We're gonna jump in right now and get started. Again, my name is Sheela Roth. I am head of clinical education here at Pearl, and really thankful you chose to spend your evening with us.

When we think about growth in dentistry, it's easy to get caught up in marketing, production, those kinds of daily goals. But let me ask you this — when was the last time your patient said yes to treatment simply because of a sales script? Right? More often than not, what actually moves the needle is trust, and your patients trust you — trust in the team, trust in the doctor, and trust in the care they're receiving.

And that's exactly what tonight's session is all about — how we compare that human connection with modern technology to create exponential, scalable growth in our practices. When we think about case acceptance, and we think about what our patients see compared to what we show them on a radiograph, there's a big disconnect there.

I'm honored, excuse me, to introduce our speaker, Doctor Jennifer Durst. After graduating from Marquette University School of Dentistry, she built her career around restorative and cosmetic dentistry, first in Scottsdale, then in Denver, changing thousands of smiles across the country and internationally. Today she serves as the chief clinical director of Aspire Dental, where she mentors doctors, guides patient experience, and leads clinical growth across multiple practices.

She's also a mentor at the Kois Center, has lectured internationally on cosmetics, restorative dentistry, aligners, and case acceptance. I can't even keep going here — Doctor Durst continues to raise the bar on leadership and hospitality in dentistry. Beyond the practice, she is passionate about being involved in her community, launching — tell me about this foundation tonight, we wanna hear about this foundation — to expand access to care and support local nonprofits. So you're gonna get into that. She brings a combination of clinical excellence, leadership insight, and people-first philosophy. Today she'll share the blueprint on how empathy, clarity, and technology can unlock new levels of patient trust, and that's really the foundation of overall scalable growth.

Without further ado, Jennifer, thank you so much for being here.

Thank you so much for having me, and thank you all who are watching this evening for investing your time and energy after work into yourself and your practice. It really is a pleasure to be with all of you, and hopefully you'll find this next hour to be inspiring and full of opportunity for your practice. My favorite thing to show, besides the awesome, cool cases that we get to do, is really our failures. And after twenty years in — and I've done a lot of Botox — over twenty years in this field, and especially the last five as the chief clinical director, where you get to see so much more of what everybody's doing, it's been great to see the good, bad, and the ugly. But failure, the bad and the ugly, it sucks to experience. But if we didn't have these situations, sometimes we wouldn't learn and grow if we didn't have something that felt uncomfortable.

So hopefully you can sit back, relax, have some wine, beer, or a soda. I know, really corny. And, you know, learn some pearls for your practice this evening. We'll get this techno party started.

Love that. And just, sorry, was gonna jump in one more time real quick — people are asking questions about, is this gonna be recorded? Because they wanna share this with their team. So I wanna make sure everybody does know this will be recorded. Your CEs will be at the end. And a special thank you and shout-out to the Sota team for joining us this evening. We're partners with them, and we also will be hearing from the director of sales, Doctor Scott Cote. So we look forward to seeing you at the very end.

Thank you for that. I'm — I'm not a doctor, but I appreciate the intro, and I appreciate the opportunity to be here this evening.

Yeah.

Thanks.

Well, you know, you all are what makes evenings like this possible. And so, you know, after you experience this webinar, if you haven't gotten to connect with these partners this evening with Sota and Pearl, please find a way to — I don't know, Sheela will tell you how to do it — but connect with them afterwards and do a lunch and learn or explore it more. I highly encourage you to do that.

Alright. Giddy up, let's go for the evening. So, agenda for tonight: we wanna build our exams in a way that's gonna boost our patient confidence. We're gonna use technology as a translation tool, and we're also gonna include our teams in this process. This evening is designed to be for the entire team — it's not just doctor-only, it's for everybody. It's for hygiene, it's for assistants, and even, you know, on your business team, you're gonna wanna understand how to use these X-rays, whether it's for insurance reimbursements, or — we all know that even if you're not on the clinical side in the back, patients will still come up to the front and ask you for more clarification. Hopefully not — hopefully your clinical team has gotten it all covered, but it's important for us to all understand and know.

And before we get started, we have to have these disclosures and disclaimers for you to be able to get CE. So, full disclosure, I am the chief clinical officer and an owner at Aspire Dental. I do not have any financial interest in our partners this evening. The commercial support for this program is being delivered by Sota and Pearl. All the clinical procedures, methodologies, participants — you can read this all, it's pretty much there, I won't waste time on it, but screenshot it if you need to dive into it more.

Alright, what's the common theme? If you look at these four photos, ask yourself — because, you know, it's not that you've got Matthew McConaughey, it's not that everybody's really attractive, because you've got the used car salesman who's not. What is everybody doing? You've got Matthew McConaughey in a movie persuading a jury. You have the used car salesman trying to get you to buy an old car. You have a teacher teaching math to elementary students, and you have a personal trainer. You've gotta think, Jen's gotta be really ADHD — and, full disclosure, I am. So I look at all of these, and I see that there's a common theme. All of these people are trying to persuade another human of something — whether they're persuading the jury, they're persuading a sale, they're persuading fitness, they're persuading the brain growth of math. They're all persuading something.

And when we talk about what we do day in and day out, there's this discomfort that people sometimes share, where they say, "I don't wanna be a salesperson, I don't wanna sell dentistry." But if you really look at the definition by the Oxford Languages dictionary, selling means to persuade someone of the merits of. So before we get started, if some of the things that I share with you feel like they might be a selling tactic, it's really a tactic to help you persuade somebody of the merits of whether it's diagnosing or treatment. It's to help you in that process. And persuading somebody to do something to take care of their body and their health is a great thing.

