Episode Transcript

Daniel Lobell: (00:00)
This podcast or any written material derived from its transcripts represents the opinions of the medical professional being interviewed. The content here is for informational purposes only, and should not be taken as medical advice since every person is unique. Please consult your healthcare professional for any personal or specific needs. Hello and welcome to the Doctorpedia podcast.

Daniel Lobell: (00:25)
I’m your host, Daniel Lobell and today I’m joined on the line by Dr. Jason Mann. I’m honored to have you here. Thank you for joining me, Dr. Mann, how are you?

Dr. Jason Mann: (00:34)
I’m doing great. Thank you so much for having me.

Daniel Lobell: (00:37)
My pleasure. And you have the distinguished honor of being the very first dentist we’ve had on the show as well.

Dr. Jason Mann: (00:45)
Thank you. I feel honored.

Daniel Lobell: (00:47)
But you’re not just a dentist – You run a dental spa, which I’m excited to find out more about. But first I like to ask the doctors to go way back to the beginning and tell me about your childhood and what it is that inspired you to go into medicine in the first place.

Dr. Jason Mann: (01:02)
Well, my mother was a dental assistant and she still is for going on 40 years now. And I did not want to become a dentist at first. I thought I wanted to do so many different things. I grew up in a family business in construction. So of course we did a lot of construction from demolition to land clearing to foundation work. So that’s my background.

Daniel Lobell: (01:29)
Isn’t that perfect training for dentistry? [Laughs.]

Dr. Jason Mann: (01:32)
Yeah, but just on a micro level, it’s super cool. Before dentistry, I thought I wanted to become a pilot. Then a buddy who was a family friend took me up in a little prop plane and I soon realized that I was extremely scared of heights and that I was going to be the lowest flying pilot ever. So I decided a career change was in order.

Daniel Lobell: (01:54)
[Laughs.] You know, it’s funny, I once had a dream that I could fly, but because I’m afraid of heights and it transferred into my dreams, the whole time I could fly, I always stayed only a few feet above the ground and this reminds me of that dream.

Dr. Jason Mann: (02:09)
So after that, I was going to go into medicine, did some shadowing and then looked at the training, looked at the education and lifestyle. And from there, of course my mother said, “Hey, why don’t you just take a quick peak at dentistry?” And I said, “You know, mom, I grew up in dentistry.” The only thought I remembered about dentistry was every time I would get sick, she had to go to work. And so she had to take me to the dental office. I got to sit in the back and then the dentist came and gave me books about teeth to read. And that was not very interesting. So I never wanted to be sick and I just didn’t like it. But then I started exploring that option and really enjoyed it. I enjoyed the surgical aspect of it, the cosmetic aspect and the immediate gratification that we can get from changing our patients’ lives by changing their smile. And that’s what really got me interested and got me into this field.

Daniel Lobell: (03:15)
Wow. That’s phenomenal. So it really came around in an organic way. It’s almost like the story of Moses. You didn’t want to lead the people, but you realized there was a calling and you took it on. There is something really altruistic about that because it sounds like it wasn’t your passion initially, but when you saw the good you could bring to the world, it became your passion.

Dr. Jason Mann: (03:39)
Oh, absolutely and going through that and just seeing how powerful it is when patients come in missing teeth and we can change things around in literally a matter of hours, and then walking out. Throughout my entire career, I had so many patients coming back after cosmetic work – people who had missing teeth for quite some time and saved up for implants and then said, “You know, I truly feel that I finally got that job I always wanted because I could literally smile in my interviews and show a self confidence of what I had internally and I can express externally now.” Seeing that and experiencing that with the patients was a really true humbling experience. So it’s super cool to see that transition and transformation for them.

Daniel Lobell: (04:36)
It’s really interesting because it is an art – it’s medicine, but it’s also an art. Like when you do dental reconstruction or cosmetic dental surgery, you have to be an artist – you’re having a major impact on the portrait of the person because the teeth are so important. I remember the comedian David Attell used to have a joke about a guy with one tooth – I won’t repeat the joke on this podcast, but it’s derogatory and it’s really interesting because it’s one tooth, it’s not one eyebrow, which would be weird. It’s not one ear, which Van Gogh got away with, but teeth say so much about the person – isn’t that an interesting phenomenon that the teeth play such a huge role in the perspective we have on people?

