Welcome And Big Questions

Dr Andrew Greenland 0:07

So welcome to another episode of Voices in Health and Wellness, where I speak with clinicians, healthcare leaders, and innovators about the ideas, experiences, and challenges challenges shaping the future of healthcare. Today's guest is Dr. Vishal Sharma from Aura Orthodontics in British Columbia, Canada. Now, when most of us hear the word orthodontics, we probably think immediately of braces and straight teeth, but Vishal's philosophy goes considerably further than that. His work explores the relationship between orthodontics, facial development, breathing, airway health, and sleep, particularly during childhood when growth and development can potentially influence health for years to come. How clinicians how should clinicians respond when they s uh when they're seeing compelling outcomes in practice, but large-scale research hasn't necessarily caught up yet? And how do we distinguish genuine innovation from getting ahead of the evidence? We're going to explore all of that today, as well as what parents and fellow healthcare practitioners should be looking for when it comes to children's facial and airway development. So with that, Richard, I'd love to welcome you to the show and thank you so much for joining me today.

Dr Vishal Sharma 1:06

Thank you so much, Dr. Greenland. It's an honor to be here. I'm uh

From NYU To A New Lens

Dr Vishal Sharma 1:10

happy to discuss some of these topics in a little bit more depth.

Dr Andrew Greenland 1:13

Thank you. So let's go back to the beginning. Can you give us a sense of your journey and how you got into orthodontics in the first place? And what eventually led you to this more functional approach that you've adopted?

Dr Vishal Sharma 1:24

It's a great question and uh dates back a bit, I guess. So uh I was fortunate enough to have the opportunity to study at NYU, uh the dental school there. And actually, I was uh fully inclined for a surgical track. I was preparing myself for that, and then just kind of like a chance, uh a chance conversation with a friend completely shifted my focus uh towards orthodontics. So honestly, the journey towards orthodontics, it was it was not by any means uh a complete uh childhood dream. Though when I met my cousin about uh 20 years later, uh this is just recently now, she did recite a story where when we were children, I said I wanted to be an orthodontist. I completely forgot that story, but she reminded me of it. So maybe it was buried deep inside, and that's why the switch over was quite easy. Um, from there, I completed uh my orthodontics also at NYU, and then I returned back uh to British Columbia here to be in Vancouver with my family. Uh the journey, I'm now in my 15th year of practicing orthodontics. Uh, and and within those 15 years, it's been a unique uh uh journey along the way from, you know, as we all know, during residency, we learn how to do what we need to do, but we're not super proficient just yet. So the first few years are always kind of understanding your flow, how you like to use certain tools, what works good in your hand. And then the evolution till now, uh, I really especially kind of the airway topic and what we're on the forefront of doing today is largely my children. Uh, you know, seeing them observing facial growth and development. And I'm fortunate enough to have twin boys, and they both have unique uh uh issues. But to see that from birth onwards, to see how the current medical system as it stands is paying attention to certain issues or not, where the blind spots are, just by nature of the construct of our system, and seeing the impact of facial growth and development or lack thereof, and how it begins to form symptoms and what I see clinically at what is considered to be the age of orthodontics 12 to 13. Uh, some parents who are mindful might bring a child in from seven to 10, but seeing my children, putting it together with the base of my understanding and knowledge, what I'm seeing in the clinic, what I'm seeing uh uh missing in terms of the medical vertical, that's kind of helped formulate this approach that we have today.

Dr Andrew Greenland 4:01

Thank you. Really helpful, really helpful to get the back the back the backstory

Teeth Follow Jaw Growth

Dr Andrew Greenland 4:05

and the journey. Thank you. Um so I know you've said that orthodontics starts long before braces. What do you mean by that exactly?

