Trials and Tribulations of Maxillofacial DCT/SHO/Residency – PDP194

Protrusive Dental Podcast

It’s your first night on-call and you are bleeped at 3am – there’s a nasty facial laceration waiting for your urgent attention. You have never sutured the face before…”who you gonna call?” – well sometimes even the Ghostbusters will be more helpful than the on-call trainee!

https://youtu.be/3RKZG3yy2sU

Watch PDP194 on Youtube

Our good friend Dr Ameer Allybocus joins us again for another episode where he gives us a lowdown of his experience when he was a DCT trainee many years ago. There is a lot to learn in this podcast from Ameer as he dives into the Trials and Tribulations of being an Oral and MaxilloFacial Surgery DCT during the early years of his career.

There are laughs and tears in this one, so hold on to your seats for an emotional podcast that will leave you wanting more.

Need to Read it? Check out the Full Episode Transcript below!

Highlights of this Episode:
00:00 Introduction
01:37 Protrusive Dental Pearl
03:26 Introduction to Dr Ameer Allybocus
19:40 The MaxFax Beginnings
24:00 MaxFax at UCL
29:37 MaxFax isn’t all bad
36:05 DCT Oral Surgery
42:16 On Call
48:26 Book Recommendations
49:15 Working at the Queen Elizabeth Hospital
54:13 A Life Changing Experience
59:57 MaxFax: Benefits, Tips & Tricks
65:26 Tips from Ameer
66:25 Trauma and Accidents
70:56 MaxFax Puts Dentistry Into Perspective
74:33 Closing Words

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Click below for full episode transcript:

Jaz's Introduction: Is a maxillofacial surgery post right for you? Maybe you've already done one before and you want to like reminisce about your time as a DCT, as a part of a residency or any post and standalone post you've done in a maxillofacial department.

Jaz’s Introduction:
Now my colleagues who’ve done it tell me that it gives you thick skin, it’s character building, it’s these amazing experiences and they have no regrets. Whereas I have other colleagues who have major regrets about doing a maxillofacial post.

My guest today, returning again, Dr. Ameer Allybocus, does absolutely fantastic job of summarizing the highs and the lows of working in a maxillofacial position as a dentist. Now in the UK, we have these DCT, Dental Core Training positions, but around the world, being attached to a hospital in the maxfax department and helping the registrars and consultants with everything from trauma to cancer and sometimes not always exodontia. And we’ll talk about all these themes with Ameer.

I actually really wish I had an episode just like this when I was considering whether to do a maxfax position or not. There’s actually a bit where Ameer actually cries in this, and I’m just respecting so much for making himself vulnerable and sharing those feelings. It was related to a patient story, and there’s so many great tips and different characters and different personalities that he describes in his stories of working in these different posts. There’s so much incredible value provided in this episode. It’s a longer one, and I didn’t want to split it into two. So you might need a couple of commutes or lots of onions to get through this one.

The Protrusive Dental Pearl today is provided by our guest, Dr. Ameer Allybocus, and it gives you a flavor of the rest of the podcast of what’s to come. There’s so many great tips and stories attached to it. So let’s hear today’s protrusive dental pearl.

Dental Pearl
So Ameer, what is the protrusive dental pearl for today?

[Ameer]
My Protrusive Dental Pearl is whatever procedure you’re doing, if it isn’t going the way you want it to, if you find yourself getting stressed, hard, you’re not seeing what you want to see, there’s nothing in dentistry that you can’t stop and take a pause, give the patient a break, set them up.

Walk away, have a glass of water, gather your thoughts, think about what exactly you’re trying to do, and then come back with a fresh set of eyes once you’ve had a chance to calm down and do it again. And not enough people do that. People get a bit stressed out and get themselves in a tizzy. You have the tools you need up here to solve these problems. So yeah, just take it easy. Don’t be so hard on yourself.

[Jaz]
I think otherwise the flight or fight response takes over. And I think that’s really good. When was the last time you had to utilize this?

[Ameer]
Oh man, placing an implant on my aunt. Like, yeah, don’t treat family like that’s my other pearl, but if you do end up treating family, I had to do a bone graft and it just, the membrane just wasn’t sitting right and she was moving around and I was getting stressed out, the bone graft materials were leaking and everything and I was just like, okay, like, put the flap back over, I’m just going to walk away.

Have a little sip of water, like, these scrub, like it’s fine. And then the nearest is all, I had a little break. And then, we just had a chat. We joked around a little bit, and we were like, okay, should we get back to it? Yeah, okay, cool. Sat down, and it was as if, there was, nothing was wrong.

There was no problem, everything just went super smooth. And I’m fitting her crown on Friday, so everything’s fine. Everything’s great. So yeah, like that’s my-

[Jaz]
No matter what field you’re in, I think you can utilize that technique. Thank you.

Now let’s listen to the main episode. Remember, it’s a long one. Get those onions ready, but I guarantee if you listen to the end, you will gain so much from this episode. It’s got so many facets to it. Enjoy.

Main Episode:
Dr. Ameer Allybocus, welcome again to the Protrusive Dental Podcast. You were so good last time when it comes to talk about bleeding sockets and managing them, the stories that you told, the exchanges we had about your experiences and just generally sharing good guidelines advice, so it’s great to have you again. How are you, my friend?

[Ameer]
I’m great. Thanks for having me back, Jaz. I’m looking forward to this. So I think this one’s going to be a bit more fun than managing bleeding sockets. So-

[Jaz]
I don’t know which direction is going to go in exactly. I’m sure you’ve got some cool stories because you’re man of stories. So maybe I think that’s what’s good. Maybe that’s what’s on your mind, making it spicy. But for those who perhaps haven’t heard of the previous podcast, I encourage them to go back to it. And obviously I’ll link them in the show notes, but interesting thing that you’re doing lots of oral surgery and practice you’re doing sedation as well.

And therefore, one of the questions I asked you before we hit record was how many practices are you working at? And you said way too many. So the really, the number one thing I want to know about is have you ever turned up to the wrong practice? That’s what I want to know.

[Ameer]
I have, but luckily it was on the same square. So I just had to walk across the road. So apart from that, no, I’ve turned up to practices I work at on the wrong day. And they’re like, oh no, we’re booked for next week, but that’s the worst it’s been. So yeah, I’ve never mixed it up that badly.

[Jaz]
Very good. And what advice would you give to someone who’s, I mean, you work in a lot and that’s kind of atypical, most people I know they work in one or two, but with the nature of the kind of more niche services that you provide with sedation and visiting sedation and visiting oral surgery type service, do you find that this is working for you in terms of lifestyle and work life balance and that kind of stuff?

[Ameer]
It was, but I found that in terms of managing your relationships, well, actually, you know what? I got a dog recently and ever since I got two dogs, actually the brother and sister, that’s a mistake. Never buy two dogs from the same litter at the same time. That’s my, like, that’s a protrusive tip.

[Jaz]
It’s like having twins, never had twins.

[Ameer]
Yeah. Ever since I got these two dogs, I’ve found that I need a much more regular work pattern. Before that, I was very happy working lots of different practices. I still work in lots of practices, but I’ve had to scale the radius down to 90 minutes from my home base, rather than wherever, there were days where I was traveling across the country from, like, Cornwall to Sheffield to treat patients, which is crazy.

And you can do that when you have less ties, but once you start to settle down a bit I think you need to kind of pick a patch and stick with it. But also, the other thing is if you have a vision for how you’re going to run a service like that If you team up with people in different parts of the country have a similar vision Synergize team up you can form a joint company and then you can work that way and that way you can build a brand that’s trusted and also continue to service those practices that you used to work at.

So that’s another way to look at it. So, you can still maintain your clients, but yeah, I think you have to remember that at the end of the day, it’s the end of the day. Go home, relax, put your feet up, be with your family. That’s what’s important. We have to work to live and not live to work.

[Jaz]
So well said, but it’s important to have that as part of your past, as part of your blood, sweat and tears, your phase of being a sponge and doing all these things to gain your 10, 000 hours, if you like. So you’ve done all that. And that was important part of your journey.

[Ameer]
Yeah. You’ve hit the nail on the head. It’s all about that 10, 000 hours to get that mastery. And in fact, that reminds me, I’m going to be recommending a lot of books throughout this podcast. So number one is Outliers by Malcolm Gladwell. Everybody needs to read that book if you haven’t read it. Outliers by Malcolm Gladwell, 10, 000 hours, become a master of what you do.

And immerse yourself as much as possible. And that also means traveling around the country as much as possible. Because you will meet experts in their field. And you’ll meet A who says do it this way. And then you’ll meet B who says A is an idiot, do it that way. Then you’ll go back to A and say B said this.

And you’ll start to test these ideas and methods against each other. And you will distill it. So it’s purest form and take away the best of both worlds. And that’s what’s going to make you unique clinician number C, who’s going to pass your skills on to D.

[Jaz]
So that’s exactly been my experience of occlusion, by the way, everything you said there, like the different viewpoints that you’ve definitely summarized that well.

[Ameer]
So, yeah, I’m not going to say young, but while, because I don’t want to be ageist, but while you have the ability to move around, do it, make the most of it.

[Jaz]
Yeah. Life comes in seasons. I’m a big fan of thinking and life comes in seasons. And then if you miss the boat of that season, it doesn’t come back, I find. So there is a time, for example, there’s a time to go out every night and get smashed and have a great time. There’s a time for that. If you decide 15 years later that actually want to go back to that time, or we want to live that time because he’s never got to live it. It’s just not going to work in life.

It’s just, there’s a time for everything. And so there’s a time where you are sometimes having to be a workaholic in your early stages to get those 10, 000 hours. Then there’s a time to focus on your family and dogs, children, whatever it could be, basically. And then there’s a time. On the other side of that, so life comes in seasons.

