Steffen Decker: And now comes the power of an orthodontist. Again, how about combining [00:00:05] techniques? Why not choose the best of each world? [00:00:10] Why not align the upper with the aligner? No speech impact? Nothing. No. [00:00:15] Very discreet. And the lower curve of spee. You do a lingual for [00:00:20] four months.

Payman Langroudi: How interesting.

Steffen Decker: Take it out. Finish with an aligner. [00:00:25] We call this hybrid approach. Why do you not use your strength and orthodontic specialists [00:00:30] to combine techniques? Why do you need to do everything with lines?

[VOICE]: This [00:00:35] is Dental [00:00:40] Leaders, the podcast where you get to go one [00:00:45] on one with emerging leaders in dentistry. Your [00:00:50] hosts Payman Langroudi and Prav Solanki. [00:00:55]

Payman Langroudi: It gives me great pleasure to welcome Stefan Decker onto the podcast. [00:01:00] Stefan is an old friend. I must have met you 15 years ago. [00:01:05] Along the way. Along the way. So that was one of one of the world’s top orthodontists [00:01:10] involved in all sorts of different things. So, uh, originally [00:01:15] I remember you doing a lot of lingual orthodontics on adults. One [00:01:20] of the world’s top providers of incognito. At one point, were you? Yeah. Um, now [00:01:25] focusing more in on kids with aligners and Interceptive orthodontics. [00:01:30] Um, Steven, it’s a pleasure to have you. You. I read on your CV you were also [00:01:35] a choice accredited orthodontist, which really piqued my interest. And [00:01:40] we tend to start with sort of backstory, but I’ve got a burning question about [00:01:45] the choice thing, the sort of the link between the orthodontist [00:01:50] and the prosthodontist. Did it open your eyes to go to the [00:01:55] choice?

Steffen Decker: You know what? Like it’s As probably a lot of people know, I’m married to probably one [00:02:00] of the top restorative dentists in the country who is a college trained dentist. Como. Como. And, [00:02:05] um, when I started working for her, the first question she [00:02:10] asked me was, Stefan, have you ever seen your cases failing? 30 [00:02:15] years after you finished them? And I was thinking at that time, don’t [00:02:20] forget, I was number one incognito provider in the world with adults. [00:02:25] So I thought, hold on. Who are you attacking me? Are you telling me I can’t do my profession? [00:02:30] What do you mean? So she showed me adult cases with rare facets. [00:02:35] Traumatic bites, destruction on the dentition caused by a [00:02:40] poor functional bite. At the end of orthodontics, a few years before that. [00:02:45]

Payman Langroudi: A constricted.

Steffen Decker: Constricted envelope of function. And if the restorative work basically [00:02:50] failed. So she said to me, Stefan, in order for you to work for me, pre [00:02:55] restoratively you will need to see John Kois and I had no idea [00:03:00] at this point who John Kois is because I’m an orthodontist. I live in my own bubble. So I [00:03:05] went to Seattle, I did the courses and I remember really well. I won the one [00:03:10] afternoon I called Komal back and said to her, I get you. I understand [00:03:15] why you speak with your patients the way you do it. What wording you use, [00:03:20] because that’s John. John says exactly that. It opened my [00:03:25] eyes to understand how to dentists think when they want to restore [00:03:30] an adult case. Because what is my work good at? If [00:03:35] it’s not good enough for restorative dentists to fail? And this [00:03:40] change for me, everything because I had a completely different understanding of the wording, [00:03:45] the word you use in the restorative world. And it helped me now even more [00:03:50] so to work with restorative dentists so that I could do my alignment job in [00:03:55] a good way, and I didn’t need their input for me to tell me where to move the teeth for [00:04:00] them to restore. I could just hand it Sandra Garcia.