Let's start with our patients' brains and our brains. When you think of "mind," and I give you a mental image, like "flying pigs" — what do you see? Do you see the words "flying pigs"? Unlikely — you're probably seeing pink pigs in the sky with clouds, and if they're flying, maybe they have wings, and they're probably smiling pigs because, you know, they probably think that's really fun. Unlikely you would ever see that word written out. So in dentistry, we have to understand the neuroscience and how our brains are hardwired for our patients to give emotions the upper hand. Everything you see, smell, hear, taste — all your five senses — travel through your brain, and they enter your brain through the spinal cord. And as they enter your brain through the spinal cord, they have to travel to get to the frontal lobe. But in order to get to the frontal lobe, they have to pass through the limbic system, where your amygdala is.

Now think about the amygdala, your limbic system — I feel like the word "amygdala," I can't even say it, it sounds like a lizard, or it sounds like a dinosaur. So, you know that is your core fight-or-flight brain, and that is also where your emotions are produced. The rational area of your brain, your cortex, way over there on the right side of the screen, is where you have your logic, and your signals can't get to your cortex without passing through the feeling system, the limbic system, your fight-or-flight state. And if you really think about our patients, patients come in most likely in a state with elevated cortisol, which puts us in that fight-or-flight state — it's how we've survived as humans — and they come into our practice in that space. Getting to their cortex requires effort and intentionality, especially when you're in that limbic "dinosaur brain." So our job is to help get our patients into their cortex, right, and help them get out of fight-or-flight and into their cortex.

Patients also don't buy a solution to a problem they don't perceive themselves to have. Think about periodontal disease — I'm gonna show you an example with my mother-in-law, who had a periodontal issue, but it never hurt. She didn't feel it. And how many times have we seen that with patients who suffer some type of bone loss, and they never know it's there? So why would they move forward with care if they don't understand it?

And why are we here all together tonight? Well, my hope for you, and hopefully for yourself, is that at least one of the pearls you get today helps you with case acceptance. And if you think about how 40% of most jobs are spent convincing and influencing others, all of you are in that space, convincing and helping others.

So how are we gonna do it? I'm gonna say the why, but let's talk about the how. Let's get this information that you are selling health when we treat — and create case acceptance, create an opportunity for you to really care for your patients while also, fortunately, growing your practice. How are we gonna do this? The first thing we need to do to get our patients out of that limbic system is to get them into this space of psychological safety.

Now, patients need to believe that they are equal in the conversation. That's a really important part of psychological safety. To me, when I was practicing, I almost wanted to have my patients feel like they were a little bit more the expert. Even before we get down to talking about the dentistry itself, I want them to feel like they're an expert. "Tell me about your career. Tell me — that sounds so fascinating, I wanna learn more about that" — because I'm taking them out of that fight-or-flight state into their cortex, where they're feeling confident and intelligent and sharing something with me. Then I also wanna make sure they do not feel penalized or judged. We wanna validate some of the good things that are going on in our patient's mouth.

I like to use the analogy of a forensic accountant, because sometimes we go in just like a wrecking ball, like Miley Cyrus, and we're looking for everything that's wrong. That's our job — that's what a forensic accountant does. However, if you come in like that wrecking ball, sometimes our patients will feel judged. I have seen enough reviews — we have a product called Birdeye that gives me the reviews of every practice, and whenever the review is seven or less, I get the email. And I will tell you, there are times when a patient writes, "I felt like the hygienist was judging me for not flossing." Whatever — they want to feel like they're a part of it, and you're pacing together. So you wanna start to explain once you get them curious — I'm gonna talk to you a little bit about how to do that.

You cannot create a feeling of safety, but you can be mindful of the behaviors. Be mindful of, you know, maybe your patient's DISC default communication style, maybe be mindful of their body language. There's so much that goes into this, but you wanna be really intentional. And remember, you're doing this ten thousand times a month, a thousand times a day, and the human being that's attached to the smile and the teeth — they have not.

I can't tell you how many times I've shown a patient X-rays and said, "What do you see here?" — and this is before we had Pearl — "What do you see here?" And they'd look at their FMX and go, "I see toes." Or I'd show them their smile and say, "Tell me what you see," and they're like, "Whoa, I need to wax my lip." The way they perceive what we're looking at isn't always the same, and it's rarely the same as ours.

So we have to remember that we are in the supportive role, where we wanna engage our patients more than educate them. We wanna partner with them more than parent them. And we can use technology to bring them into the conversation rather than confuse or overwhelm them. Because if you start using big terms and technology, and you're pointing at this grayscale that nobody understands, and they think the tooth looks like a toe — that's not gonna get you anywhere.

So let's learn how we're gonna bring them into this conversation. And this is off the technology beat, but before we go high-tech, I wanna go old school, a little analog. I can't harp enough on how important it is to call your patients before they come in for their first visit. Also, I'm a big advocate of post-treatment calls for everything, not just extractions, but anything down to just an occlusal composite. This human connection, empathy, and compassion immediately increases your patient's perception of your hospitality, your care, and increases their trust.

I'm gonna give you this verbiage — I used it for years. Every new patient that came into my practice always got a call from me. And I'd call and say, "Hi, this is Doctor Jen. I'm so excited to meet you. I wanna give you an opportunity to have any questions or concerns answered before your first visit with us. You can expect a thorough exam tomorrow, and we're gonna take as much time as you need to have all of your questions answered. If there's anything I can do to help you feel more comfortable before your visit here, please feel free to call me. Three-zero-three, three-three-three, two-two-two-one. I'm looking forward to meeting you and helping you achieve your smile goals."

Now imagine, put yourself in as a patient — imagine if you're going to see a spine surgeon, and it's scary to go see a spine surgeon (don't ask me how I know), but imagine if they call you to welcome you to their practice and reassure you that everything's gonna be okay and that they're there for you. Imagine what that would feel like for you, and now imagine how much that can increase rapport for you before your patient even comes in. And most of the time, they don't answer, so you just leave a message. And if you do get them, and you get the high-energy patient who wants to connect, well, now you know they're gonna show up. If they talk to you for fifteen minutes — and that's happened — you know they're showing up for their appointment, and you know they're gonna accept care.