So you’ve got to prepare for that. So speaking of seasons, one season that many people choose to experience is the season of maxillofacial surgery. Now, did you know in America, there’s no such thing as maxillofacial surgery? It’s just oral surgery. So you are an oral surgeon and they don’t have a separate maxfax, which I didn’t know until recently.

So to make this appeal to everyone around the world, lots of listeners and watchers appreciate you from the States and stuff. So what we’re talking about here is a post or residency or a one year thing, which you might do after you get your BDS or DDS, after you get your qualification, you then do one year attached to a hospital as part of a maxillofacial service. So very much trauma, mouth cancer, and that kind of stuff. Now, before I ask you the questions I have, Ameer, about what’s it like, the pros and cons, and how to make the most out of that year, the trials and tribulations, the stories definitely want to get to the stories.

Let’s talk about motivations because I wrote down some different reasons and there’s going to be a little bit of a monologue here. So bear with me, but interject whenever you want. Different motivations that I did not do a Maxfax post. Like I told you before, I did a restorative and oral surgery post, right?

And so the reason I did it is for me, it was in a way, it was a means to an end because at the time I wanted to be a restorative specialist and I had to do this, but it was also a taste for the future. Do I really want to do this? And so that was the main reason I was doing it. And for me, it was, it proved to be very useful, not only because I learned so much, I was a sponge.

I really wanted to, my mindset was every day. I just wanted to learn as much as I could. And of those two posts that I did, one was fulfilling for that and one wasn’t. And that’s just the way it is. But those are my reasons for doing it. Whereas other people might do it just purely for the tick box.

Think of someone who wants to get into ortho and is doing a Paeds (Paediatric) post because they kind of need to do it. They don’t like kids. They don’t want to chase children to fluoride, but they have to do it. To get to ortho, then there’s someone who might not be confident in oral surgery. And they think, you know what?

If I do a maxfax first, maybe it might, maybe better than extractions. I’m sure you’ve got lots of opinions on that, which we’ll get to. Here’s a big one. I mean, being afraid of going into general practice? Like the fear of going into the rat race or that, is that one that you’ve heard of before?

[Ameer]
Oh, that was me. I was so scared of telling a patient it’s going to cost this much. And meeting UDA targets. I was terrified of that. So, I mean, to understand where I came from, I’m going to go off on a tangent, but I’m going to circle back, I promise. But some people are going to be like, this guy shouldn’t be a dentist. I finished telling these stories.

But I remember when I was 15. It was like I was in school, we’re having a careers fair. And I was obsessed with filmmaking and cinema, and all I wanted to do was that. But having Asian parents, they’re not going to be like, yeah, go to film school. That’s that’s fine. Like, live out to the back of your car for the rest of your life.

No problem. They were like, well, you can get a career, and then you can become a filmmaker. And I said to them, alright. I really want a RED cinema camera. RED had just been founded by Jim Jannard, the Oakley founder, and a guy called, it’ll come to me, I’m having a blank now, but they just founded this disruptive digital cinema company, RED, and I really wanted a RED camera.

And being a 15 year old, you just think, how can I make money, buy a camera, make a movie, become a rich, like, filmmaking millionaire? Great. I said, how can I make the most amount of money with the least amount of effort? And then my parents lied to me and said become a dentist and then from that moment onwards I thought, oh dentistry is easy.

Like it’s not easy. We all know that. Anyone who’s watching this podcast knows that. So that was my initial motivation to go to dental school, to buy a RED cinema camera. Obviously I didn’t say that in my interview. So I went into dentistry with terrible motivations compared to everybody else who was passionate about the science of dentistry and the art of dentistry, and then I developed, and I felt really out of place in dental school.

The way I got into dental school is an interesting story as well, but that’s for another time, I guess. But I don’t want to go off on a tangent too much, but I just didn’t really find my tribe in any of the departments in dental school, because it wasn’t something I was innately passionate about, until I stumbled into the oral surgery department, and then I was like, Oh, thank God.

This is what I want to do. I want to do oral surgery and I used to spend my free sessions when you’d have a free set free period or something. I’d go everyone else would go home, we got library or whatever. I’d go to the oral surgery department and be like, can I help you take teeth out? And they were really supportive in Birmingham and I had some great mentors, Prof. Dietrich, Bilal Ahmed , Kaushik Paul, who’s now the medical director at MyDentist, so he-

[Jaz]
When they smell that from a student, when they smell that desire and that hunger, the best mentors, the best tutors will really fuel that and take it to the next level. So it sounds like the experience you had with that.

[Ameer]
So that, I found my thing. I was like, I want to do oral surgery. I’m not really that interested in the other aspects of dentistry. And I just focused in on that. And my whole thing at that point was, I have a very addictive personality. So once I pick one thing, that I’m not interested in anything else, I’m just laser focused on that, which isn’t necessarily a good thing, but that’s just the way I am.

So I went into foundation training, and I was doing all this general dentistry, but what I was craving was oral surgery, and I just hated the idea of finishing foundation training and then going into general practice and having to do everything not so well. And every now and then getting thrown a tooth to take out, and then I was like, Oh, Maxfax and oral surgery, I can just focus on my passion.

Great. Which, again, like later on in the conversation, we’ll come back to why that’s a good thing and sometimes not a good thing, because I’ve now discovered an interest in dentistry in general, thanks to the other courses I’ve done. But yeah, that time I was just terrified of going into practice.

I just wanted to do oral surgery. So that’s why I did it. So that’s just to give people an idea of where I’m coming from in this conversation. But I have a diverse group of friends who some did Maxfax, some didn’t. And I’m going to talk about them as well and the paths they’ve gone on and hopefully some of the younger dentists or students who are thinking about if this is the right path for them, that’s going to be valuable. So anyway, I’ve been talking for a long time, so I’ll let you.

[Jaz]
No, no, you’re good. I mean, it’s a very popular choice. I mean, I don’t know, maybe I don’t know how many places there are, but it felt as though after DFT, about 30, 40 percent of people went to do a hospital post. I don’t know if that’s accurate or not. I mean, it just felt like a lot of people, maybe because I was in it. So I felt it was more, but a significant percentage go into hospital training.

[Ameer]
Yeah, I think it’s one of those things that it’s like, do a year of DCT. Now, my personal opinion, and I’m going to justify this later, I think DCT 1 should be mandatory, as mandatory as foundation training. A lot of people would disagree with that statement, but I think, and as we have this conversation, I’m going to make that case. And not necessarily to learn dentistry, okay? Like, there are certain life skills that you’ll get doing that kind of job, and hopefully, I’m going to pique some people’s interest and they’ll want to do a Maxfax job after this.

But I think that, I mean there’s so much to say about it, I’m really excited to get into it, but like, I wouldn’t be who I am if it wasn’t for the Maxfax jobs. I’m not talking about the surgical skills I picked up, I’m talking about the personal skills and the tests you go through, the trials and tribulations.

[Jaz]
He said the title.

[Ameer]
He said it. He said the title. But like, yeah, it’s definitely something that I think makes you when you’re a dentist. Not to say that people who haven’t done Maxfax are any less or lacking, but I just think that for a lot of people this is going to mold you into a resilient calm, cool dentist. And it’s just going to put dentistry into perspective with the rest of the body when you’re treating your patients.

[Jaz]
I like that word perspective. And the reason I like it, because what you just said there reminds you of something. Firstly, to track back, I know people who say, who swear by your experience. They say, even though it’s not relevant to what I do today, I’m so glad I did it. It was character building. It was such an important part of my story. If you like my career story, which I get. Equally, I know a couple of people. I know one individual for sure. Very close to me, actually, who halfway through in the Midlands was like, screw this.

I hate being a pen pusher and just left. It was like, I don’t want to do this. You guys are BS kind of thing. And he just left. So I’ve had both. I’ve had people having fantastic experiences learning so much, whereas others, doing a lot of admin and not even having a laid forceps on a tooth. So the different posts will determine it like, like with everything.

So that all happens. But the thing about perspective, you said it’s a bit like this when you are there. Cause I’ve been to a few of these MDT meetings now and I’ve been to one of these posts during dental school, we like had to go to two weeks. I was in like a Lister hospital. So I got a taste of MaxFax to some degree, right?

And so there was a big case happening. There was like a neck dissection and stuff. And so they were using this sort of like zapping thing to stop the bleeding, I think, right? You probably know exactly what I’m talking about. They were zapping this stuff, right? And I was there holding this guy. And every time they zap it, like the pectoralis major would contract.

That was pretty cool. Okay. So that was pretty cool. Right? But the whole thing about perspective is that I’m looking at this, right? Like, wow, this guy’s having a neck dissection. His whole chest is, I can see it’s all his muscles here. And then next time someone comes in and like you break a root tip, it really puts things into perspective.

Or when someone comes in and says, oh, that compensated, that’s a tiny little chip over here. Do you see what I mean? It helps to put things into perspective. I totally agree with that. It’s a level of calmness that you appreciate to what you perhaps would have stressed about before.

[Ameer]
When I mentor younger dentists. There’s a lack of confidence. And the patients are like sharks smelling blood in the water. They can just smell you’re scared. Then they get anxious. So yeah, exactly. I mean, let’s say you crown prep a tooth and you graze the tooth next door. You shouldn’t, because you should be using a metal strip on every adjacent tooth.

