Prevention-First Dentistry And New Tools

Dr Andrew Greenland 0:00

So, welcome back to Voices in Health and Wellness. This is the podcast where we explore the people, ideas, and innovation shaping the future of healthcare. Today we're diving into a fascinating area of dentistry that challenges the traditional approach of drill and fill and instead focuses on prevention, regeneration, and preserving natural tooth structure. We'll be discussing how new technologies are helping clinicians detect problems earlier and how artificial intelligence is changing diagnosis and treatment planning, and why the future of healthcare may be less about managing disease and more about preventing it altogether. I'm delighted to welcome Dr. Roumiana Tzvetkova to the show. Roumiana is a dentist and practice owner based in Long Island, New York, with more than a decade of clinical experience helping patients achieve better oral health through minimally invasive and prevention-focused care. So, with that, Rumiana, I'd love to welcome you to the show. Thank you so much for joining us today.

Dr Roumiana Tzvetkova 0:50

Good morning, Dr. Greenland, and thank you so much for having me. It's a truly a pleasure.

From Bulgaria To US Practice Owner

Dr Andrew Greenland 0:56

So let's start with your story, if we may. Could you um tell us a little bit about what attracted you to dentistry in the first place? It's probably a while ago, but it's always helpful and interesting to hear about the context and the background of our guests.

Dr Roumiana Tzvetkova 1:09

Uh yes, um, sure. I um I grew up in in Sofia, Bulgaria. Um, and uh my my mom is a retired oral surgeon. So I was exposed to dentistry um ever since I was a little girl. So uh I do vividly remember I was 13 years old, uh, school had finished, and I had nothing to do during the summer. So my mom's dental assistant got sick, and I had to step in, um, had to start working as a dental assistant, and I uh I remember when she extracted a wisdom tooth and um she mounted that on a on a stone, and I drilled and removed the amalgam filling back in the days. That's that was the material we used to use and filled the cavity, and I think that was the moment when I had decided that this is the path uh for me.

Dr Andrew Greenland 2:10

Lovely, thank you. And how has your kind of journey eventually led you to become a practice owner?

Dr Roumiana Tzvetkova 2:16

That's an excellent question. I uh yeah, I went I came to the United States when I was 15 years old and went through high school um and college, and um I got homesick, um, went back to Bulgaria and decided that I will enter dental school there. So that's what I did. I graduated dental school in 2008, um, opened up my own practice in Bulgaria and worked as a dentist for six years before I moved back to the States again because something was feeling very small, and I wanted to come back for good this time and explore how the American way is when it comes to training patients. So I graduated Tufts University in 2019 and joined Aspen Dental uh that same year. Worked as a clinical director in Rhode Island um for four years, and then the opportunity to have my own practice came in 2023. So I moved from Rhode Island to New York, where my parents live, and became an owner.

Why Saving Teeth Matters Most

Dr Andrew Greenland 3:25

Amazing. So would you mind giving us a little bit of an overview of um Aspen Dental, what your practice looks like today in 2026?

Dr Roumiana Tzvetkova 3:34

Well, Aspen Dental is um is a um DSO that is mainly for people who you know haven't seen the dentist in in such a long time. Those are the people who have barriers on emotional and financial level. So we deal with those types of patients. Uh I was trained to be a very conservative, minimally invasive dentist back from from Bulgaria, uh, because in Europe I I trust and I and I still believe that there is a discrepancy between the United States and Europe of the approach. So when I when I first started, there was a lot of extract and insert cases, a lot of hopeless teeth that I had seen. But as I had built myself as a dentist, I realized that there is always an opportunity to save eight, ten teeth, because nothing can replace the natural dentition. So when I moved to New York, I guess the population is just slightly a little bit, a little bit different than the population in um in New England, in terms that uh when you work in a big city, even though we're in the suburbs, it's still very close to Manhattan, people are more self-conscious about their teeth. Their emotional and mental um health, I feel, and and as I as I work with them, is a lot more um stable. So to them, losing all of their teeth is non-negotiable. So I guess in a way, the the patients that I work with help me be the dentist that I've always wanted to be.

AI X-Ray Insights And Patient Trust

Dr Andrew Greenland 5:23

Thank you. Now, when you look at dentistry today compared to when you first entered the profession, what changes stand out for you the most?

