The DOC Podcast

Episode SummaryDr. Trevor Nichols returns to The Doc Podcast for his second appearance, and a lot has changed. Since opening Nichols Orthodontics and Aesthetics in Gilbert, Arizona, in August 2024, Trevor has grown from a two-person operation to a team of 20, with a waitlist. In this rich conversation, Dr. Mike and Dr. Nichols cover the full journey: the leap from corporate/DSO orthodontics to private practice ownership, the vision and systems that fuel their growth, the personal wellness habits that keep them grounded, and, most passionately, the case for early airway-focused, craniofacial orthodontic treatment. This episode is a must-listen for any orthodontist, dentist, or healthcare professional who wants to treat the whole patient, not just the teeth.Timestamps3:29 — Welcome back: Dr. Nichols returns to the show after ~2 years4:33 — "Probably the best two years of my life" — Dr. Nichols reflects on opening his practice5:27 — Starting with just two people, leasing space from a general dentist6:29 — "Fight for your dreams" — the case for private practice ownership6:53 — Why private practice better protects patients and the profession vs. corporate/DSO models22:03 — Building the vision: how to define what orthodontics truly fulfills you23:29 — "Do a true audit of what in orthodontics brings you happiness"29:34 — The three pillars of Nichols Orthodontics: patient experience, culture, and results40:24 — Why Dr. Nichols hired a CEO (formerly at Crumbl Cookies) to run the business side50:44 — Balancing plates: weekly date nights, gratitude practices, and intentional reflection57:32 — Shifting to the clinical: why diagnosis is what separates orthodontists from OTC aligners1:00:57 — "We're not just orthodontists — we're craniofacial orthopedists"1:02:58 — "I don't really care about the teeth right now" — diagnosing profile, growth, and airway first1:11:06 — Treating 3- and 4-year-olds: when early intervention is warranted and how to screen for it1:17:44 — 45% of Nichols Orthodontics' practice is now airway-focused treatment1:27:43 — The key to phase one braces success: bond ALL the primary teeth + disarticulate1:29:00 — The tongue as nature's expander: ~400g of force at swallow — why we don't need more1:37:18 — "Early adopters take the most scrutiny — and then we find out they were right all along"LINKSRegister for the In-person Early Treatment Comprehensive ($1000 off if register by June 30): https://www.earlyorthotreatment.com/ Episode 50 w/Dr. Nichols: https://podcasts.apple.com/us/podcast/finding-living-your-purpose-w-dr-trevor-nichols-ep-50/id1689703392?i=1000655038062Connect w/Dr. Nichols: https://www.nicholsortho.com/?utm_source=GBPInstagram: @dr.trevornicholsJoin The DOC Community on Facebook for more great content and discussions: https://www.facebook.com/share/g/1Cb9rkQVde/Check out the DOC CE Courses: https://theorthocoach.com/ce-courses/Enroll in one-on-one coaching w/Dr. Mike: https://theorthocoach.com/doc-coaching/ If this episode resonated with you, please take a moment to share it with a colleague, friend, or fellow healthcare professional who would benefit from hearing it. Word of mouth is the single most powerful way to grow this community and spread this message. Leave us a rating and review on Apple Podcasts or Spotify; it makes a huge difference! And if you haven't already, subscribe so you never miss an episode of The Doc Podcast. Thank you for your support! Together, we're changing lives, one conversation at a time.

In this episode of the DOC Podcast, I welcome Dr. Mary Motlagh to discuss one of dentistry's most critical yet overlooked issues: why beautiful dental and orthodontic work fails over time, and what we can do to achieve lasting stability.Dr. Motlagh, a restorative dentist with over 25 years of experience, shares her transformative journey from creating stunning cosmetic cases that broke down within years to developing a comprehensive physiologic approach that consistently delivers 15-20 year stability. Through compelling patient stories and clinical insights, she reveals the hidden connections between airway health, TMJ function, neuromuscular balance, and long-term treatment success.This conversation challenges fundamental assumptions in dentistry. From how we diagnose and treat TMD to the extraction debate, early intervention timing, and what "evidence-based" really means. Whether you're an orthodontist frustrated by relapse, a restorative dentist dealing with occlusal breakdown, or any dental professional seeking better outcomes, this episode offers a paradigm shift in how we approach comprehensive care.Timestamps[2:27] Meet Dr. Motlagh[4:43] Why beautiful veneer cases started failing[5:45] Muscles dominate and airway always wins[9:54] Why teeth break at the gum line despite perfect crowns[13:37] Evidence-based dentistry: beyond randomized trials[16:52] Dentists are trained as tooth mechanics, not doctors[22:57] How posture affects occlusion[27:47] Signs and symptoms we miss: scalloped