Dr. Jason Mann: (05:32)
Oh, definitely. And it really shows that internal self-awareness and their internal pride and their self-esteem. When we’re doing a lot of cosmetics, I ask them to describe what they’re looking for. And the easiest way to do this is that they bring in pictures to show me what they like and what they don’t like. And especially around the sculpting, some of the anatomy within the teeth, the softer line angles around the edges of the teeth become a little bit more of a feminine look, the boxy edges are a little more masculine. And so you can really change the person’s profile by the contours of the teeth. Like if you get a female patient that wants feminine contours, but you give them masculine contours, they’re like, “Oh wow, my smile is really bright white but it doesn’t look like me.” [Laughs.] So having a creative eye definitely plays a part in the process. And then actually listening to the patients because they’re really telling you a lot about what they’re looking for and what they want. And so it’s just really trying to take what they’re explaining and using it to create an image which is deliverable in cosmetics.

Daniel Lobell: (06:50)
All right. Quick off topic question: Gingivitis, is it a real disease or is it made up?

Dr. Jason Mann: (06:57)
No, it’s real.

Daniel Lobell: (07:00)
I once heard that it was made up by the toothpaste companies, but that’s not true.

Dr. Jason Mann: (07:05)
[Laughs.] No, you will have an inflammation of the gums. And so it is a real process that will happen, especially when you’re not doing actable oral hygiene or home care, it can develop into periodontal disease if left untreated. So it’s the first signs of inflammation of your gums.

Daniel Lobell: (07:28)
So gingivitis is to periodontal disease what prediabetes is to diabetes, it’s like a transitionary disease.

Dr. Jason Mann: (07:39)
Yeah, you’ll still have gingivitis around the gums. Then you can still have periodontitis around the bone where you start having loss of bone structure, but you have to go through that inflammatory process first and build up of calcalculus of bacteria around your gums.

Daniel Lobell: (07:56)
Anytime I’ve ever heard of gingivitis, I always thought it was an affinity towards redheads, like “You’ve come down to the real case of Gingivitis.”

Dr. Jason Mann: (08:04)
[Laughs.]

Daniel Lobell: (08:04)
[Laughs.] So what is the most common thing that people come in for treatment of in your line of work? Is it gingivitis or is there a more common dental disease that you’re dealing with all the time?

Dr. Jason Mann: (08:21)
The biggest thing that patients come in for is really around trying to find that dental home and finding a facility where they feel most comfortable, no matter what they end up having done. You want them to feel, “I trust the provider that’s doing the work.” You also have a section of the population that is just trying to find the most cost effective way to get stuff done. And combining those – that’s how we built our practice, really putting together an experience because if we can create the experience for the patient, then we can diminish or reduce the anxiety they come in with. I hear it on a daily basis, “Oh my gosh. I hate the dentist. I can’t stand the sounds.” So with creating a spa-like atmosphere with music, headphones, warm neck wraps, and dimming lights and creating some form of a sedation.

Daniel Lobell: (09:48)
Hence the spa in the name, which I thought was really nice. I think more doctors should adopt that philosophy of changing the way we frame going to the doctor. If you think you’re going to a spa, it’s an entirely different thing from thinking you are going to the dentist. I love what you did with that. I think that’s such a great device for getting people comfortable and excited to take care of themselves.

Dr. Jason Mann: (10:13)
Oh yeah. There’s a lot of complimentary amenities that we offer in conjunction with dental treatment because patients come in and their blood pressure is just going through the roof or they’re anxious, which creates an environment where it’s either impossible or very difficult for us to do certain procedures because it’s not like working on the tabletop – The patient actually has to open up their mouth and that makes them feel vulnerable So you break down that barrier and create that experience for them so that they can understand and feel, “It’s going to be okay today. They are going to take care of me and I’m not going to feel anything.”

Dr. Jason Mann: (10:59)
When they leave, they say, “Oh my gosh, the experience was phenomenal.” They don’t talk about how well we lay our porcelain, how well we lay our composite. It’s all about the experience, that concierge treatment from the time you walk in and being handheld throughout the treatment until the time you walk out. And so it’s that experience for that patient that understands that no matter what they come in with, they know what to expect. They know that the environment’s going to be amenable to their anxiety level, and we’re going to be able to reduce that anxiety for them.

Daniel Lobell: (11:41)
And you get a warm towel when you walk in. It’s fantastic. I think people are going to start messing up their teeth just to come back.

Dr. Jason Mann: (11:50)
But it’s funny that when we started doing that, we actually had phone calls and people trying to schedule appointments just for the complimentary amenities. [Laughs.].

Daniel Lobell: (12:05)
[Laughs.]

Dr. Jason Mann: (12:05)
So we had to change up some marketing strategies with that, because that was not super clear at first, but we live and learn, like “No, that comes with treatment. It’s not just complimentary amenities.”

Daniel Lobell: (12:20)
So I saw on your website that you do Botox as well. Is there dental Botox or are you doing Botox on the face around the teeth?