Dr Roumiana Tzvetkova 5:32

A lot of changes. Not I can't pinpoint only one, uh, but the the recent ones that have um uh aligned with my um ethical and moral beliefs as a dentist um are two products that I've been utilizing in my practice and and within Aspen, of course, because I do work under the umbrella of Aspen. One of them is an AI tool, it's a platform by VIDIA. It enhances our diagnosis because um it shows what the human eye cannot detect uh majority of the time, because sometimes the lesions they do not, cavities don't form overnight. It takes time for that small lesion to enter the bulk of the tooth called the dentin and reach to the nerve, right? It's not something that happens overnight. Uh, however, the human eye is uh is very interesting, it can only detect to a certain degree. So the uh the platform that we use at Aspen Dental helps us um, I wouldn't say detect, but it enhances our diagnosis. It is more visual and it makes um it makes the transparency uh more clear, I would say. What we see is what patients are able to see now because it's color um coordinated, um, and it helps a lot when we have to build that trust with the patient. And the other one that we recently have launched in Aspen um is something called Curedont. It is by um this firm called Vivardis, based in Swiss. It remineralizes the enamel and it regenerates the enamel. It's pure science, and uh, I'm in awe of what dentistry um has um come up with.

Patient Myths About Flossing And Implants

Dr Andrew Greenland 7:27

Amazing. And in terms of um client expectations, patient expectations, how have those changed in the last 10 years in your experience?

Dr Roumiana Tzvetkova 7:38

I uh do see that a lot of the time um people who had implants um and you know a lot of teeth being extracted back in the in the days 10, 15, 20 years ago when implants um were and still are the best way to restore missing teeth. Uh, they do come with, let's say, a full arch of um implants and and something fixed, and they do have they still have their natural dentition on the lower for some reason. Um their approach is completely different. Uh, I would say that majority of the time they would say dog to something to save those teeth because I feel that they at this point realize that nothing can replace the natural dentition. And again, it those type of mentalities do help me um to be the dentist that um I am today.

Dr Andrew Greenland 8:33

Thank you. Are there any other um big misconceptions that patients still have about oral health that you've kind of picked up on the misconception?

Dr Roumiana Tzvetkova 8:43

I think one of one of the biggest ones is um when they say I stop flossing because my gums are bleeding, and then we go into that vicious circle again of explaining why the gums are bleeding and why they need to floss, and the more they floss, uh, the less the bleeding. Um and uh the other misconception is again, we're going back to implants. Um I'm going to replace all of my teeth with implants so I can have a better smile. But there's so much more into extracting teeth and replacing them with um with implants. There is anatomy, there is soft tissue, there's heart tissue that we all need to think about and treatment plan before we start um taking out teeth and I would say crippling those patients. So when it when a patient like that comes to my office, I do spend over an hour explaining the pros and the cons. Um, there is a lot of misconceptions about uh overdentures and all on X. Um, and both treatment plants are expensive, but there is a component which in which they still don't understand how an overdenture is still something that they need to take in and out, even though they have implants. And this is where we sit down and the discussion is extremely thorough.

Minimally Invasive Dentistry With Curodont

Dr Andrew Greenland 10:08

Now, one thing that stood out from an earlier conversation we had was your focus on minimally invasive dentistry. So, for listeners that may not be familiar with that philosophy, what does it actually mean in practice?

Dr Roumiana Tzvetkova 10:18

Minimally invasive dentistry um is a term that I use for everything that I can do in order to prevent um future um extensive and expensive dental treatments. For instance, uh when I see a small lesion that is still within the enamel, which again um the um AI platform that I use by VIDIA in my uh in my practice helps me um enhance in visual diagnosis. Um I would rather prevent the cavity to extend to the bulk of the tooth by applying curidont. Um, and then if I see a small cavity, my prevention would be let's do a filling before it becomes a deeper filling where I need to do pulp indirect, for instance. This is a medication that we put on the top of um uh the dentin that is very, very thin. Uh, this way we can prevent uh the um the hypersensitivity in a future root canal treatment. If somebody comes that needs a root canal treatment, I would prefer to do a root canal treatment versus extracting the tooth. So, see, this is when I say minimally invasive, it doesn't mean that I would see a big, huge lesion that is um, you know, class four. Uh, for those of you who don't know what a class four is, this is when the incisal edge is in is included, and you need to do um, you know, a crown or a veneer. Uh that's that's not the case. The case is to prevent the more extensive, painful, and expensive dental treatment down the road.