But let’s say it happens. Before MaxFax, you’d be like oh my God, I’ve, I’ve grazed the tooth. How am I going to break this to them? Like, oh, I’ve ruined this person’s life. That’s it. It’s a black retentive factor. Yeah, when when someone’s blown half their face off with a shotgun and you’ve pulled the pellets out one by one with some forceps, you’re just going to be like, oh, yeah, we touched the teeth. It’s fine. We just moved it off It’s whatever like and the patients are like okay, life happened that had things happen and I’m not justifying that. I don’t want any restorative dentist.

[Jaz]
No, no, true, true. But it did the whole perspective. It’s just perspective.

[Ameer]
Yeah, like, what you’ll find is a lot of patient complaints come from them detecting that you’re shitting yourself. You have to play it cool. And again, this puts things into perspective. And there’s so many tangents we can go off on each point, but it makes you realize that your dental degree is much more expensive than the vocation we practice, in the sense that we have this baseline of knowledge that allows us to actually practice as doctors.

And a lot of people make jokes like, oh, dentists aren’t real doctors, etc, etc. I saw Rhona Eskander put a post up about this a couple weeks ago, and she had all these doctors, trying to downplay us as medical professionals. You’re doing the same job in MaxFax that a doctor is doing in any other medical specialty, and at a senior house officer grade, not in an F1 or F2 grade, and what you’ll realize is you do have that ability, and a lot of dentists don’t realize they have that potential in themselves to step up and do more than just the math that you’re going to be managing a patient’s entire body, their medications, everything, liaising with other medical teams, going to multidisciplinary team meetings.

And it gives you that confidence as a clinical practitioner. So, again, that’s a very important thing for us to take away in our profession as well. And to put some respect, your name, when you say I’m Dr. Someone, so you’re in that title and you realize you earned it.

[Jaz]
Well said. Well, so tell us about your maxfax. I see. I mean you feel free just goes away did it or you don’t have to do so disclose exactly where you did. But like how is your post before I talk about some other experiences perhaps didn’t go so well and just let’s learn about sounds like you had a really fun memories of your time.

[Ameer]
Yeah, definitely All right, so I did my foundation training at the Eastman like district in London and then I did a week in the Eastman Dental Hospital, and I was like, Oh my god, I want to be here. It’s such a shame they’ve shut it down now, and it’s become a wing in the UCL Hospital, but this used to be the actual Eastman building on Grazing Road.

And it was just my dream to get that job, and I didn’t think it was possible. I went to the DCT interviews and at that time it wasn’t national recruitment, it was local recruitment. So each district had their own DCT interviews. I went in and the first question I got asked in my interview was, what do you think of the MFDS?

And I don’t know what came over me, I was very honest with them, and I just said, it’s a bit pointless, isn’t it? Oh, why? I was like, well, everyone’s just told to do it as a tick box exercise, no one’s actually like reflecting on I shouldn’t say no, I can’t speak for everybody, but let’s be honest, everyone is just like, do the MFDS as soon as you graduate from dental school.

Why? Just shut up and do it. Okay? Like, and you just do it, and it becomes a tick box exercise. You’re not doing it with any reflectivity in mind. Not everybody, but let’s be honest, most people just do it to say, I’m MFDS RCS, Edinburgh. And you do the MJDF first because it’s easy, then you do MFDS part two.

I can tell from your smile, you know what I’m talking about. And then, I think that resonated with him and they gave me full marks for that question. And then I just relaxed into the-

[Jaz]
Brave, but we’re very true and you deserve it. So good.

[Ameer]
That’s not always going to work. I’ve been ballsy in other situations and that hasn’t paid off, but it’s high risk, high reward.

[Jaz]
You’re either going to rank like first or last.

[Ameer]
Like, yeah, but anybody who knows me, I’m the guy who just says it how it is. And a lot of people will be like, yeah, and it’s gotten you in a lot of trouble in there, but I just say, I say it now it is. Okay. So anyway, results came out, I wasn’t expecting anything special, and then I ranked second in London. I’m doing myself a favor, saying that there were two people ahead of me who ranked joint first. One of them didn’t take a DCT job at all, and she just went into private practice and is doing very well for herself.

The other guy also ended up working at Eastman, so he was doing the restorative post, which was amazing. He had a great year, and I was doing the oral surgery maxfax post. So my post was with six other people. So we were paired up. I was working with a lady called Aisha Shabir, who’s just opened up Every Smile in Leicester.

She’s doing sedation, oral surgeries and cool stuff there. So she was my like DCT partner and we had a great year together. So we went, we were all paired up and there were, that was split into three hospitals. So this is my first tip. When you’re doing DCT1, pick diverse posts. And the reason I say that is maxfax jobs come ten a penny, to be honest.

Even outside of DCT recruitment, if you go on NHS Jobs and just type in Maxfax SHO, as long as you’re not worried about where to move, there will be a Maxfax job somewhere, and I’ll tell another story about a young chap I’ve kind of guided towards a post in Cornwall later on. But pick one, pick diverse posts. So my post was three months Maxfax in UCL, three months oral surgery at the Eastman, and then three months kind of pediatrics, orthodontics, Maxfax at Great Ormond Street. So that was taking a lot of boxes.

[Jaz]
Basically, you’re suggesting take a post which has more than multifaceted and it allows you to mix with different mentors and tutors and rotation.

[Ameer]
Yeah, because as you go up the DCT years, those posts become far and few between. So there’s quite a few restorative oral surgery posts and orthodontic posts and pediatric posts. But then when you’re applying for DCT two, those become a little more hard to come by, and then by the time you’re DCT3, you’re going to be knife fighting for those posts, so, get it done early on, because you can do Maxfax later, if you want to specialize, because if you want to specialize, you need to look on the Recruitment COPDEND website and find out exactly which specialties you need to have done in order to qualify to apply for those jobs.

If you’re interested in specializing, especially orthodontics, you need a pediatric post, even if it’s just three months like the one I did, for now. They’re constantly changing the goalposts, so that might change in the future. Anyway, so UCL Maxfax was basically Maxfax with training wheels, so it was 9-5, there was no overnight on call, and we had medics who were interested in doing ENT and Maxfax working alongside us. This is why I say you are a doctor, because we were doing the same job that our doctor colleagues were doing within that specialty.

Yeah, so that was my first Maxfax position, and so now it’s story time. How much am I allowed to swear? Because if I’m going to really like bring the passion to these stories, I’m going to need to quote a few people, but I don’t want to add any profanity to your podcast.

So my first day I go in and I’m meant to be in the theater with this Maxfax consultant. So in MaxFax, I apologize to anyone who’s done MaxFax and that I’m just going over like old rope, but for people who haven’t done it before, it’s very much a hierarchy. So there is the medical director, the managers, the consultants, the registrars, everybody else.

And then you’re at the bottom of the pile when you’re in SHO. So, this consultant’s like yeah, you’re the new DCT, right? Yes, sir. Get the patient’s renal records from Queen’s Hospital and I’m just like okay and then he just walks off like down the corridor and I’m just like what the f*ck which Queen there’s a lot of Queen’s Hospitals which one? What renal records? Like who’s the patient? So I’m like flapping around like and the registrar’s. They’ve got their own shit to deal with and they’re just like yeah, it’s real records Just go get the renal records, and I’m just walking to random nurses in the corridor, like, who aren’t even in Maxfax, Renal Records Queens. And then finally, the consultant, like, does a 180 on his heel, walks over to me, he’s like, is this your first day? Yes. Will someone come and supervise this f*cking child? And I’m just like, okay, cool.

[Jaz]
No way. In those words?

[Ameer]
This is, yeah. Like, will someone come and supervise this f*cking child? And I’m like, alright, this is how it’s going to be for three months. Cool. Okay. So the registrar pulls me over, he’s like, You haven’t done anything wrong. I’ll help you. But just remember, these guys are the whales. We’re the guppies. We’re like the little fish that swim next to the whale and pick the plankton off it. Okay, cool. I’m like, I understand now. Okay, and it’s not like that in every unit.

And this was my first lesson. In MaxFax, you got to have a thick skin. And if you don’t have a thick skin, you’re going to develop a thick skin. Okay, so. And you just learn that you’re going to come across some egos, because at the end of the day, these guys are the most specialized surgeons. In the medical field, we’re dual qualified medics, dentists.

They’re on the bleeding edge of medical technology and surgical technology. They don’t have time to worry about your feelings. It would be nice if they did, and some of them do, and they’re extra special. But these guys, they’re dealing with people’s lives, and in dentistry you don’t come across that a lot.

Because, how many patients do you come across with where what you do is going to be, like, actual life and death? For somebody not often. I mean, we do amazing things for patients and we create amazing lifestyle changes for them, but I don’t want to be dogmatic about it because there might be some orthodontist saying, well, I saved a life once, but, at the end of the day, MaxFax is life or death, like, we’re talking about cancer, we’re talking about trauma, and you see, I saw some amazing surgeries that year. Now, I’ll put an asterisk there, the first 10 neck dissections you see are exciting, the next 10 are, like-

[Jaz]
Wow, I can still remember it!

[Ameer]
It’s like, okay, yeah, it’s good, and then like, the 20 after that, you’re just like-

[Jaz]
Then your legs are getting tired.

[Ameer]
You’re holding some skin flap up like this and they’re like, higher, higher. And you’re just daydreaming about like, when does this post end? Two months. Okay. Oh man. Like two months. And yeah.

[Jaz]
I mean, that’s like anything. It’s a human nature, right? It’s like a hedonic adaptation is exactly what it is, but just going, just circling back to the, having the thick skin element of it. It’s so true. I remember even though it wasn’t Maxfax. Little things that when I was doing my DC post in restorative, the post I had was not as well supervised as I would have liked. And so there was one, the guys who was kind of a supervisor, but he wasn’t reallocated to me per se. But anyway, nice enough guy, except like I got like some cement stuck around a crown, so just fit his crown in and couldn’t floss it because it’s got cement stuck as you do a real shame.