So within these first moments, it's so important — people judge you within five seconds of meeting you, and they also will determine, fun fact, if they can trust you within one-tenth of a second. I'll tell you, I met another dentist this summer at a conference, and I met this dentist for less than one minute, and I was immediately turned off by their behavioral interactions. So I judged that person pretty quickly. Now think about what our patients are doing with us — they're scanning. They're scanning for safety, and they're scanning for anything that could be wrong. So this is really important — before you dive into your technology, you wanna form that, and then you get to triangulate the technology into the picture.

So how do we do this? Let's get in here. Let's have a verbal, knee-to-knee, heart-to-heart, eye-to-eye conversation with your patients. Make sure you make eye contact. If you are not so comfortable with that — I recently saw a reel from Esther Perel, who's a psychologist on Instagram, and she's an interesting person to follow — she talked about how, if you're in the younger generation where you've grown up more on devices and random conversations don't feel as comfortable to you, she recommends going through this exercise of getting in an elevator and talking to strangers. And the more you do it, the more comfortable you're gonna become with having random conversation.

Next, make sure, when your patient comes in, I want you to go out to where they're seated. Do not have teammates call their name from the door and yell out "Sarah" — that's not personal, it's not a warm touch. The patient is probably already checked in with one of your front office teammates, so ask who that is, and then go right to where they are, introduce yourself to the patient, and say hello. Offer them a tour of your practice. It's, you know, it's your home — if somebody comes into your home, you might say, "Okay, I'm gonna throw your coat in the spare bedroom, the bathroom's right there if you need anything, if you have a guest staying with you, help yourself to the fridge." We make people feel comfortable at home — let's make them feel comfortable in our practices.

I like to break the ice immediately with conversation. One of the phrases I use is, "What is the highlight of your day today?" And if this was a live audience, I'd ask you why — why am I asking you what the highlight of your day is? The reason I'm asking your highlight is I wanna take your brain scanning for something positive. And you're in my practice, and you're already scanning, and you're going, "Oh, I had a great walk with my dog this morning." So now you're having this little dopamine release, and you're sitting in the dental chair — so there is psychology to that. I made it up, but I think it's real.

Then you're gonna graduate into your dental history interview, and this is really, really important. When you have this conversation around the paperwork, focus on the "yes" answers. If there's a "no," don't go through the "no," because that's just frustrating. But anything they say yes to, ask for clarity — "tell me more about that." This is your opportunity to acknowledge all the information they provided, and I have seen in chart audits a huge opportunity — when you have that conversation, I'll read a dental history review and see that somebody wanted aligner therapy. That's what they came in for, and the doctor never talked about that. What a missed opportunity. And they might think, "Oh, you don't do this," and they're gonna go somewhere else.

We don't have time to totally dive into that process today, but I want you to know it's a big asset in your treatment planning and case acceptance armamentarium. So if you skip this vital step, here's how they would perceive the effort of filling it out:

"I like my doctor. The one thing that drives me crazy — every time I go, I have to fill the same form out. And I'm like, what are y'all doing with this form? Last time I said, let me take it home, I'll take it — I don't know if y'all have a fire here every night. I don't know any of the answers, and they're about my body, I have to call my wife and go through them. I'm like, have I had surgery before? They always ask what your family medical history is — where am I finding that out? You think I'm just at home at Christmas, I'm like, alright, who's got diabetes? Come on now, I got a physical coming up. How many heart attacks do we got in the room? He's great."

So if you avoid that paperwork and that conversation around their dental history — remember, you're a dentist, you've gotta acknowledge dental history — you're missing out. And also your patients lose trust if you don't go through that. You gain trust — it's a win-lose, you're either gonna win them over or you're gonna lose them.

So, you know, we're focusing on the radiographic concepts today and patient documentation and case acceptance, but your checklist absolutely needs to review the medical and dental history, recording vitals, taking extraoral photographs. I'll touch on that briefly, but I like to take a DSLR photo — or if you're not comfortable with a DSLR photo, there's a product that Showfoo has that's a camera, and you can just take your smile, your arch, a bite picture, and a face photo. These are really helpful for patient conversations.

Additionally, your full mouth series of radiographs — I am gonna point out why I think that is vital to your exam. Obviously, intraoral photos. You're charting your existing dentition — that all needs to be charted. Complete periodontal charting also needs to be charted on any comprehensive exam. You have to do this. I see a lot of missed diagnoses for periodontal disease, and the good thing about having AI is — well, I'll show you those metrics later.

So, FMX at every new patient exam, and then every three to five years thereafter, depending on the patient's risk. You also wanna be taking bitewings annually, and then including two to three anterior PAs. Just know that if you do bill three PAs, you might wanna write off one of them if the patient is an insurance patient, or just in general make that your always, because an insurance company will default to an FMX if you take three PAs with the bitewings. So we will code out two PAs for that.

But this is really, really key — and also, make sure, one of the things that I learned from John like twenty years ago, is to take time, slow down, and look at the X-rays in front of your patient. It adds show quality. If you only look at them in your back office and you come out in front of them and don't look at them in front of the patient, they may think that you didn't actually look at them. I think about every time I talked to a spine surgeon, they brought up my MRIs and went over them with me, and that's really important.

But I know what you're thinking — you're thinking, "Alright, I wanna do the FMX, and I wanna do these annual X-rays, but what if they say no to X-rays?" Ask yourself first — are you having approval addiction? Approval addiction is this condition where you don't feel comfortable with a person saying no. And sometimes we get uncomfortable around patients who are like, "I don't want X-rays." So we wanna learn to ask questions rather than jump to an immediate answer and get defensive — "Well, I have to take X-rays" — because your patient might not be fully informed on X-rays, so don't give up right away. Ask questions.

If the patient says, "I don't want X-rays" — well, before I go anywhere, I'm gonna say, "Tell me more about that. I want you to feel heard — tell me why you don't want X-rays today. Do you understand the purpose of X-rays?" I wanna know why. I'll maybe share a personal story, or one of the cases I'll show you today — I don't care if you screenshot one of these and share it with somebody. And then this final question: "If you have something wrong, do you want to know about it and fix it?" Because it's really tough for someone to say no to that. Once you have an awareness, I'll tell my patient, "Let's look through all of this, and let's have an awareness of what's going on so we can collaborate and decide together what pace you wanna do treatment at. It's up to me to give you all of the information, and then we can decide together what pace we're gonna play at."

