Nicole Saldua, DDS - General and Cosmetic Dentist in Scottsdale, Arizona

Eva Sheie (00:01):
Whether you're visiting a dentist for the first time or considering a new one, the more you know about who's behind the chair, the better your experience will be. I'm your host Eva Sheie and on Meet the Dentist, we feature professionals sharing their expertise so you can feel confident about who you trust with your smile. Thank you for listening to Meet the Dentist. I'm so excited to bring you my guest today. Her name is Nicole Saldua. She is a general dentist in Scottsdale, Arizona, but she started in the middle of, actually nowhere in Washington state. Is that right?

Dr. Saldua (00:37):
Kind of. It's basically the east side of Washington state, so right next to Idaho, I guess Idaho border. So it's Spokane.

Eva Sheie (00:47):
Do they have a funny not middle funny name for that part of Washington? You know how they call Yakima, the Palm Springs of Washington?

Dr. Saldua (00:54):
Oh yes, it's not true. I have absolutely heard that and I don't know where they got that name.

Eva Sheie (01:00):
I think they're just trying really hard to make it be okay there. It's not,

Dr. Saldua (01:05):
Yeah, they're just making everyone there feel a little bit better.

Eva Sheie (01:08):
Did you go across the border for stuff to Idaho?

Dr. Saldua (01:12):
Yeah, so I mean Spokane's like maybe 20 minutes away from Coeur, so northern the panhandle of Idaho. So we did a lot of stuff over in Idaho. There's a lot of really cool water stuff. Obviously there's a ton of snow up there. And then I went to dental school in Seattle, so I was kind of on both sides of the state.

Eva Sheie (01:30):
Awesome. So did you went to UW for dental school?

Dr. Saldua (01:34):
Yeah.

Eva Sheie (01:35):
How many people are in a dental school class?

Dr. Saldua (01:38):
It varies. So I know I think NYU for example, I think has like 300 or more dentists, dental students. UW was really small, so I think it was like 60. So it varies depending on where you go.

Eva Sheie (01:53):
How many years is it?

Dr. Saldua (01:55):
Four. So you go to undergrad for four years and then you'll go to dental school for four years and then technically you could just go start practicing immediately, which is what I did.

Eva Sheie (02:04):
When did they let you start practicing on actual humans in dental school?

Dr. Saldua (02:08):
The first time you actually touch a human is when you fully do a full body dissection in your first year, usually within your first couple of weeks of starting dental school. So the first two years of dental school, and I think this is pretty standard across all dental schools, you take the same classes, same class load as the medical students, plus they add in your dental didactic. So I basically would say dental schools really, really, really heavy. Your first two years so intense, you're studying day and night, you're taking at least two or three exams honestly almost every day. It is really just you cram it all in, take a test, dump it, go to the next thing. It's pretty intense. So the first time you really do anything hands-on is with your full body dissection. So there's one body per four dental and medical students. So kind split it up. It was always interesting, the dental students were always way more willing to get their hands dirty.

Eva Sheie (03:05):
Really?

Dr. Saldua (03:06):
I dunno what that was about. Yeah, the medical students, they wanted to read the book and kind of coach us through it, but we were like, it was fine. We got it.

Eva Sheie (03:13):
What do you think that says about dental dental students?

Dr. Saldua (03:16):
I think that, I don't know, we're really hands-on a really hands-on group clearly we like to use our hands. We went into a field that is very

Eva Sheie (03:25):
Well, it's sort of a given. You're not going to go and then not stick your hand in somebody's mouth later.

Dr. Saldua (03:31):
Yeah, I don't know, maybe that was just at UW. Maybe it's different.

Eva Sheie (03:37):
I don't know.

Dr. Saldua (03:38):
Other people have had different experiences. So yeah, that's the first time. And then the second time you really get your hands dirty if you will, is they have what's called stab lab where we learn how to give injections and it's to each other, which is always kind of hilarious. And it's funny because do every injection and you're just leaving the clinic completely droopy on one side and then it's always kind of messed up because at least

Eva Sheie (04:05):
Wait, what are you injecting?

Dr. Saldua (04:07):
We'll do the IA, which is the block that blocks your whole chin and tongue. We'll do all the infiltrations on the top, you'll do some blocks up there, you'll do the pallet one, which sucks. I don't know if you've ever had an injection on your pallet, but it is one of the more painful ones and it's painful even when a really skilled dentist is doing it and they have all the tips and tricks when a dental student who's never really wielded a needle before is doing it, it's pretty uncomfortable. And then also add on the fact that we're aiming for so long, we have the needle in there, we're thinking about where we're going to go, and it's just dripping on your friend's tongue and their tongue's numb and it's honestly pretty comical. And of course, and again, I don't know if other dental students had this experience, but the fourth years throw a party like, oh, good job, you made it to stab lab or through Stab lab. And actually what they're doing is for sure hazing us because we're trying to have a drink of beer and it's just pouring down our faces and half

Eva Sheie (05:10):
Hilarious of us

Dr. Saldua (05:11):
Is numb. And then third year is when you start in clinical, so you kind of go into rotations. So you'd start maybe with pediatrics and then you go into oral surgery and then you do maybe just treatment planning or whatever the case may be, endodontics. So you're working on root canals and in each of those rotations you have certain requirements. And again, at UW we had all the specialties, so we might've gotten a slightly different experience than maybe a dental student at a school that doesn't have any specialties. There's pros and cons to both of those. And then fourth year you're basically running sort of like a clinic, so you basically have a patient load and you're just seeing them for whatever they need and then you do still have your requirements. And I think things changed a lot after, so I don't know, maybe it's quite a bit different now, but this was all pre COVID.