No, I hated myself at the time. And then the tutor, the guy pretty much says right in front of the patient, like, you’re old enough and you’re ugly enough to sort this out yourself kind of thing, walked off. So that kind of stuff, but you know what, I get it, thick skin and stuff. And I’m not, I’ve been through a lot in life.

I’m not averse to that. But the thing is, it just goes against my values of kindness. Like for me, I mean, one of my highest values is kindness. And I know that, it’s character building and this stuff and that’s why I probably wouldn’t have enjoyed that kind of environment. There’s an element of, it could be perceived as bullying in a way, right? It could be perceived as bullying. It could be perceived as a culture that’s not quite right, but I see it happening. I know it exists.

[Ameer]
I think I take a lot of shit from people and I think that’s because my MaxFax background and I spent a bit of time in the Royal Air Force and when you’re in the military as well, like the way they talk to you, you’re a grunt and they’ll just find, you might be doing everything perfectly, but part of your training is to just be kind of broadened lines.

[Jaz]
Just suck it up by the cup. It is what it is. I get it. I’ve been through that, not to the level that you just described, but, and I probably would have just nodded through it, but am I a fan of it? Do I condone it? No, I mean, I’m not a fan of it, but this is how it is. I see that.

[Ameer]
I wouldn’t treat my nurses or associates like that, or anybody who’s looting from me. So, I don’t have it in me to be mean, like, because I’ll go home and like, lie awake and be like-

[Jaz]
This is why we’d never be a consultant at MaxFax, this is why we’d never get those, see, because you need to have that.

[Ameer]
No, no, the thing is, there are nice consultants out there, there are really nice consultants out there. You’re just going to come across some personalities, but it just gets to a point where you kind of laugh about it, and it’ll be a running joke that like, did you get bollocked today? Yeah, I got bollocked. And you’ll like compare how much, how hard you got bollocked, and then it becomes a badge of honor, like how much you got bollocked.

The most important thing at the end of the day is the patience and keeping them alive. I’m not going to name the mean ones, because I don’t want to make any enemies in the profession, but I’ll name the nice ones. So, like, there were some real assholes in UCL. Amazing surgeons, massive dickheads. And then there were, like, super nice guys, like, there’s a chap, Colin Liu, who’s such a nice, probably the nicest guy I’ve met in MaxFax, to be fair. Like, so nice, so supportive.

[Jaz]
So super nice in MaxFax is like average guy in the real world.

[Ameer]
Yeah, basically. Like, just a normal, polite person. Just a well adjusted person who’s happy with his life choices. And I mean, this is the other thing, but you do get some regi. The ones, the watch out for the registrars because they’re stressed because they’re dealing with you. They have a lot to live up to that. Now. This is their life.

[Jaz]
Sometimes they have young families. They’re not sleeping well, because of all these things as well because of the stage of career and the season that they’re in.

[Ameer]
Exactly. And you know you have like, people who’ve given up a lot, I don’t know how much I can say without offending like half the population, if you know what I mean, but some people have given up a lot and they’ve made life choices that have made things difficult for them and in other parts of their life.

At the end of the day, here’s what you learn, we’re all human beings, we’re not perfect and we’re not going to be perfect every day. And every now and then, someone’s going to snap at you, someone’s going to take out their frustrations on you, even though you haven’t done anything wrong. And you’ve just got to roll with it.

But this is life, I think about everyone’s seen this in every cheesy motivation mashup on YouTube, but I think about Rocky talking to his son, and saying, it ain’t about how hard you hit, it’s about how hard you can get hit, and keep moving forward, how much you can take, and keep moving forward. That’s how winning is done. And I think about that whenever I’m getting low, sorry, that was a really bad Philadelphia.

[Jaz]
That was really good. I liked it. I like that. You’re a nice one.

[Ameer]
And to me, that’s the essence of MaxFax. It’s what are you made of and how hard can you push? And like, well, I mean, we’ll get into the on calls and things in a minute, but you will be tested mentally and physically, and you’re going to develop resilience. That doesn’t mean you have to act like that, and you’re going to take those lessons away, but that’s just part and parcel of the job. So, you will encounter egos, and you got to have a thick skin. And another film comes to mind, The Departed, which is in Maxfax.

I’m not going to quote the whole speech, because there’s a lot of racist terms in there, but Jack Nicholson at the beginning of the film, he says, no one’s got to hand it to you. You got to take it. And that’s the other thing about Maxfax, is no one’s going to walk up to you and say, you there, would you like an audit?

Here’s an audit, here’s an audit to do, and here’s a paper to do as well, and here’s a case report. You have to decide, I need three audits, two papers, a case report, and also I want to reduce amendable, like that’s what I want out of the year, and you’ve got a pass to them, and they’ll tell you to f*ck off a lot, until finally someone’s like, Okay, yeah, you can do it. That’s fine.

[Jaz]
Someone will give you a shot eventually, if they see that within you, basically, that desire.

[Ameer]
It’s like asking a girl out, eventually someone’s going to say yes. So, yeah.

[Jaz]
Well, I’m so glad you made that point because this is my experience. So when I did one of the posts, I won’t name exactly where it was like a split post, oral surgery, restorative, the oral surgery was pretty decent.

The restorative, like, just like you said, like you did the hierarchy of Maxfax, whereas when I was in restorative, the highest grade was obviously the consultants and stuff. Then it was, there wasn’t even registrars. It was the international guys, you’re paying the big money to do a specialist training, basically.

They’re paying a lot of money, so they need to get their money’s worth, kind of thing. And it was like, the registrars, the specialist trainees, and then you’re at the bottom of the pile. So, I was literally twiddling my thumbs. I was like, this sucks. I really want to learn. I’m really hungry to do all these cases, but I don’t have anything.

I have a lack of supervision. I was having all this dead time. So I said, okay, well, this is the year I’m going to do my first publication. I want to do something, I want to get published. I want to write something meaningful and helpful. And so I knocked on a lot of doors and eventually, Prof Avijit Banerjee, let me in, in it to have a little five minute talk with him.

And he said, I don’t know who you are. I don’t know what you’re made of. So here’s your challenge. He said it might take about 20 minutes. So go and like, look at all the different dental updates that have happened so far. And let’s find something that we need to talk about. It took me like eight hours like to do this right and do it well, but, but actually they loved it so much that professor Trevor Burke wrote to hand wrote to me a letter saying, you know, well done.

We really appreciate what you did kind of thing. And so through that, we found out that actually Resin Bonded Bridges hasn’t been written on in a long time, especially in Dental Update. And then that was a topic that I ended up doing thanks to the consultants who helped me out with that. And then from that, I got published in Dental Update by the end of that year.

So if I didn’t actually make it happen, it would not have had, no one would have said, hey, Jaz, do you want to get published? Do you want to do this? Just like you said. So that’s a big, big tip right there.

[Ameer]
Do you want to know? Here’s something crazy. I have had my first publication go through two months ago. First publication, my big barrier with applying to oral surgery training was I just didn’t know where to start. With getting it written and who to send it to and I was just going around in circles and I never managed to get over that hurdle. And then after our last podcast, so many oral surgeons and MaxFact surgeons reached out and they were like listen to the podcast, what’s going on?

You haven’t done oral surgery training yet? And I was like, I don’t know where to get started with this publication. And finally, they were, a lot of them were like, okay, I’ve got a report for you to write, I’ve got a study for you to write up, I’m doing a literature review. And I’ve loads in the pipeline, but don’t be like me.

Don’t like leave it and just circle around. Not sure what to do. Like you have to be assertive and say, I need this. So, anyway, like I said, you got to know what you want. No one’s going to hand it to you. You’ve got to take it. And that comes with everything in life. And when you’re applying for jobs, when you’re trying to develop yourself, when you’re looking for a mentor, pester people, people pester me.

Sometimes I don’t have time to get back to them, but once they’ve sent me the sixth text message, I’m like, okay, yeah, this guy’s keen. Let’s get him on board.

[Jaz]
I totally agree there.

[Ameer]
So I did maxfax and there’s a lot more to say about maxfax in my second year when I was at the Queen Elizabeth hospital, but I’ll circle back to that. Then the second part of my rotation was Eastman oral surgery. And there, I had this baseline oral surgery knowledge, but you don’t really learn how to take teeth out until you’re doing it in an oral surgery department, in my opinion. Now there’s two sides to that, two edges to that blade. Before I was used to like, you have 45 minutes to extract the teeth, no problem.

At the Eastman it was like, you have 20 minutes to extract the patient’s teeth. And it doesn’t matter if it’s two impacted wisdom teeth, or one, or a retained root, or six retained roots. Every patient is 20 minutes. Okay, go. And that seems like an impossible task, but this is, again, where you learn to work at quality and pace.

And at first, the registrars and the consultants will be helping you out. So I had Josiah Eyeson, awesome surgeon, teaching us, and Dr. Kaushal as well. And you just, again, learn how to work at pace and they won’t let you use the instruments that you’re comfortable with. So I love Luxators. They’re like, yeah, you’re not touching a Luxator.

Here’s a Couplands. Get it out with the Couplands. And I put, but I want to use the Luxator. No, you learn to get it out with the Couplands. And that’s how you learn. But through having someone next to you, that’s how you learn. F*cking it up and then having someone rescue you and then rescuing yourself. And you can be more experimental because you have that safety net to deal with. So yeah, again, like that was an awesome experience. And then I worked with an amazing surgeon.

[Jaz]
Highest form of learning when you need rescuing and then you watch how they do it. Definitely. I’ve experienced that myself and when I did oral surgery at Guys, just being rescued was amazing. And so I was so grateful and I just learned so much. Just assisting for how I could have done it. It’s very valuable.