Steffen Decker: At that point in Harley Street, the case is over. And [00:04:05] she did the veneers. Easy. It was a very lovely relationship, work, relationship. But [00:04:10] if you look at what’s happening nowadays, dentists tend to do [00:04:15] everything themselves. They do the alignment with clear aligner, then they do the bleaching [00:04:20] and the bonding. But if they would have had a good orthodontist [00:04:25] who would know how to position teeth correctly, they wouldn’t have the [00:04:30] need to do the alignment. They could just focus on what they would like to do, which [00:04:35] is the restorative side of things, because I worked in enough places to make that become [00:04:40] aware that, financially speaking, there they are lowering the price [00:04:45] of the alignment so hard that they don’t make a lot of profit on the alignment. [00:04:50] They make the profit on the restorative. So for them, it’s not even a big business. [00:04:55] The alignment. It is something they want to do good restorative work. So if they [00:05:00] would give that to a good orthodontist who has the knowledge from John in Seattle, that [00:05:05] would help them to have more business themselves, but unfortunately that’s not happening. [00:05:10] The orthodontists live in their own bubble, the restorative dentists in their other bubble, and [00:05:15] more and more restorative dentists knowing how to use aligners.

Steffen Decker: So the market [00:05:20] becomes very limited for me as an orthodontist to be different. And at [00:05:25] the time you were talking about with lingual, that made me different. I choose to choose use [00:05:30] a device that was different, and not everyone could do lingual braces. That [00:05:35] made me different. But now everyone wants aligners. What makes me different now? Maybe [00:05:40] I focus on an age group nobody is catering for, which is [00:05:45] children. And then when you do that and my fundamental training is children, [00:05:50] I was trained in Germany and Switzerland. When I was in these countries, I treated children, [00:05:55] no adults. But when I moved to London, I was forced to treat adults because [00:06:00] I was in the middle of London. So my training was kids. And by me, having this new [00:06:05] technology of clear lines in my hands made me realise it comes with benefits [00:06:10] with kids. Because compared to what we used to do with screws and [00:06:15] acrylic devices, bulky devices where kids tend to not wear it long [00:06:20] enough to have an impact with the liners. They love it. It’s comfortable. [00:06:25] They can decorate it with stickers. Biomechanically speaking. It’s really predictable [00:06:30] in kids, so that made me.

Payman Langroudi: Moves quicker.

Steffen Decker: Because the research is very [00:06:35] clear that expanding an arch and opening spaces with the liners is [00:06:40] super predictable versus root movement, not so predictable extraction disaster. [00:06:45] So. But with kids in in early interceptive. Treatment. All you have to [00:06:50] do is create space, widen the arches, create a good foundation [00:06:55] bone foundation in order for the teeth to fit in. This is your task, so [00:07:00] an aligner is really good in it. And guess what? They love it because their [00:07:05] parents might have an align already. The kid says I want this as well. I want to be cool as well, like [00:07:10] my mommy and my daddy. So it’s in fashion. And that is really to the benefit of me [00:07:15] now because the kids demand it. They go to the mom, I want this now. And my friend is [00:07:20] saving now. The community where I live in is growing. And because orthodontics [00:07:25] seems to focus on tooth alignment and it doesn’t focus [00:07:30] so much on what does the creating space do with tongue [00:07:35] positioning, what does it do to more airway available for a child [00:07:40] to breathe properly? What does that do to their sleep quality to their [00:07:45] behaviour? So unless as a side effect of doing good prevention, creating [00:07:50] bigger foundations, we have a lot of health benefits for a child. And this [00:07:55] is where I get now emotional because you actually help them not [00:08:00] only in their appearance and to fit teeth in, you also help them to have [00:08:05] a better, healthier life. And the more you do that you get, [00:08:10] then suddenly cases in who come to you because their child is getting [00:08:15] bullied at school because their child had a trauma in rugby, because their child is [00:08:20] suffering with breathing or speech, and then you help them.