Eva Sheie (06:01):
If you specialize beyond general dentistry, is that after you're done with four years? So there's even more ?

Dr. Saldua (06:09):
So an oral surgeon give them a lot of love because they went to a lot of school. So after they get done with dental school, they go to four to six more years of oral surgery residency and they often also leave with an md. So they'd have the DDS, the doctor of dental surgery or DMD, those are the same. And then they would go in and get their MD so that they could perform full on surgeries. I'm pretty sure endos usually about three years, perio three years. So two to four more years is usually a common specialty requirement.

Eva Sheie (06:46):
It's really interesting.

Dr. Saldua (06:47):
It's interesting too because if you specialize as any kind of specialty, you are legally not allowed to do anything else. Even though you originally left as a general dentist, they legally cannot do anything else. So like a root canal specialist, an endodontist legally cannot do a crown and that's to protect the referral system. So a general dentist isn't going to want to send their patient over to the endodontist if the endodontist is going to go ahead and just do the crown also. So there's a system there.

Eva Sheie (07:18):
How did they get that passed into law? That's fascinating.

Dr. Saldua (07:21):
It is. I know. I think there's a lot of law stuff that goes on behind the scenes.

Eva Sheie (07:27):
It's like the complete opposite and in aesthetics, because any MD can do any cosmetic surgery and it's not against the law.

Dr. Saldua (07:35):
Well, I would say any general dentist can do anything, but you can't go backwards. So basically a general dentist can do a root canal and a crown and veneers and extractions and a sinus lift and blah, blah, blah, blah, blah. But if you're going to specialize in endo and you're going to just be a root canal specialist, you can't do anything else ever.

Eva Sheie (08:00):
Wow.

Dr. Saldua (08:00):
Really interesting. Yeah, so that's why too, when I'm as a general dentist and I do a lot of cosmetics, but I always say if I'm doing this for you, it's because I know I'm doing it just as good if not better than wherever the specialist would be. So I personally don't do any root canals on molars. I'm just not going to do it as well as an endodontist and as the patient, as the consumer, I would want to know that my dentist is going to protect me and yeah, that dentist, that general dentist is making less money because they're not doing it, but they're also recognizing that me as the patient and their client, essentially they're going to get the best experience. So if a general dentist is referring you out, they actually love you, but legally they can do anything

Eva Sheie (08:51):
You just said. If you take something on, you're going to do just as good of a job. But that's not true for everybody, is it?

Dr. Saldua (08:59):
No. And I think that that's where you have to decide if you trust your dentist. And I will also say, let's say the patient comes in and they're like, Hey, I'm not going to be able to afford whatever, and I'm like, look, I'm not going to be able to do as good of a job as that specialist, but I can help you, but let's make sure our expectations are this, right? So if I'm saying, Hey, I'm going to do this root canal, it's on a front tooth, I know I can do a really good job and I know that the endodontist is going to do the exact same thing as me, but if we're talking about let's say a root canal on a molar, an upper molar, those have four canals and probably some hidden side canals that is not as a no-go for me.

(09:37):
I started a root canal the other day and I stopped halfway through because I was like, Nope, I'm not going to be able to get in there. And so I just refunded the patient the money that she was going to spend with me and she went and got it done and she was like, she came back for her crown and she was like, they spent so long on that because they were like, wow, this is a really hard angle. And they were like, I'm glad that your dentist knew enough to stop, but the other thing would be that the dentist has to be paying attention to know that they're not going to get that angle. It was again, a hidden canal. I didn't see it initially, and then as I was working, I was like, oh, there's something else here and I'm not going to be able to get around this corner.

Eva Sheie (10:16):
There's something wild to me about us still in the year 2025 not being able to see these things with imaging, even with all the technology that you have now.

Dr. Saldua (10:26):
And I think that that's true though in anything, and I think that dentistry does get a little, people have this expectation that we can see everything, and so when something doesn't go perfectly, if the dentist didn't set that up well enough on the front end, it can be pretty shocking for the patient. Let's say I'm like, Hey, we've got a problem with this crown. We need to replace it. I see something wrong with it. I mean, there's a possibility I take that crown off and there's no tooth under there, but I couldn't see that on the x-ray. There's no way.

Eva Sheie (10:58):
I can't believe you can't see that. That's crazy.

Dr. Saldua (11:00):
The way an x-ray works is you've got the head that shoots out little tiny beams, there are x-rays and then you put something on the other side to catch those beams. So really it's just looking at density. If you have something really dense like metal, it blocks all the x-rays beams from hitting that sensor on the other side. So this is true for a hand x-ray or a chest ct, A CT is an x-ray. We're literally only looking at densities. And so if there's something metal over the top of a tooth, I can't see underneath there because the metal blocked all those beams going through and there's no other imaging option that's going to show it like MRI won't ultrasound obviously no other way to image that. And so there are always limitations with our systems and same with even just looking at a tooth and being like, is this a cavity or not? This is literally shades of gray. We're deciding is that area a hole, which obviously would not be very dense so it turns dark, right? Because all the beams are making it through to the sensor. And if it's on the edge, then you decide as the dentist, am I treating this? Am I watching it? What risk level is this person? You talk about it with the patient, but ultimately, yeah, we can't see everything. And I think you're right, it is frustrating for the dentist too, but especially for the patients.