[Ameer]
And then I worked with a really good surgeon. I should say really amazing. His name is Tim Lloyd. There’s two Tim Lloyds. This is an older Tim Lloyd who works at the Eastman Dental Hospital. Yeah, I worked with an amazing surgeon called Tim Lloyd.

And he’s like the maxfax surgeon to the Saudi royal family and stuff. And they fly them out to do their surgeries and things, and I think, don’t quote me on that, but anyway, he was like the wisdom tooth guy, and he had a general anesthetic list at the Royal Eye Hospital next to the Gray’s Inn Road Eastman Hospital, and we used to go there every Tuesday, and the nurse would say, put patients to sleep, and we’d just be taking wisdom teeth out, horizontally impacted, distally impacted, vertical, whatever, and he just got me so fast at taking wisdom teeth out.

Yeah, so he taught me how to take out wisdom teeth basically under general anesthetic, to this date, I’m still using the techniques that he taught me. And a lot of my referrals are wisdom teeth. The dentists don’t feel confident to take it for the simple fact that they’re wisdom teeth. And I have them out in less than a minute sometimes, or even impacted wisdom teeth.

I think, these days, the surgery is less than 10 minutes. If it’s taking longer, something’s going wrong. Generally. And that’s all thanks to Tim Lloyd, to be honest. Like, he just got me super slick at taking out wisdom teeth. And again, it’s tell, show, do. That lead that learning pattern. And you get that in MaxFax, and you have that time.

And because these are salaried posts, no one is thinking time is money. Well, I don’t have time to teach you. Like we have to go, it’s people take their time and especially generally-

[Jaz]
You say that, but then there’s a whole 20 minute per patient thing as well.

[Ameer]
So that’s different.

[Jaz]
Okay.

[Ameer]
Yeah. So that’s what I’m talking about is theater. So the 20 minutes is about meeting the patient volume because so many patients are referred for LA and if they took any longer, the waiting lists would go nuts in London. It’s crazy, especially now after COVID. I can only imagine how long the waiting lists are. But even at that time, they were very oversubscribed to the point where a lot of patients go and still get rejected because they’re just like, this is simple, you should be able to do this at breakfast, but so local anesthetic was 20 minutes and it’s not like that in every unit.

It’s just like that in Eastman. And I know that when I was working in Birmingham, they had like an hour per patient or something, so it’s not always like that. But that’s the pace that we were working at the easement. It was 20 minutes, sometimes half an hour, if it’s like a particularly difficult ectopic tooth or something.

Anyway, again, I come back to tell, show, do. You can watch, and then what’s great is when you get two impacted wisdom teeth, I’ll do one side, you do the other. And you learn a lot basically. And Tim was so supportive and nice and even if you weren’t doing anything perfectly, we’re talking about guys who are like the Roger Federer’s of their profession, and we’re like-

[Jaz]
Sounds like this guy was also a Roger Federer in his demeanor and the way he was too as well. I think it makes a difference, man. I’m sure there’s got to be some study in the education set somewhere where if you teach someone all the right things, but if you’re miserable to them as you teach it versus it’s like that thing, that the two jars of rice and one jar of rice or whatever you swear at every day.

And the other one that you say nice things to, and then something good happens with that. The one gets spoiled and fungi and the other one, like, it doesn’t get ruined. I’m sure it’s the same as that, except you’re the rice.

[Ameer]
Yeah. You are the rice. Be the rice. Yeah, definitely. I mean, you wouldn’t want Nick Kyrgios teaching you how to play tennis. Let me put it. I don’t know. Maybe you would. McEnroe’s a good coach, right? You will learn something from everybody. Let me put that. There was one guy actually who was banned from having registrars because he was so mean to them. Then it got to a point where he had to privately hire his registrars from abroad and they even stopped him doing that because he was so mean to them.

This was a guy in the, I won’t say where. Anyway, so, then I was quite unfortunate when I came to my Great Ormond Street job, the head consultant there, Peter Ayliffe, was retiring. This is a guy who’s a Maxfax consultant in Oxbridge. Arts lecturer, like an apparently an amazing surgeon from what I heard from the other DCTs.

[Jaz]
Also, very imminent TMJ surgeon, I believe, right?

[Ameer]
Yeah. Yeah. I never got to work with him, unfortunately, but he was prior to me starting the Maxfax head at the Grand Ormond Street Hospital. That was a bit of a, I was there kind of spinning my wheels, because I hadn’t really figured out what was going on.

I got the tick box of, doing a paediatric job and an orthodontic job, but I didn’t get a lot out of that final term. So yeah, like, it was a really good year. Then I came to the QE, which is a major trauma center in Birmingham.

[Jaz]
This is where the on calls happen, yeah?

[Ameer]
This is where the on calls happen. So like, when I first got handed the bleep at UCL, my first ever on call day, they handed me the bleep and I was like, okay, so what happens now that we answer the bleep?

Okay, if anyone has any questions, a patient comes in, you go see them. I was like, okay. My first belief was this guy had fallen off his bike and scraped all his face and then there’s flaps of skin hanging off. And I remember going into the room and I was just like, okay, I’m in this A& E room, don’t know where anything is, don’t know what I need.

So I called the registrar. Nice guy, Michael, he comes down. I’m like what do I do? Okay, anesthetize the patient. Where? Just around the lacerate, because in dentistry, you have like anatomical landmarks and stuff and like, there’s very specific ways to anesthetize people. In MaxFax, it’s just like stick the needle in the face, make it numb, try not to hit the eye or a foramen and you’re all good. So we’re numbing these faces up and-

[Jaz]
When you’re numbing a face, should you hit bone or not?

[Ameer]
It’s been way too long for me to answer that question. No, that’s the takeaway from that. Don’t hit the bone. One piece of advice I’d give actually is field block. So like, if someone has some, if you’re trying to numb this area-

[Jaz]
Just for the listeners, just say which area you’re pointing to.

[Ameer]
So I’m pointing to my right cheek. So for example, if I wanted to anesthetize that area, instead of just sticking it in the right cheek, I would go around the point of interest and form a square of anesthesia and do it like that.

And from my understanding, that’s called a field block. There’s probably some MaxFax consultants screaming at this car radio right now going, It’s not a field block! I think that’s what I was told. By somebody, it’s a field block.

[Jaz]
So anyway, is it like when you’re injecting into the cheek area, let’s say, is there a lot of space? i. e. Is it like the palate or is it like the buccal mucosa?

[Ameer]
Yeah, it’s very forgiving. I’m not going to give anybody any like specific Maxfax tips because it’s been five years since I did a Maxfax job now. But one thing. Don’t forget to stitch the muscle, like I’ve seen a few people come in with lacerated eyebrows and people just stitch the skin up and they forget to stitch the muscle back together as well and then they walk around like Clint Eastwood for the rest of their lives. So yeah, remember to layer by layer, okay? And that’s the thing.

[Jaz]
Let’s talk about that. That makes a lot of sense, but if I had that issue in my first encore night, I’d be like, I’m sorry, I haven’t been trained for this. I don’t know what to do here I’ve only had to do some sutures on some piece of plastic and an orange and a banana skin before.

Now you’re telling me to do it muscle. So what type of, what form of training do you get to be able to do these kinds of things? Cause from what I hear, it’s very little. You’re just learning on the job. A lot of time.

[Ameer]
We watched Planet Earth.

[Jaz]
Yes, the older ones. I wish I could watch the new ones, but the older ones.

[Ameer]
Have you seen that clip of the baby iguanas that hatch and they have to run across the snake pit to get to the sea?

[Jaz]
No, but every planet on earth seems to have like a similar theme of, okay, you need to get through, you need to survive this journey, right?

[Ameer]
Okay, okay. You know that the turtles who hatch and need to get into the ocean before the seagulls eat them?

[Jaz]
Yes, yes, yeah.

[Ameer]
That’s MaxFax’s DCT. You’re the turtle. They just drop you in the deep end. Life is harsh. From day one. Okay, so I’ll tell you a story that, like, basically will give people an idea of what that’s like. So, it’s my first night shift ever, I’m at the QE hospital, and it’s early on as well in the job, so I think I was like the second person to go on call or something, so we’re talking like September, so we haven’t had time to like bed in.

And at UCL it was a lot of cancer, not a lot of trauma, because as far as I know it’s not a trauma center, it wasn’t when I was there. So, So QE, you just get all the fractured mandibles and zygomatic fractures from drunk fights on Broad Street in Birmingham and I’m on call, and we have this waiting room on floor six.

Six, I remember, ward 620 was like the trauma ward, and the nurse calls me, it’s like, hi, so, is this MaxFax on call? Yeah. Yeah, so we’ve got two fractured mandibles, zygomatic fracture, blah, blah, blah. Also, a girl who’s tried to kill herself by setting a house on fire. Fell down the stairs and split her head open.

So she’s got third degree burns and ITU, but her head’s split open, so if you could suture that back up as well, would appreciate it. And I was just like, what the f *ck, like, how do I, like, triage this? Where do I go? What do I do? I have no idea. So everyone’s asleep, nine o’clock at night and ten o’clock.

So I call the registrar, this woman, and she answers the phone, and before I’ve said a word, she’s like, I’m here. I have a list tomorrow morning. It’s 10 o’clock at night. You should not be bothering me with this. You’ve done an oral surgery job. Deal with it. Okay.

[Jaz]
Before you even said a word?