Steffen Decker: And that is the most [00:08:25] rewarding part of your profession. Why you did that in the first place when you started [00:08:30] is you, you, you said, I want to help children. Now. [00:08:35] I do exactly that every day, which means I have job satisfaction. [00:08:40] And five, six years ago when the market went crazy [00:08:45] with the liners. My fees were too high with lingo. Everyone used to go [00:08:50] to a dentist because the price package was lower. So I was frustrated because all [00:08:55] that was left for me as an orthodontist was surgery cases. All [00:09:00] the easy alignment cases was done by dentists. So I said, why did I study [00:09:05] for years and years to only treat adults who need eventually jaw surgery [00:09:10] or very complex alignment? And don’t forget adults. They come with a [00:09:15] backpack of emotions of other things that impact them in their life. So [00:09:20] you don’t just have to do your job, you might as well be a psychologist on the side as [00:09:25] well. With kids, they want you. They want your help. [00:09:30] They want to look better. They want to breathe better. They want to speak better. If you do this job, [00:09:35] they love you. They might just say to you, thank you or give you a hug. [00:09:40] But sometimes they really write you a nice note. And that is something for me as an orthodontist [00:09:45] is the most rewarding thing I can perceive. So I love my job again [00:09:50] versus six years ago I was at the time in my life, I said, why am I doing [00:09:55] this? Why do I fight for it so hard to get eventually disrespect [00:10:00] from an adult or at the end of a line? They say to me, now you know what? This and [00:10:05] this is not perfect.

Payman Langroudi: Incredibly picky at the end right here.

Steffen Decker: Because they want bonding, they want whitening, [00:10:10] they want the perfect world, which is shown to them every day on social media in [00:10:15] a kit. They don’t want that. They’re getting bullied at school. They’re embarrassed to [00:10:20] socialise. They want you to improve their smile. That is it. They’re [00:10:25] not picky at all. And if you do that and you do that in a child, the parents [00:10:30] comes back to you and says to me, thank you for changing the life of [00:10:35] my kid. Can you see me as well? Would be a huge honour if I see [00:10:40] them very different. So my market has completely changed from focusing [00:10:45] on kids. They bring their siblings and hence their parents. [00:10:50] So I don’t need to do marketing on adults anymore because they’re coming through the door anyway. My [00:10:55] wife, Komal, we have a practice together. She does need to do marketing on adults because the parents [00:11:00] are coming with the kids and then they eventually ask, do you offer dentistry for us as [00:11:05] well? And we can then choose to say yes or no. If [00:11:10] we like the parent, we can say yes. My wife will help you if we don’t like them [00:11:15] because of whatever reason it is, we can say no. We focus on children, so it makes [00:11:20] my life much more lovable, liveable and our atmosphere [00:11:25] in the clinic changed because we have smiles.

Steffen Decker: Yes, we all talk about creating [00:11:30] smiles, but it’s a feeling that comes with it. And my girls, the most important thing for my girls [00:11:35] that they’re happy smile because that’s what we’re doing every day. So my life [00:11:40] changed again, and now, most likely I will never change back to anything else. Because [00:11:45] what I’ve seen is the demand for doing early Interceptive [00:11:50] orthodontics is so huge, especially here in the UK, where the [00:11:55] NHS funding tends to be for teenagers. Even so, there [00:12:00] would be funding Interceptive orthodontics by the guideline, but it doesn’t give them enough [00:12:05] remuneration. Hence orthodontists tend to do teenagers, but [00:12:10] they forget that the kids are not happy, they’re suffering. [00:12:15] And if you understand that that the need is there, maybe you would dedicate [00:12:20] yourself more time in kids and have more job satisfaction. That’s my personal opinion [00:12:25] in that because it changed my life and I’m really happy with what I do now [00:12:30] and with the teachings, I think, to create more awareness. That’s why I’m here today as well, because [00:12:35] I would love more dentist, paediatric dentist or orthodontist to understand. [00:12:40] We should do kids. It’s much nicer when you say kids.

Payman Langroudi: Do you mean pre 11 year old [00:12:45] kids pre 11?

