SPECIAL REPORT: COVID-19 How the International Dental Community Is Handling the Pandemic

In this Ruddle Show Special Report, Dr. Ruddle and Lisette discuss via Zoom how the dental profession around the world is dealing with the COVID-19 pandemic. We hear from several international clinicians regarding established protocols and get these clinicians’ unique perspectives. Further, Ruddle talks about social distancing, supply shortages, testing, and the overall psychological impact this virus is having on the international community. Lastly, Ruddle looks at how clinicians can maximize their time during this unprecedented moment in history and continue to be relevant. We are all in this together!

special E01
Duration 51:17
Released 04/10/2020

This transcript is made available by The Ruddle Show in an effort to share opinions and information, and as an added service. Since all show text has been transcribed by a third party, grammatical errors and/or misspellings may occur. As such, we encourage you to listen/watch the show whenever possible and use the transcript for your own general, personal information. Any reproduction of show content (visual, audio or written) is strictly forbidden.



Welcome to the Ruddle Show. I’m Lisette, and you can see, next to me is my dad, Cliff Ruddle. And, we are coming to you today through Zoom because we’re practicing social distancing just like the rest of you. And you might’ve noticed that a couple of weeks ago, the last show of our first season aired. And we’ve already started working on the second season, but we’re kind of in between seasons now, and since we’re at home, and sheltering at home, we wanted to bring you a Special Report show, and it’s on COVID-19. And we wanted to talk about it because it’s not often that every country in the world has exactly the same problem. We’re all dealing with this outbreak and how to stop the spread. So, today we really wanted to focus on discussing how the dental profession around the world is handling the outbreak, and what protocols the various governments have put in place to handle the outbreak.


Exactly. And we’d like to talk a little bit about, as the pandemic has unfolded rapidly, starting in Wuhan, and then rapidly going to South Korea, Italy, taking off in Europe, and of course a visit to the United States. And as that’s all happened, of course, governments around the world have pretty much classified business as either essential, or non-essential. And what this pretty much means without telling you, but you can get groceries, you can go to the pharmacy, fire trucks, fire departments, police departments, they’re all in action. But really, dentistry kind of falls into non-essential. So, today we’ll talk a little bit about true emergencies versus so-called emergencies. Social distancing means we can’t really get too close together, so we have to get good at teledentistry, we have to look at our patients on the phone, and speak with them, and hear their chief complaints, guide them properly. And of course, part of this whole thing is knowing when you can to the pharmacy, get something over the counter, when you might need to prescribe something versus when you need to suit up in your protective equipment and get in there and make sick people well. So, that’s a little bit about what’s going on in dentistry, Lisa.


Yeah, I think when we started working on what we wanted to talk about, around last week, really, it was Italy that was really being hit hard at that time. And, they - a couple of weeks ago, their deaths surpassed China’s deaths, and it just seemed pretty grim, what was happening in Italy a week or two ago. But right now, it seems to be slightly improving, fingers crossed. But I know that you reached out to your friend, Dr. Fabio Gorni in Milan. And he’s a Master Clinician. You’ve known him for a long time. Do you want to say anything else about Fabio?


No. Ciao, ciao, Fabio. Ci vediamo all’apice… You taught me that back in the 90’s. Give us your words, Fabio.


Yeah, we want to hear what Fabio has to say because he made a little video for us about how things are in Italy. And this was about, I guess, a week or two ago, when he made this video. So, let’s look at that.

Fabio Gorni

Hi to everyone. Fabio Gorni from Milano, Italy. It’s a great pleasure to be here just to say, hello to you and to Cliff. And, as you know, guys, we are in trouble. In Italy we have a lot of problems with the Coronavirus. And especially in the north of Italy. Milano is one of the biggest cities in the north. We closed the office three weeks ago. So, very difficult as economic problems. And we are doing just some emergencies. For [inaudible] or something like that. It’s very difficult to work on the patient with this situation. We have to use a lot of tools and devices to protect us and the patient from the virus. Please, stay at home. Please, don’t work in the office if it’s not that necessary. Strictly necessary. Be careful because this virus is terrible. A big hug from Italy and I hope to see you soon everyone, face-to-face. Bye-bye.


Yeah. So, the situation in Italy is really dire right now. I read a quote a couple weeks ago from the Undersecretary of Italy’s health ministry. Her name is Sandra Zampa. And she really sums up the situation well. Here’s what she said: “Italy looked at the example of China, not as a practical warning, but as a science fiction movie that had nothing to do with us. And when the virus exploded, Europe looked at us the same way we looked at China.” So, yeah, now, we were looking at Europe, in the United States, and we were thinking, wow, look what’s happening there. Now, it’s blowing up here, too. I noticed that Fabio said that in Italy, it’s emergencies only for endodontists right now.


Yes. In fact, when I talked a little bit earlier, Lisa about non-essential versus essential businesses and social distancing, that immediately cut it right out to true emergencies. So, yeah, I guess for some context, we should tell the viewers, today is, in fact, April 7. The clips we’re going to be showing you across this little skit is going to be pretty much harvested in the last 10 days. So, you can kind of have a context when these clips all came together. Because everybody knows the pandemic - oh, geez.




Pandemic. It’s got different curves in different countries and different cities within countries, and everybody is kind of going through that. So, fortunately, Italy and Spain look like - if you look at three-day averages, it looks like they’re starting to peak and come down. But as we go up through northern Europe, and we go to Switzerland, France, Germany, and that takes me clear up to the Netherlands, it’s not quite as rosy. And of course, they’re just a little bit behind some of these other curves that we’ve talked about. I’ll learn how to spell pan - pan - pan - pan - pandemic. But anyway, pandemics are needing to be followed and Rick is a friend of mine. Van Mill. Dr. Rik van Mill. And he lives in Amsterdam, or very close by. And let’s hear what he has to say. He’s a great clinician. And Lisa, you might have a couple words to get him going.