Another one — this is really straightforward — but most patients don't understand that nowadays there's very little exposure. We aren't even required to wear the apron anymore, and you can offer that data and still offer to use the apron. Ask them, "Are you open to hearing some updated information on X-rays?" The word "open" is super key, because people want to be considered open-minded. So use that word "open" in so many situations — you'll hear me say that in just about any opportunity I have to teach and share with them. "You know, we've invested in these state-of-the-art digital X-rays — there's less radiation than you sitting outside in the sun, microwaves, flying, any of it. So if it gives you peace of mind, I'm happy to put a lead apron on, and we're gonna only take the necessary X-rays — FMX, necessary."

"I can't afford them" — now, this isn't something I wouldn't offer them complimentary at the initial exam, because then I'd be really concerned about the patient not being able to even move forward with treatment. But if this comes up at a recare visit, I do sometimes create an opportunity for them at no cost, because it's been a long-time loyal patient. But when you're having this conversation with a new patient — "I can't afford them" — "I know you're here because you are proactive about taking care of your health. I'm curious, is that still the case? Because I'm concerned if we omit these — they help me see what my eyes can't. We can move forward, and we can work together to prevent larger treatment, and that could potentially add more cost. And if you're concerned about affordability, it could actually backfire on you." And, you know, we've got stories to share about it.

So everyone deserves an FMX — and I say the word "deserves" an FMX because I really do believe they deserve that time, rather than just tossing a panel at them. And if you wanna add a panel in, I don't care, but that FMX provides you so much more clarity and detail. I've seen enough missed on the doctors that only take panels — like this is an example from a doctor that is no longer part of our team. And this is the chart notes, and he talks about there being a missing restoration on number thirty, so they're gonna place a crown. Well, what happens next? I'm gonna zoom in on this for you — oh, actually, I'm sorry, we've gone to the next patient. I want you to look at this closer, and if you can, on your screen, I'll pause for a second — zoom in.

When the patient came back in to get the PA that's necessary for their insurance coverage, they then saw the abscess that was on the mesial root of number thirty. So they missed the abscess at the comprehensive exam and then saw it later at the treatment. So they had to abort treatment, then had to switch to an extraction and bone graft referral versus doing the crown that was scheduled. And the patient was pretty upset — they actually left the practice.

This is another one, a doctor that's no longer with us. This patient — this doctor was adamant about just taking panos, for their radiation and exposure and to see everything. But what happens next in this story is that the patient came back with some discomfort two weeks later, and this was not noted at the new patient exam. I want to be clear that the doctors I'm showing you are all licensed providers — there's also hygienists in here that missed some of this, and some of them had two years of experience, some had ten, some had thirty. We all think that we are gonna catch everything, and that's not always the case. So please pay attention to this.

Here I'm showing you my mother-in-law, and this is pretty frustrating — she went and saw a dentist in her hometown, and I asked her if she saw a new dentist because her insurance changed, and it turns out she's gonna lose some teeth. She sends me her X-rays and says, "Jen, I want you to take a look at these — I'm not understanding why I'm suddenly experiencing periodontal disease." So she gets the X-rays and forwards them to me, and they tell her, "Well, yep, here's your panel, and here's your bitewings" — but bitewings are not a chopped-up panel. You can see the lesion there on the distal of number three and the mesial of number thirty — you don't see it as well as what the next dentist took with actual PAs. Look at the clarity there, and you can see why she's really, really upset.

So, more often, patients are undertreated than overtreated, and I hear doctors say all the time, "Well, I am conservative, I'm not gonna overtreat." When you tell me that, I'm actually a little worried that you're gonna miss something. Think about this — 43% of periapical radiolucencies on X-rays are undiagnosed, and 49% of caries are undiagnosed. If we rely on our naked eye for radiographs — and for some of you, AI — think about it, you're looking at grayscale. Our brains aren't even designed to read the amount of grayscale that a computer, that AI, can. So I'm gonna keep showing you some of these examples because I really want this to hit home.

Here's an example of another patient who was being undertreated in a practice with two really experienced doctors and an experienced hygienist. If you look at this image — this is all screenshotted right out of Sota — you can see this was taken in February of 2024, and the doctor and hygienist both saw this patient. Now, I will also share with you, when I log in to my software in Sota, it defaults me to the Riverfront location, so I don't want you to look up my Riverfront doctors and say, "Oh my gosh, you're missing stuff" — they're great doctors, it's not necessarily Riverfront, okay?

But let's zoom in on those pictures I wanted to show you — we can click on any picture here, and there's the little dots that show up saying there's the calculus, or decay, but Pearl says there's a lesion. So we open it up, and both the doctor and the hygienist missed that lesion — it was decay under number four and number twenty-eight. And what you can see in the smaller picture there, I highlighted with the arrows so you can see — when you turn off the AI, it's there. This patient went a full year, and then the second time the doctor saw them again, they missed it a second time. If they would have looked at the dots, they would have been cued to open it up and pay attention to what to look at, and Pearl highlights it. It's also highlighting not only the caries under the crowns, but also any notable margins — and you get to decide if you wanna keep an eye on that overhang, or if you think, "Oh, maybe that's just calc or cement, I wanna clean it up." You decide, but it's gonna highlight it to bring your attention to it.

So let's go to another example — this one had a few opportunities that were missed. You can see all the little dots that are on there. If you looked at the radiograph just on its own, I would have missed this — I know I would've said, "Okay, cool, really nothing to look at here, just looks like some lower incisors doing their thing." But then when we turn on Pearl, it highlights that there's maybe some bone loss and some calculus. The calculus is hard to see — maybe you can zoom in and see it. But then what I did do is I inverted the image, and then used the tools on the right to zoom in so I could add little green arrows, and that way I can screenshot that for my patient and for the insurance company to see. My RCM team or admin team can now have that image to submit, in addition to charting the bone loss and the measurements to the insurance companies, along with your intraoral photos.