Dr Vishal Sharma 4:13

So the most important thing to understand here, because that's a loaded question, but the most simplest way I can explain this is teeth are like passengers on a ship. So the size of that ship, the position of that ship will determine where the teeth are able to go, just like passengers. So what we current orthodontics largely, but not exclusively, focuses more on the final position of teeth. And I think orthodontics is under an evolutionary process to understand this, but driving the message home down to parents and patients is really the more the bigger challenge. We have to understand and respect how much shaping the jaw, like what are the pressures that shape the jaw into what it's going to become? And how can we influence that for the most optimal health, which includes, in my view, at the very tail end the alignment of the teeth? But prior to that is the structure of the bones, how do they fit together? Are they distributing pressures appropriately? Are they allowing space for teeth to form? Are they allowing for us as a species to breathe correctly? And what I'm seeing in short is that much of our modern-day habits are not leading to that. So we have issues, those issues show up in the teeth, but the issue is really underlying. We have to kind of peel back the layers to understand okay, what's happened here? How do we correct it? And what other impacts on health are happening as a result of the crowded teeth. So traditionally, we see children at seven to eight, as recommended by our uh professional bodies. I reckon that as healthcare providers, dentists, physicians, pediatric uh dentists, and pediatricians, both, should be mindful of just a few things before the age of five. And those are completely non-dental. Maybe one we could consider to be dental. If a child less than five has dental crowding already, they are already undersized in the jaws and likely to be displaying other signs if we're paying attention. Not always, but likely. The other things are completely behavioral and physical. So, how well are they sleeping? Do they sleep through the night or are they waking up often? Bed wetting is related to that. The more you bedwet, the less likely you're in REM sleep, the less likely you're breathing properly, and the the greater the chance that the jaws are not large enough. Are children grinding their teeth? Grinding results in the same issue. When teeth don't fit together properly, the muscles don't really find a place to rest. And when they don't rest, they end up becoming hyperactive, almost like a fidgety leg, you know? So that's what grinding really is. It's just a fidgety muscle that hasn't found its peaceful home and resting place. Bags under the eyes. Are they waking up unrested? Do they fatigue generally easier? Now, of course, some of these things have multiple possible inputs, but these are just hints that we can detect and pay attention to that, hmm, maybe there's an underlying issue that we could resolve with a deeper analysis.

Dr Andrew Greenland 7:53

Amazing. Um, I think you

Early Clues Before Age Five

Dr Andrew Greenland 7:55

described um orthodontics to me essentially as dental facial orthopedics. What does that mean in practical terms for those listeners?

Dr Vishal Sharma 8:02

Yeah, so for those of us who are medically inclined, we can put the words together and break it down to like basic and medical uh terminology. Dentopacial orthopedics means you know, face, uh growth of the face, jaws, muscles, bones, and the whole complex, and how to manage that. So when we think of an orthodontist, even in the medical facility, our minds go to aligning teeth with braces or uh invisible aligners. Uh uh, there's several different companies that do that. So that's where our mind goes. But in our actual credentialing licensure, and the title of our vocation is dentofacial orthopedics, and that is exactly what I'm speaking to. How can we assess, diagnose, treatment plan, and treat misshaped jaws? Again, so that at the end of the day, which won't by the time the child is 12, 13, or 14, we can have aligned teeth that fit together well and function well, but in the meanwhile, that allow us to breathe properly, distribute pressures properly when we eat, and allow our body to get the most primary uh uh nutrient we need, all of us, which is actually oxygen. So rooting all of this back down, and this is where I take it a little bit further, I might say, is being cognizant of how that link relates to how are we breathing, tongue position, and other things that help formulate good growth and development.

Dr Andrew Greenland 9:39

And with all of that, I mean, how much influence do we actually have over facial development whilst the child is growing, in your opinion?

Dr Vishal Sharma 9:49

If I understand the question correctly, you're saying how much influence can we have while they're growing?

Dr Andrew Greenland 9:54

Yeah, facial facial development specifically.