Dr Andrew Greenland 12:01

Really interesting. Um, I'm really fascinated by this curidon. And you you've just mentioned it, but what's um happening biologically when this treatment is used? Give the listeners a little bit of the scientific background just to understand a little bit more about this.

Dr Roumiana Tzvetkova 12:14

Yes, so curidont is a um is a treatment um that regenerates the enamel from within. But again, it works on non-cavitated lesions. Those are the white lesions and white spots that we see on the facial aspects of teeth when people had worn prices, for instance. And who hasn't had those white lesions? We all know that back in the days we would just do amnesial facial distal filling, right? Um, or it had happened in the future, in the past, when um you see that white decalcification and you go with the ultrasound, and then the ultrasound goes straight into the dentin, and there you are, you've cavitated the tooth. So when I see those types of lesions, Curiton, I apply curadon, and curidon is a treatment uh that is being attracted uh by the lesion because it has a more acidic environment. Um, and then it attracts the calcium and the phosphate from your saliva, from the patient's saliva, uh, and rebuilds the uh hydroxyapatide, uh, which is the the bulk of the of the of the enamel.

Dr Andrew Greenland 13:29

Thank you.

Dr Roumiana Tzvetkova 13:31

I've had I've had a great uh results. Sorry to cut you off. I've had great results so far. Uh, and I am um monitoring and documenting uh those patients that are coming for their six-month periodic exam. And it's nothing but pure joy to see that uh we've been able to safety without the needle and without the trail.

Dr Andrew Greenland 13:55

Fantastic. So I'm both hearing about the results is fantastic. What results have surprised you the most? And have there been any patient stories that really stand out for you since you started using this?

Dr Roumiana Tzvetkova 14:06

Uh I would say um 16-year-old girl. Um, she and her mom came to my practice, and the lesions were were on from premolar to premolar, not to mention um molars as well. Um, we um we my hygienist um did the scaling and the root planning because she had a lot of buildup in between the gum and the bone level. Um, and then a few weeks later they removed the the braces and we applied curidon. Um I would say six weeks after that, we saw that the lesion started to become the color started to become more of the color of a natural tooth. She is about to follow up with me at the end of July, and I'm dying to see the results because I've documented the before, and I will um take pictures um from the after uh we have applied uh and treated those lesions with uh curidont, and I'm so excited because I trust and I know that the results will be phenomenal.

Why Prevention Struggles Under Insurance

Dr Andrew Greenland 15:11

Amazing. So, I mean, with your preventative focus, do you think healthcare in general spends too much time treating disease and not enough time preventing it from what you see?

Dr Roumiana Tzvetkova 15:21

Yes, I would say that uh unfortunately um insurance companies uh would rather pay for the damage when it's done versus paying for the preventative for the preventive dentistry. And it works in almost every medical field, I feel that uh they're more willing to pay for that uh versus screening and preventing problems that could be avoided on 100%.

Dr Andrew Greenland 15:51

Thank you.

AI Limits Risks And Future Impact

Dr Andrew Greenland 15:52

So coming back to the AI that you were talking about earlier on, um there's a lot of fear around AI in replacing clinicians, a lot of it's unfounded, and you clearly have a different perspective. How do you kind of treat the new technologies coming in dentistry, particularly with reference to things like the AI that you were talking about earlier on?

Dr Roumiana Tzvetkova 16:12

I think that the most important thing for clinicians out there who are just um starting to utilize AI in their practice is to know that AI is not here to replace the clinical decision. The clinicians are the ones who put the diagnosis and the treatment. AI is here to help us. Because AI has so the way the way I utilize this in my practices, before I see a patient, the first thing that I do is I always open the regular x-rays that we take. I never rely on the AI to give me what the diagnosis is going to be. And it it is kind of a battle between the AI and myself because I say, you know, this is a true cavity, this, this, this, and this. And I'm like, let me see what AI has to say. And to my surprise, of course, as I've said it before, the human eye can detect only to a certain degree when when the damage is already done. And I would be surprised to see that AI had um detected those small lesions that the human eye cannot see. And again, it is totally up to me to decide whether to do a cavity on that tooth. I mean, to do a filling on that tooth or to uh apply a curidon based on my clinical judgment, because we all know that diagnosis is based on your clinical judgment and the radiographs that you take.