So remember, they don't wanna pay you — the data that I saw in our UHC claims is almost 50% denials on the first claim. They are trying not to pay you, so the more evidence you provide, the better. So the ROI on investing in all of this is there, not only in you actually seeing the treatment, but also in your revenue cycle management. And then also, when the insurance company denies something, it does sometimes erode trust with our patients — they don't understand, they think, "Oh, is the doctor trying to scam me?" or whatever. So let's bring it full force and take care of our patients.

Here we're looking at the same patient, Ken, and then we'll go in closer. Here I'm just showing you, simply, that you can see some of the highlights that are showing up — there's an overhang being circled, and it's allowing you to make a decision. The same patient, the doctor placed the implant, and they were really excited about placing that implant — and I celebrate all of our doctors' successes, I'm proud of them, and they did a great job. But when I pulled up the X-ray and said, "Oh my god, this is so cool, I'm so excited to see it" — I was like, wait a minute, I don't see anything in the notes about the lesion on twenty-seven. Did your assistant turn off the AI when you came into the room? Did anybody look at the X-ray? You can't miss this, it's really hard to miss, so you have to stop and look at it. But the AI is gonna support you, and it's there, and there's no point in doing any of this if you don't look at it — don't take the X-rays and not look at them.

But when you have this big blue glob, there's also a great opportunity for you, as a dental assistant, to say — I know you don't wanna overstep, but say, "Hey, patient, the AI is reading something here, and I wanna have the doctor come in and confirm what's going on with that tooth. Are you noticing any pain or discomfort over there that I can share with the doctor?" Because now, when the doctor comes in, you have the opportunity to share that with the doctor. "Hi, you know, Sarah here — we noticed this lesion, we want you to take a look at it, it's showing up on the X-rays, but they also are noticing that they felt a little discomfort when chewing, and they just thought it was because of losing the other tooth, but maybe you can take a look at it."

Another example, and I promise I'll keep going here and get through this. This was my mom — the doctor was super experienced, a Kois mentor. We didn't have AI at the time when this was done, and they missed the apical lucency. My mom lives two hours away from me and was waking up in the night with pain, but she didn't wanna be a burden on us and on the practice. And, full disclosure, I wasn't able to take care of my mom because of my spine issues, so I referred her to another doctor in my practice, and they took care of her, and I trusted the process — I didn't even go in and look, and be controlling, like I normally am. And my mom was leaving for vacation, so I had to emergency get her to come down from the mountains, get the tooth removed, get her finger — situated. But there's obviously a lesion there, on the furcation and the apices of number eighteen.

So we have to ask ourselves — is failure to diagnose, or misdiagnosis, malpractice? Technically, yes. A failure to diagnose or a misdiagnosis can be a form of malpractice, and this is a common form, when the doctor fails to take the proper steps to diagnose a medical condition properly and correctly. These are three cases right here where periodontal disease was failed to be diagnosed and the patient was awarded. Now, one of those cases, the patient refused treatment and still won their case — the doctor actually recommended periodontal therapy, and the patient won their case. So, you know, Google those if you want. But remember, jurors are patient-friendly, they're not provider-friendly.

So what do we wanna record at our visits? We wanna make sure we're doing at least one intraoral photo. We're gonna at least do bitewings and PAs annually, and, yes, a full mouth series every three to five years, depending on risk. Now, when you see a new patient, think about — everyone is gonna design this different for their practice. What do you want to do? Do you wanna do your X-rays because you're doing those annually? Will you perio chart again at six months and then alternate them, or are you gonna do your perio chart and X-rays every year and then do an intraoral scan? You figure out as a team what works best for you, but make sure you create a system and a cadence for that.

And if you're incorporating intraoral scanning annual visits, that can show a big picture of decay, fractures, wear, all this — it's just more tools to have in your armamentarium, and a way for patients to process this. So if you haven't integrated AI into your practice, it's time. Our practice, we use Pearl, because it's integrated right onto the Sota platform, and that was really important to me — I did not want my team to have to open up another window. That was our original reason for going forward that way. And what is also really great about the AI tools is that your patients can now visualize — you can do the tooth colors and show your patient the calculus, show them the decay. This doesn't look like tools, this looks like a pretty watercolor. So you can show them and say, "Are you open to seeing what I see? I'd love to share with you so we can decide together what's going on and how to move forward with treatment."

And I will often say — I feel like sometimes, and they're probably not gonna like that I say this, but it even underdiagnoses the bone loss more than overdiagnoses it — it measures what it sees in the bone, it doesn't always see when you've got that bone loss that angles towards you. So if it's showing those yellow or red lines, it's there. So, for what it's worth, if you don't create the opportunity for your patients to visualize and see their X-rays, they're gonna think of you like this guy does:

"This is what dentists do — they take an X-ray of your mouth, usually the first X-ray, they don't get what they need. Already you're panicking, you're like, 'What? X-ray's not working?' They want you in this stage, they want you to be like this. Second or third X-ray they put in front of you, you can't even tell what's in the X-ray — they know you can't tell, they still consult you. Suddenly you are the senior dentist. My dentist, he put the X-ray in front of me, he's like, 'Can you see this over here?' Nothing — I could see nothing, I didn't know those are my teeth. He could have said it's your luggage X-ray from the airport, we found a tooth in it — I would have believed it. You know when your eyes don't even know what plane to focus on — like I was seeing through the exit, there was another dentist working on the other side, I was clueless. I will forget dental checkups, I need an eye checkup."