Dr Vishal Sharma 9:57

Yeah. Um quite a bit, rather, uh, because at this young tender age, everything is still uh formable, uh malleable in a sense. We can uh manipulate and guide the growth to be in the direction that we want. So, how much can we influence? Quite a bit, more so than you might say after, let's say, 14 or 15. So, for example, uh my twin boys, who are now just five, just started kindergarten. I have them both in palatal expander devices. And one of the twins needed it more than the other, but the other one is gonna benefit from some expansion, nonetheless, just not as much. So, because the bones are soft, because the everything is kind of choosing its direction of growth, we know what the trend is going to be. We can't say with precision, oh, this is exactly how your child will grow and develop if I see them at five. Can I predict what they'll look like at 14 with 100% accuracy? No, most certainly not. But I can definitely give you a trajectory of which direction is this child heading? Is he heading north? And if so, how much north? I used I use the compass as an example, as a metaphor here, right? So, what type of malocclusion, misfitting bite issues might this child have are evident in their growth up until five, to I would say almost the 80 to 90 percent accuracy in terms of what range they would fit in. And that is enough for us to decide whether we should intervene or not intervene.

Dr Andrew Greenland 11:36

Thank you. Um so this um the audience for this podcast is generally practitioners. So, are there any particular signs that should prompt a fellow practitioner or dentist, GP, or other healthcare professional to consider an earlier orthodontic assessment? Because you're certainly advocating for early assessments. What things should practitioners be looking out for that would warrant that?

Dr Vishal Sharma 11:58

So I'll speak primarily to the dentist first, uh, and then I'll move to the medical colleagues. So uh dentist, pediatric dentist, anyone who's seeing children from that two to five window,

Airway Red Flags For Clinicians

Dr Vishal Sharma 12:10

if a child has dental crowding, especially in the lower anterior section, that is a definite sign of insufficient spacing, which will likely lead to other issues. Uh, and the reason for why that happens needs to be explored a little bit. So dental crowding is one of those primary things that does show up early. Now, yes, a child is growing, so some of that crowding will alleviate, but the most ideal alignment for children who have no permanent teeth is adequate spacing between each tooth, at least a half a millimeter, if not greater. So essentially it should look like a white picket fence. And if it doesn't look like a white picket fence, with most humans not having that, because of modern-day habits, which we'll perhaps get to in a moment, but if they don't have that, then there's likely a jaw size shape discrepancy. So that's kind of like the red flag that anyone can kind of see from afar. You don't even need to be a dentist to tell that there's either crowding or there's spacing, and that's pretty much as black and white as it needs to be. Beyond that, we can there are some auxiliary signs. Grinding at night, some level of grinding is normal, but constant and uh intense is a different style. So if you either speak to a parent of a young child and be like, oh my gosh, I could hear them from the next room or are you walking away, like that type of grinding is not pathological, but abnormal. We would say that for now. And then the last thing is if they're not feeling rested, if the child is not getting sleep, that's likely to be a sign of an undersized jaw. There are absolutely confounding factors in the soft tissue, such as enlarged adenoids, which also lead back to jaw size and position in terms of airflow. But if they're not rested well enough, they're waking up with bags under the eyes, they're generally irritable. Um, oftentimes, and this is research proven, that on the lower end of the spectrum for ADHD and even mild, mild autism has been sometimes confused with pediatric sleep apnea. And that's the one thing that we ultimately have to acknowledge that, and now I'm gonna veer towards my medical colleagues, is any such similarities to adult sleep apnea and children is the ringer-dinger. That's the one, that is the bell. If your patient is demonstrating um the type of behavior that comes from being unrested, easily irritable, agitated, and oftentimes, and it's necessary to have these diagnoses, but oftentimes we're too quick to shunt towards things that may not be true versus going up the ladder or down the ladder, however you view it, of invasive diagnoses. Is this potentially an airway issue? It should be uh assessed before we get into deeper uh uh diagnoses that stay with children for for their life. This is a modifiable component, and oftentimes, which I've seen in my patients, simply opening up the airway via arch expansion. And this is not a hundred percent uh linear uh relationship, so I need to acknowledge that for our medical colleagues, that this is an attempt to open up the airway, that oftentimes helps alleviate several of these symptoms. Um, one symptom that I haven't mentioned that I think everyone should be aware of parent, patient, dentist, or uh uh physician is pediatric snoring. If it's constant, if it's uh uh consistent, and if it's fairly frictioned, you know, you can tell the sound. Is it a mild, like I'm just kind of breathing because I'm changing positions, or is it an actual snore? That is likely a sign of airway blockage, and that relates to jaw growth and development. So I think amongst those uh four to six uh signs I mentioned, there's enough kind of like red flags we can just burn in our memory to keep to help us as we see patients on a day-to-day basis.