I just was wondering if the Netherlands is on a nationwide lockdown right now like Italy. Because I know Italy did their lockdown starting on March 9. It’s been about a month now. And it’s just starting to show, like some improvement. So, I know it seems like it’s getting a little worse in the Netherlands, currently. But yeah. Let’s hear what Rik has to say.

Rik van Mill

Our dental office and all the other dental offices in Holland, they see emergencies, only. And I’m excused from doing any dental treatments because of my age. And my question was, isn’t that discrimination? I hope not. And at the beginning of January, the office ordered a lot of facemasks, so we don’t have shortage there. And if one of our staff happens to be positive on the COVID-19 virus, the whole office closes down. No question. It's done.


So, it’s interesting that Rik is immune to seeing emergency patients because of his age. It does make sense, as well, because that is the age group - the elderly is the age group that’s most affected by the virus. I know, here in the United States, the situation is so dire that we’re calling up whoever - whatever healthcare workers we can get. Like, if you’re retired, report for duty because a lot of our healthcare workers are even getting sick and we need more. But I also thought - I noticed that Rik said that he bought a bunch of facemasks in January. So, clearly, he saw a need to prepare. How are supplies doing in our country? Well, you know there’s the old expression, fail to prepare, prepare to fail. So, I can’t speak about the world, but I’ll speak about the United States. Each state is responsible in the United States of America, they’re responsible for pandemics, plagues, floods, earthquakes, all that. When you get overwhelmed, then they go to the Feds. So, the states weren’t prepared. They went to the Feds. The Fed had some inventory but certainly what they’re doing is, they’re triaging it and they’re looking at these curves we’ve been talking about, so that they’re sending the stuff and the supplies where it needs to be at that moment. With that said, everybody in the world is trying to get to these supplies. The supply chain needs to go upstream. They get back to about two or three countries, and we’re all trying to get our stuff from about two or three countries. So, it’s tricky right now. But we’re getting though it but we’re flattening the curve. That’s what it looks like, and some curves are just beginning. So, that would probably take me north of Italy, where we heard from Fabio, and we might want to go up to Switzerland, and hear from my old friend, Pierre Machtou. Pierre -


And he also - doesn’t Pierre spend some of his time in France, as well? So, he has a perspective that’s coming from two different countries.


Yes. Pierre - most people in the world might recall that Pierre was at Paris 7, for probably 45 years. So, was the Chairman of the Department of Postgrad Endodontics for decades. He then moved to Lausanne, and he’s now with George Sirtes at Geneva. So, Pierre’s an old friend. We go back to the 80’s. All these people on this - guests today that we’re going to talk to, I’ve known them for three or four decades. So, let’s hear from Pierre.

Pierre Machtou

Hello, Cliff. Glad to be with you on the radio show today. It’s important to give you fresh news about the dentistry situation in Switzerland and in France. In Switzerland, in my opinion, the Swiss don’t tell us the situation as given too loose recommendation, so far. Dental offices can still open, but must forego all non-urgent treatment and intervention. Emergency must be treated at the office, only if all hygienic precautions are met. But in that, a patient should be referred to a hospital. The global situation is worse in France and Paris. So, the National Dental Council just asked that all dental offices in France be closed for a four to six-week period of time. Emergency patient should be systematically referred to hospital or dedicated dental clinics. Hospitals are overloaded with patient infected by the COVID-19 virus. There is a great shortage of surgical masks and body protection, even for staff working in emergency care and registration. Personally, I have two close friends who are infected in Paris. But fortunately, not serious. As you know, we are living in an unprecedented period of time. So, I urge you, Cliff, your family, and all the people in the states to stay locked up at home, and only leave home to go to pharmacy or to go and shop at the supermarket. In France, we have the example of Italy. And our main and big mistake was not taking seriously, this situation, at the right time. So, please don’t do what we did. God bless you.


I’d like to make a couple comments, Lisa about Pierre’s clip. He did talk about personal protective equipment. And then, of course, he made another point about the social distancing and emergencies. So, the first thing on PPE, so that everybody’s clear, I think we all know as dentists, because we went through AIDS and SARS, and MERS, H1N1. So, we’re pretty clear about practicing protocols in the auditory, but let’s take it to another level during this pandemic. What Pierre is suggesting, and what Rik is, is if you have a patient call you and they’re an emergency, we can just talk to them on the phone, and we can even use Zoom like today, and we can look them right in the eyes and we can ask them a little bit about the symptomology. They might be eligible for just over the counter. If it’s a little bit more, we might be able, with proper questioning, which we’ve talked about in other Ruddle Shows, whether it’s going to be a pharmaceutical need, which would be a prescription through a physician and through a pharmacy. Or, do we need to actually seen them? And if we see them, then we need to call them on the phone, we need to ask them if they’re feeling well. If everybody in their household is feeling well, we need to ask them little questions like, have you been traveling and where? Tell us where that is. It could’ve been a hotspot. And once they get through the screening, we’ll meet them in the parking lot and we’ll use a thermometer - an infrared - and we can get their temperature right in the parking lot. And if they’re with a family or friend, we would want them to stay in the car, we would escort them up to our office and of course, then we would have the head gear, the goggles, we would have even sometimes masks. Mask for sure, but I’m talking about an outer mask. Plexiglass. We would want to wear the full equipment, want to have it tight around the neck, we want to have our gloves, have tape around it where it meets the junction. Now, a lot of people don’t mention this, but don’t forget your booties. Okay? You’ve got to put those booties on because when you leave that laboratory, probably one of the first things you’re going to do after you take off your mask and your gloves and your uniform is, you’re going to probably take off your shoes and you’re going to touch shoes that could be contaminated. So, that was one point we should just harp on because all the clinicians are making these excellent points. And the last thing I’d like to comment on is the importance of reaching out, being there for your patients. I mean, we don’t have to be disconnected. We can actually give them a lot of solace and comfort by just letting them see who we are and talking to them.