So these images are great for conversation, and using that color change and using the AI is really gonna support your diagnosis, and then, therefore, you can move on in the treatment plan. Also, highly encourage taking at least one intraoral photo at every recare. Here's the language that I use, and you've heard me say it already this evening: "Are you open to seeing what I see?" Now make sure you ask, because some people will come in — you might have a strong DISC "D" personality who's gonna come in and say, "I just wanna know what I need to do, how much it's gonna cost, let's get it scheduled." I've had patients like that who come in and literally sit down in the chair, and they need a crown on every single tooth, and they don't care how much it costs — they just wanna get it figured out, and, okay, let's do that. But for the majority of our patients, bringing them into the conversation like we talked about, and pacing with them, is really important.

So I ask, "Are you open to seeing what I see? May I show you — this bleeding is not normal? Tell me what you see." If you put a picture up — I won't do this with an X-ray, because it feels a little bit like you're shaming them or confusing them, but when it comes to an intraoral photo, I will ask them, "Tell me what you see." And then we're gonna celebrate — we're gonna say, "Great news, we have a solution for this. It's not too far gone, we can save these teeth, we can do periodontal therapy, we can put a crown on this. Guess what, you have a lot of bone, we can do an implant, you're gonna still be able to chew." Think about how that sounds versus, "You're gonna need a crown." Let's turn it into the more positive and exciting part — these pictures are powerful.

The permission statements are really, really important. I ask them, "Are you open to seeing these photos so we can make your plan together?" Because if one person shows up as too much of an expert in a conversation, the other can feel diminished. So you wanna meet your patients where they are, take out any hierarchy — and remember, do you enjoy being told what to do? I mean, everything my parents have told me in my adult life, I did the opposite. So these people, when you put a picture up like this, they're gonna pick themselves apart — you're allowed to compliment the good.

This person, I would say, when I showed them — obviously this person's in a rough spot — but I showed her her pictures, and I worked to collaborate with her, and I said, "You've got these bottom front teeth, they're really, really healthy, they were great. You've got some cavities up here, and there's some gum disease. Great news is I can fix that for you if we work together. So tell me, do you like options, or do you prefer I just create the most beneficial healthcare plan for you? What would you like? Because I'm here to help you." Think about how that feels.

And using these pictures — somebody once said to me, a picture's worth a thousand words and thousands of dollars — well, it's kind of true. You put a picture like this up on the screen, where it's real and it's them, and they're like, "Whoa, what's that pink thing? What's that black stuff?" And they have their own response to it. "And those two bottom teeth, they're a little bit crooked — can I fix that?" So, again, I work with a DSLR primarily for all of my work, but my hygienists have an Eyespecial, because it's less intimidating and easy to use, and my hygienists are all taking DSLR photos at the comp exams.

Also remember, do not store your photos on a server where they can be deleted — you want them in your software. Before we had Sota, we were storing our DSLR photos in just a server folder, a drive. And a really crummy story is, I had a patient come in — she was unhappy with our previous dentist, we did a smile design for her because he had done some front teeth on the CEREC, and she didn't like them, she said they felt bulky. And I don't know what happened, but she left him in the middle of care and came to me and said, "I want you to do my teeth, or I'm going to LA." I was like, this is easy, I can fix this. We fixed it, and then after she was happy, she decided to sue her previous dentist. So she came in and asked for her photos, and my teammate had dragged and dropped the photos instead of copying and pasting them onto a file, so now I didn't have any of the pictures of this case. And then, two years later, the attorney general for Colorado calls me and says, "Hey, this is a case that we wanna ask you some questions about, since you saw the patient later, and she's doing her role — can you send us all her records again?" And I didn't have the pictures anymore. Can you imagine going up to the Colorado attorney general and saying, "I'm sorry, I don't have the records, my assistant deleted them"? That sucks. So now I tell everybody, put it in Sota — there's unlimited storage, just put it in there, and that way you always have a copy, nothing can be deleted out of there.

You wanna be a superior doctor — you gotta take the X-rays and images. You present the disease — superior doctors prevent the disease. Mediocre doctors, they might treat the disease before it's evident, and inferior doctors are gonna treat the full-blown disease — they're gonna wait. And I wanna be proactive with my patients and give them these options.

So why are we here today, and why have I mentioned that we chose Sota and Pearl, who have graciously sponsored this webinar? Primarily, the integration with our practice management software was important — it's easy to integrate, there's the architecture and accessibility. I love that I can be at my desk while my teammate is taking pictures in the office, and I start developing a treatment. I love that I can access them from home, so that when my patient calls with an emergency, I can pull up the X-ray. Hopefully they don't have a lot of emergencies because they've been proactive, but I love that I don't have to have a server and backups and worry about losing pictures. So that's an important thing. It's awesome to also be able to share these images with your patients.

And you've got 3D imaging capabilities, you've got Pearl analytics — this is all huge, to be able to integrate with your practices, and this is scalable. We have forty locations — we need it scalable. Also, every week I get a dashboard from Pearl on our practices. If you look at this data in here — if you think of even treating half of these incipient lesions with Curodont, think about what that does for your patient, to keep them from having to get a filling, or for your practice, or for your hygiene revenue, because we all know that wages have increased and compensation has not. So hygienists can do Curodont — it's great. Think about half of the decay on this chart — it could be an indirect or a direct restoration, like even just half of it.

You can also generate reports on your overdue hygiene. I love the daily huddle — the daily huddle is huge. The daily huddle is gonna show, here's your treatment today, what's unscheduled treatment that's in your chart but not diagnosed. And then there's also the predictive stuff that Pearl has detected — maybe a pathology on a radiograph in the last eighteen months, but no treatment code. I also used to have to manually audit our charts to make sure that the X-rays were being taken annually. And this is just six months, year over year — I want you to see, the lower line is before our Sota and Pearl, and then the next two lines are the growth of production from just radiograph codes over a six-month period. I did the first half of the year, three years in a row, and that's after implementing our morning huddle, so it pays for itself.