Eva Sheie (12:27):
I had a experience recently where my root canal started to fail after 12 years, still have the same dentist. She did it the original because I've been going there for so long and because I've been working in practice management for so long before podcasting, I also know that this practice has a lot of revenue consulting going on. And so they do a lot of things as process that I know are sales tactics, but I recognize them and most people don't. So it kind of makes me, I wouldn't say a horrible patient, just maybe more skeptical than an average patient. And so I always laugh at some of the things they do. One day they said, this is 12 years of history. I can remember so many of them, they were so funny. They put up a really nice looking slide and they said, oh, just in case you're curious, this is what your teeth would look like if you did Invisalign.

(13:33):
Let us know if you want to talk about it. It was like 10 seconds. And I looked at it and I was like, my teeth look amazing. And then I was like, oh, I know what you're doing. They weren't wrong, but they're always experimenting with these little things. So the day that they told me there was a crack, the hygienist freaked out. I got way too emotional about this crack and I said, I'm leaving on Wednesday. I can't. I'm going to have to do it when I get back. And she said, oh no, this is an emergency. You probably need to get this dealt with before you leave. I'm like, in two days if it's cracked, it's been cracked for years. And I reflected on it a ton because I thought later I thought, I wonder if the reaction was built in to drive urgency because if you know it's been there for years, then do you go, oh, if it's been there for years, I don't have to do it right now. So I still don't know if it was a tactic or not and never had that conversation with them. But I did end up getting three different consults on that tooth and paying for all three because I was so thrown by the way they handled it that I didn't know if I could trust them.

Dr. Saldua (14:52):
Trust is huge in dentistry and I think that's my biggest thing. That's what I talk about all the time on my Instagram. How do you build trust? Because I have another post about this, but dentistry is a business, so of course we want you to pick us, we want you to pick us to solve whatever problem. And yes, certain problems have more urgency, some things can wait, some things, sometimes the dentist is like, it might go, it might not go. So yeah, it's hard because that may be something that she's not rehearsed, but that's something that maybe she knows helps people help themselves. I think probably she's coming at it from maybe a good, I'm going to go with the good intent, but to have a really strong reaction like that. Yeah, it's hard to know. Is she getting, I don't know, something out of having the patient say yes in her chair? I don't know. I don't know. There may be some kind of benefit to her. It's interesting though because I love hearing a patient's perspective on stuff like that because she obviously is trying to get you to treat it for whatever reason. And it's interesting that it's coming from the hygienist. Because usually the hygienist isn't directly going to benefit from you saying yes. So that's a weird one.

Eva Sheie (16:24):
It was weird.

Dr. Saldua (16:25):
Yeah, I would say cracks can be very urgent, but also I'll say cracks like you said, can be there for a long time and do nothing until they do split the tooth in half. And so that's what I talk about with my patients a lot. If I'm like, Hey, there's a really large crack here, I'm going to just take a picture,

Eva Sheie (16:44):
And nobody could see the crack. So if we go back to you can't see anything with an x-ray, then we also couldn't see anything with two different sets of 360 imaging either.

Dr. Saldua (16:56):
Oh, and I always do what's called intra oral photo. So it's a true picture with there's, it's like a little thing that goes in the mouth with a little light on it and I can take pictures and that does help a ton. And then I basically put the power back with you. I'm like, if you have no pain, the crack's probably been there for a long time. Really all we're doing is risk management, right? I'm I say, are you a gambling person? And usually they're like, and I'm like, look, I don't know when this is going to break. I have a friend that always says, I don't have a crystal ball. You could be chewing on it tomorrow and it could snap in half. You could have it look like that for another 10 years. And it's so hard As a dentist, of course, we do make money off of you as a patient deciding you want to get something done, but we still have to legally back it up.

(17:46):
We still have to send whatever off to maybe insurance or if legally not even insurance, let's say the patient comes in, they have no insurance, I'm still taking a ton of photos because what I don't want is for me to touch this patient, do something to this patient on their tooth, and they come back at me and go, you did a crown on here, it didn't even need it. And now I need a root canal. And I'm like, well, I need to make sure legally I protect myself. So again, there's a lot, there are shitty dentists out there and there's people always trying to make a quick buck, but the implications of touching a tooth that doesn't need it is way more dramatic. We can lose our license, we can get sued, we can get bad. I mean even just bad reviews, we don't want, so dentists,

Eva Sheie (18:34):
It's so difficult. You are also stuck in this place where you need to make a confident recommendation, but you can't. They're just such a weird balance. You need me to make a decision, but I don't have the information or the education to make the decision. So I need you to tell me what you think I should do.

Dr. Saldua (18:54):
So I know, and that's the thing, patients, the problem with dentists is that we either talk way over you, we use way too fancy of language. We're basically speaking Japanese or we talk down to you, you're a toddler, and both of those things are going to turn a patient off. And so that's really my big focus is I always say I try to demystify dentistry, make this less scary. And the way to do it is with analogies, it's with imaging, it's with photos, it's with, I use a lot of Google images. I'll literally just go on Google and I'm like, okay, this isn't you now, but let's just look this up and this is where you could go with that. Or if I'm trying to explain, oh, we could get this crack could continue down below the bone. Well, that's a weird concept to think about, but if I just Google image like crack tooth, there's a ton. So I use a lot of that. So I'm not trying to scare someone. I'm just trying to educate them and then they can make the best decision for them. And again, if they choose to not, that's fine. It's there too. It's their help.