Dr Andrew Greenland 16:30

Obviously, your parents your patients come with parents attached. Is there one thing that you would um really like to change the thinking about the parents have regarding orthodontics?

Dr Vishal Sharma 16:42

I think it's kind of already that, which we kind of spoke to, but I'll speak to it a little bit more clearly. Is if you notice a dental issue, which is the reason actually most dentists refer patients to me, and even parents themselves, when they come directly, uh, they come to me for a crowding issue. I notice that this tooth is way in the wrong position. What can I do about it? That's a great sign to also burn in your memory, as I mentioned earlier. But the one thing that I would like for us to start viewing differently is that this all of these issues are pointing towards actually an airway issue. So, not coincidentally, what I see in the patients is when they do present with a severe crowding issue, there is more likely to be some level and degree of airway blockage via the adenoids and tonsils, or both. So when we and that's the one thing I want us to take home is that we need to look at this as an airway problem. Is my child breathing correctly? If you're 100% sure that they are, fantastic, continue on. But if you have any drop of a doubt, I would suggest seeking an opinion from an airway-minded uh dentist andor orthodontist, because most often that issue can go undiagnosed. It's not airway management, it's not necessarily on the pediatrician's radar because they see the child generally in the first year, unless there are other complicating factors. And we're not getting to see an ENT with diagnoses until the airways are far too blocked. At that point, at least in Canada, the SOP for treatment is monitor, moving towards steroidal spray. And then, if there's no resolution, surgery. And oftentimes we do need our adenoids for the duration of life. So I encourage you to seek an airway assessment, um, at least from an orthodontist again or dentist who's airway-minded. This will help us because without oxygen or adequate oxygenation, the analogy I like to use in my uh lectures, is one of a light bulb, which we can all resonate with. And when it receives too little power, what happens? Right. If you said it flickers, you're exactly right. So the brain and the nervous system at the top of our anatomical tree, you might say, but every system, when significantly or sufficiently deoxygenated, simply cannot grow and develop the way it's supposed to grow and develop. And that's as mat medical practitioners, that's what we have to understand that okay, all of these systems are developing early. Central nervous system, respiratory, circulatory, muscoskeletal, and endocrine, and every other system that goes beyond that. They're all developing at this young, tender age, and without adequate oxygenation, they simply cannot grow effectively. And that is likely to have a myriad of complications down the line. Um pediatric sleep apnea

Evidence Gaps And UBC Research

Dr Vishal Sharma 20:10

just being on the very early end and detectable range.

Dr Andrew Greenland 20:16

Thank you very much. Um when we chatted before, I think you described a sort of split mentality within orthodontics. Could you um speak a little bit to that? And what what what are the issues and challenges in your profession?

