows a new Dr. Colburn, who was a champion of ergonomics back in the day. And he said to me one time at any moment in time, there's probably one way that's the best way of doing anything. So I mean, the digital age has provided all this wonderful diagnostic. I just wonder if it will also apply and I anticipate it will apply to this volume of knowledge that we're trying to assimilate into our heads and somehow, you know, generate into the truth that could even be involved in in the political system that we're currently operating under. So anyway, those are just my thoughts. Well, first off, thank you. Donna, I'll let you answer and then I'll come back to me. Just a remark about the speed from Jerry. We know there's a number of things, beliefs, treatments and so forth that have been done through the years that have been since discredited. We don't do them anymore. And yet once they take hold in society or even something that's not particularly old, but it begins with a short, usually sensational newspaper or a television blurb about something and it takes hold in the general population where if if it's not discredited quickly, it it takes a place in the ethos of the culture and it's almost impossible to get rid of it. Now, if we want to talk about the disinvent of trying to cope with so much material and the speed, like you're all on a racetrack now a days, could it ever be said that this same speed could be turned into an advantage in which if some technique is proposed and saying a fair amount of people try it, it doesn't it does not work. It does not be it has not proven a good approach. Could it be that that could also be an advantage that the word gets around it? And we don't have techniques recommended for vast swaths of dentists who continue doing something that does not benefit their patients. That's a very good point you bring up. I mean, because because the positivity or negativity, I mean, it goes in both directions. And I think as long as we I think I think our responsibility, I think, again, the takeaway is going to end up being if I were to guess what the takeaway at the end of this, this discussion is, is that we as the leadership of this profession need to guide that we need to empower the individuals who are taking in this information to do exactly what you said, take the positive out of it, learn it, learn the proper way to disregard the misinformation. And I think I think it'll only benefit. One thing that I wanted to say, Jerry, I don't know if you've seen this before, but there's a couple of different dental companies that have popped up recently. Kyle Stanley out of USC in Southern California started dental AI, which is a diagnostic tool and it's all AI. It's it's pretty interesting. I'm not going to delve into it. I also want to show the group. I'm going to share my screen for just a moment here. I let's see if I can get this. And everybody see this article right here. This was I wasn't planning on sharing this, but I had it on my screen. It was in preparation for this meeting. The physicians experience of changing clinical clinical practice, a struggle to unlearn going back to what you said, Jerry, how how how the body of knowledge is changing so rapidly. How do we unlearn the things from 10 years ago that have now been replaced?  So I purchased a practice, a little bit of my history. I purchased a practice two years ago in my hometown. And there was the practitioner that I took over for who was going to stay on for quite a while, COVID changed that, but graduated in 1982. Fantastic clinician, wonderful human being. But a lot of the techniques that he was still using were from 1982. This struggle to unlearn, I think is going to I think it's going to be compounded in the future with the rapid with the rapid turnover of information. That's I mean, I don't need to say anything more there. I just wanted to share that article in case anybody was curious later. Dan, chime in. Yeah, yeah. Just as far as AI, a great question. My response is depends what algorithm is controlling the the the narrative. Yeah, because that's the problem with AI, especially when you look at the social media and if anybody wants to get freaked out about social media, if you haven't yet, watch the Netflix documentary Social Dilemma. It is absolutely terrifying, yet I'm still on it. So what does that say about the world we live in? Right. But I don't put as many pictures of my family, but they're still out there and somebody owns them because. I want to keep going because my thing with the AI is if you look at social media and there's other applications for AI, but social media, their goal has nothing to do with the words you're putting out. Their only goal is that you stay on that platform for as many minutes a day as possible.  So I think that's my thing. And that's always economics, but that's dollars and cents. That's a business. So that's kind of terrifying to me. For the question with General Dennis and being able to decipher, as we heard from the current student, I mean, I think they still have the skill set, but I've I have seen anything, especially in large metropolitan areas where it's really complex and competitive and dentistry. New practitioners do not have mentors to reach out to. Yeah, they do not have mentors like they used to. They're not getting involved with organized dentistry as much. They're not finding that local dentist, you know, who's three three streets over, who's taking them under their wing and they're finding new routes. So that I think that's really the big thing. I don't think it's that they don't want to engage. I think they're just finding their own mentors and their own information. So I think the tough world to find that right now, because the traditional means are changing. But let me do this. I'm going to move this discussion along just a little bit. And I'm going to skip a couple of questions.  