Eva Sheie (20:04):
The other thing I'm hearing that you're not really saying is that you take enough time to have this conversation. And in my own situation, she actually, she could not be bothered to talk to me on the phone. So I had gone out to the endo to have it looked at the first time, and then I called her to find out what she thought about it, and the whole office was like, didn't want to let me talk to her on the phone. Seriously, guys, 12 years, give me five minutes on the phone with her, just does not, didn't sit well until ultimately I decided I'm going to go get another one. And everyone was saying the same thing. And so once everyone was kind of saying the same thing, you really probably need to have it taken out. Then I finally came to the conclusion that they were right and I could move forward, but it was really,

Dr. Saldua (21:01):
Well also taking it out or getting a crown or even getting a filling is a really big decision. And I think that one of the, another thing that dentists don't do well is we don't realize how big of a deal this news is that we're giving people even, hey, those three fillings that you need, that's shitty news. That sucks. I would be so bummed if someone looked at my mouth and was

Eva Sheie (21:25):
Kind of embarrassing.

Dr. Saldua (21:27):
I was going to say, not only is it like, oh shit, I have to get an injection. You're going to drill on me, but now you're telling me it didn't clean well enough. You're saying what? I'm unhygienic. It feels very immediate defensiveness. So I do a lot of, oh, this looks like maybe it was there and I'll do a lot of letting things be blamed elsewhere because I think that's important for people to know. It's not just that you were bad with your hygiene. We all have stuff going on. There's also changes in our saliva, in our minerals and our saliva. Things fluctuate all the time or you're stressed. Stress can play a role. Food habits can play a role mouth breathing because you had a cold. It's not that I'm just saying we can put blame elsewhere, but really there is a lot of things that factor into every single thing that happens in dentistry.

(22:18):
And I'll say even a lot of things go back to how your teeth fit together, your bite, which again, I guess you could look at as another sales tactic, but if your teeth are not matching well and you're having a ton of dental problems, it really does all come back to occlusal traumas and forces on the teeth that really aren't designed to be there. And then we start talking about Invisalign. And so yeah, it can definitely take a turn and now we're talking about a bigger thing, but it all comes down to the patient understanding and being able to follow the logic, not, oh geez, she's just randomly recommending Invisalign. I have a cracked tooth. Why is she talking about Invisalign? That's when people get shut down.

Eva Sheie (23:03):
Well, that was many years before the cracked tooth. That one just cracked me up. It was such a blatant cosmetic tactic.

Dr. Saldua (23:13):
Oh yeah, no.

Eva Sheie (23:14):
Out of nowhere.

Dr. Saldua (23:15):
For sure. And again, I think that Invisalign can be very pushed for cosmetics, and I don't necessarily think 50% of the time that I'm talking about Invisalign. I would say actually 80% of the time I'm talking about Invisalign. My main thing that I'm worried about is the posterior bite. We're going to get a benefit with some aesthetic stuff, and I am a cosmetic dentist. Yeah, I'm going to talk about the cosmetics, but usually when I'm talking about Invisalign, I'm talking about an issue with the back teeth, the bite I always talk about if you put up tent poles and you put 'em in too close and then you try to put the cover on the tent, everything kind of droops towards the center and collapses and the tent falls down. That's the exact same concept. You need a nice wide back bite. You need the teeth to be taking forces. The way that they were designed to take forces, helps the gums, it helps the bone, it helps the teeth, helps your jaw. So all of it comes back to that. But again, it's really easy to go too fast and talk about that before you talk about some of the basic stuff because yeah, people are ready to be a little bit defensive and I don't blame 'em.

Eva Sheie (24:25):
Talking about things in the right order is really important. And the one that I see everywhere, I feel like this is a system-wide problem in all of dentistry, is that insurance dictates the way we talk about the whole problem problem. I actually would prefer not to talk about insurance until I understand what's going on because aren't most of us already in the place where insurance isn't helping?

Dr. Saldua (24:51):
I feel like people don't fully understand their insurance. And so that's where a lot of the problems come from is they think, oh, my insurance will probably help with that. And I'm like, what? Maybe. So I think that's why a lot of private practices are dropping a lot of insurances because one, it limits us on what we can do for you, especially if we care what things look like and materials that are going in. If we actually care about what we're giving the patient insurance coverage isn't necessarily going to be bad. I always compare it to your house goes through a wind storm and the roof got damaged, and now insurance is going to help you pay for new roof. Well, they're probably not going to pick pretty roof shingles. It's going to be basic. It might not really match your house, but you can go ahead and get the nicer stuff. It's just going to cost you more. But it's a personal choice. And if your dentist is dropping insurances, it's not because they're money hungry or they're assholes or they personally don't like you, it's because that insurance isn't paying them enough to do the quality of work that they want to.

Eva Sheie (26:03):
And I think the staff get really worn down by the whole thing because no one went into that business to do insurance verification. It's miserable.

Dr. Saldua (26:16):
Well, you said you were a practice manager, right?

Eva Sheie (26:19):
No, I've been in plastic surgery practice consulting for a long time, and so I spend a lot of time on the retail side and then when I have to go anywhere that involves insurance, I'm always really like, wow, this is terrible.

Dr. Saldua (26:32):
It's terrible

Eva Sheie (26:33):
Because it gets in the middle of the relationship you're trying to have with me and my provider or you and your patient in a way that is really all consuming. So my daughter had a, what I call a shark tooth, you know what I mean?

Dr. Saldua (26:51):
Oh, another layer of them.

Eva Sheie (26:52):
She had one extra tooth behind her front teeth and it was like the shape of a Christmas tree.

Dr. Saldua (26:57):
Dens.

Eva Sheie (26:59):
Yes. She loved that thing. She believed she was so special because of this extra tooth.

Dr. Saldua (27:04):
That's so cute. I love that.

Eva Sheie (27:05):
Well, she got it pulled two summers ago, and the surgeon, the OMS was amazing. He had three little girls, he just got her. We had such a good experience, and so when it came time for me to get mine pulled, I was like, I'm going to get a consult from him. He was awesome, and I have never been so battered by the staff over All I wanted was a consult. I was like, I'm going to write you a check for the consult right now. And

Dr. Saldua (27:34):
Weird.