Dr. Jason Mann: (12:30)
Yeah. We do a lot of Botox that’s associated with TMJ therapy. So when people have pain in their jaw from clenching and grinding, what you can do is you can have a night guard, you can do a lot of massage therapy or for patients that have chronic cases of chronic pain for clenching/grinding inside of their jaw, inside of the head, I’ll do some Botox therapy for them. It takes me anywhere from a couple of days to set in to maybe up to two weeks and it lasts anywhere between three to six months. And every patient’s a little different -some patients have to come back every three to six months for some treatment just to reduce the effectiveness of the muscles, and so that they can eliminate the tension headaches that they get from clenching and grinding.

Dr. Jason Mann: (13:27)
I also have some patients that have had it for 12 months or 18 months and have yet to get another round, because it almost feels as if it deprograms the muscle enough, so they can get some relief. So we use it for therapeutic purposes for that aspect, because there are so many patients that come in and have migraines associated with it. And back in the day we would say, “Okay, well, we’ll give you a night guard that you wear at night,” but sometimes people can’t sleep with stuff in their mouth. And now they’re stuck between a rock and hard place, taking anti-inflammatories to help out with inflammation and pain. And now we can just do a couple of injections of Botox in certain key muscles and greatly reduce that pain.

Daniel Lobell: (14:12)
That’s really interesting. I have to admit that I am a tooth grinder. I wear a night guard at night. I still feel like even with the night guard, my teeth are grindy. I don’t know.

Dr. Jason Mann: (14:28)
You are still going to grind, but at least you’re grinding through the acrylic. And as I tell the patients that come back and notice a hole through their night guard, “The good news is it’s working. You’re grinding through that acrylic. And once you wear a hole through it, we’ll get you another one, but consider it an investment.” And it’s like tires on your car: Are you going to wear it out over a period of time? And at least it’s not affecting the drive train, the reason that the wheels are rubber and not metal.

Daniel Lobell: (15:00)
Is the reason why people grind their teeth psychological? Do we have any understanding and is there a way to deprogram yourself from doing that?

Dr. Jason Mann: (15:09)
So there’s a lot of things that can contribute, everybody has their own philosophy. It could come from imbalance of occlusion, the way they bite. If they’re having certain teeth, they hitting prematurely, then that’s when orthodontics come into play to realign the teeth so that everything is distributed. It could be psychologically where patients that are having certain disorders that are creating that grinding, or it could can be induced by stress – People biting their nails and just grinding at night because of the change in job or are about to get terminated from a job. And so a lot of these different factors actually come in and play into this. And we actually see different aspects within the oral environment, a chip in the teeth and a scalloped tongue, almost little slight indentations on the side of the tongue, but then we can also look a little bit further as well, because some of these patients may show signs of sleep apnea as well.

Dr. Jason Mann: (16:20)
So we usually dig a little deeper and try to find out whether this is coming from an external environment or is it something a little bit deeper or they have an app. And so then we look at co-morbidities associated with patients and then talk to them about talking to their primary care doctor to see if they are predisposed to having a sleep apnea or do we need to do a sleep test to rule that out? Because the last thing we want to do, if they do have apnea is to put an oral appliance for deep grinding in there, because it decreases their airway space and the increases apnea. So we do have oral appliances for sleep apnea because a lot of patients that have sleep apnea wear a C-PAP, which is a lot more effective than oral appliances traditionally, but when patients do not have the ability to wear a C-PAP or can’t tolerate it, then oral appliances are the next best thing for them.

Daniel Lobell: (17:19)
Are you saying that if a patient has sleep apnea, you’re doing them a big disservice by putting a night guard in? I have sleep apnea and I wear a night guard. Am I doing it all wrong? I have a machine and the night guard.

Dr. Jason Mann: (17:36)
Yep. As long as you have that machine and you have been titrated by your physician or sleep specialist, you’re doing everything right. So it’s really around the patients that have undiagnosed sleep apnea. And we’re actually trying to treat them for TMJ and putting night guards in and we’re not looking a little deeper.

Daniel Lobell: (17:59)
So I once spoke to a dentist and he said, “You train yourself to stop urinating in the bed when you’re a child. So you ought to be able to train yourself to stop grinding your teeth.” And I thought about it. And I just think there’s a bit of a difference in that it seems like grinding your teeth is more conscious than going to the bathroom, but is he on to something? And if so, how would one do that?

Dr. Jason Mann: (18:29)
Well, that all goes back to a lot of different scenarios. The what-ifs: What if I can control the mind enough to get me to stop certain things? What if there’s some psychological factors that I can control? However, there are a lot of people out there that unfortunately cannot control that even into adulthood. So could I say that it’s possible? Yeah, of course – at this point in time, the likelihood of that happening for the majority of adults tends to be very slim, but it’s always a possibility.