Yeah. I really noticed a lot of urgency in Pierre’s video to definitely stay at home and take this seriously. And what you were saying about all of the PPE, that’s all great. But it seems right now, in our country at least, they want to reserve most of the PPE for the people in the hospitals, and the medical people that are actually treating COVID patients. So, it’s all nice if we had all of that gear. I know that actually, in California, the dental profession actually saved up a lot of gear. Masks and that kind of thing, for if something like this happened. Why don’t you tell us Dr. Nagy’s story?


Richard Nagy’s is a periodontist. Practices next door to where I’ve practiced for over 45 years. And he’s the president of the California Dental Association. And, under Nagy’s watch, we were prepared. In fact, I think the story you want me to tell is, he sent a letter out to every dentist in the state of California, and there was a crisis because we had saved up - the California Dental Association is “we”. And we had warehouses full of personal protective equipment, and we were going to now move this to deploy it into action for those first-line responders that are treating true emergencies. Four tractor-trailers full of PPE equipment for dentistry were confiscated by the federal government, and they took it because you know, you can argue and I’ll stand down on this. But it’s for the greater benefit. You know, risk versus benefit, and lives were at stake. And I guess toothaches aren’t a life. So, the government took our masks and our PPE stuff.


Yeah. It would’ve been nice - I mean, you think that you try to prepare and have stuff in case of an emergency. You want to be ready. It’s too bad when all of your supplies are taken from you. And I guess you’re supposed to - now how are you - what are you supposed to use when you see emergencies if you can’t get a hold of masks. Because now they’re telling us to wear masks. They’re telling us to make our own masks. So, okay. So, we’re getting, pretty much the story around the world right now. At least in Europe and our country, is that we are sheltering in place, clinicians are just seeing emergencies, and that we have a big supply shortage. But other countries in the world, for example, South Korea, Singapore, seem to be getting a handle on the virus. South Korea was initially hit very hard, and really rallied, and seemed to get it kind of under control. So, we do have a little clip from Dr. Henry Kim who’s in Seoul, South Korea. And maybe, - how do you know Dr. Henry Kim?


He’s Phyllis’s friend. Phyllis and Henry Kim go way back. I’ve known Henry. I give him a hug, meet him at conferences around the world. But Phyllis and him actually visit, and they actually - I don’t know if they text or, they’re Facebook friends, or whatever. But she’s always telling me little stories out of Pusan. So, Henry’s a dear friend. Well-known all through Asia. And prolific researcher. So, Henry, what do you have to say? Tell us…


Yeah. Let’s see what he has to say because he has some good stuff to say about protocol.

Henry Kim

I’m with General Korean Dental Hospital. Usually at the main gate and the main entrance, we are checking the body temperatures and taking special history of any symptom, if they have, and travel history to a specific area. If they have some suspicious condition, we do not accept them, and ask them to go the COVID testing place. This is normal over here in Korea everywhere.


Okay. So, I heard him say something that you had just said. You know, like, getting the patient’s temperature, outside, before they come into the office is ideal. When I first heard Dr. Kim talk about this, I thought, well, that’s not going to fly in the United States. The way our mentality is here, we’re not going to want - we’re going to think it’s an invasion of privacy for someone to take out temperature. But then, you showed me this thermometer where you can - it’s a no-contact thermometer. And if it was that way, then that would actually be ideal to be able to take someone’s temperature without having to actually touch them at all. Because that might actually work in the United States. I did also hear that - Dr. Kim say, that if you do have a temperature, they immediately send you to a COVID testing place so that you can get a test done. Now, I don’t even know, like if we were in our country, and say you did actually have one of those thermometers, you went out to the parking lot, and you tested your patient’s temperature and they had a fever, then you say, “you need to go get a COVID test”. And then, - we don’t have an easy place to go. It’s actually - would be more challenging to try to find out where you would even go to get one. I mean, in our country.


Yeah, that’s true Lisa. We have a big shortfall in test kits. And actually, how to administer the test kits. I don’t know if people know this around the world but I’ll tell a little - I don’t know. I guess it’s not a joke. But cars would que up in the United States or miles, miles. That’s kilometers for the Europeans. Okay? And when you go to the station, you are met by three hazmat people, and they stick a cue stick about nine feel up your nose. Well, maybe not nine feet, but it would go up. And I heard several people that had had the test say it was unpleasant. So, the good news is, that’s kind of falling away because several of the big pharmaceuticals have stepped up. It’s amazing what can be done when companies come together and put their might together. But we’re now having kits available, as I speak, and you can self-test at home, and it’s five minutes. But to Lisa’s point, people like me, Lisa, normal people, can’t get the test, still. These tests, even as bright of a future as they hold, and they will become normal across the country. But we’re not ready for prime time. So, it’s just medical people, patients that are showing may be getting towards, you know, they’re at home, they have a temperature and not feel well. But just like when Boris Johnson crossed the line in England and the UK, suddenly when you start to have it for a week and the temperature is not going down, you go off to the hospital. And certainly, they need tests in that arena. So, they’re testing just the afflicted or the people potentially in serious and medical personnel, nurses, staff, auxiliary’s, people that clean the rooms, the real heroes behind this whole pandemic.