Eva Sheie (27:35):
They just we're in such a routine of dealing with insurance that they could not wrap their heads around what I was trying to do.

Dr. Saldua (27:44):
They were like, no, we don't even know how to not take insurance.

Eva Sheie (27:49):
Yeah, I got a little bit yelled at by one of 'em. She had printed out my insurance card on it. I don't think she did it on purpose, but it was Anna an eight and a half by 11 piece of paper, and she was holding it up like this and shaking it at me. What she was saying, you're out of network.

Dr. Saldua (28:07):
Which usually I'll say maybe she meant good by that because I would say most dentists don't tell you if you're out of network unless you ask directly because they're just kind of like, we're just happy you're here. If you're in network out of network, we're going to make it work.

Eva Sheie (28:23):
Yeah, I don't know.

Dr. Saldua (28:23):
That's so interesting. I wonder if they just because they know that surgery fees are so high, maybe they're like, we don't want to go down that route if you're not in network. But yeah, I would say most, I think that that's another confusion with dental versus medical is in medical you get effed if you go somewhere, not in network, we're talking about tens, $20,000 differences. But in dental, that's not the case.

Eva Sheie (28:53):
Not at all.

Dr. Saldua (28:54):
If you're in network or out of network, you're not going to be out tons more money. And really what's happening is a lot of really good dentists are still accepting some insurances, but they're out of network with them. So they let them sort of help with their fees, but they're not going to fully take them as in-network fees. And so when people call, Hey, do you accept this insurance? Like my office for example? Yeah, we're in network or we won't say we're in network. We'll say, yeah, we take your insurance. But again, we're not trying to screw anyone over. They're looking at our reviews and they're going, oh shit, this is a really nice office. I want to go there and we're not going to be like, we're not in network. And then the patient's going to be like, oh, shoot, okay, I'm going to not come.

Eva Sheie (29:41):
Nevermind.

Dr. Saldua (29:42):
Yeah, exactly.

Eva Sheie (29:43):
When you work the problem backwards and you start with your insurance company card and you go to their portal and you look up the dentists for what I needed to do, I could see that there wasn't anyone I was going to want to go to.

Dr. Saldua (29:56):
And that's where things are trending. And so I think in five, 10 years, a lot of private offices will be even maybe just out of network, but accepting insurance or they won't take any insurance at all. And then I think big practices like your big DSO type practices, Aspen Dental, whatever, those will be the ones that you go to if you really want to utilize some dental insurance. I think that might be not a bad way to have things trend. I think that's okay.

Eva Sheie (30:26):
Well, since you're trapped here, I'm going to ask you some more of my burning dental questions.

Dr. Saldua (30:31):
Let's hear 'em.

Eva Sheie (30:33):
So I take the girls to the pediatric dentist a couple times a year, twice a year. We never miss, we're good patients. They've been going since they were babies, which I kind of love because when I was little, you didn't really go to the dentist until you were what, five? Yeah.

Dr. Saldua (30:52):
You had a problem probably.

Eva Sheie (30:54):
Yeah. And so I know my sister and I have a mouthful of silver fillings from when we were little. It doesn't really happen now as much, right? Because we're starting earlier.

Dr. Saldua (31:06):
I think it depends on where you live, and that's because some areas have, and I am back and forth on this topic and we can talk about it, but fluoridated water I do think plays a little bit of a factor. And then also access to healthier food options. So those two are my big factors that I see where kids have either a lot of cavities and they get a bunch of, they have to go under for dental work and get a bunch of crowns and whatever, or they kind of don't have anything because they again had access to care or they had that fluoridated water.

Eva Sheie (31:42):
It's a great mystery because my mom did not let us eat candy, and she tried to convince us that car chips were just like chocolate chips, not, they're not.

Dr. Saldua (31:54):
Yeah,

Eva Sheie (31:55):
I know. I take the girls in and every time, and I wasn't catching on until recently, but every time they would say, is it okay if we do the vitamins today? And I would be like, sure, sure, whatever. And they rubbed the fluoride varnish. I didn't even know what it was. I never asked. I just let them do it. It's just the vitamins.

Dr. Saldua (32:20):
I know. I actually

Eva Sheie (32:21):
One day I said, wait, wait, wait, wait, wait, wait. What are the vitamins? What are you even talking about right now? Then they get defensive. They don't really have their explanation ready. So then I asked for the documentation and she came out with this piece of paper that had a red exclamation point triangle printed on the paper. It was like the insert from the package with all these scary warnings that said, do not get this on your skin. Said you don't want to get it on your skin, but you're going to stick it in my 18 month olds mouth. How's that make sense?

Dr. Saldua (32:57):
First of all, that's really bizarre that she grabbed the insert, right, whatever.

Eva Sheie (33:03):
Was I the first person who ever asked?

Dr. Saldua (33:05):
I don't know. That's weird. If someone was like, I need documentation, I would guess go to Google or something and look up why we use fluoride varnish, which again, I'll say I don't love fluoride varnish personally, but that's not the point. First time be like, here's the insert

Eva Sheie (33:26):
The first time. So she brings me back, but I sat there, it was at the beginning of the appointment, and I sat there and I read tons of journal articles, and there wasn't really any definitive yay or nay. It was just sort of like, meh. Well, when did fluoride varnish come along? How long have we been doing this?

Dr. Saldua (33:44):
I don't know when it started. Probably around the same time as water fluoridation. It would be my guess. Or maybe after when they realized it was helpful. So I think it's helpful to talk about why fluoride is helpful.