Question number three that we have down on our agenda. So we've talked a lot about these trends. We've talked a lot about where this information is coming from. But the impact on social media, group information and collaboration. Does this trend? Does it positively or negatively affect the profession? And how does the average practitioner filter out this misinformation and find which ones are correct? I mean, what are your thoughts there? My on you are. Well, we already touched like you were implying somewhat on this. Yeah, again, the the universal justification would be that the credentials of whoever is advising. And that has much to do with their education, but also their character and their person, their personality, how to filter all of this. Well, that's the problem, isn't it? That's why we're here, where we're at really investigators. You know, if you were a crime investigator, generally you need three people. You cannot just take one person. It needs to be verified by somebody else. And generally you require three people, three people to be able to say something is is proven and something has you need some evidence of longevity in some ways of verifying the other. The disadvantage, you could have some fragmentation of the profession in which we are not all necessarily guided into what the standing standard of care is, you start doing things in too many different different methods. It could it could lead to some problems even in analyzing the results. But, you know, I would leave that to the the specialists. So mainly I'm saying things should be tracked. And I'd also like some ideas we should have about how we're going to do future standards of care. Standard of care generally came from the profession. It came from CDA and then the state board uses it and so forth. But now we have how are we going to have a good way of beneficial a scientific, humanitarian way, even of changing with ethical and legal risks and working into our science. The speed that we're affected not by our own desire for speed and our research and our treatment, but we're also influenced by by the general population, people, people are in a hurry. Everybody's in a hurry today. So your your your impetus can be too much trying to do something faster that might not hold up that well. All of the all of these things I think are more problematic in the future because of the speed and the ease, things that are easy might not be the best approach to actually solve a problem for the patient. Those those were my remarks about the my the reason I felt it certainly is a net positive, but it also opens up some decision making, including including standard of care and and ethics and legal risks, all of these things. We have to have to take into account with your clinical decisions. You make a very good point, Dan, you had something to say. Yeah, no, those are fantastic points. When it comes to standard of care, kind of because of my weird cross training, I do a lot of litigation reviews as like a subject expert. And, you know, in the end of the day, we can talk about all this social meeting, what's going on in the profession. But when it comes to standard of care, improving standard of care, I will tell you in every case I've ever been an expert on it always goes back to the governing documents of an association or profession. So like in oral maxiopacial surgery, we have our parameters of care. They are written by a group of experts, by the American Association of All Maxiopacial Surgeons. And although we say it's not the standard of care kind of workbook, it kind of is and that's what either will put the news around our neck or save us from litigation, you know, in the future. So I think there's still a lot of respect, especially from like the legal system and from like a purely litigation into organized dentistry, ADA guidelines. Once again, just being married to pediatric dentists. I mean, the APD guidelines are kind of like scripture to the pediatric dentists. And they really, everything they do falls under those APD guidelines that they've memorized since they were residents. And the APD does such a good job sending out the new version every couple of years to recalibrate the entire specialty. So I think there still is a lot of that for standard of care. But I agree with you on percent data that it makes it very difficult to track. And that's where the difficult is. So how much are we deviating from normal and are we still within the confines? So it's a good challenge. Really quick, I'm going to respond to that. Then I'm going to go to Richard and then Dick. So Dan, something that's interesting there to keep the conversation going. So I think it's amazing that APD does that. Orthodontists do not. Only 40 percent of orthodontists are board certified. That's one set of standards. And then you have the other set that's just simply defined by standard of care. And what is the standard of care? It's what the average practitioner would do in a specific situation where it's being called into question. I don't know if it's happened in dentistry as much, but where it's happening in orthodontics a lot is now we have Smile Direct Club. We have Candid. We have Byte. We have all of these groups coming in. And what's happening is you've got the you've got these these other groups moving into the orthodontic space. And so if we allow the standard of care to be lowered, if we're not sticking to that, that, that high standard that was established by the profession previously, if we lower that, then it makes it so much easier for these DIY groups to come in. So orthodontists, I think we're seeing it that hurt us a lot more. I, you know, and I haven't seen it permeate other parts of the profession yet, but that's not to say that it won't come. You know, and so I think it's something that we need to be aware of, alert, you know, alerted to. And honestly, that format that you just gave, what a great road map. What if the profession did actually write standards and orthodontists don't have that period? We could, but we don't. OK, Richard, sorry. I think this goes back to an earlier comment, but I had a question for Mike, Donna and Rebecca, and I want to know currently do do schools teach critical thinking and how to review literature? I'm going to defer to back on this one because you're in school, you're a senior. Are you still there? Oh, you're driving. Don't die. Yeah. Can you hear me? Yeah. Can you hear me? OK, I'm I'm on I'm on the 60. We're pretty dead stopped right now, no worries. We're worried. Yes. At least in the USP, we do the PPL, the problem based learning method, as far as reviewing literature and all that. And the whole point of that is to be able to critically think about what you're looking into and why you're using that resource and is it valid? And what information are you getting from that? And what you know what I mean? Like, how are you approaching the information? And I think that's the whole point of