And so if you're worried about that investment — no, I mean, look, in my practice we have twelve treatment rooms, so five or six hygienists every day, but in six months that was almost three hundred thousand dollars of revenue of X-ray growth. So look at that. Remember, the more you see, the more you know, the more you do — and the more you do, and the more proactive you are, the better your patient experience is. They don't wanna come back, they don't wanna get numb a second time in the same area, they don't wanna have pain on the weekend, they don't wanna almost miss a vacation because of an emergency.

And I got really close on time — I wanna say thank you again to Sota and Pearl for making this evening a possibility. I'm Jen, I'm open to questions — if you think of something afterwards, my website is currently down, but you can reach out to me on Instagram, jendrcds, you can direct message there, I'll do my best to answer. And again, thank you, Sota and Pearl, for making this an opportunity.

Excellent, thank you so much, Doctor. We already have a comment that says "amazing presentation." So thank you so much for spending time with us — we're gonna open this up for questions.

I'm gonna check the chat here. One of the questions was, how do you get everybody on board with using Pearl AI? And they seem to have struggled with some providers not wanting to use it consistently — what are your thoughts on that?

That's a really good question. So I would ask your doctor that doesn't wanna use it if they wanna send a really important email and turn off their spell check. I'm keeping that one, I'm running with it. I mean, listen, when I do my email, Aspire Dental — Outlook still can't figure out "A-S-P-I-R-E," it wants to change it to an "E" every time, but then I've typed so fast and I'm hurrying, there's a lot of typos, and I always have to use my spell check. So if you think about that, if your doctor doesn't wanna use AI, maybe they need to reframe it — get them into a space where they're going, "Okay, this is an opportunity for me to make the X-ray and the AI the hit man, and I get to be the hero." So that would be my hypothesis, and I hope that answers the question — please ask more if that helps.

The other thing, if I could interject real quick, is if it's not embedded into the imaging software, it's not as easily accessible. So that's a key point as well — it's part of, you're not having to flip to another window or what have you, so that's an important aspect as well.

That's a great point, Scott, that's huge. I mean, don't you think too, Doctor Durst, as fast as your team runs through radiograph review and case presentation with the patient, to have it inside of your imaging system is really the best way to, in essence, avoid change management, right? It's already there. So I think that's the beauty of having Pearl integrated into Sota Cloud. And I love your input on that — and before you answer that, the other part that I think is super valuable in this day and age in dentistry is to be able to call your patient right away if there's an emergency, and you can look up their X-ray right on your phone, right from your living room. That's a big win as well, as far as taking patient care to the next level. So kinda walk us through that a little bit.

I'm sorry, can you say that one more time?

I was just wondering, imagine having it on automatically inside of Sota Cloud, right, so you just have the AI turned on, you don't have to go to a separate screen — that seems to be the best way to have your team be able to know that this is really flawless, and there's no change management, right? You're already in your imaging system.

That, and it just screams at you, is incredibly key. And then let's just be real — assistant turnover, hygienist turnover — I'd rather them go, "Oh, what's this big blue blob?" than have to be like, "Oh, you've gotta open up another window." Think about your practice, your room — for us, we have CareStack, so we've got CareStack open, and we have our Sota window, and it's all integrated. I can pull up CareStack, I push on the button, Sota opens up, and the periapical is right on top of it. I couldn't create a system across forty locations and eighty doctors if I didn't have that.

Love it. And I think another question here — and before we jump into these questions, which we would love for you to stay in for, and we're gonna share the CE code in just a second — we're gonna talk about CBCT here in just a minute. But these two QR codes, now, before I put up the CE code, are for you to really just kinda pick the best time for you to spend some time with your team getting an introduction into what Pearl AI is and how you can use that directly in Sota Cloud. So I'll keep this up for a few more minutes as we go through questions, but I will be putting up the CE QR code in just a second.

I think there's a question about CBCT — I'll take it on the Pearl side, and then, Scott, if you have anything else to add, love for you to do that. We are now moving into showing real-time AI on CBCT scans — right now it's just anatomy, pathology, some airway stuff, TMD, being able to really kind of assist with implant placement. You can see the nasal floor as well as the IA nerve. So that's been a big win, and we're excited to be the first ones to get FDA approval for AI on CBCTs. I think that's gonna be a game changer as we move into 2026, and teams are using that almost as standard of care these days. Scott, anything you wanna add to that?

So we recently incorporated 3D capabilities within Sota Cloud — we're building out some of the integrations with the various platforms, from a hardware standpoint. But, yeah, you can store CBCTs within Sota Cloud alongside your 2D images, you can share them with referrals, or with a lab, or what have you — gives you those capabilities. That's a big pain point, how do I get my CBCT over to another office, so we've helped solve that, and we've got our own viewer that you can pull up on any type of device and do manipulations and so forth.

Excellent. And I think one of the other questions is, how fast does the AI actually show up? So walk us through kind of a hygiene-doctor event, Doctor Durst — your hygienist took the X-rays you recommended, how long does it take for you to pop in, maybe look at those in your office before you go into a patient? Tell us about that.

Well, the AI shows up immediately — it's just a really fast process, just like if you're doing your own normal process without the AI. But what I do think it helps you speed up is your ability to read the X-rays, because if you think about when you're trying to lean in and look at things and highlight stuff and invert the images, it's basically putting the colors on there for you. So then you just click it off and go, "Oh yeah, it really is a black hole right there," and then you click it back on and click it off again, and you're like, "Yep, that's there." And so you can see — even that picture up there, the one on the bottom is what it looks like immediately, and if you want those tooth colors that you see on the top, you click on it to turn it on. But when you snap the X-ray, it looks just like that bottom image right there. So it's easy to integrate — we try to make things as easy as possible, so better experience that way.

So we have a question for you — somebody asked, which is funny because I remember this happening in my practice — they're trying to ask, what do you discuss first on the radiograph, and how do you prevent the doctor from doing hour-long discussions? It's a very thorough discussion.