Dr Vishal Sharma 20:29

Um currently there are a handful of us within the profession viewing things this way, and it's largely uh tied to the lack of research around it. And this is why I'm very passionate about affiliating with uh a local university here, so that we can start to get this information into publications more deeper assessed, uh, you know, so that we can make these links um more concretely. And within the profession, it's helping us all get to the same page. Now, orthodontics is very unique in the sense that if you get five opinions you'll pro uh from different doctors, you'll probably get at the walk away with at least three different treatment plans for the same end result. And that's just orthodontics, but I can understand how that becomes super confusing for our parents. Um, and it also speaks to the challenge within our direct profession, that being orthodontics, before I even stretch out to dental at large, and then before I even include the medical umbrella. But getting to the same page and understanding that the likelihood of this connection prior to it being completely backed with full substantiating research, uh, there is research that does exist, Dr. Greenland, but it's just not as like crystal clear and like, you know, it's not ringing the bell from the top of the mountain. Type of research yet, you know, where the whole profession goes, Oh my gosh, we've missed something. You know, this is very early stage. This is early understanding. Um, you know, understanding uh uh how our biomedical development intertwines with our metaphysical existence and how we're able to actually function as a fully developed, how we get to be fully developed in the first place, um, and acknowledging that this airwake issue is a component simply because of one fact that we cannot deny. Nobody can deny this one fact. And I suggest that this is where we start. Adequate oxygenation is vital for proper development. Just that I think we can all agree upon, doesn't matter which field of study you come from. So once we root there, we said, okay, is there something perhaps blocking the airway? And then just start to make these connections because getting these types of case reports, seeing these things in your clinic, such as I am, are going to be the things that wake up the light bulb within your mind and say, okay, this is how we can actually take a different course of direction. And if we resolve the airway blockage issue early, we may be on the benefiting factor of several potential complications that we don't even know about. We don't even know where that trade's gonna go, right? Um, so that's the challenge, and I and I want to be part of a uh healthy discussion. Uh, you know, there are naysayers and and disbelievers, as with any you know, new way of thinking, but the goal here is unification. Uh, for honestly, and this sounds like a reach, but is this not for the betterment of all human species? If we're all breathing better, and you and you'll notice me uh defaulting back to breath, not to dental alignment, when the jaws are proper size and shape, the teeth are more likely to fall into the right place. The likelihood you need orthodontics decreases, or maybe mild orthodontics for aesthetic and functional improvement. But if we all focus on that improving the airway, let us all breathe better. Let us all breathe better. Then we're on the right track.

Dr Andrew Greenland 24:20

Thank you. And with that, how do you personally decide when there's enough evidence to change the way you practice personally?

Dr Vishal Sharma 24:28

Um, so a lot of this was kind of like a little bit of a rabbit hole, if you say, you know, a lot of us have done this in our careers. We get to a certain point. Is this all there is? Like it happened for me when I was gifted with uh my twin boys, uh, and turning 40 was exactly the same point of my life. And this is kind of like an assessment, you know, like a let's say like a rest stop where you take a checkpoint and those kinds of things. It was also coinciding with COVID. And I'm sure a lot of us did a lot of deep thinking at that time, and I had that opportunity. So this is where I began to uh see things differently, see the face differently. Again, I just changed it this way that okay, are we breathing correctly enough? Uh, and this is like on a side quest that's happening for me in my personal life was my discovery of meditation and understanding that the more I slowed my breath, the deeper I could connect to myself. And every single answer I ever wanted would just pop up on its own. And anyone who's meditated deeply enough can tell you that, yep, that is true. So then I began to appreciate the power of breath. And all the while I'm understanding with my own children, observing my children, but my understanding of dental facial growth and development, how what I do impacts how well people can breathe. And um, I went in a rabbit hole and discovered that these links exist, but they're not fully interconnected. Think of like a spider web that's disjointed. And if we just take a little bit of time to kind of like put all the pieces together, you'll begin to see that this body of work is actually pointing in a certain direction, right? We don't need the you know to get full conviction from to your previous question from the field and the science. We need to have that red flag research that makes us all go have that moment. But until then, we can see that the research is actually already pointing in a certain direction. It does stop short, and then there's shades of gray, which is where I recommend we start to consider doing a little bit more research. And I know it's already underway with fantastic fantastic scientists all over the world uh to appreciate this airway connection.

Dr Andrew Greenland 26:47

Thank you. And on the subject of the research, so I know you've been talking about the uh work of the University of British Columbia. What data are you hoping to collect and what questions would you ultimately like that research to answer for you?