Steffen Decker: Because especially when it comes to lines that the companies will make [00:12:50] you believe the big market for aligners is teenagers. But [00:12:55] when you treat a lot of teenagers with aligners, you understand eventually [00:13:00] they drop out. They have a girlfriend, they have other things in their life to do. They forget there [00:13:05] is no incentive for them anymore to do more because the teeth look good. [00:13:10] Are they perfect? Maybe not. Why would I wear an aligner if my teeth are straight? Why [00:13:15] would I wear elastics if my teeth are straight? So the perception changes versus [00:13:20] a young child. If your little princess has a problem and you will say [00:13:25] to her, look, you should do that, otherwise we might have to extract teeth later on in life, every [00:13:30] girl and every boy will say, no, I don’t want that. I’m going to do it. Daddy tells [00:13:35] me to do it. I will do it because we are more in charge. I have three children myself. They are all finished with [00:13:40] orthodontics. They are now 11 and nine. They are finished.

Payman Langroudi: Is that the key? [00:13:45] I mean, I understand the social benefits that you alluded to, but the clinical [00:13:50] benefit is the key clinical benefit that you don’t need to do extraction well later in life. They had a.

Steffen Decker: Lot of [00:13:55] benefits to that. Number one, coming back to John Kois, we [00:14:00] learn when we talk in John, we look at adult cases of where of destruction, [00:14:05] and we talk about how to deprogram the buy to get care position [00:14:10] and then how to restore that case in order to be stable long term. [00:14:15] But the I went to John and I said to him, John, what [00:14:20] would have happened to that adult if we would have a better foundation, if [00:14:25] we would have widened the arch, if you would have done good orthodontics as a child, would [00:14:30] that have still happened? And he said to me, Maybe not. This [00:14:35] was the day I went back to my children to look for function and occlusion [00:14:40] problems. And I see where on five for six [00:14:45] seven year old kids with deep bites, very minimal, maybe half a millimetre, [00:14:50] one millimetre. But with technology scanner, you can see it. You can you can measure [00:14:55] it physically. Every year the destruction happened. So it came clear to me, oh my [00:15:00] goodness, when does this start? This problem with function constriction [00:15:05] envelope of function. Because what we tend to do is one tooth dentistry. We have a tooth [00:15:10] failing. Put a crown on it. We don’t look at the overall. Where does it [00:15:15] start? Where did it start. And I can go in both directions. [00:15:20] Now I can say to a child, if you don’t address your bite right now, you [00:15:25] might have where in ten, 20, 30 years time you might end up in extractions. [00:15:30] You might end up in TMJ pain if it happens. And guess what the pans tell me. [00:15:35]

Steffen Decker: Excuse me. I’m happy that all. I had four teeth taken out. I [00:15:40] have TMJ pain, I have a lot of restorative work and my teeth are perfectly fine. I [00:15:45] don’t eat sugar. I don’t do anything. I still have root canal. Why? Because the teeth cracked, [00:15:50] the bacteria went in and the root canal. So when you talk to kids like this and [00:15:55] explain them what could happen, it opens the mindset of the parent and say, [00:16:00] hold on a minute. He just told my story, which happened to me all [00:16:05] the way because my parents didn’t know any different that we can do it early. So I had the extractions [00:16:10] and before you had someone talking about mouth breathing, sleep apnoea, [00:16:15] in order for a tongue to have to rest on the palate, [00:16:20] we need space in the palate. If there’s no space, how can the tongue [00:16:25] rest there? What is happening with this tongue? At night when we are at rest, it will [00:16:30] fall into your airway. We open our mouth. We adopting a mouth breathing habit which [00:16:35] is not good for our sleep quality. So we might struggle, we might snore. We [00:16:40] might have sleeping disordered breathing. So that is where it can be. The link. [00:16:45] What happens to your child if it’s very disrupted? Sleep. It’s heavy, active [00:16:50] all night because it needs to wake up to get oxygen. How do you think that child will concentrate [00:16:55] at school? How do you think your child will behave if it’s consistently [00:17:00] being reminded by the nervous system? Wake up, get oxygen, get oxygen. So [00:17:05] there might be a link to this.