[Ameer]
Yeah, before I said a word. And then half an hour later she called me back and she was like, right, so what you need to do is reduce the mandibles, get the cannulas in, clerk them, make sure they’re nil by mouth, from midnight, blah, blah, blah, like, and then, you learn, and then I made a point, I got a year long calendar, just for this person, and if they’re listening, I did this for you, I got a year long calendar, And got red dots and put the red dots on every date that she was my on call registrar.

And I made a point of not calling her, do not call her. I mean, yeah, and I never did. Never again did I call her, but yeah, so you’re going to get some, there were some very supportive registrars, like the guy, David McGoldrick. I think he’s a consultant now, but really nice guy, like if you were stuck he would come in and be there with you and show you what he’s doing.

That’s super patient. Nikki Mahon as well. Lovely consultant. She must be a consultant now because I’m talking about people who are in training five years ago. Really nice people who are just there to they understand where you’re coming from and they’re there to support you. Now, the thing is, if you’re going to do this job, you can’t be like that for the whole year.

Maybe for the first month it’s acceptable, but after that, you need to know what you’re doing. And that’s why I would recommend, first of all, this book, for those who-

[Jaz]
So it’s called On Call in Oral and Maxillofacial Surgery. Back when I was considering it, it was like, On the Ward or something, right? Dentist on the Ward, it was that book. So you’re recommending a different one, which I will put, you got that one, Dentist on the Ward. So I’ll put these books in the show notes for everyone.

[Ameer]
Maybe we should blur them out for the Protruserati, subscribers only. I’m joking. Everyone can-

[Jaz]
No, no, no. We’re good.

[Ameer]
I’m kidding. So, read up what you’re doing so you have some, I mean, it’s difficult because I don’t know how other people and for me, I need context. If I just read that book without doing the job, it wouldn’t mean anything to me. So I had those on me, and I would do an on call, then I’d go and read up on what I’d done and reflect on it and see what I’d done better, you know.

And the QE was very challenging because in UCL you had four consultants, so it’s pretty easy to remember how each one likes it. In the QE you have ten consultants who have very differing views on what should be accepted under MaxFax and how to manage the patients, how to clerk them, what they want. And you’re basically like a glorified secretary sometimes and going to Starbucks and getting everybody’s coffee and remembering everyone’s order and they’ll leave you, they’ll hang you out to dry as well.

I remember there was a debate within the department because it was like, there was a certain condition. I can’t remember what it was off the top of my head, but it was, some people were like, yeah, that should be accepted under Maxfax and other people were like, no, that’s not a Maxfax issue. So it was like five versus five.

[Jaz]
Potentially ENT realms or something like that.

[Ameer]
Yeah. Yeah, exactly. There was five versus five, and I was the idiot who they were like, okay, in the next Maxfax meeting, bring this up. So I put my hand up and I was like, hi, so like, can we just get some clarification on whether or not this is an issue. This is definitely a Maxfax issue.

And anyone who says it doesn’t is an idiot. I turned around to the other five consultants and they’re just sitting there, super silently, swiveling on their chairs and looking at the floor. I was like, okay, I see how it is, thanks. So, like, yeah, you’ll often be left hanging out to dry.

But like, no, I’m kidding around, but it was, again, that was a year that was very different to the UCL and Eastman year. That was pure Maxfax. And the thing is, you don’t get a lot of oral surgery experience in those jobs, because you’ll get like a list here and there. It’s not the volume that I got at the Eastman, so, like, it’s, they say that it involves oral surgery, but that is a pure MaxFax job, and most of the people who do that job want to go into MaxFax.

Now, you’ll get some, in my year, like, one person went into public health, one person went into Paeds, another went into orthodontics, and I think three of them said they were going to do MaxFax, but two ended up doing oral surgery, and only one of them ended up actually doing MaxFax. A couple went to medical school, but dropped out soon after.

[Jaz]
It sounds like no one went into general practice then.

[Ameer]
Well, I guess you could say I did, in a way, even though I’m very specific in what I do in general practice.

[Jaz]
I mean, you’re talking about the DCTs, or you’re talking about the registrars. Obviously, if you’re talking about registrars, then obviously it makes DCTs interesting.

[Ameer]
The DCTs, yeah. I mean, I’d be very surprised that the registrars went that far and then didn’t continue.

[Jaz]
Exactly. Then I knew it was just clarifying that really no, no DCTs went into general practice. That’s great.

[Ameer]
In my year and in QE, everyone was quite like fixated on becoming a specialist. So, like that job. No, I’m sorry. I’m making that up. I can think of three people who did go into general practice. Sorry, I made a mistake. Three people did go into general practice.

[Jaz]
Waving the flag for general practice, but before you could continue, you mentioned about having different consultants and like learning about their different temperaments, if you like, and their styles and that’s very important.

You know what that reminded me of in the general practice? Well, that reminded me of our nurses. Our nurses that have to keep adapting to a different dentist. That’s a tough gig. So I always just want to say shout out to our nurses. They do a really tough job, right. And to have to adapt their style or adapt to the different dentist style, it is very dynamic and very difficult. So it’s one just reflection I want to put in there actually.

[Ameer]
I’ve often said to principals and other dentists who have been a bit short with their nurses, that I can really relate to them because you’re kind of like a dental nurse to the registrar in surgeries and things. And I think dental nurses, along with therapists and hygienists, are some of the most under appreciated members of our dental team.

And that we wouldn’t be able to do our job without them, and the best dentists are, their backbone is their dental nurse. If you look at the most amazing implant surgeons and things who travel around the country, they will travel with their dental nurse because they’re an invaluable partner in providing the treatment that they need.

And from everything from greeting the patients to obviously like making the treatment happen with you, presenting treatment plans to patients. And what you have to remember as well is they’re the ones who are taking the patient into your surgery and walking with them to the reception desk.

And they’re the ones who are going to seal the deal when you’re presenting treatment plans and things to the patients. So I think people really need to appreciate their nurses. And I think practice owners need to invest more in their nurses as well. But yeah, there definitely needs to be a big change.

[Jaz]
And the second, I totally agree. And the second thing you said there, which I want to highlight was the whole thing about if you go for a pure maxillofacial post, then you’re right. That actually the oral surgery experience may be less than therefore. One of the reasons I outlined earlier is that you go in to do a maxfax post because you want to improve your exodontia. And really what I’m hearing is that probably that’s not a great reason. What do you think?

[Ameer]
Let me tell you a few stories and put things into context. When I was, I’m jumping back and forth in the timeline here. So let’s go back to UCL. It’s December 20th. And I’m doing the TTOs, the take out drugs for a patient, that’s what you call it when you discharge a patient.

And there were two patients, an Indian guy and a Pakistani guy in opposite beds. They both had the exact same surgery, hemiglossectomy and neck dissection. So that’s where you remove half of the tongue and you do what we call a radial forearm free flap where you take a portion of skin from the radial part of the arm and you basically plummet into the neck, and that portion of skin becomes the new tongue.

They both had this exact same procedure, and the Pakistani chap was being discharged. And the nurse comes over to me, and she’s patient in bed 12 doesn’t look so good. Okay, I’ll be there in just a sec. Next thing I know, the crash alert’s going off, so I run over to the bed, and this guy’s just leaning forward, vomiting dark red blood, does not look good at all, so I’m leaning him forward, just trying to see what’s going on.

Is there a bleed? Next thing I know, his eyes have rolled to the back of his head, and he’s on the bed. And I’m doing chest compressions and the nurse is trying to clear his airway, the curtains are drawn, we’ve put the crash call out. At the same time, I learned later, there was a pediatric cardiac arrest, and another cardiac arrest in another part of the hospital.

So for about ten minutes, it was just me and these two nurses, life support on this guy, and then finally the crash team shows up. And I think we tried to resuscitate him for about 40 minutes, which is a lot longer than you’d usually try.

Unfortunately, he passed away. He’d suffered a major bleed as he’d swallowed a lot of blood and inhaled a lot of blood. And the saddest part of that was his family arrived to collect him thinking he’s had his surgery, he’s gone through all this and they’re taking him home. And instead we had to tell them that he’d passed away. And he had a daughter who was pregnant. Sorry.

[Jaz]
I appreciate you sharing this man. I mean, these stories, these experiences are very real man.

[Ameer]
She was pregnant and they hadn’t told her that he had cancer. Sorry.

[Jaz]
Please don’t be sorry, man. You’re tapping into that state, that time, that memory, which is a very tragic memory.

[Ameer]
Yeah. They hadn’t told her that he had cancer because they were worried about her being stressed during the pregnancy. And him and this other chap had become very good friends, because they’d gone through the same thing, recovering together. And that guy died in my hands, I was covered in his blood. I was just sitting in the UCL, it’s a very tall building, I was just sitting in the staircase for hours afterwards, just. Sorry.

[Jaz]
Oh, please don’t apologize, man. I’m so sorry. That’s very tragic.

[Ameer]
And thank God the Indian guy, recovered, was discharged, cleared. But, I think it’s that 50 50, you are on the edge of life in these situations. So it’s not, you’re not on work experience, you’re not dealing with minor things, you’re dealing with major things and you see a lot of things. You see patients who decline to have treatment and then one lady a young girl, 17, left a tumor, didn’t want to go through the surgery, then changed her mind after, when she changed her mind it was too late. So she was brought into the ward, they just made her comfortable. She was there when we walked out of the hospital, and she was gone the next morning when we walked back in. You know? You see some crazy stuff. When I go back to the QE, I’ll tell a few other stories, but-

[Jaz]
I mean, I just wanted to say that I remember this experience whereby I was making a complete denture for this gentleman, really sweet man, and I’d seen him for the impressions both times. I saw him for the wax jaw reg.

I saw him for the try-in. So I think, I’m going with this by the time I got to the fit appointment, he didn’t turn up. I was like, huh, very common in hospitals, the patients in dental hospitals, for them not to come up. So I said to the receptionist, hey, do you know why this guy didn’t turn up?