Eva Sheie (33:58):
Sure.

Dr. Saldua (34:00):
So your teeth are made of mineral, right? So first I think the most important point is that your tooth is set up. There's an inside nerve, and then there's literally just a block of minerals over the top. So it's not like a bone where there's nerves that go out to the ends and we can feel everything. It's a central nerve, and then there's this block of minerals over the top, and the middle part of the tooth is this kind of spongier material. So that's why you can sense somewhat what's going on in your mouth because the block of minerals is slightly porous. And then there's this spon area called the dentin, and then the central nerve. So the nerve is just trying to interpret basically changes in temperature, changes in pressure, whatever. But your tooth, the outer block of mineral is made of hydroxy appetite, which we've all heard of. That's the natural toothpaste, which again, I don't think they did a very good job when they really started talking about hydroxy appetite, explaining that that's literally what your teeth are made of. Your teeth are made of hydroxy appetite, which is basically phosphorus and calcium connected.

(35:11):
What fluoride does is because it's such a charged element, fluoride has that negative on there. It's such a charged element that if you start to lose some of the mineral bonding, because your teeth have been, let's say, exposed to acid like sugar, your tooth starts to dissolve. The mineral starts to dissolve. Well, the fluoride goes in and it's such a strong ion that it goes in and bonds and it strengthens the tooth and makes a new type of mineral, and it's called fluorite. So it's not hydroxyapatite anymore. What's interesting about Fluor appetite is it's actually a lot less prone to acid exposure. So it's harder now. That's great. And that's why fluoride works super well. I mean, it is well documented that fluoride is amazing, but I am a really big proponent in that fluoride should only be applied topically

(36:12):
And it should not be something that you swallow. So the issue with the fluoride discussion is that fluoride, because it's such a small, small little molecule ion, it's technically small enough to cross the blood brain barrier, which makes it a true neurotoxin. That's what the fear is, right? We don't want heavy metals or metals in general that can cross the blood-brain barrier and get into our brains, and it's hard to detox. It doesn't really come out. And so that's where the fear is coming from, and it's real. I mean, if you swallow a bunch of fluoride, the first thing that you need to do if your kid swallowed fluoride, first thing you need to do is eat or drink something really high in calcium because calcium is positively charged and fluoride is negatively charged. So you got to bind it

Eva Sheie (37:04):
Like milk, drink a big glass of milk?

Dr. Saldua (37:07):
Or a bunch of an acid tablets would work.

Eva Sheie (37:09):
Tums, yeah,

Dr. Saldua (37:10):
Anything that is calcium heavy because it's going to help bond it in the stomach. So basically like a chelating agent,

Eva Sheie (37:17):
Sure.

Dr. Saldua (37:18):
But if you are constantly swallowing a little bit of fluoride, then with fluoridated water, that's why there's issues with different levels of fluoride. And that's why when they have fluoride, which does naturally occur in some streams, fluoride was just like a lot of discoveries was an accidental discovery. It was in a stream in this little community at really high levels, and they were confused because this community, literally, they would never get cavities. And so they started studying why this community was different, and they come to find out it's this fluoride. However, too much fluoride causes what's called fluorosis, which is essentially when fluoride is in the inside the stomach while teeth are developing, and it gets infused into the tooth structure as the tooth is being made. So ingested fluoride can cause developmental tooth fluorosis, but you can't get it from the top. So all that to say, I like fluoride, if you have a high cavity risk and you know how to spit it out.

Eva Sheie (38:25):
This just came up at my house because I took the iPads away permanently like three weeks ago. And so now my daughter has to read whatever's in the bathroom when she's on the potty, and she decided to read the entire tube of toothpaste out loud to me. And then she said, why does it say that? It says on the kid's toothpaste, call poison control if you swallow too much, whatever it says. So they know not to swallow the toothpaste now.

Dr. Saldua (38:58):
So basically once my kids, so my son is two and a half, he spits his toothpaste out. I did switch him to a Fluoridated toothpaste. However, we filter our water a hundred percent so they don't get any fluoride in the water. And again, fluoride in the water is because of a topical exposure. It is not done to be ingested and go into the teeth. Now it can help.

Eva Sheie (39:25):
Is it problematic that we drink fluoridated water?

Dr. Saldua (39:28):
I think that the problem comes from drinking too much. And again, there are a couple of articles that came out that was basically like fluoride can decrease your child's iq. And again, I don't know how I need to look at that study, I think to figure out how they measure that, but because it can get in the brain, it can interfere, it's a toxin, it can interfere with how someone functions. So anyways, I like fluoride for topical, but I don't love a topical varnish simply because I just don't think it's one time exposure is going to do that much. I would rather you just brush with a fluoride, spit it out, do it every day. Consistency is always going to be better.

Eva Sheie (40:13):
I think what you're saying is it's probably not going to hurt them. It's probably not even really doing much either.

Dr. Saldua (40:19):
That's kind of my thought. And our office is very like, if they say no to fluoride, we just move on. It's offered.

Eva Sheie (40:28):
No, they recite the poem about how I denied their fluoride now.

Dr. Saldua (40:33):
No fluoride. I think too, maybe it was just to make sure you didn't get billed for it. We'll just go with that

Eva Sheie (40:39):
Assuming good intent again.

Dr. Saldua (40:40):
Yeah, we'll go with good intent.

Eva Sheie (40:42):
They don't think about how it's coming across.