Steffen Decker: Yes, research is very [00:17:10] vague on that. And you can say now there’s not enough evidence. And the [00:17:15] new research says yes, there’s not a lot of evidence. But not having evidence right [00:17:20] now doesn’t mean there’s no evidence, because if you speak to parents, you speak to [00:17:25] adults, it always comes back to the same pattern. And very interesting [00:17:30] thing. Just lately Apple launched a new watch. Now Apple Watch ten [00:17:35] detecting sleep apnoea. So that means very [00:17:40] soon our kids, our parents will have variables on their wrist saying [00:17:45] to them, morning, your sleep changed. You stopped breathing. So [00:17:50] what could happen now if they had an intervention, whatever intervention it is. [00:17:55] And suddenly that changed from good sleep quality to poor sleep quality. [00:18:00] Eventually, with the education they get on social media, they might refer back to something [00:18:05] that happened to them in the arches. They had maybe four teeth taken out, which made [00:18:10] the arches smaller so the tongue didn’t have enough space. And [00:18:15] now again, I know the research. You could say there’s no evidence that the extractions impact [00:18:20] sleep. Yes, that’s true, but there’s evidence that posture [00:18:25] changes your airway. So have we [00:18:30] looked at how extraction affects your posture? Because if we extract and we suddenly [00:18:35] adopt the forward head posture, that will open up the airway. Hence there’s no [00:18:40] difference in airway but the posture change. And that’s another thing we see. How [00:18:45] do kids grow when they go through puberty. They change in their posture eventually [00:18:50] because the bone grows quicker than the muscles. So that means we need other participants [00:18:55] in that team approach osteopath, physiotherapists, speech therapists. [00:19:00]

Payman Langroudi: I’m really happy you’re saying this stuff here, because I remember when I became a dentist around probably the same time as you became [00:19:05] a dentist, if anyone mentioned any link between ortho and [00:19:10] posture or neck, or they were just dismissed as a, as a sort [00:19:15] of a goo goo like ridiculous. No, no evidence behind it. But the [00:19:20] idea that you can stick wires and things in the mouth on a growing child [00:19:25] and not affect posture is the most crazy idea. You know what I mean? It’s [00:19:30] so obvious to me.

Steffen Decker: Look, it comes down to dentistry is not so easy. It’s not. [00:19:35] You do one thing and it doesn’t have impact on another thing. Yeah. Functional occlusion. When [00:19:40] I seen it in my own eyes, it starts super early on and John [00:19:45] confirmed it. If you go to the symposium of John once a year, he will [00:19:50] talk a lot about airway now, about our expansion, about orthodontics, the need. It’s [00:19:55] just the beginning of this research. And when I was in training, that was in [00:20:00] 2008 when we took a bite to change the position of the [00:20:05] lower jaw, we had an osteopath coming into the clinic. And [00:20:10] what I’ve seen is the leg’s length changed, so the hips were [00:20:15] shifting by me changing the bite, which at that time, that’s a long time [00:20:20] ago. So hold on a minute, I do this. This happens with the body. [00:20:25] So very early on in my career, I was told, you cannot just look at [00:20:30] the teeth. You need to look at what is happening to your body. And we can talk about [00:20:35] airway. We can talk about posture. We can talk about behaviour. We can talk. Victoria [00:20:40] Samson is very big in gut health. But if your mouth breathing, how does it impact [00:20:45] your oral microbiome, the bacteria that you’re going to swallow into your gut? I think [00:20:50] airway.

Payman Langroudi: Is the next big thing in dentistry, like.