tongue, tinnitus, vertigo[37:15] The 17-year-old who couldn't open her mouth for 2 years[42:57] The extraction and airway debate[48:20] Introduction to MyAligner and the diagnostic phase[49:30] Ultra-low frequency TENS and neuromuscular CR[57:27] Case presentation: correcting facial asymmetry in 40 minutes[1:05:35] Final message: it is essential to screen for TMD and airway issuesNotable Quotes"We were trained as tooth mechanics and not the doctors of the oral cavity. We learned to look inside the mouth, not sit back and look at the face, look at the body, look at the connection of the orthopedic alignment of the head and neck." - Dr. Maryam Motlagh"When you do the diagnostics more thoroughly, your work gets easier and becomes more profitable because you cut a lot of the noise out, a lot of the headaches. It's not profitable to do a hundred aligners on somebody - you're paying the patient to treat the case at that point." - Dr. Mike"This is a complex problem, but once you see it, you cannot unsee it, and it becomes such a simple solution." - Dr. Maryam MotlaghLinksBite Circle: https://www.bitecircle.com/Myoaligner: https://www.myoaligner.com/ IG: @drmotlagh_Maryam’s Signs & Symptoms Sheet: https://www.myoaligner.com/_files/ugd/06070e_03dd7aac8db8431782111c81c1018d50.pdfDr. Mike’s Orthotown Article on Evidence Based Orthodontics: https://www.orthotown.com/magazine/article/9835/defining-evidence-based-orthodontics?fbclid=IwY2xjawP14fxleHRuA2FlbQIxMABicmlkETFrVWE3M3EwYWJTRWpEdENTc3J0YwZhcHBfaWQQMjIyMDM5MTc4ODIwMDg5MgABHhwMNgFJyCJB6JMvVDSomu6drLwAym2SI7CDx-eXbuwrUwBxzP6NpyP7HpT8_aem_NmfJlB15aUQgioH6xWUu3A Join The DOC Community on Facebook for more great content and discussions (https://www.facebook.com/share/g/1Cb9rkQVde/)Check out the DOC CE Courses: https://theorthocoach.com/ce-courses/

Episode Description:Join me for an in-depth conversation with sleep medicine specialist and quadruple Board Certified Physician (Internal Medicine, Pulmonary Disease, Critical Care Medicine, Sleep Medicine), Dr. Sima Tahir, as we discuss the critical role that sleep plays in overall health. Dr. Tahir shares her journey from working on the COVID-19 frontlines to opening her own boutique sleep practice in Manhattan, and why she believes sleep should be at the forefront of medical care.Key Topics Covered:Why Sleep Medicine MattersThe lack of sleep education in medical schools and residenciesWhy sleep disorders are missed by traditional healthcare systemsHow sleep affects every aspect of health, from mood to chronic diseaseRecognizing Sleep DisordersWarning signs in children AND adults (headaches, jaw pain, teeth grinding, brain fog, irritability)Why children should NEVER snoreThe connection between sleep disorders and ADHD/behavioral issuesHow sleep problems manifest differently in kids vs. adultsThe Diagnostic ChallengeLimitations of polysomnography (sleep studies)Why a normal AHI doesn't rule out sleep disordersUnderstanding upper airway resistance syndromeThe importance of reviewing raw sleep study dataThe Multidisciplinary ApproachWhy "sleep takes a team" - collaboration between physicians, dentists, orthodontists, and specialistsHow dental providers can detect sleep and breathing issuesThe role of orthodontics in addressing airway problemsBreaking down silos between medical and dental Sleep Quality vs. QuantityWhy 7-9 hours isn't enough if quality is poorUnderstanding sleep architecture and circadian rhythmsHow weekend sleep schedule changes affect your entire weekThe one-hour-per-day recovery rulePractical Sleep HygieneThe importance of consistent sleep/wake timesHow hormones (especially in perimenopause) affect sleepWhy waking up multiple times per night is NOT normalRed flags that indicate you need a sleep evaluationPerfect For:Healthcare providers (medical and dental)Parents concerned about their children's sleepAnyone experiencing chronic fatigue, brain fog, or sleep issuesProfessionals interested in the intersection of sleep and overall healthTimestamps:3:08 (188s) - Meet Dr. Sima Tahir: From COVID Frontlines to Sleep Medicine3:45 (225s) - Dr. Tahir's Background: Quadruple Board Certified Physician8:08 (488s) - Why She Left Traditional Medicine to Open a Private Practice13:25 (805s) - The Shocking Lack of Sleep Education in Medical Schools22:17 (1337s) - Warning Signs of Sleep Disorders: Head-to-Toe Assessment27:15 (1635s) - How Dentists & Orthodontists Can Detect Sleep Issues33:52 (2032s) - The Truth About Sleep Studies: Why Normal Results Don't Rule Out Problems45:22 (2722s) - Hormones, Aging, and Sleep: What Your Doctor Isn't Asking53:30 (3210s) - What Does Good Sleep Actually Look Like?60:38 (3638s) - Sleep Quality vs. Quantity: Waking Up During the Night66:30 (3990s) - Wearables for Kids & The Future of Sleep Monitoring70:59 (4259s) - Closing Thoughts & How to Connect with Dr. TahirConnect with Dr. Sima Tahir:Website: https://drsaematahirmd.com/