And she had a look. And even this receptionist, she was shocked. She was like, oh my God, it says deceased. And I remember how bad I felt. Right? Just in that, I can only imagine what you would have went through, man. I can only imagine. I was really in a sad mood that day, so that I couldn’t fit this guy’s denture.

Not because I want to fit the denture, because I felt like, wow, man, I had a relationship with him, and he died mid treatment. Like he was almost there to having his teeth cut, and I felt so bad. And so the story you describe, again, goes back to that thing, perspective. Right? It goes back to perspective and what you saw, if thick skin comes into play, makes you have thick skin, it makes you experience these things, which is a real shame, but it’s part, it’s a reality of that post. You are pretty much a doctor when you’re doing that kind of post. So thank you for sharing that, that story with us.

[Ameer]
Sorry, but I went off on a tangent and you were asking about oral surgery. You will see anatomy that you have only seen in textbooks. And again, it will lend perspective when you are sectioning that wisdom tooth or creating a trough to, or even if you’re interested in implantology and developing into bone grafts and for large things, again, you’re getting this perspective that you just don’t get.

You will see it over and over again. People are paying thousands and thousands to go on cadaver courses and things and just for a little taster and you’re immersing yourself in this and it gives you that confidence to raise flaps, to do surgery to work with hard tissues. So, that’s the benefit of MaxFax, even if you’re not doing oral surgery.

It’s a live anatomy demonstration every day in front of you, and that’s so valuable. What I’d say is this, go for the restorative and oral surgery posts in the first DCT. And then if you want even more, then do that Maxfax job in your second DCT. They are different, but Maxfax, in my opinion, is still worth doing, even if you’re not interested in Maxfax as a career.

That’s what I’d say. Yeah, honestly, there’s so much to say about that, but I’ll stick with the QE stories for now and log everything. What I’d say to young dentists who are going into the, them maxfax jobs, is log everything. Log your facial lacerations, your biopsies, any interesting patients you clerk.

If you do get to reduce a mandible, log, log, log, because that’s going to be your calling card when you do apply for everything. Jobs, Tier 2, or, I mean, I was applying for Tier 2 oral surgery registration, and the things they were asking for, I actually had to go back to the secretary’s office at the QE recently, and say, can I please have all my letters that I did my biopsies for, because I need, I forgot to log them, and luckily they let me do it.

But yeah, so log everything, and work as a team, because I’ve been in good teams and I’ve been in crappy teams and the good teams all thrive and work together and the crappy team’s very individual and it becomes a lot harder. My QE team, we were like a very solid family. Everybody got on well.

We were all there for each other and it was a very solid team. What I noticed about the year group afterwards when they were all very individual, which isn’t a good way to be, I stayed on a little bit to kind of shepherd them in. I locum for about a month. And I remember one girl, she was really stressed out about the job, so I was like, okay, come over for dinner, I’ll make a steak, we’ll sit down and I’ll talk you through it.

So she comes over and we’re in the kitchen and I’m making this steak and having a couple drinks and then she turns to me at one point and she’s just like, why are you being so nice to me? I was like, huh? Why are you being so nice to me? And I’m like, I don’t know, I’m just like, I like to help people.

She’s like, yeah, but like, you know I want to do oral surgery as well. I was like, yeah, and you wanted oral surgery. So we’re like competing, you know that right? I was like, I guess like and it’s such a strange like attitude to have so don’t be like that Like everybody there’s room for everybody in this profession We can all help each other and like just we’re stronger together. So yeah. Go watch a Planet of the Apes film. Apes Stronger Together.

[Jaz]
I think that’s great what you said. I think everyone needs to remember that cause you can get carried away in the competition when it comes to specialist training there. So on that note, do you think it’s possible to have a social life and do a full on Maxfax at the same time?

[Ameer]
Your social life will be your Maxfax team, that’s it. Like, we used to hang out together afterwards, go out for dinner, organize our socials. So yeah, most of your social life will be with that team, because you have no regularity in your week, and that’s another issue. You, my ex, I’ve still got the 20 kilograms I put on during that QE year, because my night, I’d go in in the morning, I’d get my Costa, and then I’d have another Costa after the ward ran.

And then maybe one before the shift ends. And then you’re up all night. And you’re just stuffing your face with sugar and caffeine to keep you going. And it’s very unhealthy. And that’s the other thing. My sleep pattern is still f*cked up from all the night shifts I was doing. I mean, there was more.

I’ll tell you about that later on. But I’d say try and try and be kind to your body. And it’s very difficult. But there will be long term effects on your health after doing a job like this, so that’s something to bear in mind. But social life is difficult when you’re doing Maxfax and that’s why it’s important to do it while you don’t have children and other commitments and things.

I’m not saying you can’t, but there’s two issues with that. One, the pattern of the job. And you’ll have, like, a rota that is an eight week rotation, so week one is, like, eight till eight on cult, and then week two is one eight till eight, then theater, nine till five, which never finishes at five, and then another eight till eight, then you’ll have the weekends, and then you’ll have night shifts, etc.

And then you’ll have days off to make up for the night shifts and this is the work pattern and it’s a bit crazy. So it’s very difficult to say like, oh, Tuesday is taco night. Tuesday is not taco night. Tuesday is you don’t know what Tuesday is going to be.

[Jaz]
I’m more of a chippy Tuesday kind of guy myself, but okay.

[Ameer]
Yeah. Okay. So yeah, you won’t have any regularity in your life during those years. But like you said, it’s a season, you go through it, you do it, and then you leave it behind. Yeah. So it’s part of life.

[Jaz]
I’m very inspired from everything you said at the beginning. It was like kind of the people who are listening, watching like, hmm, yeah, I’m not convinced this is for me, but then you made some great points at the end about why we should consider it.

And I think the strong recommendation you made is that actually you should do it for all the reasons said it is enriching. It will help you. It’ll give you that perspective. Like you said, in the interest of time, my friend, I have time for one more story, one more story, and then I’m going to ask you for a Protrusive Dental Pearl that’s going to feature at the beginning of the episode. This could be a clinical tip. This could be a non clinical tip. It could be anything. It could be related to this episode. It doesn’t have to relate to the episode.

[Ameer]
Don’t believe your own hype. That’s a low, actually. Let’s start with a low. Don’t believe you’re on high. Now, like, you are going to think you’re the bee’s knees and you’re like some sh*t, and these guys will put things into perspective for you, and also give you an ideal to live up to in terms of the way you operate and the way you act.

And you have a lot of dentists these days who’d want to be celebrities immediately. MaxFax really, like, gives you perspective in that regard as well and slows you down and you realize that there’s a lot to achieve and that can be achieved, but you got to take your time and do it the right way.

So, that’s one thing. I’ll tell one more interesting case. I’ll tell everyone about one more interesting case. That kinda summarizes the MaxFax experience. So I’m on call, it’s middle of the year, I think, and I get a call, and they say, okay, we got a kid coming in, and he’s been involved in a bar fight, he’s got what we think is a retrobulbar hemorrhage.

So, obviously Maxfax is the first protocol. Now, the retrobulbar hemorrhage is when you have a bleed behind the eye. The issue there is, one, risk of blindness, and two, risk of pressure being applied on the abducens nerve, which can then throw off, throw an irregularity into the patient’s heart rate and precipitate the heart attack.

The way you treat this is with something called lateral canthotomy, which is where you make a cut, generally above it to the side of the eye while depressing the eye to drain blood from around the eye and relieve this pressure. And this is a very technique sensitive procedure. I call my registrar and I’m like, this dude’s got a retrobulbar hemorrhage.

He’s like, okay, do a lateral canthotomy. I’m on my way. The registrar’s aren’t in the hospital. They live there at home. They’re off site. Okay, I haven’t done one. Okay, ping. YouTube link to a lateral canthotomy. I’m in the lift, going down the hospital, watching a YouTube video on how to do a lateral canthotomy. And I’m just like, what the hell, so.

[Jaz]
Oh my goodness.

[Ameer]
So I’m going down, I go down to the A& E, and they’ve got like the major trauma area. Go in there, and oh man, this poor kid, I see his two cousins on the floor, like, just with their head in their hands. And basically, this guy, he was studying in America, and he’d come back home to see his family for, it must have been Easter or something, like, the night before he was flying back, his cousins had convinced him to go out for a drink with them on his last night.

He does. A brawl erupts next to him, and someone just catches him with a bottle, and his face is just covered in glass, his eyes just bulging. So, thank God the registrar arrived before I had to do lateral canthotomy. He arrives, we anesthetize his eye, well around his eye, and he’s screaming and the nurse is like, do you have to do that here?

And if we don’t do it here, he will lose his eye or die. So yes, we have to do that here. So he, must have the Reg does the lateral canthotomy. We drain the blood out. By that time, the CT report comes back, and he actually has a shard of glass embedded in his eye, so he’s losing the eye anyway.

And then his parents come, and we have to, me and Westerfield take them to one of the side rooms and explain that their son, he’s a good looking guy. I mean, not that that should count for anything, but he’s a shame. He’s a handsome boy. And we have to explain that, your son, he’s once scarred for life across the side of his face and he’s lost his eye as well.

And then, my dad is a doctor. He’s an A& E doctor. And he is so annoying because everything me and my sister do is like, careful, be careful. But, be careful. Are you opening a fridge? Be careful. You’re crossing the road? Be careful. And I used to be like, why is he like this? And when you see the stuff you see in MaxFax, I’ve seen gunshot wounds, I’ve seen machete attacks. Those are like, attacks and fights. But then you see all kinds of little accidents. I mean, we all find ourselves in a bar, we’ve all been next to a fight. Could happen to any of us, it’s scary.