Daniel Lobell: (19:11)
All right. On another note, I always heard that disease starts in the mouth. Can you detect diseases in your patients by looking at them when they come in for routine dental exams and if so, what diseases are visible through the mouth and how do you know?

Dr. Jason Mann: (19:29)
So you can start looking at a lot of different things. There has been a lot of literature between correlation of periodontal disease and cardiovascular disease, because when you start developing periodontal disease, that bacteremia can get into the blood, but also you can start looking at different types of cancer. You do have oral cancer that you’ll look at in the mouth. Sometimes different types of cancer can metastasize to the mouth which mean that they basically move to the mouth. So whenever we start seeing that, we’re always trying to do our oral cancer screening all the time, whenever patients come in, but also when we do see it, we try to get them to the specialists in order to do the proper therapy treatment, whether it’s resection, biopsy or radiation. So there’s a lot of diseases that tend to start, but if we can catch it early enough, we have the opportunity to help treat those areas.

Daniel Lobell: (20:36)
So it seems like it’s a pretty big responsibility in terms of being able to help people in a broader way with what’s going on when you look into their mouth.

Dr. Jason Mann: (20:47)
Oh, absolutely. I don’t think everything’s the nail and we’re the hammer, we’re working with the ability to have colleagues in the medical field as well, and primary care and cardiovascular care, really creating that synergy and that conversation between us and dentistry and other practitioners in medicine, so that if they do have something come up, they know we’re readily available and vice versa because we learn a lot from them and they learn a lot from us as well. Because we have to do whatever we need to do to create that collaborative care in order to take care of that patient. So we’ve created a pretty large network here and around my office with a lot of physicians that we work with, so that we can actually create that opportunity for those patients, that when they do come in and haven’t been to their primary care physician in five plus years, we know that they need a complete workup because they may have undiagnosed diabetes that could affect oral surgery outcomes, hypertension, cardiovascular disease.

Dr. Jason Mann: (22:05)
And in just about anything and everything that we do, we always use an anesthetic which has epinephrine in it, which tends to raise the heart, so we want to make sure that we do everything possible to take care of that patient medically by referring them to the appropriate physician.

Daniel Lobell: (22:26)
You’re located in Georgia. Is that correct?

Dr. Jason Mann: (22:30)
Yes, sir. I am.

Daniel Lobell: (22:31)
Is that where you were born and raised?

Dr. Jason Mann: (22:33)
Yes, sir.

Daniel Lobell: (22:34)
Oh, wow. Cool. What part of Georgia?

Dr. Jason Mann: (22:36)
Middle Georgia. I was born and raised in a little town called Thomaston, which is about an hour west of where my practice is in Macon, Georgia. It’s a fairly small town compared to all the other towns I’ve been living in through schooling. But that’s where we all began, all the construction and growing up on farmland or just really just having open fields where we can actually go in there and ride dirt bikes and all this stuff. And now we have kids and taking them back to where we grew up, of course, it’s definitely changed and going back and looking at the homes where we grew up, and they say, “Dad, you used to live here?” And I say, “Yeah. It’s home.” It’s definitely an experience.

Daniel Lobell: (23:31)
When I think of Georgia, I think of a lot of sweets, candied nuts and peach cobblers. Do you think it’s good for business out there? Do you have a bigger challenge with people with sugar and how big a role is sugar playing in tooth decay?

Dr. Jason Mann: (23:49)
It always plays a huge role just because of how much it can destroy the teeth. And the difference in pH balance is one of the things that I tell a lot of our patients. It’s all about the sugar intake, the pH balance of the foods that you ingest and the duration of which you ingest them. We have a lot of people that come in and say, “Doc, I brush my teeth all the time. I floss all the time. I still get cavities.” And once we start listening to what they’re actually doing throughout the day, they’re usually at a desk job and they say, “I’ll have a diet Coke or I’ll have a regular Coke, or I have sweet tea sitting here and I just sip on it all day.”

Dr. Jason Mann: (24:39)
And I say, “Think about back in chemistry, you have a bowl of acid sitting in on the table. You know, if you stick your finger in real quick and pull it right back out within a quarter of second, doesn’t hurt quite as bad as if you just stick your finger in and hold it in there. So if you’re constantly drinking, sipping on those carbonated beverages, high sugar intake, you’re constantly changing that pH balance of your mouth. And then the whole purpose of your saliva is to re-buffer everything and to flush all that out. So every time you drink something you’re creating that imbalance of pH balance in your mouth, and now your saliva is trying to have to pick that back up and rebalance that. And that’s happening all day every day, as long as you’re sipping all that. So just sip on water throughout the day. And if you have to drink that, you can drink it at a meal. I will never tell you to stop drinking it, but just do it in moderation and think about how you do it in order to at least reduce that chance.