the system. Thank you. One of the challenges, Richard, that I think that we have is I. So and when I was president of the American Student Dental Association and then shortly thereafter, when I worked as a consultant with them for a few years, I traveled to a lot of dental schools. I don't know how many I hit, but, you know, probably half of them at some point in time here or there. And what I would say is, is I believe that each university is teaching critical thinking, but is it going in one year and out the other? I don't know. I think there are so many stresses in dental school, whether it be boards or whether it be, you know, passing your clinical exams, whatever it is. I think what's happening is students. And honestly, I did the same as a student, but you're looking for what's the quickest way to receive the information, get a decent score and move to the next whatever it is. And so I don't know that I sometimes worry that the critical thinking piece is being taught but missed because access to other information is so immediate and easy.  I was down in the library digging up in the old files trying to find journal articles that somebody told me they thought it was from, you know, 1998 and, you know, volume six and I'm digging for it and it was wrong. It was in four, but it took me three days to find it. You know, that has changed so much. And so I think it's being taught that I wonder if it's being missed by some. Dan, would you agree with that? Or where do you stand? Just real quick and then see Rebecca as her hand up.  Think to study. I'm in the Naval postgraduate war college right now. And we have a semester on critical thinking for intermediate leadership in the US Navy. And it is by far the biggest deep dive. So, you know, I think in dental school, they can have it through PBL. They can have it through whatever, but like that's like the starting point. And your everyday practice is how you gain that critical thinking skill. And man, I'm still working every day to become a better critical thinker. So that's kind of my thought on critical thinking. I think it needs to be part of the hidden curriculum of dental school, the hidden curriculum of residency. I was just taken out of Subman, Dibbler-Gland with my resident. OK, the whole time I'm teaching him how to be a surgeon, but I have a whole other curriculum that I'm teaching him on how to be a surgeon, how to be a teammate, how to be a collaborator with the staff, how to make critical decisions on what to clip out, what not to clip. So I think it's a lifelong tool. Thank you, Dan. Quick response from Becca, then Dick, it's over to you. So just chime in after her. I was just about to say, I think it was pretty naive of me to say that, that yes, we're doing critical thinking. I think, like Dan was just saying, critical thinking is also a maturity thing. Over time, as you mature as an adult, you also understand why you do things and how you critically think through things and responses and everything. So I think that they give you the toolbox to be able to use it later on in life, but it doesn't necessarily mean that we know how to utilize it in every situation as a student. Right. Thank you. Perfect. So, Dick, over to you. Well, real quick comment on critical thinking. My son-in-law's twin graduated from Indiana, I guess it's two and a half years ago now. He was 12th in his class, so good student. And I asked him that very question and he goes, no, they didn't teach it to us. But I really put my hand up to agree with Dan about standard of care. And I come from two places. ADA, for some reason, has avoided standard of care. But in the late 90s, when we started seeing these large group practices, they're getting freaked out. They're thinking, we've got to do something to control the environment. That's when we started doing parameters of care. And I was on the committee with the Prasadonists that wrote our parameters of care. I thought all the specialty groups wrote parameters of care. The other angle I come from is I was Indiana's chair of peer review for 30 years until three years ago. And standard of care is defined by, first of all, any official position, which is what the parameter care is, an official position. Then the next level would be peer reviewed literature and the next level would be what's taught in schools predominantly. And if you can't find any other official source, then you look at what the peers would be doing in a similar situation. So in and remember, no matter what we think is professionalism or ethical or proper, eventually it all goes back to what the courts are going to do. And I think the courts are always going to go back to official information, the parameters of care. If the ADA has a standard about taking radiographs or what's in peer reviewed literature, I think we might be protected with standard of care. Great points. Over. Thank you. That was awesome. Lance. Yeah, I am only on guard, and I suppose most of the people on this call are as well, that the standard of care sometimes is usurped, even in courts, by frequency of care, by usual practice. And that may be dominated with the same sort of let's check online to see who's doing what and how many are doing what. So mentorship being substituted with to a certain degree, as you've described it, with social media linkage and information to recent graduates, certainly proliferates as to how to get more information. But I'm concerned that it's not about how to get more reliable information. The I'm certainly confident that you on this call are carefully digest the information that you use as a basis for your decisions about interventions or sometimes more important about not intervening. But misinformation certainly proliferates at least as rapidly as reliable information. And that's always been the case. But when it does it in the dimensions that we're talking about now, it gets really spooky, really fast. And certainly as a patient, I have to ask, do I want care that's the most reliable at the moment and under with the conditions that are known now about me and about situations and about relevant and appropriate treatments? Or do I want what's most trendy? And my heavens, I certainly would think most patients would elect the former. I'll stop there. Thank you, Lance, Donna. Yes, UCSF. Yes, we do teach that space dentistry and so forth. The students have exercises, particular cases to criticize on studies and