Dr Vishal Sharma 27:00

Um I I think the first is really trying to see if expansion adequately opens the airway within um statistically significant means. So as a case report, I had this one patient who had approximately 1.5 to 1.25 to 1.5 millimeters of airway opening uh between the adenoid and the uh larynx. After expansion, this opened up to 19.5 millimeters. So we had a 2,000% increase in airway. Now, unfortunately, and I'm not making any claims here, but just to be transparent with the story and give us all food for thought, because this, what I'm about to say, did help bridge something for me. That poor young girl was diagnosed with a tumor shortly thereafter. And I just asked myself, I wonder if the oxidative stress that she was under for all those years had a contributing factor to the development of her tumor. And I just simply asked, I'm not making a claim, but I say if we all ask that question, whether you're an oncologist and you're listening to this, you're a physician, you're a radiologist, dentist, orthodontist, doesn't matter. You might say that, yeah, oxidative stress is not good for our bodies, and it could cause a lot of problems. Is that a problem with the tumor? I don't know. Now that's an extreme example. No, not every patient is getting a 2000% opening. It was kind of like a freak occurrence. I floored me to see it honestly. But what we are seeing is the average patient will get 30 to 40% increase, and a handful of patients are seeing 200 to 600% increases. 2,000% is an outlier. But that is the first question. That is the first thing I think we start with, because then we'll be able to understand that okay, yes, jaw size and shape is related to oxygenation. We can improve it via a very simple tool that we're already using. And this is kind of like the lowest barrier to entry to be like, okay, let's focus on early expansion when we see the signs and symptoms for it. And that would be uh ultimately

Leading A Growing Practice

Dr Vishal Sharma 29:10

opening the gateway for better health for everyone. And I think that's the first question that I'd like to answer.

Dr Andrew Greenland 29:15

Brilliant, thank you. So for sure, I'd like to switch gears a little bit now. So maybe because um there's another part of your story which I think is very interesting. You're not only trying to change how people think about orthodontics, but you've also had to build an organization that's capable of delivering that vision. So, what's been the most challenging part of growing or orthodontics while maintaining the clinical philosophy you believe in?

Dr Vishal Sharma 29:38

Yeah, that's a great question. I mean, I think the challenge for any leader is to get uh buy-in from everyone who's on board. Um and I mean, look, we're all independent thinkers and we all have our uh autonomy, especially amongst the professions. So when it comes to our uh uh medical colleagues, dental colleagues, we all have our way of looking at things. And that's more of a dialogue. I think being a person who understands that unique perspectives are the norm. And rather than trying to force-feed people into a way of thinking, I like to address the doubt in their mind and present it and through dialogue bring them into perhaps considering that this is what I'm saying is true. And it's not because I'm saying it, it's just because it's one of those universal laws that might exist, you know, constricted airway is gonna lead to deoxygenation, hypooxygenation. That's just true. So, and then similarly, we we all need oxygen to survive. These are facts, right? Um, and I think that's the biggest challenge, even in an organization as a entrepreneur like dental in in Canada, North America, is very much like a business uh in order to survive the test of time and have people buy in. It's it's really like communicating with them adequately, giving them space to do it on their own. You know, it's like when we for those of who those of us who have uh uh teenagers, I deal with teenager patients all the time, so I I know I don't have my own yet, but we have teenagers and they kind of like, you know, they're they're in that strong opinionated phase, um, where you know, we kind of have to let them see it on their own and guide them into what is the the the true mat the true essence of the matter here. And I think having that stance is what's helped me immensely, not force people into it, but come into their own right. And when they do, there's more buy-in. Of course, things like presenting the data, presenting the cases, like without actually highlighting the case reports, uh, we're not able to appreciate the impact of uh this potential uh way of thinking. So we must do a combination.

Dr Andrew Greenland 31:47

So I think you've got a team of 15 people, if I've got my information correct. So, what does your role in the business actually look like today? And how has that changed over time?

Dr Vishal Sharma 31:56

Yeah, actually, just a slight correction there. We're a team of 40 now, and we have the three locations, three doctors. Um my uh day and time have been a bit of an evolution. So when the children were younger, I was a little bit stepping aside from the clinic just to kind of give the support necessary here and be present. Um, and I'm super glad that I did. But about 60 to 80 percent of my time is clinical in a week-to-week basis, and 15 to 20 percent is management. Uh, I do have a wonderful management team. Um, we have a CFO who manages all things financial and legal. Uh, and then there's an HR manager and a marketing manager just to help uh you know achieve the multi-prong goals that we have simultaneously. So it ends up being uh um not as heavily clinically uh uh as it used to be in my earlier years.