Daniel Lobell: (25:45)
Do you determine the pH in the food that you’re eating? Is there a simple way to know?

Dr. Jason Mann: (25:52)
A lot of carbonated beverages are always a lot more acidic, if you’re cooking with red wine, it’s always a little bit more acidic. There are more alkaline waters that tend to be a little bit more basic. So that’s really what you’re trying to look at. You can do testing strips, you see a lot on social media where people will test different pH balance of water, especially in the dental community, trying to figure out which water is better, which one is more neutral, which one’s more alkaline. So you want to stick to more of the alkaline water, if at all possible.

Daniel Lobell: (26:37)
So club soda, for instance, that’s got acid in it?

Dr. Jason Mann: (26:43)
So it depends on what you end up having in there. I guess once you go in there and you can probably take a pH balanced strip and test it and see how acidic it is.

Daniel Lobell: (26:58)
It’s really interesting. It’s something I never considered, but I’m sure it plays a huge role in terms of not only your tooth decay, but your overall health.

Dr. Jason Mann: (27:08)
Oh yeah.

Daniel Lobell: (27:09)
So for people who grind their teeth, do you recommend veneers because I’ve heard those can be a buildup for bacteria?

Dr. Jason Mann: (27:20)
Yeah. So whenever people are grinding their teeth, you have to take into consideration what’s causing the grinding and what are you trying to fix? Because depending on the type of porcelain you put in the mouth, especially over the teeth, if you’re putting something a little bit softer and with not enough thickness, then all of a sudden these porcelain crowns start chipping and breaking. So that’s what you tend to see with a lot of patients that come in with past dental work, you’ll start seeing the porcelain chipping and the patient saying, “I literally just had this crown done last year and it’s breaking.” One of the reasons is that there’s not enough thickness of porcelain on there. And so porcelain is super strong if it has enough thickness, but if it doesn’t, then the chances of fracture are fairly high. So you have to really evaluate the entire oral environment to determine what type of restoration would be best suited for the patient.

Daniel Lobell: (28:22)
In other words, in general, there’s no real way to know. It’s all based on the specific patient.

Dr. Jason Mann: (28:28)
Yes. It depends on what the patient presents with.

Daniel Lobell: (28:33)
Interesting. So what are some of the advances in dental surgery and in the field in general that are you’re most excited about that you think are really going to be game changers now?

Dr. Jason Mann: (28:45)
Well, digital technology is such a huge movement in dentistry because right now we’re investing a ton in digital and trying to do it better, faster, easier and reduce the timeline for patients. They’re coming out with 3d printed dentures. We’re just trying to finalize some processes for ourselves in the practice, but I know there’s some locations out there that will be doing 3d printed dentures. Patients come in, they take some scans of the patient and of the oral environment as well and then in the short amount of time, they can print a denture for them to deliver.

Dr. Jason Mann: (29:28)
Some of the things that we have to look at are the longevity of it, the strength of the material, what can we compromise? What can we not compromise? Because everything with technology is getting a little bit better. So some of the other things in digital workflows, we do a lot with CBCT, which is almost like a CT scan. So we take a lot of digital imaging for our patients because we do a lot of implant placements here and surgeries. And so we have like a mini CT scan in our office so that we can evaluate bone structures, vital structures, so we know how to place the implants, where to place implants, whether we need bone grafting, any type of pathology associated that we see in the jaw that we can get in communication with our all oral surgeons or plastic surgeons or ENT surgeons, and work with the medical community that way.

Dr. Jason Mann: (30:24)
And the full extent of what we can do is something called “Teeth in a Day.” It’s where patients that have either debilitating diseases where they have lost all their teeth, accidents, or throughout their youth, didn’t take care of them, now they have saved up some money and really want to restore their smile, but their teeth are just so broken down that we can’t really use them. So with some preliminary work, we can basically take their teeth, take them out and do some dental implants on the upper and lower jaw and converting those dental implants on the same day to teeth that are tied into those implants. And they’re walking out with screwed in teeth that same day, of course those are provisional teeth, temporary teeth until the implants heal after four to six months. And then we finally put a set of porcelain teeth on them, but we have that ability now through digital technology and analog technology that we can actually do that in one day with some preliminary work.

Daniel Lobell: (31:32)
Amazing. How close are we to having retractable teeth like vampires? [Laughs.]