so forth. Some schools are better than others. So some schools even have I think in Buffalo, they would have a librarian. Yes, the librarian come on the clinic floor, see what the students are doing and give them an idea of what on that particular procedure, what they could talk out and go look up and verify in a research study. Obviously, one of your dilemmas at school, students have nowadays an aversion for a great deal of reading, shall we say? And they they might they might not enjoy trying to look up long research articles before they really have the expertise to be able to determine flaws in the study itself, which is always the hardest part for me. And plus, of course, they have their full, full, full curriculum that maybe some on the faculty are not eager to have questions. And yet those are the very things that are most relevant for the student to determine if they have a if they have a bone to pick with that, that might be the most interesting for them, rather than some of the more hypothetical exercises that they get. But they are they are taught how to look up things in the Pico format and so forth. So I hope we can only hope they put it to good use. Thank you. So let me pose this, I'm going to start the question out to Dan, but, you know, then to Donna and the whole group, what is our role? You know, looking at this screen right here, we've got educators, we've got publishers, we've got past leaders of dental organizations. We've got the president of the American College of Dentist. We've got a really, you know, kind of diverse group in leadership and dentistry. What is our role, if any, in helping to guide this, mitigate whatever it might be? Dan, start us off. You know, I think this is a huge, huge question because we all are leaders on this call. But I think that you don't always have to lead from the front. And I don't think this is something that organized dentistry is ever going to control. Yeah. So I think we just need to forget about that. This is its own world. The ADA says stop doing this or doing that. It's not going to work. So like this isn't like, you know, school children being told what to do. It's how do we embrace it? So what I think organized dentistry needs to do is we need to move out of, you know, one of the things that Richard asked or stated, that was so awesome. And I've never thought about it, but it's totally true is, man, we are moving away from geographic existence when it comes to organized dentistry and things. Geography doesn't really matter that much other than local. I will say local matters because that's your ecosystem. And that's what how you, you know, you make your living and you provide for your family and you need to have that local level. But really it's it's interest. So maybe as organized dentistry, that's where we need to go and start looking at our org structures and start looking at our, you know, communication strategies and think of it more as a special interest group, kind of like subset, rather than you're from Florida and you're from New York. And I think that would be a huge, huge step forward. I know Amos is struggling with this. You know, I'm now working a lot with our International Association, which has been extremely enlightening, because when you're working on a global level, social media is the most economic way to communicate. When you look at like truly like how much it costs to get to the number of people, there's nothing cheaper, especially if you're promoting something. So, yeah, that's kind of my thought on organized dentistry. It's it's just morphing and being flexible and adapting. And instead of trying to control because, you know, like was mentioned, standard of care, those things are going to be protected. They're I really don't think this is going to change anything there. But as far as not having bourbon and baby teeth be bigger than the APD one day, I think they need to adapt. Thank you, Dan. Let's go to Donna and then Lance, if that's OK. I'm cool. I'll just say that we all need to be concerned with failures, because you can learn as much for failures as some of your successes and how any group, Facebook, Booker, others teaches you from failures is a mark of not just integrity, but their their their their expertise. Things happen in sharing your failures is very is very critical if that is done in this avenue. Thank you, Nancy. Yes, I was actually quite surprised, Mike, by your comment that orthodontics does not seem to have a central repository of standards of care that I'm shocked and and and please don't see that as a downer. It's a surprise. It's just a prize. And if that isn't there as an anchor somewhere, then I am seriously concerned that you are very vulnerable, especially regardless of whether it's people that are fully trained, qualified and certified or people that have jumped in in the various ways that one can do that by restricting practice or not even bothering to restrict practice. But I think organized dentistry, if anything, does need to monitor as a group that standards of practice are continually reviewed and and continually declared in light of emerging popularized techniques. Certainly that has to be part of the reflection by which we look at these things. But I suppose I would like to see some sort of, if you if you will, snopes type resource that evaluate social media groups, ongoing evaluation for reliability and authenticity by some sort of indexing that could serve as a as a coaching anchorage coaching matrix for dentists rather than what they what we find are usually have reported that is used, which is popularity. If it's straight popularity, then I'm worried again. These are worries that you have to understand in context. But I am concerned. It's a serious concern. And unfortunately, there are trends in that direction. And we saw those multiplied astronomically and tremendously, not even in our own domain, but in the political domain in the last US election, you know, look around, are we talking about numbers? Are we talking about right or wrong? Are we talking about money?  And again, I think that that there's, if anything, the curve strongly favors unreliable information, if it happens to agree with what you really thought along or would like to think, well, then that probably gets more credit. And we know that's not correct. You all know that's not correct, but it's still a risk.  