General SummaryIn this comprehensive episode, I sit down with Dr. Avinesh Bhar, a board-certified pulmonary, critical care, and sleep medicine physician who left traditional private practice to revolutionize sleep healthcare through telemedicine. Dr. Bhar shares his journey from recognizing the profound shortcomings of the US healthcare system to founding Sleep, a virtual practice designed to provide accessible, personalized sleep and pulmonary care.The conversation explores the critical gaps in sleep medicine, including the severe shortage of sleep physicians (only 150-200 trained annually), the limitations of traditional sleep testing, and why women and children are disproportionately underdiagnosed. Dr. Bhar challenges the conventional reliance on polysomnography as the sole diagnostic tool, emphasizing the importance of clinical symptoms and thorough patient evaluation. The discussion reveals how the multifactorial nature of sleep disorders requires multifaceted, often multidisciplinary solutions, and why "mild" sleep apnea isn't always mild, and negative sleep studies don't always mean you're fine.Key PointsThe Sleep Doctor Shortage Crisis: The US produces only 150-200 sleep physicians annually, creating massive access barriers and 6-12 month wait times for patientsFalse Negatives Are Common: In-lab sleep studies suffer from "first night effect" and single-night testing limitations; home sleep tests with multiple nights provide better baseline dataClinical Symptoms Trump Test Results: A negative sleep study doesn't mean absence of sleep issues; patient symptoms must be explained and addressedWomen and Children Are Underdiagnosed: Sleep testing data have been validated primarily on overweight male populations, causing women and children to be systematically overlookedMild Doesn't Mean Mild: Sleep apnea severity ratings correlate with heart disease and stroke risk, but not necessarily with quality of life impacts; mild cases can cause severe symptomsMouth Breathing Is a Red Flag: It's an adaptation to airway obstruction, not normal behavior, and signals underlying issues that need investigationThe Co-Opted Healthcare System: Financial incentives drive practitioners toward in-lab testing (3x higher reimbursement) rather than more appropriate home testingMultifactorial Problems Need Multifaceted Solutions: Sleep disorders rarely have single causes or single treatments; adenotonsillectomy alone resolves OSA in only 27% of children long-termYou Don't Outgrow Sleep Issues: Childhood airway problems persist into adulthood, often worsening with age, weight changes, or hormonal shiftsTelemedicine as the Solution: Virtual sleep medicine can provide faster access (2-3 days vs. 6+ months), comprehensive care coordination, and better patient outcomesNotable Quotes"You can be a better physician to your patients if you understand their sleep issues as well.""If a patient has a sleep issue and the test is negative, so what? You have to figure out why. You have to give the patient an answer...why are they sleeping poorly? Why are they bruxing? Why do they have headaches? Why do they have anxiety?""Sleep has always kind of been looked at as a passive process, a side issue. Now that the data is coming out, it's driving everything that we're seeing as problems, whether it's heart disease, mental health issues, blood pressure control, metabolic syndrome." "Once you see it, you can't unsee it. That's the scary part, because now I'm out socially, I'm looking in people's mouths. I'm like, oh, she has a sleep issue. He has a sleep issue. And you can't stop yourself because it's everywhere."Timestamps[0:00] Introduction and Dr. Bhar's credentials[3:15] Dr. Bhar's journey: From fellowship to MBA to leaving private practice[10:30] The shortage of sleep physicians in America and its impact on patient care[18:45] Why sleep has been overlooked as a "passive process" and the emerging data on its critical importance[28:20] The problems with in-lab sleep studies and the advantages of home testing[42:15] Why "mild" sleep apnea isn't always mild and negative tests aren't always negative[56:40] Women and children: The biggest victims of sleep medicine's blind spots[1:12:30] The co-opting of healthcare: Financial incentives vs. patient care[1:28:45] Mouth breathing as a warning sign and why we're the only animals with crooked teeth[1:45:20] Do children really "outgrow" sleep issues? The truth about adenotonsillectomy outcomes[1:58:10] How Sleep works: The telemedicine solution for accessible, comprehensive sleep care[2:15:35] Final thoughts on changing the healthcare system and voting with your feetRelevant LinksSliiip Website: https://sliiip.com/ The Ortho Coach Website: www.theorthocoach.comJoin The DOC Community on Facebook for more great content and discussions: https://www.facebook.com/share/g/1Cb9rkQVde/Check out the DOC CE Courses: https://theorthocoach.com/ce-courses/Guest Suggestions: Email Dr.mike@theorthocoach.comThis episode is part of The DOC Podcast's mission to help healthcare providers lead happier, healthier, and more prosperous lives both personally and professionally.