Steffen Decker: 100% I. And now [00:20:55] we’re talking airway kids. Airway is relatively easy to correct because [00:21:00] we have a growing individual here. We have a malleable upper jaw, which is [00:21:05] the main problem. The problem will start when they’re growing up teenagers, [00:21:10] adults. Because the longer you wait with getting bigger foundations, [00:21:15] the more invasive it gets. We need mini screws. We might need surgical assisted [00:21:20] opening of the suture. Yeah, we need double jaw surgery. And I have it every [00:21:25] week. And I have a dear friend, Christian Leonhard, in Germany. We’re doing the voice course [00:21:30] next year in Seattle. Five days, where we talk from kids to adults. [00:21:35] What’s happening? The whole realm of dentistry. And what he has to do in [00:21:40] adults, 6 or 8. Mini screws in the palate, weakening the suture dome technique [00:21:45] to get the structure weakened. So then he opens the palate versus what I [00:21:50] have to do with kids, put a device in, turn them every other day. Four weeks later. [00:21:55] Done. Finished. Phase one completed. Makes a lot of sense. So [00:22:00] my profession becomes suddenly very rewarding and compared to adult [00:22:05] orthodontics, if you do it well, considering airway, which is super complex [00:22:10] because how Christian does this diagnostic, he does much more functional occlusion [00:22:15] assessment, good diagnostic pictures. He does everything by the book choice [00:22:20] philosophy. But the treatment letter is huge. [00:22:25] What’s happening out there? Post-grads are being told a lie and bleach blonde magic [00:22:30] button eye.

Steffen Decker: The treatment plan is done for you with I accept it, [00:22:35] everything will be good. But Christian’s letter is 15 pages. [00:22:40] Maybe it’s not as easy as just pressing a button. Understand there’s a commercial [00:22:45] benefit to a company that more and more liners are being ordered. But is [00:22:50] it now a hunt to get a better discount? Or do we want to focus [00:22:55] on good quality dentistry that is being taught by the big guys like John [00:23:00] Kois and as an orthodontist? Now, if I know all the restorative problems, [00:23:05] it’s easy for me to make the swap to kids because my life gets easier. [00:23:10] Because I know now how complex an adult really is. Hence, I [00:23:15] need to charge accordingly because I know I need to deprogram. I need to find CR. [00:23:20] I need to articulate models. I need to speak to restorative dentists because orthodontics [00:23:25] alone doesn’t do it with an adult. You need restorative. You need whitening. You need all the rest [00:23:30] of it. So I need them in the boat anyway. So the treatment becomes complex. [00:23:35] And it’s not a 3000 £4,000 treatment plan any longer. Hence, [00:23:40] who can afford it? Like if I treat the case with my wife, we talk about [00:23:45] big figures because it’s orthodontics, it’s perio, [00:23:50] it’s endodontics, it’s hygiene, it’s restorative.

Steffen Decker: That adds up. Coming [00:23:55] to kids. If I can do one tool and change their life, potentially [00:24:00] forever, that’s it. No destruction, no root canal. [00:24:05] Yeah. Yes. I don’t say it all can happen like this. But [00:24:10] what I feel is, like Chris and me, we did our own research. We looked at all the [00:24:15] problems adults have. And we we basically configured a bell curve like John [00:24:20] Kois shows ten, 80%, 20% mild risk, moderate or high risk. [00:24:25] And we’ve seen all the problems in terms of airway in adults. Yeah. [00:24:30] And then we went back. Okay. Let’s go down in age and see what’s [00:24:35] happening with these problems. And they get less less less until you are [00:24:40] at an infant from 0 to 3. And guess what plays a role. Lip [00:24:45] seal. Tongue positioning. Breathing. That’s [00:24:50] it. So let’s go back to that. If a child is born, the first [00:24:55] thing a mother wants to do is feed their child. And the ideal scenario is [00:25:00] feeding with their own breast milk, ideally for 1 to 2 years. That is what we should do. [00:25:05] But bottle feeding came in easy. Open your mouth. Put it in. [00:25:10] So with breastfeeding you need a lot of muscle activity. So that creates stimulus [00:25:15] on the bone structure to grow fundamentally. So what happens if [00:25:20] a child is tongue tied and they don’t get the tongue mobility.