[Jaz]
I’ve seen some crazy ones. I used to work in Sheffield in a bar and I’ve seen some really nasty stuff. Lots of blood and stuff. So I’ve seen that and you’re right. And you know what you reminded me of? My wife reminded me of your dad because she’s on a Maxfax in Sheffield. And she had to stitch up lacerations on children. And she’s so overly cautious with our children. And I actually forget that actually she did that maxfax I suppose.

[Ameer]
Yeah, well that’s my daughter. I’m so nervous, because I’ve seen so many, when I worked in Cornwall, and I worked there for in Maxfax a little bit, but so many little foals and things, and that a little kid, I stitched his ear up, he couldn’t go, I can’t remember why he couldn’t go for GA, he was so brave.

Cornish kids are built different. He’s just holding his dad, three year old, and I’m anesthetizing his ear and stitching his ear and cartilage and everything back together and while he’s waiting, he was such a good boy, he just sat there, quiet as a mouse, and just let me do it, he was so, I was really impressed by him, but anyway, so I’m off in the tangent, and so we’re telling these parents about this, and, they’re very stoic, and they’re holding it in and then they go to the boy’s bay.

And the mom just collapses on the floor on her knees. So, why am I telling the story? You’re going to see extremes, and it’s going to put dentistry into perspective. So, like I said at the beginning, MaxFax puts dentistry into perspective. So, if I was going to quickly reel off why people should do MaxFax to summarize, you’re going to build resilience.

You’re going to earn that doctor title. Not that you haven’t just because you haven’t done Maxfax, but I’m just saying like you realize you realize you are a doctor, and you can be a doctor and I always say this. I always say when people say, oh, dentists aren’t real doctors.

A doctor wouldn’t last five minutes in a dental practice, and hundreds of MaxFaxSHOs around the country are proving that a dentist can survive in a hospital because we have that base knowledge. We are specialists. We’ve just come to the chase. So, that’s the second point. If you want to do specialty training, MaxFax always looks good on a CV for a variety of reasons, including the actual, the curriculum of practicing MaxFax, and you will just get an appreciation of anatomy and physiology, and it really reinforces that extra stuff we do, the pharmacology, the physiology, then full body anatomy. So it’s definitely worth doing. And you just don’t know where your career is going to take you in the future. You might think you’re going to do one thing, then you’ll want to do another.

And this is always going to be that baseline. And you’re working with the best surgeons in the world at the end of the day, like the MaxFax consultants, whether or not it’s they’re dickheads are really nice, whether or not they have an ego or they don’t, they are the best at what they do. They’re the most, it’s the most exciting area of medicine and dentistry and you get to experience that.

And I think that’s definitely worth doing when you have the time. So, we could do a part two on this or whatever, because there’s so much to say. And if anybody wants to talk to me about it. I’m happy to discuss it with people, and there’s so much I’ve missed out because there’s so much to say about it.

But I really enjoyed my MaxFax years. I look back at it fondly. I don’t regret doing it at all. And if I had the energy to do it again, I would. It was so much fun. I didn’t do MaxFax as a specialty. A lot of people told me I should because I was a good SHO, but my dad told me not to do medicine because the night calls and everything like night shifts, but then he told my sister to do medicine. And now my sister’s like, well, I’m a real doctor. What are you a tooth doctor? No, but it’s sorry. One last thing. One last thing. Just, I’m sorry. I know I’ve gone over time.

If you are interested in sedation or PRF or anything like that. A skill that you will get in Maxfax that you can’t get anywhere else is cannulating. I’ve mentored so many sedationists and they know the drug well, they can titrate well, they can manage patients who are nervous, but the most important part of sedation is getting that cannula in, and that’s such a fine skill that you can only pick up when someone’s called you at three in the morning, all the cannula sites are exhausted, and you’re down there with a crusty foot trying to find a vein to put a cannula in or draw blood to get some ABGs or VBGs and you’re only going to get that in the hospital. So another tip I’d give to anyone who’s going to do Maxfax, who’s thinking about it, is when you’re doing it, follow the phlebotomist around on their bleeding wards. They are the most adept at doing that at getting veins. And you will get good at it. That’s what I did on the phlebotomist came around. I said, can I please, I had some time. Can I please come with you? And I’m pretty good at finding veins in our UK sedation team. I’m the vein guy. So it’s you’re going to get that skill in hospital. So, yeah.

[Jaz]
This is the second time you’ve mentioned on this podcast whereby you took it upon yourself to start following someone. Like for example, back in dental school, you start to go to all the surgery people you went, you follow the phlebotomist. I think that’s a real trait, a real great trait that you have.

Yeah. And I think if even a few people listen to this and think, you know what I’m really more like, Ameer, that attitude that you have, then I think no one wants to be more like me. That’s a real great thing. Of course they do, man. Of course they do. You mentioned about people reaching out, which is, I always welcome that.

Yeah. I think is great for people to learn more from our guests and stuff. What’s the best way to reach out to you?

[Ameer]
So, Instagram is DrBocus, D O C T O R, B O C U S. That’s the best place. Follow me on there and send me a message, I will get back to you. Since the last podcast, quite a few people it was weird, one guy walked out of his surgery, because I was operating in another surgery, and was like, are you Ameer Allybocus?

Yeah. Oh, I heard your podcast with Jaz Gulati and I was thinking, I’m kind of a big deal now. Like people, I’m a known person and he was like, yeah, your voice just puts me to sleep, man. Like I nearly fell asleep while I was driving. Okay.

[Jaz]
Thanks dude. Holy moly.

[Ameer]
Anyway. So I’ve mentored him now for sedation and and oral surgery as well. And so, and another chap who say this is a guy who graduated abroad. Wanted to get into oral surgery and develop those skills, so I sat down with him. We went on the NHS jobs website and I spoke to the team in the Royal Cornwall Hospital got him a job there I mean he got the job himself. He interviewed for it But he’s having a great time there now developing his oral surgery skills.

So I’m Here for younger dentists who do want to reach out that are students. And if you just want some career advice, not that I’ve done it the right way, but I’ve done it my way. And if you’re interested in that, just let me know. And I’m happy to give you some tips and tricks so you don’t make the same mistakes as I do. And if, and maybe you’ll do some of the things that I did that I’m happy about. So.

[Jaz]
And guys, if you play your cards right, maybe he’ll invite you for a steak. Very good. That’s fantastic. I also want to just say, I don’t know if you know about Intaglio, something that we’re working on, we’re developing stuff to make this mentoring platform. It’d love to have you as a mentor on there for people who want to reach out for sedation. Obviously you do a lot of this anyway, but if you have any capacity, we’d love to have you on there at Intaglio.

Ameer, thank you so much. Honestly, it’s been absolutely fantastic. So the stories, the emotions, everything. I’m going to leave this as one big, long episode. Actually, instead of cutting it in two, I just think that it captures, people can just do it over two commutes, but I appreciate your time. I appreciate your stories. Appreciate your wisdom. Appreciate experiences. The highs and lows, everything. Thank you so much.

[Ameer]
And what I’d say is, get some more people on who’ve done MaxFax. Because when you sent me the questions you wanted answered, I asked all my friends who’ve done MaxFax. What would you say? And everybody had such unique experiences in hospitals. They were so different. So what I’d say to people is reach out to people who’ve done MaxFax and they’ll have a lot to say, a lot to say, a lot to say.

Jaz’s Outro:
Well, I certainly wish I had something like this when I was at that stage just after done school to get some guidance or a flavor of what to expect. I think this has been absolutely fantastic.

Wow. There we have it. I mean, thank you so much for getting to the end of that one. That is a long one. That’s a really special one, but I hope you gained a lot of value from his stories. I want you to reach out to him in and tell him, well done and, and thanks for making himself vulnerable, some of those sad stories. I mean, it reminded me of some of the sad moments I had with patients, but man, I have a new found respect for anyone who’s done MaxFax. I always, always did, but even more after today’s chat with Ameer, I’m hoping maybe you’re feeling the same. Maybe you’re thinking about going into MaxFax and maybe this is giving you some answers that you need.

I was worried that perhaps after this episode, you wouldn’t want to do MaxFax anymore, but I do think that Ameer obviously made it very clear that he does recommend doing such a post because it kind of is like a once in a lifetime experience. It’s your journey as a dentist. This episode is eligible for CPD.

So there’s 90 minutes of CPD to be gained for this episode. The way to do that is by answering a few questions in the quiz. This quiz lives inside our app. It’s called Protrusive Guidance. Now you can access Protrusive Guidance on your laptop, on your browser. You go to www. protrusive. app, or if you want to access it on your iPad, Android, iOS, using the native app, you can download Protrusive Guidance and if you have any of the paid plans, you can get CPD.

For those who are looking for CPD in terms of webinars, mini courses, even like extraction, sectioning school videos, that’s all available on Protrusive Guidance. And even if you just join for free, we have such a wonderful community of dentists. It’s the nicest and geekiest dentists in the world.

So that website again is protrusive. app, or you can download it from the iOS store or Android store. Now, there were a few book recommendations, so I’ll put them in the show notes. And I’d like you to do me a favor. If you got to the end of this episode, obviously you got a lot of value for this episode, so please share it with someone. Share it with someone who’s considering MaxFax, who maybe you did a MaxFax post with, and you want to send this to them because you want to, like, reminisce about your times as a maxillofacial DC.

Maybe you remember some stories or some consultants, and you want to share these memories with a colleague. Well, make sure you share this episode with them. I hope that was good insight for everyone, and I hope to catch you same time, same place next week. Bye for now.