Dr. Jason Mann: (31:38)
It’s just removable teeth. You just have to take all your teeth out and you just take it in and out. [Laughs.]

Daniel Lobell: (31:44)
Well, it’d be cool if they could just have them come down when needed.

Dr. Jason Mann: (31:49)
Yeah. With computer generated stuff nowadays, I’m sure that it will get there sometime. It will be all an illusion.

Daniel Lobell: (32:00)
What is your opinion regarding wisdom teeth? Should we keep them or get rid of them? Is there a definitive answer?

Dr. Jason Mann: (32:06)
It all goes on a case by case basis – one of the main reasons that people end up removing wisdom teeth is they just don’t have enough room for them and it creates crowding. It creates periodontal disease on the tooth in front of it or it creates a cavity in front of it because of the angulation in which it starts coming into the mouth. So if it comes straight out and it doesn’t turn, it doesn’t come in at an angle and you have enough room, then we leave them in there. I tell the patients that just because you have wisdom teeth doesn’t mean they need to be removed. It all depends on what issues they pose. And if they’re partially erupted, not completely through the gum tissue and they’re in their twenties and it looks like they’re doing a great job, but we know that based on the position, based on the opening of the gum, where it is, there’s a high likelihood as they tend to get older, that they may have a bigger issue with it. And if they do, we always have that conversation – you’re going to heal a lot easier now when you’re younger than older. And the last thing I want to do is be having a conversation with you when you’re in your forties, fifties, and sixties, talking about trying to get some wisdom teeth out, and it just tends to take a little bit longer to heal. So if we can see a situation that may arise, then I would suggest getting them out earlier.

Daniel Lobell: (33:39)
So there’s no evidence pointing to people who are able to keep their wisdom teeth actually being smarter. [Laughs.]

Dr. Jason Mann: (33:45)
Other than the name of the tooth. [Laughs.]

Daniel Lobell: (33:48)
Because I have them. And I often think that that puts me a cut above the rest …

Dr. Jason Mann: (33:52)
Yeah. I have my ones on top, because they’re so far up there and my ones on the bottom had to be removed. So I had to lose half my wisdom on that one.

Daniel Lobell: (34:03)
Oh boy. Well, they still seem smart to me.

Dr. Jason Mann: (34:08)
[Laughs.] Thank you.

Daniel Lobell: (34:10)
[Laughs.] So what about crowns? They’re so expensive and it can be quite a painful thing. Is there anything on the horizon that you’ve heard of that’s going to transform crowning teeth?

Dr. Jason Mann: (34:25)
No. You have to dig a little deeper about why you crown teeth. Every experience is a little different, because some people that come in will say, “The process in which we were getting the tooth crowned was horrible,” while others say, “I’m so glad I did it because it ended up saving my tooth.” And so you have to look at the reason for crowning teeth: When a filling becomes more than one half size of the chewing surface, the remaining parts of the enamel tend to become undermined and they have a chance of splitting or fracturing and breaking. And if you hit it just right, you can create a vertical fracture through the tooth. Then if you end up fracturing the tooth vertically, you end up losing the tooth. And now we’re talking about implants and that’s usually my conversation with patients: if there’s a high chance of not doing it, if there’s a high chance of fracture and you don’t want to do a crown and you end up losing the tooth, now we’re talking about implants.

Dr. Jason Mann: (35:28)
So why don’t we go ahead and consider crowning the tooth so that we don’t have to go through the implant conversation because you lost the tooth. So we also have technology where we remove some of the fracture lines and we still have good enamel left, we can do something called an onlay or an inlay, which is basically a porcelain insert on the tooth that preserves the untouched enamel. And we actually bond to the tooth structure itself. So it’s less aggressive than a crown, but it’s still usable as a crown for the broken areas of that tooth. It all goes back to what the patient presents with – If they’re a clencher/grinder, we might want to do some full coverage, like a crown, because there’s a high chance of the other part of that tooth structure for an onlay breaking off.

Dr. Jason Mann: (36:22)
And because every time you drill on the tooth, every time you work on a tooth is one more time, you’re getting closer and closer to that potential chance of the root canal. And that’s that dreaded word that patients want to stay away from, “Oh my gosh, just please tell me I don’t need a root canal!” And just educating the patients around it and just telling them when they want to do it and when they can do it and how to stay away from that.

Daniel Lobell: (36:50)
The root canal, just for us non dentists, that’s when the nerve that’s in the tooth starts to get rot around it. Is that correct?