Dr Andrew Greenland 17:58

So you have obviously a very balanced view about the AI technology. Um the patients trusting the technology, the ones that you're using and uh using AI to help you with the diagnosis and treatment?

Dr Roumiana Tzvetkova 18:10

On a hundred percent. I would say 200%. They do trust us, they do trust me. Uh, and I feel that people can sense when people uh when when when doctors are are being um you know more on the sales part, which um I don't appreciate. Um they they see the colors, they see the colors, they see what a small lesion looks like, they see what a big lesion looks like, they see the radiolucency um on the apex of the of the of the root if they have an infection. Uh it's something that before utilizing AI, they couldn't see what I saw. And that was more uh that put a lot of um restrictions um and and boundaries. Uh the shield was was there and it never it never went away. And the moment I started utilizing AI and started explaining um what they're seeing uh and how it translates to what I see on the other on the other end, the the my treatment acceptance got through the roof. And I'm so so so extremely grateful. And again, AI is being when when put in the in the hands of good people, uh it could do phenomenal things for for for the population. You give AI to the hands of people who don't have good intentions, then maybe their results are going to be bad. But in my in my situation, my patients trust me, I feel more confident explaining um what the treatment plan is going to be. Um, and I have a lot of trust that continues to build as time goes by.

Dr Andrew Greenland 20:01

Thank you. So you're obviously embracing AI in your work. Um, where do you think AI is going to have the biggest impact in dentistry over the next five years or so?

Dr Roumiana Tzvetkova 20:13

That is an excellent question. Um I again I don't think that AI is going to fully replace or will ever replace the clinical judgment. Uh, the only thing that I can see AI implementing it in the future is to continue to enhance things that we can miss as clinicians and just pinpoint a couple of things because just like anything else, if you look back in the days when we first started using or placing implants, people would place implants based on a panoramic x-ray. But we all know that this is a two-dimensional image versus a three-dimensional um implant that you need to place within the bone. And we know that the bone is a three-dimensional structure. So, what happened was as we had advanced, the CBCT scan became the standard of care when it comes to placing implants because it gives you that three-dimensional image of where the nerve is, where um where the arteries are. So uh, same thing here. AI is being launched in the dental field and in the medical field right now. Um, and the future, who knows what the future will hold, but all I know is that it's going to continue to help not only clinicians, but patients as well, because it does show to the patient what we as clinicians see, but the patients cannot.

Dr Andrew Greenland 21:50

Thank you. Are there any risks practitioners should be mindful of in the AI era?

Dr Roumiana Tzvetkova 21:55

The only thing that I would say for young dentists is to be careful. Careful, yes, because it could make them um I wouldn't I would I wouldn't like to use the word lazy, but the eye could become lazy if you are not as experienced. Solely take a look at the x-rays, have a mentor um by your side with whom you can discuss those x-rays, and then do the clinical exam and then take a look and open up the uh AI so your eye can be trained to look at both um both x-rays.

Dr Andrew Greenland 22:34

Thank you.

The Hard Parts Of Practice Ownership

Dr Andrew Greenland 22:35

So switching gears slightly, I'd love to talk a little bit about the business side of dentistry. Um, what are some of the biggest challenges facing dental practice owners today?

Dr Roumiana Tzvetkova 22:46

Um that's that that is an excellent question because there's there there isn't only one challenge that we face. We face um a lot of a lot of things that um dentists back in the days did not, and that comes with mental, emotional barriers, um, and a financial burden, I I trust, especially here in the United States, is uh tremendous because people have insurances, and unfortunately, by the time they need to do a scaling and a root planning or one filling, they exhaust their benefits for the year. And this, as we all know, dentistry is um is an expensive field, and a lot of the time people are on a fixed income, and that makes it hard for them to continue their treatment. And I feel that this is when people fall into that vicious circle, I'll do one thing at a time, but by the time they come, the problem has become bigger and deeper. And I feel that back in the days, comparing to what you know, how my mother used to work because she had her own practice in Bulgaria, um she, I don't think she had ever faced those those problems because everything was a lot less expensive back in the days, materials, um just anything, and I mean everything, the way the way things have changed for the last even five, ten years. Um, it's it's the the gap between um I would say the rich and the poor is getting bigger and bigger, and that's the biggest challenge that we face these days.