Despite the fact that your three thousand user group or attendee group is much more credible and reliable and authentic. And so I think some sort of index there could be very helpful. It'll be a non-ending task, but it seems a worthwhile task. Just for our thought, and I'd appreciate your responses to that. Thank you. I'm going to respond to it. Then, Richard, we're going to go to you really quick. And what about the orthodontic piece? We have had a standard of care in the past, right? When you look at, I mean, class one, your occlusion works, all of that type, that's there. But I think technology had advanced faster in orthodontics than it did in some of the other specialties, you know, sure, steric machines came out to build a crown, but it was still a crown. Braces went away, clear liners came in, a completely different modality of treatment, and standards were never set for that. Tads came in, mini implants came in. Standards weren't set for that. And so I don't think the orthodontics, so the orthodontic profession did have that baseline, but I don't think we've kept up at setting what the standard is for those other things. And that's where these newer groups, the Smile Direct Clubs of the world, have moved in because we, on our end, didn't do a good enough job of setting that. And that's all I meant, Lance. But if you if you if I may, if you set that and you set standards and they and they appear to exclude certain portions of some of the contenders that you have named, aren't you fully expecting that it will be seen as an economic defense position rather than as as something which recognizes credibility and evidence-facing? And I don't there's no way to avoid that. Probably no way to avoid it, but it has to be considered. Agreed and great point, Richard. It's going to follow up on Lance's question. You know, are there any media sites or formats out there that are just plain evil? You know, I think I wrote an editorial a while back about Napster. And Napster, when this was 20 years ago, when it came out, I mean, they had 80 million 80 million followers. And but they they they made their living by stealing people's livelihood. And they finally got put out of business by the court. So my question is, are there any dental Napsters out there? Not that I'm aware of, Dan. Are you aware of any to my knowledge? And I think that's why it's grown so quickly, although the evaluating, you know, evidence-based. And I love the idea of a score and like some reliability measure. I don't know who would leave the charge on that, because as it was mentioned, that would literally be a never-ending task, you know, trying to get that together. But I haven't seen any evil Napsters in the space. And I think it's actually you're talking about the generation on Instagram that is the most, although if you look at the Gen Z data, it's going to say that they're the most isolated generation, you know, as far as feeling, but they actually are the most connected generation there's ever been. And so I think all of us want to be part of something. All of us want to connect with people. And I think that's why it's been an overall positive experience. You don't see evil Napsters everywhere. Because when I talk to people on these platforms, like people care, like they really want to talk about cases. They really want to be better clinicians. They really want to do the right thing. I've never seen anything contrary to that. Maybe I'm naive, but I haven't seen it. And I would agree with that, Dan, wholeheartedly. And though I have seen advice given that I would find to be incorrect when it comes to evidence-based dentistry, I just don't think it was given maliciously. Does that make sense? That they were trying to help, though they might not have had the best information. And going back, I think that's I mean, that's the only challenge. But no, I don't think any of it's been malicious. Napster was malicious, but I don't think that is something that's been on my mind. Jerry, I'm going to call you out. Is that OK? Oh, let me go to Donna and then I'm going to ask you a question, Jerry, if that's OK. I had a comment that's quite an intriguing idea or problem raised by Lance about classifying the quality of these groups. Certainly, there it would not be easy to determine who is going to classify them, because if you're maybe a little outside an old or maybe some out some some factors of outmoded standard of care, then you might not be able to get a classification. So you might consider some other ways such as longevity, how long the participants stay with the group, meaning they're satisfied, they they they are enriched. Some type of a self classification like that.  Judges are usually uncomfortable with scientific and medical issues anyway, but it would be good to for the for the group to think of some some way to give give give yourself some specific credentials that way. So those would be my response. First off, yeah, thank you is what I was going to post to you, Jerry. I think ties in with all of this going back to what you said a few minutes ago. And I'm going to throw this out there and tell me if this is what you were thinking, because I haven't been able to get over when you started talking about AI, and I think maybe I took it in the wrong direction. After you said that, what's been in my mind is and tell me if you're meaning this, if we had an artificial intelligence entity or software program that looked at these questions that were posed on these social media sites and that then could recommend or give you evidence based information that it could tie in that it would automatically like if somebody posed a question on Second Valorando, I don't know. And then it would pull out articles that are legit and insert it. Is that what you were referring to? Yeah, I mean, if you think now, like with JPD or any of the scientific echelons of investigation, you know, that there is this distillation, somebody has to do the distillation in order to come to a conclusion.  