Dr. Saldua (40:45):
But I don't love the term tooth vitamins either. I think it's a cop out, and I think it's, again, talking to people like their toddlers, and I think that that's super annoying. I think that people given enough information, and I obviously don't explain it as in detail as I just did here, but I can explain to you, Hey, fluoride, if you wanted to know more about it, fluoride will just go in and strengthen the areas where you've lost mineral. It's a mineral and it binds to the tooth and it makes it stronger. It doesn't need to be dumbed down. And I think that patients get really defensive when you dumb things down because the patient is a really smart person. They're just not an expert in dentistry. So don't talk down to them. And if they don't understand, just maybe try a different tactic.

Eva Sheie (41:30):
The other thing they do to me, that drives me bonkers, that's not them, but pretty much every doctor's office that I go to now, instead of just using text messaging for transactional messages, like your appointment reminder or our address changed, they send me marketing messages with the transactional system, and I am drowning all the time in notifications on my phone, on my computer, on my email and this and that. And so I'm in a really self-protective habit of unsubscribing from anything that's noise. And so I can't unsubscribe from the doctor's office, and that means they can misuse the system. So one day they sent me the mom happy birthday from the pediatric dentist. They sent me a happy birthday message. So I said, stop. And then guess what happened the next time one of the kids had an appointment? I didn't know it because I didn't get the text. And they were like, oh, you unsubscribed. Oh, you told me happy birthday.

Dr. Saldua (42:38):
Yeah, you're like, that's not right. Maybe they meant happy birthing day the day you birthed your baby.

Eva Sheie (42:43):
Thank you for producing two customers for us.

Dr. Saldua (42:46):
They love you so much. Happy birthing day. I do actually celebrate all my friends' birthing days more than I celebrate their kids.

Eva Sheie (42:54):
Oh, I love that.

Dr. Saldua (42:55):
I always send them flowers

Eva Sheie (42:57):
That's really sweet.

Dr. Saldua (42:59):
Up until they're like three. And then I'm like, all right, we've moved on. But

Eva Sheie (43:03):
By then you've forgotten.

Dr. Saldua (43:03):
When it's still fresh.

Eva Sheie (43:04):
Yeah, it's good. It's

Dr. Saldua (43:06):
Still the fresh pain of it.

Eva Sheie (43:08):
Tell me what you're doing on Instagram. As of today. 17,600 followers on Instagram, which is very unusual for a dentist.

Dr. Saldua (43:20):
I talk like this on it. I think people just want to know that your dentist isn't an asshole. And I think that a lot of dentists don't know how to connect. Well, actually, you know what it is, my page is not linked to a practice. So I can say things on there that can be a lot more honest and I can connect more. And there's a lot of dentists that are on there that follow me, but there's also a lot of patients. I do a lot of educational explaining, but I also do a lot of like, Hey, your dentist is a real person, and it's kind of not the funnest career. So I think that because it's not a platform for a business necessarily, I can say things and I can talk about things that are more real. I can be really authentic with everybody. And I think that that's what translates, because you'd be like, oh my gosh, I've been waiting for someone to say that.

Eva Sheie (44:20):
If it was for your business, I would tell you you're absolutely on the right track because people, especially now that AI is sort of becoming this wave, I feel like it's coming and it's overtaking us.

Dr. Saldua (44:34):
Yeah, it is really overtaking us

Eva Sheie (44:37):
That the more human we can be, the more we'll stand out. That's always been true, but now I think it's going to be more true. It's just going to keep going.

Dr. Saldua (44:46):
Especially with educational content, because Chat gbt, you can look it up and you can ask it questions, and it's really catering it to what you need. You could look up a lot of the stuff I talk about probably and get a semi good answer, but I think maybe,

Eva Sheie (45:01):
But I want to know what you think.

Dr. Saldua (45:04):
Right? And I think that that's the differences. You can look up on Chat gpt, why does my tooth hurt after a crown? Well, it's going to give you a bunch of stuff and talk through it maybe, but I don't know. I think that when you can explain it in terms that again, aren't dumbed down but aren't too advanced, and there's also a person that's explaining it, there's something about that where you can look them in the eye and be like, oh, that's interesting. Did you have any other burning questions with your kiddos?

Eva Sheie (45:39):
I don't know. My 5-year-old, she took a really long time to get rid of her pacifier. She was terrible

Dr. Saldua (45:49):
So hard.

Eva Sheie (45:50):
And so they told me when she finally got rid of it, they gave her a big prize. They were really sweet about it. They gave her a Target gift card and they had a big celebration and they made her feel better, but then they were like, she's going to need ortho.

Dr. Saldua (46:06):
Luckily young enough. Usually things will work their way out. The lip is strong enough to usually push that down. I get more concerned when there's a thumb sucking because it's really hard to get rid of the thumb.

Eva Sheie (46:19):
Did you see that TikTok last week-ish about the 20 something year old who still sucks her thumb?

Dr. Saldua (46:25):
I'm not kidding you. It's actually pretty common. I just saw a guy that I have to do Invisalign on. So if you have that, what you also need to be doing is myofunctional therapy. You cannot just move the teeth. And I think that that's my biggest pet peeve is dentists that just move the teeth and they don't correct whatever the reason that the teeth flared out. Your teeth don't just move. Your muscles are pushing your teeth into the position that they're in. And if your teeth, let's say you're one of those really lucky people where your teeth just came in straight and they stayed straight, that's because you have perfect balance of all your muscles, your cheeks, everything is kind of locked in. If you think about your teeth, they're sitting there between lip line, lower teeth, tongue, everything should be balancing it. And so if you don't have the right balance, then that's why you get ortho relapse. So when you get ortho and then it goes back after you stop wearing a retainer, there's a muscle imbalance that's happening. And again, I would say most of us have some level of muscle imbalance and probably would do really well with doing some level of myofunctional therapy, but a really severe, let's say, tongue thrust or a thumb suck. Those are obviously big habits that you have to resolve.