Well, I did - speaking of testing, I wanted to see - I this is a little bit of a digression. But we do talk about sports a lot on this show, so maybe I’ll just say it anyways. This morning I listened to the television… A big thing about baseball wanting to get started again. And they were talking about plying all the games in Arizona and isolating the team members from their families for a few, and testing all the time. Testing, testing, testing. And it’s interesting because someone else came on and said, well, we don’t even have enough test kits to test our people, like, just our regular citizens, and we’re going to be devoting all these test kits to sports? So, I guess people were seeing a problem with that. You know, I think that the testing is really important though because that is a major component to South Korea being able to handle the situation where they are. I’ve heard numbers like, there’s probably ten times the amount of cases that we actually think are - that are recorded, because of, just lack of testing.


Yeah, Lisa, I think you hit it right on the head. Society will open up internationally when we can do wide-ranging testing, to all citizens. We can suddenly say, “you’re well”. You go back to work. We can say, “you’re testing wrong”, you’re still quarantined. All parks will open up, stadiums will open up, arenas will open up, we’ll all go back to work when everybody can be tested. So, testing is huge, and it’s what’s going to open up a return to normal. And then, of course, the vaccine would be just beyond that.


Right. I know that, pretty much, South Korea, although they do have some new cases springing up, they have kind of handled the problem, in a pretty efficient way. And then, they show, on the news, they show people walking around in South Korea. Every single person is wearing a mask and that’s very different than the message we got in the United States first, that we didn’t even need masks unless you’re sick. But I’m just wondering how the mask shortage - is there a mask shortage, even, in South Korea? Because it seems like they have enough mask supplies. But maybe Dr. Kim can enlighten us on that. Let’s hear from him again.

Henry Kim

About the masks, yes, here in Korea, that dentists can get the masks quite normally, but not same as before. We are asking the masks to the Dentist’s Associations, and they give us - not for free. They give us restricted amount of the masks. But we can get s much as we need, actually, in our practice, but the price is somewhat expensive comparing it with the - before this outbreak.


Yes. Great to hear what Henry’s insights were. It didn’t sound like they had a big shortage. I will say one think in favor of South Korea. They were - I don’t know about the second country, but they were one of the most published second or third countries of the world who got it right after it spread out of Wuhan, China. So, probably the supply lines weren’t as impacted then. Probably product was more available because other countries were thinking, that’s over there. It’s a long ways away. It’s not over here. And I think that also should be pointed out, that they have a country of 51 million people, and they’re a little bit smaller than the state of Florida. So, I think Korea did a pretty good job, though, to your point, and they did have masks, and they’re still wearing masks. And that brings up one of my irritations. That - you and I have talked about this before COVID. Anyway, we talked about masks. And our Center for Disease Control - CDC, here in the states. They clearly said that you don’t wear a mask unless you’re in the hospital setting, emergency people. But laymen do not need to wear masks unless they are sick. The CDC has flip-flopped, and now they’re suggesting everybody should wear a mask, whether you’re sick or well. And this was kind of irritating to me to hear, and for all dentist’s to hear because, why the hell did we ever wear a mask in the operatory if they were so inefficient and didn’t work?]


Oh, do you mean like, they were saying that we don’t need them because -


They flip-flopped.


Okay. Yeah. I know. I’ve heard like, oh yeah, well those masks don’t protect you from the virus anyways. Like, you need only this one kind of mask. But it seems to me that it might help a little bit. I don’t know. It just seems like you might feel a little safer with one on.


Well, we see them in construction, we seem them in painter’s union guys painting buildings. They’re using them. It’s not so unusual to wear them around concrete work. So, yeah. We use them in the operatory, so why not on the streets? I’m making a whole bunch of masks myself. I have grandkids. They’re making at least three or four per day.


I do think that I want to talk a little bit about how they handle when they - when someone does test positive in South Korea, because it could be effective here in the United States. However, it’s another issue that I think people might think is an invasion of privacy. If someone test positive in South Korea, they take their cell phone and they can immediately see everyplace they’ve been like in the last week. They can contact everybody that they’ve come in contact with, and then they go into isolation for two weeks, and the people that they came in contact with go into isolation for two weeks, and it really kind of just stops it right there.


You said earlier in this very show that that might be a little trickier here in the United States with our - the freedoms that we have learned to love. We might think we’re losing some freedoms by knowing where we go, who we see, how we’re moving around in our areas. So, that is something that certainly can help suppress a virus.


Yeah. It seems like we need to balance a little bit, like our freedom versus our health and the health of our loved ones. And we’re not looking to give us these freedoms forever. We’re just looking to temporarily give them up so that we can get a handle on this. I think I we should listen now to - you know someone in Singapore. He is the Chief Dental Officer for the Ministry of Health. Or, maybe he just stepped down from that position. But his name is Dr. Patrick Tseng. How do you know him? How long have you known him for, and where do you know him from?


Oh, Patrick and I go back decades. He came back to Santa Barbara many years ago on his way to an opinion leader forum. And him and Gary Cheung from Hong Kong stopped off in Santa Barbara, and we spent some very pleasurable days together. We’ve since been over to Singapore. I’ve been in his life, his world, seen what he’s done. He’s an outstanding dentist. He’s influenced endodontics internationally, and certainly is a massive name in Southeast Asia. Let’s hear from our good friend Patrick.