Steffen Decker: Tongue strength [00:25:25] to extract milk of a mum. If it’s bad enough the mum might get concerned. [00:25:30] They go to a dentist. The dentist says to them oh no, there’s nothing [00:25:35] for you. Try harder or use the bottle. They missed an opportunity [00:25:40] here because eventually it’s a tongue mobility. The tongue function. [00:25:45] Also bottle feeding was only invented for the 4% of the [00:25:50] kids. They needed it because they couldn’t be fed. But 96% should have been [00:25:55] still receiving breastfeeding. Now it’s the opposite. So they’re not being [00:26:00] breastfed. So there’s no muscle structure, no strength. Then also folic acid. Folic [00:26:05] acid research shows it’s linked to tethered tissue. So we [00:26:10] get supplements with folic acid. It, we get more theta tissue tongue [00:26:15] function decreases. The funding for tongue tie release is gone in [00:26:20] NHS. So there’s a lot of kids out there who struggle to [00:26:25] extract milk. That creates emotional frustration for mother. I [00:26:30] can’t feed my child. The child is not being fed. The sleeps will be disturbed. Waking [00:26:35] up every so often that already has an impact on the family. What [00:26:40] should you have done? Maybe address the tongue and the function is back and the child [00:26:45] can grow. That’s just one example. Go to a school class. How [00:26:50] many kids sit there in the school? In primary school?

[TRANSITION]: Mouth [00:26:55] breathing.

Steffen Decker: Mouth breathing. Look for an interview with Harry Kane by [00:27:00] Munich, now former Tottenham player.

Payman Langroudi: Yeah, yeah. [00:27:05] Classical.

Steffen Decker: Classical. How come that he’s a professional [00:27:10] footballer? No medical professional told him. Oh, let’s look at your tongue. [00:27:15] Tongue positioning, maybe. We have to increase your tongue space to make you breathe [00:27:20] at night. How is that happening? That professional athletes don’t know this [00:27:25] yet. That tongue. Tongue positioning. Tongue space can improve your airway, [00:27:30] your sleep quality. So Saggi in LA is doing talking all about [00:27:35] it. He was trained by Christian Gimeno. Christian Gimeno in LA. Discovered [00:27:40] the word sleep apnoea. He discovered it. And he says if [00:27:45] you need to expand in a child, it’s already too late. [00:27:50] What? Christian Gimeno said if you.

[TRANSITION]: What did he [00:27:55] mean by that?

Steffen Decker: That means you start already too late. You should have focus on tongue positioning. Tongue function. [00:28:00] Because in a baby you can malleable the palate with your finger. So [00:28:05] your tongue should do that all day, every day. If the tongue is not [00:28:10] there, the palate will be narrow. Hence, we might develop a cross by [00:28:15] going back to Jonquils. The teeth are erupting. We are biting on these upper front teeth. [00:28:20] We drifting forward. That will cause trauma. On the lower teeth. On the upper teeth. The [00:28:25] roots moving out. We are getting where they come back. As an adult, we see the gum receding bone. [00:28:30] Look at it. What’s happening? You missed an opportunity. So when you need [00:28:35] to expand, it’s already too late because you missed a lot of opportunities to see very [00:28:40] early on in life. So what is my job to do? Or what is the job of any [00:28:45] dentist is to at least detect there could be a potential problem. [00:28:50] Is your child not speaking properly? Why? Look at the tongue. Look [00:28:55] at the tongue spacing. Is your child not feeding? Is it avoiding certain food like chewy [00:29:00] food because they struggle to chew? Is it impacting their mental health? Do [00:29:05] they have trauma? Yeah, there’s a lot of things to consider. I’m not saying everyone should [00:29:10] treat children, but I think everyone should at least know about that. [00:29:15] It’s much easier than just single tooth dentistry. And if you don’t know, go [00:29:20] to someone who might know. So education is my priority now because [00:29:25] me as a professional.

[TRANSITION]: You want to get this.

Payman Langroudi: Story out there.

[TRANSITION]: You need to.

Payman Langroudi: I’ve got a couple of questions around [00:29:30] it though. Number one, are we well behind on this in the UK compared to other countries? [00:29:35] Because I feel like I feel like the UK.

[TRANSITION]: It’s a worldwide problem. Oh really?

Steffen Decker: I teach in whole. [00:29:40]

[TRANSITION]: World.

Payman Langroudi: In the US and deceptive is much bigger than it is here.