And so they're given the human brain as it currently exists, that AI could be of assistance to us in developing, well, your standard of care for that for that matter. And it would be an acquiescence on that part of our humanity to allow a machine to do that, but we're allowing machines to do other things. I mean, the only for the longest period of time in my practice, the only thing I ever had was a digital hydrocolloid machine. And you probably don't even know what hydrocolloid is. I just started Googling it. So I'm just thinking that, you know, given how we try to progress as a society. And it like like someone said earlier, this goes well beyond dentistry, it goes into our political system. We're currently facing that, you know, it could change the way we all view democracy because of the way we can be influenced. And I don't know about the rest of you, but I've never restored. The creator has not shared one bit of the design specifications with me on any of this, so I'm left to speculate a lot. But I like to speculate with other people that know more than I do. So. Well, thank you. I'm glad you clarified that because I think it's a fabulous idea. I have two close friends who own artificial intelligence companies. And I wasn't I wasn't hot on the idea of it until they showed me what they were doing, and then it completely changed my perspective and not how it took over what humans did, but how it how it accentuated it. And to your point, if we could use that to accentuate what we're doing, I mean, gosh, if we use it properly, it could only it could only improve us. Lance, there's a hand up. I'm sorry, one last thing. There's a philosopher named Ken Wilber, who has spent a lot of time in studying the philosophy. He says by night, by the year 2050, all of our all of us are human. Humanity will be subject to AI and controlled by AI. But anyway, that's speculative. Hopefully not controlled. But yes, thank you. Lance, did you have your hand up? The cynic in me would say that we already are at that level and beyond. But that's my cynicism. It's an aside and ironically, probably minor compared to some of the scope of the issues that we're that we're dealing with and talking about here. But, Mike, when you first brought up the issue, I believe it was Mike, it might have been Dan, that brought up the issue of case presentation on a group. I guess it was Mike and having responses to that case with some advice from from others who are on that whatever their level of reliability or expertise. I'm concerned when that's presented. What about confidentiality disclosures, information, privacy protection for those patients? Because we've had those issues pop up in dental schools already when students are attempting to share information, even with other students on student groups, but it goes beyond that and suddenly the vulnerability goes skyrocketing and the school gets more than a little nervous. Let me address that really quick. And Richard posed the question before everybody else here got on. As far as I understand, so every one of these groups is a closed group. There is no way from anybody outside of the profession, everybody in there is a professional. You have to go through a series of questions to be admitted into these groups. And as far as I understand what they've looked into is as long as you're with these closed groups, only speaking with doctors, that it has that it has followed a HIPAA guidelines. Now, I've never seen that challenged and maybe it will be one day. But as far as I understand it, it's allowed because they're closed and only with professionals. Dan, maybe you have no more than that. So, I mean, it's super gray.  I will tell you that a lot of people just say as long as the face and eyes are not part of it and you're just looking at teeth or mouths or things that can't be identified as individual without their dental record, that it's OK. What a lot of people are moving to now is like, I'll be honest, every single one of my patients signs a complete disclosure or has the opportunity to sign a disclosure. Now, they do not have to say it's OK for me to use their cases for education, publications, social media, etc. But a great majority do sign it. Now, I still follow the same thing. I do not put faces on social media, etc., etc. Now, I work with tons of plastic surgeons with what I do and the plastic surgery community has had horrific issues with HIPAA compliance with their surgeons because it's they're working on faces, they're working on other parts of the body and they're putting it all over every social media in order to get patients. They actually it has gotten bad enough. The American Society of Plastic Surgeons has come up with their own police system to look and I mean, they have come up with an own like kind of like standard of how to use social media as a plastic surgeon. And it is the position of their specialty organization, and that's how they've dealt with it.   And in plastic surgery, it's a really big deal to be an ASPS member. And to say you are board certified and the two go hand in hand. Same thing with oral maxillofacial surgery, board certification is a huge deal. Ninety five percent of or more, I think of oral surgeons are board certified. And so anything that would ever jeopardize that for me, which in the cannons of ethics that is part of my board certification, I think social media and HIPAA compliance is part of that. So it's definitely a huge deal. People justify it in gray and leadership and organized dentistry and organized medicine are taking note and creating standards before their specialties get under the gun legally. Thanks, Dan. And we do the same in our office. Everybody signs that I use. They sign a waiver as well, or it's part of their informed consent. As we get to the end of this, so this is I feel like the last hour and a half has flown by for me. This discussion has been robust and I feel wonderful. I'm going to I'm going to turn to Donna and to Dan. Any final thoughts, anything that's been on your mind before we close and then any comments or final questions from the group? Donna first, if that's OK. Yes, simply you had a question about the role of organized dentistry, such as, you know, ADA and CDA. Certainly one of their roles. To exist would be to provide a forum for dentists to be able to communicate with each other. I'm assuming, you know, the IT developments move too fast for these things, such as you're describing with Facebook to ever be done within the ADA, so that won't happen. But I think they should support it. And I also think if you could ever have a communication, for instance, if you had evidence that an approach of technique was recommended in a group and it didn't work, you already you all realize that that you could inform the ADA so they could make sure the public knows about this and so we don't have. We don't have misinformation and even