Patrick Tseng

As far as dentists are concerned, they are still seeing their regular patients, elective cases. Cases, before they are seen in the clinics, they are actually screened, and there’s a risk assessment done, as well. Whether they’ve had travel to countries with the epidemic ongoing. Countries which have history - well, records, of patients having the pandemic, of course they quarantine for 14 days first before they are allowed to be seen in a dental clinic. As far as endodontic emergencies are concerned, if a case is a known case, they are all referred to the hospitals. The hospitals are equipped to these patients who are - who have tested positive for COVID-19. As far as, what is the protocols, dentists who are managing these patients have to put on full PPE, which is their personal protective equipment, which is either N95 masks, together with a full-face screen. And of course, their personal protection scrubs, as well. Now, who is treating the emergencies? Certainly, the dental offices in the first line are managing them. Again, with full PPE. And they are managed, subsequently, by endodontists for the endodontic treatment. The screening precautions, like I said, are basically travel history, temperature-taking, which is compulsory at the doorstep of the dental clinics and the hospitals. What are we doing as far as to mitigate fear and anxiety? Well, I think temperature screening of all patients entering into the hospitals, as well as travel history. So, contact history, as well. If they have family history or family members who are positively tested for COVID-19, they of course have to be quarantined first before they are managed in dental clinics. Our nurses are quite - our dental assistants are well-trained. They are all trained in infection control measures, as well as, avoidance of - spread of infections. Are supplies readily available as far as masks, N95’s? Both surgical as well as N95’s and full-face screens are available relatively available quite easily. Especially since we had stockpiled them very much earlier on, due to experience from SARS. If any of our staff becomes infected, certainly - and they are known to be infected, they are taken off the clinics. They are put into an isolation ward in the hospitals. We have dedicated some clinic wards within the hospital which are able to restrict or confine them in these clinics until they are recovered fully from the virus. And they, as far as the staff who are infected, they are also isolated from their families as well. And they are asked to stay in the isolation wards until they recover. What is an immediate future after the pandemic? I guess it’s hard to say at this point of time. We are still trying to understand the behavior of the virus. We are now purposing social distancing, in which case we are trying to keep away from large crowds. Even in the shopping centers and the supermarkets, they are asked to keep at least a meter away, in which case they are trying to reduce the amount of contact, as well as the spread of aerosol’s, as far as they are concerned.


Two comments after hearing Patrick Tseng. First of all, Patrick, my family was getting prepared to see you May 5 and 6. So, don’t think because of this pandemic you got out of your visit to Santa Barbara. Patrick was going to join us on the set and he will. He just doesn’t know when yet. This will pass. But thanks for coming in, Patrick, and letting me see you virtually. The other comment is, as good as Singapore seemed to be doing early, we read just yesterday - Phyllis read to me in the newspaper that there was a little outbreak - actually some hotspots, because there’s a lot of foreign workers that make Singapore go as a major hub in the world. And these people live in dormitory’s and there’s been some COVID-19 positive tests. And so, they’re trying to damp that down. So, all this stuff we’re talking about today is to flatten the curve so we can get back to normal.


Yeah. I know that - I’ve heard it said that there are some cases that have been springing up in Singapore again. I do think that they have a lot of the protocols in place to be able to handle the outbreak officially, kind of in the same way South Korea has - that they have a lot of the resources they need. What really struck me in what Patrick’s saying was today was that it just seems like everyone is very well-trained, and that there’s a clear system in place. And I think in the United States that would do a lot to help alleviate people’s fears and anxieties if they felt like, we have the supplies, we’re prepared. Everyone knows what they’re doing. And don’t worry, there’s a system in place. Because I feel like here, it’s just kind of evolving day-to-day. Like what you were saying about the CDC. You don’t need masks. Now we need masks. It just makes us be like, well, what’s going on? Does anyone know what’s going on? I also really liked how he said that if a healthcare worker is infected, that they have a special ward reserved for healthcare workers. It would be nice if we had like, a special area to treat the healthcare workers so that they could also feel safe and comfortable, instead of just being told, - I just read this think about a healthcare worker that was just told to stay home, and ended up dying at home by herself because she felt like there was not even space for her at the hospital. So, she just stayed there. So, yeah. And then he also said, you know, social distancing of one meter. Here we have six feet, which is larger than a meter. But we also don’t have masks. So, I guess if you have a mask, you can get within one meter.


Well, I think it’s true that a lot of those Asian countries, because of their experience with SARS, H1N1, Swine Flu, things like that, they have had these before, and they’ve had them right in their backyard. And so, you could probably say they were better prepared. That’s what Patrick said in one of his clips that they were probably a little bit more d prepared than the rest of the world because they’d seen these kinds of things before.


Yeah. And so, I now want to turn it back to something I heard you say earlier. Because say you are a dentist or an endodontist in the United States right now, or a lot of places in the world, and you’re at home, and you’re not going out and you feel like you want to do something to help. And obviously I know that you’ve been very motivated to do this Ruddle Show Special Report. But if a dentist is at home, and they want to help but they don’t have the gear, and they’re not practicing right now, I heard you mention teledentistry. And the fact that we even can do a show in this format right now is pretty amazing. And that you can even see patient face-to-face in a teledentistry type of situation. So, I think Dr. Gary Glassman, he’s in Toronto, and tell us a little bit about him because I know he said something about this, too. But tell us about how you know Dr. Gary Glassman


Yeah, all the things you just said were a perfect setup for Gary. You know Gary as well probably as I do, virtually. I mean, I’ve had more dinners with him around the world. Different conferences. But you’ve worked with him right along with Oral Health, the comedian magazine that he is the Chief Editor of. So, Gary is a bright guy. Very, very smart, and very influential. Wonderful guy, fabulous clinician. I could go on and on. Great wines from Argentina. You know, Malbec. We know that region, Gary. Keep it coming. The chardonnay’s, and those big reds. But anyway, let’s hear from Gary.