Dr. Jason Mann: (36:59)
Yeah. It’s where a cavity gets close to the nerve and starts killing the nerve or the nerve dies within the tooth. And so it has the circulation within the tooth that creates almost an environment to keep the tooth alive. So once that tooth becomes devitalized from necrosis of the nerve, the nerve dying, then that’s when what’s called root canal therapy happens where we create a little access point on the top of the tooth, the chewing surface of the tooth, and use a little hand files to get in there and clean out the nerve tissue, whether it’s dead or still alive or about to die. And then we fill it back in with a kind of a rubber based material to seal it off. And then we put a crown on top of it to protect the tooth itself.

Daniel Lobell: (37:53)
Once the nerve is dead, there’s no way to get a new nerve to move in.

Dr. Jason Mann: (37:58)
Not yet. They’re still doing stem cell research. So that may be on the horizon – you lose one tooth and implant new stem cells and grow another tooth. But we have yet to see that prove a success in the dental field.

Daniel Lobell: (38:15)
Sharks can do it.

Dr. Jason Mann: (38:16)
Yeah, I know. They probably kept their wisdom teeth. We didn’t.

Daniel Lobell: (38:21)
They have terrible dental care. I’m sure they never checked the pH of the water they’re in.

Dr. Jason Mann: (38:26)
No, no. They keep losing it. They keep eating all those fish.

Daniel Lobell: (38:33)
I always wonder how it is that we human beings get two chances with our teeth. It’s very funny how close together they are – wouldn’t it be nice if your baby teeth lasted until your thirties and then the next ones came in? [Laughs.]

Dr. Jason Mann: (38:49)
[Laughs.]

Daniel Lobell: (38:49)
But why do we need baby teeth and then secondary teeth? And why does the process stop there?

Dr. Jason Mann: (38:58)
Well, the process of once the baby teeth come in and the losing of those baby teeth to the permanent teeth is just as the jaw tends to develop, because those baby teeth are just the right size usually for the anatomy of those children. And as the jaw expands, these permanent teeth are a lot bigger, thus accommodating the majority of the mouth. And that’s where wisdom teeth get in and try and start crowding the back of the mouth. Why that process? Yeah. You got me.

Daniel Lobell: (39:38)
We have no idea why it stops because it is like an incredible miracle that you get two sets. And then that’s it.

Dr. Jason Mann: (39:51)
Yeah. So be glad you get your second set and not just one and take care of that. And if you can’t take care of it, we do have replacements. They’re not going to be your teeth. They’re implants. But they are just the second best thing.

Daniel Lobell: (40:08)
Let’s shift gears for a second and talk a little bit about the online health space. Of course, this interview is on behalf of Doctorpedia. So there’s a natural bias in what I’m asking, but what do you think of the online health space? Do you encourage or discourage patients to look online before they come in and visit you?

Dr. Jason Mann: (40:28)
I tell everybody to be careful what they review. That’s why we put as much information that’s relevant about what we do on our website, and I say, “Please go to our website. If you cannot find it, there are certain websites out there. Of course you can go to Doctorpedia which is heading that up as well.” And making sure that the information on these websites has been approved, reviewed, and performed or delivered in such a way that it doesn’t confuse patients. Because there have been so many times that patients will come in and say, “Hey, you know what, I googled this. And I think that I went from having toothache to having some secondary disease that I’m just worried about.” But as the online space starts getting more and more prevalent with a lot of patients being online and that really starts driving the need of making sure that all the information on specific sites are valid and credentialed, because it can confuse people, there are a lot of sites that you could potentially believe if they’re not peer reviewed.

Daniel Lobell: (42:03)
Yeah. Get new teeth now, and then you find out they come from some prisoner. [Laughs.] So it’s exciting that you’re involved with Doctorpedia – to what extent is your involvement and what can people look for from you on the Doctorpedia website?

Dr. Jason Mann: (42:24)
Well, I’m going to head up the dental channel for Doctorpedia. I know they’re big in medical and are getting started in dental. And my background of course is dentistry. I’ve been involved with a lot of dental practices to the point of helping out with Walmart Health, helping them launch some of the practices and helping with some of the personnel with the dentist onsite, helping train the docs on our Walmart Health initiative and really seeing where that need is. And so a lot of the need is around education, not only for the practitioners, but also for a lot of the patients, because as dental offices start opening up and new grads coming out, unless they’re part of the larger organization that has all this information on their organizational website, people are really thirsty about doing their research before coming in so that they can narrow down for themselves to feel like they’re empowered.

Dr. Jason Mann: (43:36)
So, those are some of the things that I really want to look at and head up and have peer reviewed and understand what are the things that people don’t know yet, and what are the things to look out for and also creating questions to engage your providers, your family members and to get them to the right place in order to receive proper dental care, by creating that camaraderie between dentistry and medicine. There are a lot of things that are in the way of that camaraderie and that has to be looked into. And so one of the things that really excites me in trying to head up the dental channel for Doctorpedia is also to be in communication with the medical side as well, and seeing what synergies will arise from that.