Dr Andrew Greenland 24:37

That's really insightful. So um which challenges or bottlenecks are most impactful to you right now, or if not right now, have been on your journey to where you are today?

Dr Roumiana Tzvetkova 24:48

I again just repeat that question, I couldn't hear you.

Dr Andrew Greenland 24:50

You should be asking about um which challenges or bottlenecks are most impactful for you in your business right now, or if not right now, you know, at some point along your journey along the way.

Dr Roumiana Tzvetkova 25:02

I would say um I wouldn't say that it's so much um the financial aspect because at Aspen Dental we do have different payment plan plans that people utilize. Um it's more um the emotional, the emotional state that they when they especially when they have to um extract all of their teeth. The terminal dentition, that's what I call that. Um and they postpone it postpone, and it takes a lot for me to convince them that they're better off um having full dentures, and then down the road we can think about getting more implants and getting over dentures or all on X versus staying with um roots that are filled with infection and uh and etc. And I did have a very bad experience uh with a patient a few a few years ago when they refused. And again, you know, if I take out all of my teeth, which were just root tips, um, it's just I'm going to be completely identalist. And I'm like, you are already identless. So the patient postponed that and ended up in the hospital. Thank God they're still alive. Uh, but I would say the mental and the emotional component is the biggest challenge in dentistry these days that we face.

Dr Andrew Greenland 26:29

Yeah.

Fear No Shows And Pain Management

Dr Andrew Greenland 26:30

Um, I think you mentioned previously that new patient show rate has been an ongoing challenge. How do you think about that today in your practice?

Dr Roumiana Tzvetkova 26:40

This, so thank God we have uh a great marketing team uh and uh that help us a lot with uh new patients. Um at this point in my practice, I do have a lot of um word of mouth. So uh patients are bringing their parents, patients are bringing their, you know, their whole families. So it's getting better and better with um new patients um show rate. Uh but again, when that declines, there is nothing in the world that can convince me that it's not fear. Fear of the dentist. That is what makes the patient come to the door. And I've had patients that they would come to the door, they would see me, and they would just walk away. I'm sorry, Doc, it's not you, it's me. I've had patients when I was working in Rhode Island sitting on the chair, big abscess, I have to take out the tooth. Uh, the moment they saw the needle, and I I tend to believe I'm very gentle when I administer the lidocaine, he's they saw the needle and they just jumped out of the chair and and ran away. So fear is the number one um barrier when it comes to new patients show rate.

Dr Andrew Greenland 27:56

That's really interesting. And I guess that's an age-old problem, but is there anything innovative in the in this in the dental space that's been able to kind of solve or help with that? Because I I guess it's been going around for years and years and years.

Dr Roumiana Tzvetkova 28:09

If there is someone who's gonna invent a painless way of administering lidocaine or anything in dentistry that's sweet, I think they will be millionaires, billionaires. Unfortunately not. Um, I don't think that uh at this point we have anything. We, I mean, I do try different techniques uh to ease um that infiltration and to make things um less painful. Because if they have that experience uh as a good experience, everything else is just a piece of cake. And and I hear that a lot.

Dr Andrew Greenland 28:49

So you're

Time Drains Team Culture Staying Sharp

Dr Andrew Greenland 28:50

a practice owner, you obviously wear lots of hats in the work that you do, clinical, operational, business, administrative. What is your biggest time drain for you as a practice owner that takes you away from the things that you prefer to do?

Dr Roumiana Tzvetkova 29:03

Long hours. You have to be when you're an owner, you think about everything. You think about every single person that works with you, um, your office manager, your practice coordinator, um, your dental assistants, your lab technician if you have one, your hygienist, um, your assistant office manager, you think about all of them. And uh you spend you tend to spend a lot of hours in the office, which to be honest with you, I still don't mind. Uh, but I wish those hours could be a little a little less than what it is right now.

Dr Andrew Greenland 29:40

And is there anything that's um in the things that you've just mentioned that keeps you up at night? What's as a practice owner, what's the kind of the biggest worry that would keep you up at night or wake you up?