Gary Glassman

We are living in an unprecedented time where the whole world is on emergency alert. All good reason to pause and reflect on what really matters most to us, both personally, and professionally. Although we are insisting on social distancing from one another, it doesn’t mean we have to professionally, or socially disconnect. Professionally, docs can make themselves available to their patients, and if possible, dispense teledentistry advice. And if necessary, provide the appropriate analgesic and antibiotic prescriptions, if over-the-counter medications don’t work.


That was great, Gary. Thanks so much. I mean, good coaching. So, I did want to get back, just a little bit more about social disconnecting versus the social distancing. Gary’s really saying, social distancing is fine. But he’s saying, as a doctor, especially if you’re an endodontist, for decades, we’ve been on the front lines of pain. So, when there’s pain dentistry, it typically ends up, we’re the garbage can of pain. So, that’s the endodontic offices. So, he told us a way, and he’ll tell us even more as we hear more clips from him, about how he prepares to see people, and what does he do during these downtimes when there is more downtime on our hands than we would’ve otherwise expected.


Yeah. Let’s hear more about what Gary - I think he has some ideas of how we can spend our time in isolation.

Gary Glassman

This is also a great opportunity to catch up on continuing education. There is an abundance of online programs available that are AGD pace and ADA cert approved, that can be enjoyed from the comforts of your own home. Personally, it’s a great time to reconnect with loved ones and friends. Life is short, and it’s high time to forgive those who may have crossed you, and to apologize to those that you may have crossed. Put down your smartphone, get off your computer, get out the jigsaw puzzle, dust off the Scrabble, Backgammon, Monopoly boards, and let’s bring back family values, and let’s reconnect with each other, once again. Until life normalizes to the new normal, we need to body slam this virus out of our lives. And until then, we’re going to have to improvise. We’ll need to adapt. But we’ll have to overcome the challenges and obstacles that we face today. And when that day comes, and it will, we’ll be stronger than ever before. Be safe out there. Thank you.


Okay. So, I did - the thing I heard - the big thing I heard in what Gary said was, you can still take this time to get some CE. So, I don’t - I mean, what do you think about that?


Well, you know, we’re all in the same boat. So, it’s not like this is Mr. Knowledge here. But like everybody in the world, I’m adjusting to not being in my normal rhythm, and I thought gave us some wonderful clues about things we can go with our wives, or our girlfriends, family, games. Kind of to reconnect in ways we have failed to do because of our “busy lives”. But one thing I did get from Gary and I have thought a lot about it myself. Dentistry will come out of this and will forever be different. There will be enormous changes just ahead. And as one single example, I can see a whole business arising into teledentistry. Because really, endodontists have already known this for decades. We can have our ladies at the front desk screen patients. And we can pretty much know if it’s a tooth that’s viable, if it’s a tooth that’s necrotic, if it’s a tooth that’s had a root canal that’s failing, and that all let’s us know how to triage. So, we’re going to be better communicators, and our patients are not going to clog our offices, and we can do a lot of this online. So, we’ll be different.


It is interesting, because if you go to a dental office, and you don’t even really need to speak. The dentist can look in your mouth. He can maybe ask you some questions that you figure that you’re the professional, so you can see in my mouth. You know what’s going on. But it does force this type of situation, this teleconferencing situation, forces people to really communicate better and to describe exactly what’s happening with them better. So, yeah. Communication’s going to be pretty important in, like a teleconferencing situation.


I’d like to tell all the colleagues that are listening that we did a Ruddle Show in season one, I believe. If I’m wrong, it’s probably a show that we’ve shot that’s just laid away that’s going to be coming on soon. But we talked about training up that lady or guy at the front desk area to ask four or five salient questions to the patients, and you’ll learn a lot about that patient’s “chief complaint”.


Okay. I wanted to go back to Dr. Rik van Mill’s particular situation. Because maybe you noticed that he was the only one that gave us a little video from his boat. Everybody else was in an office-type setting. So, why - and Rik also had some interesting things to say about how his family - his parents dealt with a very hard time many years ago, and how they got through it. But first tell us why Rik was on the boat.


Well, Rik is probably on the boat because if you look at the 1600’s, the 1700’s, and the 1800’s, the Dutch were the sailors. And Rik’s grandfather was a boat builder. So, I think there was always an affection for the sea. So, Rik is a prolific sailor, and has a great little boat there that he likes to go out into the Norse Sea. It’s not unusual for Rik to get there with Wilma, and their dog, Loefje that I think the people will see shortly, and to take off from the north of the Amsterdam area, get out into the Norse Sea, and go across the UK. He does that. He’s taken boats around the world. He’s delivered boats from people from like, one country to another. So, yeah, Rik got his boats repainted. He told me just before the outbreak he was just getting it ready for the sailing season. And he got it befouled and it was ready to go. So, when this broke, him and Wilma went to their favorite island in the Norse Sea, just north of the coast. And it’s in the - it’s a little island called Vlieland. And he said it’s their favorite island, and that’s where we’re going to see Rik. So, Rik, what’s going on in Vlieland?