disinformation as a threat to harm the general population. And you could have a little relationship with that, maybe, because everything flows from them. You know, doing the standard of care and the Board of Dental Examiners. They do an occupational study, I think, every 10 years. They find out what's being done in offices, which might not be the best treatment or the best treatment plan or anything. It might not be, but that's what's done there. So they're going to fashion their tests on that. So you almost get boxed in. It's not really a box. It's like a circle in which you're not going to make progress. And you might make you have to make the case with these groups that your chances of making progress for the world is better because you have more people, more ideas floating around, more energy. They are more thought provoking things in a more usable manner than the old ways of simply in journals. So I think there's more advantages than disadvantages. Wonderful. Thank you. Yeah, just to kind of close my thoughts, I just want to thank everybody. I loved this discussion. And although I'm quote unquote part of the panel presenting, I feel like I was just as much a participant in learning from everybody on my call at the same time, which I think is the best CE or education you can have. So I really have two things. So we're all leaders on this call. We all have influence as those leaders. So what are the two things we can do? You know, after a discussion like this, I think one is we have to double down and invest on standard of care and our professional associations and the importance of it and communicate it with our specialty groups, the ADA and other, you know, key influencers, not on social media, but the influencers of our profession. And we cannot lose hold of those standards. The second thing is going back to dental students and young professionals. Instead of talking about evidence based dentistry from a literature review perspective and what you're going to do, we need to start teaching dental students with a with a screenshot of an Instagram post and start critical thinking in that way. We need to stop talking about lit reviews and we need to start talking about what they're actually using and what they're using is Instagram and Facebook and other things and then to going back to Mike's opening statement, show him a slide, have the discussion and then say, OK, if you want to fact check them, where would you go? What would you look on? What would you do? And now you're creating a critical thinking person in the context of a 21st century social media environment. So that's kind of my call to the educators here is going back to the dental schools and evaluating what's being done. And I'm actually going to send Dr. Nader Shahi at Pacific and email right after this, who's a dear friend of mine, because I'm going to find out how it's being taught at Pacific and maybe I can zoom in and be part of the new education curriculum for that. So this is kind of my final thoughts and just thank you for everybody for sharing so so many amazing, incredible insights tonight. Thank you, Dan Lance. And that's really very, very good insight. And it occurs that it would be very helpful for the American College and any other organization that was interested in doing so to to do just what you've mapped out, but to include some of the extremely popular high user sites as examples with some of the offshoots that that you know are just preposterous and would not stand up to even the most basic tests. And similarly, some of the very small sites that have produced so that people could begin to dissociate popularity from reliability. Will that happen? Maybe I'm dreaming, but but I would like to think that we could certainly include that message in the very important literature that that is made available and the teaching. And if those sorts of templates are prepared and made available to dental schools, I think they would use them. I think there would be people in the schools who know that the concerns there, but really don't have the time or the opportunity because it's published or perish out there. They want help, direction if they're provided a template that they can customize. They can at least get those points across to the critical groups of dental students that are all out there. And I must say just my closing, this is probably one of the most intriguing and productive discussions that are in which I've participated. And I and I thank everyone for this. My brain's full now, but I would certainly want to continue the discussions. And I certainly hope we shall thank you, Mike. Thank you, Dan. Thank you, Donna. Thank you, everyone. Yes, there are.  Sorry, last piece for me. The only thing I wanted to add to what everybody said is moving forward. I also think we need to partner with these groups. Let's just make sure that it's not a contentious relationship. As we move forward, if we partner with them, I think the sky is the limit. I think they're looking for leadership and we're the leaders that they need. You know, and and everybody on this call, I think has a role in that. So again, thank you for allowing me to moderate this and be a part of this. It's been wonderful. Richard, over to you. Well, first of all, I'd like to thank our three presenters, Mike, Dan and Donna for taking their time on a Friday evening to to meet with us and share their thoughts. And I see my fellow editor, Dan, or is on the call here. And I think you'll agree with me. Editors and publishers are always looking for the right medium or media to communicate with other other other dentists. And I think that's sort of kind of their the holy grail of dental communication. The problem is they keep moving the goalpost. So. But again, I'd like to thank our three doctors, Hammer, Maru and Horowitz for for sharing with us tonight. And also I'd like to thank Susan Pittman and the ACD office staff for all their help. Without them, this would not have been possible. If you need CE credit, Susan Pittman can supply that information. And I believe we were offering two hours. And if if you can either contact me or her and we'll get you that information for your city. Before we sign off, did we have any questions? If not, I wish everyone a good evening and a good weekend. And thank you for your time tonight. We appreciate it. Thank you very much. Thank you. Good night, everybody. Thank you. Good night all.