Dr Andrew Greenland 32:51

Um and with that growth and the the change in the way you apportion your time, has there been anything you've found hard to let go of personally? Is it the clinical thing or is it other stuff that's um involved in the in the role?

Dr Vishal Sharma 33:03

I think uh anytime you want to have you want to see growth, there is a certain level of, and this kind of goes back to your earlier question, is like it's not a lesser a reduced quality, but it it it this is what it feels like, right? So when we're practitioners, we think, okay, no, we're all alpha until we've gotten to this point. We have an alpha type of way of thinking, and we like to do things our way, we know that we can do it well, and so we have a hard time letting go. Um, I think doing that within a safe space. Again, I'll I'll bring I'll bring the example oftentimes to rearing children, but when you're trying to teach your child that how to walk, you have to let them walk a little bit, right? So you're kind of holding them just lightly and loosely, you're not actually moving the legs step by step, although that's may how it may start. You have to allow yourself to let it go and let them maybe perhaps fall. Um, and so running a team and allowing them to grow uh um themselves, sharpen their own skills and their own talent while guiding it at the same time is is is kind of like uh how you know we're able to grow and and and what my uh philosophy generally is.

Dr Andrew Greenland 34:18

And it's a it's a much bigger thing than I mentioned just earlier on. So 40 people, three locations, it's pretty pretty impressive. What are the biggest challenges and bottlenecks that you currently face in the day-to-day that that may have been completely different a few weeks ago, a few months ago? What are the things that keep you up at night that you're having to work through as a founder owner?

Dr Vishal Sharma 34:40

That's a great question. And it does seem to change from the you know week to week. Currently, um right now, as we're speaking, we're entering into our education uh season. So uh we do a lot of webinars and a lot of like in-person sessions. And so it's my primary focus is uh trying to recruit audience because when you do a webinar, as you may know, Dr. Greenland, like you know, getting an audience to kind of listen to your message is a challenge um that we all take on at some point, especially you know, venturing into uh this type of field, you know, being a being a physician, Dr. Greenland. Like like I was discussing with my team. Many props to you for you know carving out this niche, designing the podcast, getting it ready and everything. Um but when we take on uh these challenges, yeah, it does change over. So currently we're in education season, but one of the constant things is uh recruiting great team. You know, there's uh it's kind of a qualified uh individual shortage where I practice. Uh, and I think a lot of the practitioners would would agree. So constantly finding you know good talent, people who uh want to grow, want to contribute to something like this, see themselves in this in this field, that that is one of the constant underlying, it doesn't matter what year you ask me that question. It's one of those things that's always there, Dr. Greenland. Uh, and it's no different now. But those are kind of like the two primary things I would say.

Dr Andrew Greenland 36:08

And how do you find great team players and you know the ones that are going to be aligned to your philosophy?

Dr Vishal Sharma 36:15

Oh, I think the most important thing is really attitude. Uh, you know, I'm a big energy believer, as I spoke to metaphysical and meditation a little bit. That's not a necessity by any means, but how you approach life, how what your mindset is, is it resilient? And these are things that are not easily detectable through traditional uh interviewing means. So we do have a fairly rigorous onboarding process. Uh, it's multi-tiered. We do have, we do utilize a personality test that gives the candidate and us a little bit of insight into how this person thinks. Uh, and we're very protective of our energy in space. There was a time that it wasn't so harmonious, and we felt the impact on multi on a multi-level uh uh, you know, uh uh in a multi-level way. So being rigorous about onboarding, uh being quick to let people go if they're simply not a match is very, very important. Uh, because oftentimes we think, oh, opportunity costs, we've got to find someone else, train them again. I'd rather just, you know, make do with this individual. I and I did that for several years, but I think that's not the way to be developing like a really you know with it team. And to the last part of your question, buying into the vision, that's something that just reveals itself over time. But I think um sharing the passion, and I am a generally passionate person, um is integral to that mission.