Well, I think he’s going to tell us a little story about - well, first of all, I’d like to say that I wish I could go down to the harbor, get on a boat, and sail away from all of this. But that’s not going to be happening. But I do like what Rik says. Like, his talking about, giving us a little bit of historical perspective that might help us get through this. So, yeah. Let’s hear from Rik now.

Rik van Mill

My parents lived through the horrible winter of 1944 and 1945, here in Holland. And they were cooking tulip bulbs and sugar beets on a little stove made by an old beer can and little pieces of wood they collected while searching for food. And there wasn’t any Internet, or Facebook, or any other means of communication. It was just staying inside being afraid of Germans and tried to stay alive. So, what I say is, no worries. Keep safe, love each other, and Phyllis, and your daughters, and your whole family a big hug from us. And for now, our hugs will be digital. See you, and we love you. Bye. And Wilma wants to say goodbye.


Goodbye. We love you. Take care. Stay safe. Bye. Kisses from us. Okay.


Well, I think that was great. Good to hear Rik’s perspective. You know, life is about our experiences. I like to say, who you are is where you were, when. So, you can see how Rik saw it through his parent’s eyes. World War II. A little story that I don’t know that you heard. But it was another clip. But Rik had an older brother at that time, and he was 12. And they were so hungry, and so in need of food that he stole two loaves of bread from a German supply wagon. And he became legendary, in the family, anyway. And I guess the stories are still spoken about fondly today about the little kid who stole the bread.


Yeah. That’s - yeah. I like his story a lot. It is - but I do think, when I hear his story, I really think we are very lucky now, that we have the Internet, and we don’t have to just completely be socially disconnect from everyone like it sounds like Rik’s parents had to do. So, we’re lucky that we have the Internet. We can conference like this. We can even do shows like this. So, yeah. It is comforting now but I guess it’s also not comforting in that we get to hear a lot more bad stuff coming in through the media that might scare us. So, anyways, that’s our show for today. We hope that you were able to get a good perspective on how the dental profession, internationally, is dealing with this outbreak. And we’re just happy we could bring you this special report.


Yeah. Couple last comments about Rik. You know, sometimes when you hear about what others have gone through, we can use that as inspiration to know that we’re going to be okay. So, in a show that we’re going to do that’s not part of our regular Ruddle Show, but it’s special segments during this pandemic. In maybe two, three, four, more weeks, we’re going to bring you another clip. And from that perspective, we’re going to be standing on top of the flattened curve because we’ve all been doing a good job of social distancing and closing the non-essential dentistry. And we’re going to look out into the future and how the big machine begins to turn. Remember, you’re a cog in that big machine. And all those cogs will begin to turn, and we’ll get back to normal. So, we’ll see you then.


Yeah. See you next time on the Ruddle Show.



The content presented in this show is made available in an effort to share opinions and information. Note the opinions expressed by Dr. Cliff Ruddle are his opinions only and are based on over 40 years of endodontic practice and product development, direct personal observation, fellow colleague reports, and/or information gathered from online sources. Any opinions expressed by the hosts and/or guests reflect their opinions and are not necessarily the views of The Ruddle Show. While we have taken every precaution to ensure that the content of this material is both current and accurate, errors can occur. The Ruddle Show, Advanced Endodontics, and its hosts/guests assume no responsibility or liability for any errors or omissions. Any reproduction of show content is strictly forbidden.

DISCLOSURE: Please note that Dr. Ruddle has received royalties on and/or continues to receive royalties on those products he has designed and developed. A complete listing of those products may be found at www.endoruddle.com/inventions.

Watch Season 10


s10 e01

Delving Deeper

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s10 e02

The Dark Side & Internal Resorption

The Resilon Disaster & Managing Internal Resorptions


s10 e03

Advanced Endodontic Diagnosis

Endodontic Radiolucency or Serious Pathology?


s10 e04

Endo History & the MB2

1948 Endo Article & Finding the MB2


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Collaborations & Greatness

Crown Removal vs. Working Through & Thermal Burns Q&A


s10 e06

Vital Pulp Therapy

Regenerative Endodontics in Adolescents


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Clinician Influence & Fractures

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s09 e01

Moving with the Cheese & Delving Deeper

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The Dark Side & Post Removal

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s09 e03

3D Tomosynthesis

Special Guest Presentation by Dr. Don Tyndall


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Controversies & Iatrogenic Events

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AAE & Endo/Perio Considerations

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Fresh Perspective & Apical Divisions

Fast Healing & Irregular GPM and Cone Fit


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Microscope Tips & Perforation Management

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Knowing the Difference & Calcification

Esthetic vs. Cosmetic Dentistry & Managing Calcified Canals


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The Loose Tooth & Guest Dr. Josette Camilleri


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AAE Discussion Forum & 3D Irrigation

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Articles & Preferred Access

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Patient Protocol & Post Removal

CBCT & the Post Removal System


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Avoiding Burnout & Ledge Management

Giving New Life to Your Practice & Managing Ledges


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Start-To-Finish Endodontics

Special Guest Presentation featuring Dr. Gary Glassman


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Laser Disinfection & Obturation

The Lightwalker vs. EdgePRO Lasers and Q&A


s07 e06

Extra-Canal Invasive Resorption

Special Case Report by Dr. Terry Pannkuk


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GentleWave & Microsurgery

Every Patient Considerations & Surgical Crypt Control


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Artificial Intelligence & Endodontic Concepts