Dr Roumiana Tzvetkova 29:51

My biggest worry is always the patient. A patient who um I did a root canal treatment but swelled, who knows why. Um, a patient that I placed an implant but uh is in pain uh three, four weeks since the day we've planted that implant. Um patients are my biggest uh, I wouldn't say nightmare, it's a sweet nightmare, but uh if I if I could if I could have a magic wand, it would be all of my patients are free of pain, happy, and come back just for a periodic exam. That would be the perfect scenario. And I would say that majority of the time I I have achieved that, and that is because of the um hundreds of hands-on courses that I had attended. That gives me the stability. Stability comes when you have solid knowledge because you connect the dots and you know when to worry and when not to worry. So um patience will always be number one priority in my life.

Dr Andrew Greenland 31:01

Thank you. You mentioned a moment ago your various team members that you have. What's your approach to building a team that shares your values and your patient-first philosophy?

Dr Roumiana Tzvetkova 31:12

Oh, that's a tricky one. Um, so I uh do have um standards that I hold up myself up to, and this is how I choose my team, teammates. And um, it is hard. It is hard because uh people don't have the same work ethic as I do, especially the the newer generation. Um, and um that makes things difficult for the majority of the people that I've been working with. Um and um we I choose very, very carefully. I prefer to work alone versus having people who are going to disobey what I um have built, uh, the rules and the regulations, not to mention that there are still rules and regulations that I live by uh because I'm still under the umbrella of Aspen. And I I give that as an example so many times, especially to the younger generation when they just want to come to work and look at their phones and um and the lack of accountability and the the lack of uh not being able to have a normal conversation without somebody getting offended is very, very hard. And uh and that's why I prefer to work alone sometimes, but have the right people by my side uh versus having 20, 30 people who are just there to exist.

Next Steps Ten-Year Vision Hindsight

Dr Andrew Greenland 32:41

Got it. So where do you think you're gonna be in the next 12 months? Any particular goals or aspirations you have for Aspen, your your career in your career path in the next 12 months?

Dr Roumiana Tzvetkova 32:53

Next 12 months, I will continue as we speak. I'm in uh North Carolina um taking a master class in general dentistry bonding, which is my um bread and butter. I uh I love restoring um teeth with uh with composite. Um and um in the next 12 months I will take master classes in restorative work when it comes to implants. I've done the Maxi course last year with the American Academy of Implantology. The surgical part will always be something that I am thriving to improve. My incisions, my my suturing techniques, um, and um restoring those implants to me is one of the most important things because of the um biomechanical aspect of that. So um hands-on courses ahead of me and uh continuing to deliver um impeccable uh dental care to my patients, minimally invasive.

Dr Andrew Greenland 33:54

Wonderful. And what do you think the wider world of dentistry is going to look like in say 10 years from now?

Dr Roumiana Tzvetkova 34:00

I hope for the better. I hope for if I if I have to picture dentistry in 10 years, I would picture contemporary look. Um everything is in uh beige and in white colors. Um, there is no rushing. Uh, people are more united on preserving the natural dentition and uh not destroying, if and when possible. Uh, and more united society, more united dental society, less criticism, um, more um study clubs, uh, more vulnerability between dentists, because I feel that majority of the time we don't talk about our failures, and they do exist uh maybe because of shame, I don't know. Uh, but I would like to see the dental community more united in 10 years.

Dr Andrew Greenland 34:57

Wonderful. And finally, if you were starting out again tomorrow, starting your career again tomorrow, would you do anything differently with the benefit of hindsight?

Dr Roumiana Tzvetkova 35:06

Yes, I would start more slowly. Yes. I would invest, I will continue to invest in my education, but I would master one thing at a time. That's something I started doing six years after I graduated, dental school from Bulgaria. And uh I trust that if I had started that since day one, I would have become the version of myself a lot sooner.

Dr Andrew Greenland 35:40

Amazing.

Closing Thoughts

Dr Andrew Greenland 35:41

Rumiana, this has been a fantastic conversation. Thank you so much for joining me today. I think what stands out is that you're showing what healthcare looks like when we combine prevention technology and clinical expertise rather than waiting for disease to progress. So thank you for sharing your experiences, your insights around minimally invasive dentistry, and your perspective on where the profession is heading. I really appreciate it.

Dr Roumiana Tzvetkova 36:02

Thank you so much, Dr. Greenland. It was truly a pleasure speaking with you today.