Eva Sheie (47:47):
I thought for a moment I can find that again. And so I start Googling adult girl sucking her thumb, and I realize very quickly, I don't really want to Google that.

Dr. Saldua (47:57):
Yeah, yeah, no, your algorithm's going to change in a way you're not gonna want.

Eva Sheie (48:03):
Put the phone down.

Dr. Saldua (48:04):
Yeah, I know. I think there's a lot of crazy videos out there. There's a lot of people also looking for attention. That one though, I'm sure is real because you have to have a lot of tooth movement in order to,

Eva Sheie (48:17):
She looked crazy. Her mouth was like,

Dr. Saldua (48:21):
Yeah, yeah. I just had a patient, I think it was two weeks ago, and he had a full on anterior open bite fit perfectly with his thumb. I asked him, I was like, do you know what this is? He's like, my thumb.

Eva Sheie (48:34):
How old was he?

Dr. Saldua (48:36):
I think he was in his upper, it might've been 35.

Eva Sheie (48:39):
Oh, man.

Dr. Saldua (48:41):
Yeah. So it's not super uncommon. It's just what are you going to do? It's your thumb. So there are strategies out there you'd probably want to see some kind of myofunctional therapist. So the reason the thumb is a habit, and my one and a half year old is just barely stopping, and I wish she had stopped even six months ago. But again, what are you going to do? But the issue is that your brain as a kid, a baby wants that pressure on the roof of the mouth. It's a calming, right? So the nipple when you're breastfeeding is that pressure, it's soothing. And when that stuff starts to go away, then you're ideally putting your tongue to the roof of your mouth. But most people, especially now because of a lot of reasons, but we all mouth breathe pretty much the tongue isn't up there.

(49:32):
And so for a thumb sucker, they're replacing it. They're replacing that soothing pressure. Same with, that's why a bottle soothes them. That's why a pacifier soothes them. It's that pressure, that suction pressure, but it should be replaced with the tongue. The tongue needs to go up there. And that's how you get that really beautiful expansion of the jaw. And the lower jaw follows the upper jaw. And if you think about even just the anatomy of a tongue where it's attached, it's attached to your lower jaw. So when you go on the airplane and you're like, geez, everyone's just passed out with their mouth wide open, and then there's one guy or girl or whatever, they're sleeping, but their mouth is perfectly closed, and you're like, that's so annoying and weird. Look at them. They're perfect little sleepers. For example, my husband, he sleeps with his mouth closed and I'm wide open and he's always laughing at me for it. But that is because the tongue is making, imagine a suction cup. You're in the shower, it's like a suction cup. And it is attached to your lower jaw. And if you make that correct, suction to the roof of the mouth and it literally just stays there. Your lower jaw will stay shut and you will nasal breathe and you'll get more restful sleep. And so that's why also there's that big trend with mouth taping.

Eva Sheie (50:44):
Mouth taping.

Dr. Saldua (50:46):
You're trying to promote nasal breathing, but the problem with mouth taping, and I actually love mouth taping. The problem with mouth taping is it does not solve the myofunctional issues. Right? Because you aren't suddenly going to get your tongue up there. It's just now it's forcing nasal breathing, which again is fine. It's better than nothing. But a lot of times that's why they're like, don't mouth tape. If you might have sleep apnea or an actual breathing issue is because well, now you minimize the ability to breathe and you're not going to just force nasal breathing if you have a tongue obstruction. So all of it comes back to the tongue, and ultimately then that creates the bite, which then ultimately creates dental health. But really it's all the tongue, actually, which is interesting. You need to do a video on that,

Eva Sheie (51:36):
I guess. So tell us where we can find you and where's the practice, and if we're nearby or not nearby, how would we go about becoming a patient?

Dr. Saldua (51:49):
Yeah, so I'm up in North Scottsdale. I'm at s and c Dental, S as in Scottsdale Road, and C as in Chauncey Road. So S and C Dental. Yeah, you just call the office and make an appointment. Or if you reach out to me on Instagram, I can always help guide you from there. But my Instagram is @dr.saldua.

Eva Sheie (52:12):
I'll make sure we put it in the notes for me.

Dr. Saldua (52:15):
Too old for TikTok, I think.

Eva Sheie (52:18):
Yeah, maybe.

Dr. Saldua (52:19):
I don't understand it. I think it's interesting as an app, but I don't know how to, the content on there is different. The people on there are different. They're more aggressive.

Eva Sheie (52:29):
It's like an

Dr. Saldua (52:30):
Angry bunch.

Eva Sheie (52:30):
Yeah, it's a whole thing. I don't do it either. I don't even have it.

Dr. Saldua (52:35):
It's interesting. I have it. It's fine. I don't really focus on it, but I do have it there. And if you message me on there, I probably won't see it for months and months. But on Instagram, I'm very active.

Eva Sheie (52:47):
Awesome. Well, I am pretty sure we're going to have to have you back. I don't know when, but the opportunity will present itself, I'm sure.

Dr. Saldua (52:56):
Yeah, it was so fun chatting with you. Thank you again for having me on. It's so fun to do these things and you're so easy to talk to.

Eva Sheie (53:03):
Aw, thanks. There's no substitute for meeting in person, but we hope this comes close. If you're considering this dentist, be sure to let them know you heard the mom the Meet the Dentist podcast. Check the show notes for links to this dentist's website and Instagram. To be featured on Meet the Dentist Book your free recording session at Meetthedentistpodcast.com. Meet the Dentist is Made with love in Austin, Texas and is a production of The Axis, theaxis.io.