Update on AI in Dentistry and Q&A


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s06 e01

Comparisons & NSRCT

Chelator vs NaOCl and Managing Type I Transportations


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Special Guest Presentation

Dr. Marco Martignoni on Modern Restoration Techniques


s06 e03

International Community & Surgery

Breaking Language Barriers & MB Root Considerations


s06 e04

Launching Dreams

ProTaper Ultimate Q&A and Flying a Kite


s06 e05

Rising to the Challenge

Working with Family & Managing an Irregular Glide Path


s06 e06

Controversy… or Not

Is the Endodontic Triad Dead or Stuck on Semantics?


s06 e07

Endodontic Vanguard

Zoom with Dr. Sonia Chopra and ProTaper Ultimate Q&A, Part 2


s06 e08

Nonsurgical Retreatment

Carrier-Based Obturation Removal & MTA vs. Calcium Hydroxide


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s05 e01

Common Endo Errors & Discipline Overlap

Apical and Lateral Blocks & Whose Job Is It?


s05 e02

Post Removal & Discounts

Post Removal with Ultrasonics & Why Discounts are Problematic


s05 e03

EndoActivator History & Technique

How the EndoActivator Came to Market & How to Use It


s05 e04


New Disinfection Technology and Q&A


s05 e05

Exploration & Disassembly

Exploratory Treatment & the Coronal Disassembly Decision Tree


s05 e06

Advancements in Gutta Percha Technology

Zoom Interview with Dr. Nathan Li


s05 e07

By Design... Culture & Surgical Flaps

Intentional Practice Culture & Effective Flap Design


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Workspaces & Calcium Hydroxide

Ruddle Workspaces Tour & Calcium Hydroxide Q&A


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Cognitive Dissonance

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Tough Questions & SINE Tips

Who Pays for Treatment if it Fails and Access Refinement


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CBCT & Incorporating New Technology

Zoom with Prof. Shanon Patel and Q&A


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Best Sealer & Best Dental Team

Kerr Pulp Canal Sealer EWT & Hiring Staff


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Ideation & The COVID Era

Zoom with Dr. Gary Glassman and Post-Interview Discussion


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Medications and Silver Points

Dental Medications Q&A and How to Remove Silver Points


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Tough Questions & Choices

The Appropriate Canal Shape & Treatment Options


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Q&A and Recently Published Articles

Glide Path/Working Length and 2 Endo Articles


s04 e09

Hot Topic with Dr. Gordon Christensen

Dr. Christensen Presents the Latest in Glass Ionomers


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AAE Annual Meeting and Q&A

Who is Presenting & Glide Path/Working Length, Part 2


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s03 e01

Treatment Rationale & Letters of Recommendation

Review of Why Pulps Break Down & Getting a Helpful LOR


s03 e02

Profiles in Dentistry & Gutta Percha Removal

A Closer Look at Dr. Rik van Mill & How to Remove Gutta Percha


s03 e03

Artificial Intelligence & Endo Questions

AI in Dentistry and Some Trending Questions


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How to Stay Safe & Where to Live

A New Microscope Shield & Choosing a Dental School/Practice Location


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3D Disinfection

Laser Disinfection and Ruddle Q&A


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Andreasen Tribute & Krakow Study

Endodontic Trauma Case Studies & the Cost of Rescheduling


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Ruddle Projects & Diagnostic Imaging

What Ruddle Is Working On & Interpreting Radiographs


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Obturation & Recently Published Article

Carrier-Based Obturation & John West Article


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Retreatment Fees & the FRS

How to Assess the Retreatment Fee & the File Removal System


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Research Methodology and Q&A

Important Research Considerations and ProTaper Q&A


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s02 e01


Product History, Description & Technique


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Interview with Dr. Terry Pannkuk

Dr. Pannkuk Discusses Trends in Endodontic Education


s02 e03

3D Disinfection

GentleWave Update and Intracanal Reagents


s02 e04

GPM & Local Dental Reps

Glide Path Management & Best Utilizing Dental Reps


s02 e05

3D Disinfection & Fresh Perspective on MIE

Ultrasonic vs. Sonic Disinfection Methods and MIE Insight


s02 e06

The ProTaper Story - Part 1

ProTaper’s 20+ Year Journey as Told by the Creators, the 3 Amigos


s02 e07

The ProTaper Story - Part 2

ProTaper’s 20+ Year Journey as Told by the Creators, the 3 Amigos


s02 e08

Interview with Dr. Cherilyn Sheets

Getting to Know this Top Clinician, Educator & Researcher


s02 e09

Broken Instrument Removal

Why Files Break & the Ultrasonic Removal Option


s02 e10

3D Obturation & Technique Tips

Warm Vertical Condensation Technique & Some Helpful Pointers


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s01 e01

An Interview with Cliff Ruddle

The Journey to Becoming “Cliff”


s01 e02

Microcracks & the Inventor's Journey

Ruddle Insights into Two Key Topics


s01 e03

Around the World Perspective

GentleWave Controversy & China Lecture Tour


s01 e04

Endodontic Access

What is the Appropriate Access Size?


s01 e05

Locating Canals & Ledge Insight

Tips for Finding Canals & the Difference Between a Ledge and an Apical Seat


s01 e06

Censorship in Dentistry

Censorship in Dentistry and Overcooked Files


s01 e07

Endodontic Diagnosis & The Implant Option

Vital Pulp Testing & Choosing Between an Implant or Root Canal


s01 e08

Emergency Scenario & Single Cone Obturation

Assessing an Emergency & Single Cone Obturation with BC Sealer


s01 e09

Quackwatch & Pot of Gold

Managing the Misguided Patient & Understanding the Business of Endo


s01 e10

Stress Management

Interview with Motivational Speaker & Life Coach, Jesse Brisendine


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