You ask them, are they angry? And they say, no. And you just absolutely flabbergasted that they have no idea. You think that they're lying. That's your repeated assumption. Like, they're obviously angry. So why are they lying to me? It's probably because they don't notice it. It's not their fault. I'd say that in a lot of these circumstances, it's important to take a step back. It's not the best idea if someone is displaying anger to keep poking them. To ask them how they are. Unless they're okay. And then you say, you look angry. You show you're not angry. And they just keep going round in that. They keep poking the beast. And they get more angry. And then they can tell whether they're angry because they've blown up. They haven't self-regulated enough. You need to give them space to withdraw, to contemplate, to think. Because if you keep pushing them like that, they're not gonna feel very comfortable.


A thing with feathers, like a griffin, soaring across the page or screen, a fantastic beast that helps us face what we fear stronger because we are together. The act of consciously waiting, freeing our senses to experience the divine in all living beings, opening to what might be possible if only we dare to imagine it. Casting a patronus, we push away the dementors that seek to consume us, and hope beyond hope, create justice.


Water lamps the bridge over South Willow Creek on the outskirts of Willows and Glen County. Heavy equipment fishes out to breathe one bucket after another in an ongoing effort to prevent a log jam and keep the bridge over the water instead of under it. Flood levels like this haven't been seen in nearly two decades. It looks like it did back in 96-98 and I don't think I've seen that area that high since then. Cal OES's regional administrator, Eric Lamero, meets with the Glen County Sheriff's Deputy. There's no better intel than seeing it with your own eyes. At this point during the storm, Glen County is ready to activate its emergency operation center. Just down the road, a stretch of Highway 99 is closed. A long big rig makes the right decision to stay put. Emergency responders like Lieutenant Sean Arlen are keeping track of the storm and its effects on Glen County. And we're going to monitor the situation constantly and hourly and we'll be in contact with our partners. One partner is Cal OES. Here at the Regional Emergency Operations Center, or REOC, representatives from Cal OES, the Red Cross and other agencies conduct conference calls to keep everyone informed and up to date. We've pre-deployed. We're in many areas where local EOCs are not yet activated. Those regional centers are coordinating and working with local authority and those three region centers are funneling up information to the state operations center here where we are keeping a statewide snapshot of what's happening. Here at the state operations center in Sacramento, teams commingle incoming information and data to put that statewide picture together. That snapshot is then conveyed to the public by way of interviews with the media. At the same time, the effects of the storm continue to evolve. With slow going on Southbound I-5, traffic backed up for miles due to flooded highway lanes north of Willows. This mobile home park in Red Bluff was inundated with floodwaters while right across the street, the Tahama County Sheriff's Office defended itself with sandbags. Inside, Tahama County EOC held a briefing mutual aid agencies represented. Then it's back on the road for Cal OES to meet with Tahama County residents, some of whom have lived here a long time. 55 years, my whole life. Rancher Kevin Boer says this is typical during years with normal rainfall. He's seen worse. 83, 96, I can't remember them all, but 83 was the worst. It surprises me that everybody gets all excited and I'm sure there's some people that have damage and don't get me wrong. I feel for those people but this is how it is, how it has been in the past and that's why we have flood zones. And folks in these parts know how to build in and around those flood zones. Build it high and it'll stay dry. A prime example of hazard mitigation. A lot of water, I don't discount that at all but you know, we've had this before, hopefully we'll have it again. It's a lot better than not having any water.