Dr Andrew Greenland 37:43

So it has to give you a magic wand and you could fix one thing in the business tomorrow. Um talent acquisition aside, would there be anything else that you would love to be able to solve?

Dr Vishal Sharma 37:54

Um I think if people physicians, dentists, you know, the qualification aside, if people could make that one link, that how we breathe has a massive impact into how we grow and develop and overall systemic health in the long term, that would be the magic wand. Because I personally do believe that if we're able to oxygenate properly, if we're able to take time out to quietly breathe and slowly breathe for a few minutes in a day, we're all more connected to a single thing that unites us all. And many, and this is gonna be a stretch to some people, many of the issues that we currently face as a species, which are out there, we all know them. I think they begin to fall apart because we're in a harmonious rhythm with ourself, and that is much uh more synchronous and coherent at large, not just medically speaking, but our entire existence. So, at

Where Orthodontics Goes Next

Dr Vishal Sharma 39:15

first, we'll start with the medical.

Dr Andrew Greenland 39:18

And finally, what's the future hold? What where do you see Aura Orthodontics being in the next 12 months or so? And what about orthodontics more generally? Where is orthodontics heading in your view?

Dr Vishal Sharma 39:30

Um, so Aura specifically, I think we're just gonna continue this mission. It is a large mission that we have undertaken, um, you know, but I feel very passionate about it. And we're just gonna continue on, Dr. Greenland. You know, doing things like this, the podcast is a great, fantastic way. I cannot uh tell you how grateful I am for the opportunity uh and you finding us to help propagate the message one individual at a time. Uh, you know, especially with practitioners, we can make a large impact by hitting that single point because we see each practitioner sees so many patients. And if you're able to have this conversation with your patients, the message propagates. So that's gonna be the immediate 12-month. Again, we are developing further our uh online educational presence presence in terms of webinar. We're developing a website, we're gonna have a portal where people can access these things. We all need education for CE and credentialing. So if we can fill a role there, um we're we're working on developing that. And then just again, even in my own, when I go to the office, being present-minded and just assessing each case on an individual basis and keeping that question in the back of my mind: are there any possible potential complicating airway issues here that I can help resolve? And then again, I am by no means making uh cause and effect uh statements. I am stating that we as a body of people can look at this a little bit deeper so that we can get to a point where we can make cause and effect statements. Um and at large for orthodontics, I truly believe we're in a revolutionary phase, the early phase of it. Um dental alignment is obviously immensely popular, but much more accessible. And I think if we're starting with the orthodontist, focus more on dental facial orthopedics, and I really do reckon that we are going to be seeing patients and wanting to be seeing patients. It's not like we are, you know, self-serving in this in this mission. This is a need. As I can see with my own child, he simply was not breathing correctly. If I recited his symptoms to any ENT, physician, sleep doctor, you would say 100% your son has sleep apnea. And if at four years old he has sleep apnea and he's not oxygenating properly, I have to ask the question what other possible impacts are there while his body's developing? So that I think for orthodontics at large, dental alignment will always be uh a facet of our profession. Um, but I think in the long run, um, we may need it less and less if we're addressing the jaw size shape discrepancy

Final Takeaways And Thanks

Dr Vishal Sharma 42:20

earlier on and focusing our attention to the possible airway complications that might exist.

Dr Andrew Greenland 42:28

With that, Michelle, I was laughter. Thank you so much for joining me today. Um and sharing your mission, because it really is a mission. And I've enjoyed this conversation so much because we've covered something much bigger than braces and straight teeth. We've talked about childhood development, we've talked about breathing, we've talked about sleep, we've talked about evidence-based practice, and perhaps more importantly, when clinicians begin asking questions that the research hasn't completely answered yet. So thank you very much for joining me. It's been an absolute pleasure, and obviously I wish you all the best with your mission.

Dr Vishal Sharma 42:56

Thank you, Dr. Greeland. I hope to cross paths uh again at some time in the future. But until then, uh take care and thank you for the opportunity.