Good, this is so good. You know, it's funny, because doctors do love to hear themselves explain. I remember sitting outside the room with a doctor once, and he was telling this patient he was gonna do a crown on number eight — and just a little note, if you're gonna do ceramic on one tooth, the way the light refracts, it's always good to do two, do things in pairs — but he was explaining the difference between e.max and zirconia. And I thought, what in the literal hell, why are you going into that with your patient? Does it help you feel smart? Patients don't care — they care that it looks alright, tell them it's gonna look great, it's gonna feel good.

But really, if your doctor is spending that much time explaining — listen, people trust you the more you know about them, not the more they know about you. So, you know, they say we were created with two ears, one mouth — use it proportionally. I coach doctors to ask questions, because you can ask lots of questions that make your patient feel heard. "So tell me, do you have pain here? Do you see this lesion? What has been your experience with a crown in the past?" Ask enough questions, and then you say, "Well, you've shared all this with me, my recommendation is to put a new crown on it," and they feel so heard. You don't have to explain away the difference of the ceramic.

I tell the patient — I don't even explain tooth by tooth. When I was right out of school, I'd say, "Oh, you need a crown on this tooth, this tooth, this tooth, and then you need a filling over here and a filling over there," and I was probably chaos to these poor people. And then, as I matured and I learned how to interview, at the end I'd say, "Do you want me to just make your treatment plan? You need a couple crowns, a couple fillings, and then we'll do some aligner therapy, and you should be good to go. Is there anything I missed, anything you want me to cover that I hadn't? And will you promise me that if I give you a plan that you don't feel comfortable with in any way, shape, or form, you'll call me back, and we can collaborate on it together, because I really wanna pace with you and do this in a way that makes sense for you."

I love that.

When they know they can come back to you about it — yes, that's huge. And I think what we've heard too is, you're not standing in front of an image for so long showing them black and white, because they now see color, they see a cavity, and you get to be the hero if your hygienist says, "Hey, there's an area there that we said we could watch and weren't sure," and you come in as a doctor and say, "Oh, we're gonna keep an eye on this one, we're gonna do this bigger one." We have found, really, from teams using AI, there's less time that we're talking and more time, to your point, that we're listening. And that's really the foundation of building that relationship, building trust — we have time to sit back and answer their questions while we're in the practice, because we're not showing shades of gray in the enamel that are scary, but in the pulp, it's fine, right? I mean, it's amazing that 64% of patients have no idea what you're showing them. So I think that's really valuable feedback too, and I really appreciated how you walked through all of the basic standards of what we should be doing to take care of our patients.

Those simple X-rays we sometimes forget — I've not seen that statistic before, but it doesn't surprise me that the ROI on just taking more radiographs alone is one thing, but let's take a step back and think about — that's much better care for our patients, right? That we're taking the X-rays we need more consistently, so we can find things earlier — they're less invasive, less expensive, and that's what I have found to be really the foundation for scalable growth in a practice.

Being proactive.

Yes. Oh, can I add to your comment? Sorry, you said the word "watch," and watch is not allowed if you're around me. I wanna point out, whenever I'm having this conversation with a patient, if I see an E1 or E2 lesion, I am never actually watching it. I will tell a patient, "There is a lesion here, and you're lucky that it's currently just in your outer layer, the enamel — it's not in that second layer where it spreads faster." This is kind of like a skin cancer analogy. "But if you are in just the enamel, I'm gonna treat that. I'm gonna treat it with Curodont and Carifree toothpaste, which is a calcium phosphate toothpaste, and I'm gonna treat that with your home care, and something here, and fluoride. And then I wanna see you back, and as long as you take good care of this, this should work — but it's still a tooth, and if you go home and drink a bunch of soda, the acid could break it down, and it's still a real tooth." So having that conversation, more of "I'm gonna treat it this way, and I'm not watching anything," is something I highly recommend integrating into your vocabulary.

Yes, it's good you said that too — one of the office managers asked a question on the last webinar, she said, "What do you do when your doctor's a watchasaurus?" I was like, that's really funny, but we're really stuck. Right? It's great because it's true. Before we were really focusing on minimally invasive dentistry, as well as remineralizing, that really was the only course of action. So I think having the highlight from a light pink lesion that's enamel-only into a darker pink lesion really allows you to have those conversations with your patients, focusing on incipient areas of concern that could be remineralized versus those more progressed lesions.

Yep, I just wanted to wrap this up, and thank you guys for staying so long with us this evening, and share with you a couple things. Again, here's the CE code — you will all have this recording sent to you. Love for you to spend some time with us, and bring your team along for a quick overview, a fifteen- to twenty-minute demo, at a time that works for you. And I wanted to send a special heartfelt thanks to Doctor Durst for putting this all together and sharing those images from your practice, and really just your message is so incredible — hopefully that's resonating with a lot of clinicians this evening. We couldn't have done this webinar without our Sota team, we so appreciate our partnership here. I'll let Scott wrap us up, and then, Doctor Durst, if you wanna finish out with the last statement.

Alright, thank you, Sheela. Really appreciate Pearl allowing us to be a part of this, and appreciate all the participants. We would love, as well, to have an opportunity to show you why Sota Cloud is the fastest-growing imaging software on the market. We appreciate everybody's time — thank you.

Thank you all for listening and letting me ramble and rant for the evening, because I get amped off of this kind of thing, and sharing everything — like, the amount of time that I've devoted to dentistry — and I can't practice anymore because of spine surgeries and some problems there, but I still live and breathe and love this profession, and there's so much that you get to do now. Biomechanics has changed drastically, and from the technology that we have here, to our ceramics, to the composites that we have — you're in a really cool era of dentistry, so enjoy it. But get the technology, it's worth it.

Excellent. And one more person had a question about CE, so I will leave that up here one more time — there is a little code at the bottom, you know, they make it so easy, it's only twenty-five characters. But right here, W-T-W-6-T-Y-S-E, that will be your code. Again, that's my email — if you have any questions, feel free to reach out. And again, thank you all for joining us. Have a wonderful evening, and don't forget to look at our website, hellopearl.com, for more webinars. We'd love to have you join us in the near future, and have a wonderful evening, everyone. Bye-bye.

‍