Daniel Lobell: (44:26)
Right, as we kind of covered a little earlier, all the different things that you can detect from doing dentistry that would go into different fields of medicine. It would make sense to have these partnerships formed between doctors and dentists and have a network already in place. I’m excited to see what you’re going to do with the channel.

Dr. Jason Mann: (44:51)
I know – I’m excited too. We’ve got a lot of work ahead of us and I’m super excited to get started on this and seeing where it might go.

Daniel Lobell: (45:01)
Yeah. We’ve got to get people off the Dark Dental Web, buying canine teeth and all kinds of things.

Dr. Jason Mann: (45:08)
Yeah. Well, you are going to have to trademark that one the DDW – the Dark Dental Web.

Daniel Lobell: (45:17)
[Laughs.] We’re buying baby teeth …

Dr. Jason Mann: (45:18)
That’s right. [Laughs.]

Daniel Lobell: (45:22)
When you see some adult with a mouth full of baby teeth , you’ll say, “He’s been on the Dark Dental Web again.” [Laughs.]

Dr. Jason Mann: (45:28)
Yeah. You’ll see some of those photos out there where you’ll have the dentures for the nursing homes, the elderly patients and of course, it’s one of those little screenshots where the husband and wife both had a new set of dentures and they got swapped out – the husband’s wearing the wife’s dentures and they’re super tiny teeth and the wife’s wearing the husband’s dentures and they’re massive.

Daniel Lobell: (45:55)
[Laughs.] Yeah. I remember my grandfather, may he rest in peace, had dentures, and he used to keep them in a glass of water next to the bed. Is that still the standard practice for dentures?

Dr. Jason Mann: (46:07)
Of course we do have little containers that we can keep them in, it just depends on the denture. We always like to try to keep them clean. A lot of times people like to soak in them, depends on what you put in the dentures because a lot of times after surgeries, we put a resilient material in there that becomes a little brittle over a period of time. But now with the new technology and new materials out there, the dentures tend to be a little bit stronger. One of the things that you’ll see, especially with people with dentures, is that they start brushing them and they end up dropping them and all of a sudden the front tooth falls out. So I think that happened on Dennis The Menace, not to Dennis, but to the two Chiclets. [Laughs.]

Daniel Lobell: (46:58)
[Laughs.].

Dr. Jason Mann: (46:58)
So you’re always trying to protect it – new stronger materials ensure that the dentures are a little more likely to sustain a fall.

Daniel Lobell: (47:10)
It is a little scary for kids to see their grandfather’s teeth in a cup next to his bed. And then they wonder if their grandfather has got his eyeballs in another cup or if he just takes himself apart before he goes to bed? What happens when you get old?

Dr. Jason Mann: (47:27)
[Laughs.] Oh my goodness. I can only imagine.

Daniel Lobell: (47:32)
Sometimes there’s a toupee too with some seniors. All of a sudden, all the parts of you are on the side of the bed. [Laughs.]

Dr. Jason Mann: (47:39)
[Laughs.] Exactly.

Daniel Lobell: (47:42)
Dr. Mann, it’s been a pleasure speaking with you today. I’m going to round off this interview by asking you the same question I ask all the doctors to end the interview, which is what do you personally do to stay healthy?

Dr. Jason Mann: (47:54)
Well, I have three kids. They try to keep me active. I have one in college, two in grade school. I do personal training and try to do it two to three times a week and try to work out. I try to live as healthy of a lifestyle as I can. However, I do a lot of traveling and it’s not the easiest. But the biggest thing is just trying to stay active, not only physically, but mentally as well and trying to figure out different ways to reshape the curve in dentistry for myself, just because that’s my profession and trying to break the mold and excite people about what we’re doing in dentistry and where this may go and really trying to do team building. So that all brings me to the point of my mental workout and my physical workout. And so with all that, it keeps me pretty busy. I tend to try to juggle a lot, but so far so good. And it’s been keeping me pretty healthy.

Daniel Lobell: (49:17)
I’m glad to hear it. I hope it continues to keep you healthy and looking forward to seeing more from you and keeping in touch in the future. Thank you so much.

Dr. Jason Mann: (49:28)
Awesome. Thank you so much.

Daniel Lobell: (49:33)
This podcast or any written material derived from its transcripts represents the opinions of the medical professional being interviewed. The content here is for informational purposes only, and should not be taken as medical advice since every person is unique. Please consult your healthcare professional for any personal or specific needs.

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