Steffen Decker: It’s much [00:29:45] bigger in the dental world. If you speak to key opinion leaders in the [00:29:50] prevention side of things, they are dentists and a lot of them are trained [00:29:55] because John Kois knows now because I’m there as well. So every year we’re [00:30:00] talking about it. So there’s a lot of groups in the US who do To podcasts [00:30:05] and to talk about it. But they’re dentists, not orthodontists. [00:30:10] Orthodontists? What are you doing? This should be us helping the dentist [00:30:15] because we’re getting eventually also back the patients. We see the kids early. We [00:30:20] see the teenagers. We see the adults. So let the dentists do what they’re good at is restoring teeth. So [00:30:25] in Germany, it’s the same. This airway, like you mentioned, is for [00:30:30] me as well. I think this is where we need to look at in future. And Apple knows this. [00:30:35] Sleep apnoea is on the Apple Watch. Yeah we have the.

Payman Langroudi: Sleep apnoea [00:30:40] and adults has been linked to all sorts of heart conditions strokes and everything. Right.

[TRANSITION]: So [00:30:45] how about dyslexia.

Steffen Decker: In kids and.

[TRANSITION]: All the other ADHD. It’s [00:30:50] become such.

Payman Langroudi: A big area.

Steffen Decker: Adults have these problems. But how about attention deficit hyperactivity [00:30:55] syndrome in kids it starts just kids adapt really well. [00:31:00] And then later on when we become maybe a bit bigger in adulthood. It impacts adults [00:31:05] in kids. Generally, what is the first point of call is adenoids. Tonsils. We [00:31:10] breathe through our mouth that the air is not being cleaned up, hence [00:31:15] our adenoids. Tonsils get overwhelmed with dirty bacteria. They swell up. What’s the first [00:31:20] point of call in a child below six? Remove them. That’s happening. They’re [00:31:25] getting ear infections. Let’s put a tube in there. That’s happening every [00:31:30] day. How about in a child? Okay, let’s get the tongue space. Go. [00:31:35] Let’s get tongue function up. Lip seal, nasal breathing. Let’s get the filtration going. [00:31:40] Maybe the size of the tonsils will decrease. Yes, I do agree. [00:31:45] We might outgrow the tonsils because the facial structure is growing later [00:31:50] on. But this alone is not harming the child. They [00:31:55] have a crossbite generally. So by correcting a bite, a crossbite is [00:32:00] not making them.

[TRANSITION]: Feel.

Steffen Decker: Worse.

[TRANSITION]: So it’s an.

Steffen Decker: Easy intervention we can do [00:32:05] eventually to help. But yes, we need an INT. Yes, we need to assess allergies [00:32:10] and all the rest. Speech therapy Myofunctional therapy. So it’s not an orthodontist alone. It’s [00:32:15] a whole team approach because airway is not expand the palate. We can breathe. No [00:32:20] it’s tongue function. It’s adenoids, tonsils, allergies, septum deviation. [00:32:25] It’s a lot to this story. But the challenge is to connect [00:32:30] these professionals, to think alike, to get a holistic approach to [00:32:35] their child. So now comes the problem again. Every one of these professionals has [00:32:40] a charge. If I want to do a child correctly, [00:32:45] they need to see eventually an ENT, a myofunctional, therapist, osteo [00:32:50] circle orthodontist, dentist. They all want a charge. [00:32:55] So now it becomes a luxury good for a child. But [00:33:00] where’s the money from the NHS going? It’s going into treating [00:33:05] symptoms. 130 million are being spent a year in filling baby [00:33:10] teeth and extracting baby teeth. 130 million. That’s just baby teeth. [00:33:15] How? Why can we not go into schools and talk about [00:33:20] mouth breathing? The impact it can have? Why do you not create awareness? How kids should clean their teeth. [00:33:25] That fizzy is not good for them. It’s easy prevention things we can do. Paediatric and orthodontics. [00:33:30] Why cannot invest that money in these things?

Payman Langroudi: I think look, when [00:33:35] something’s new, it tends to be expensive. When something’s [00:33:40] out of the ordinary, it tends to be expensive. Um, if it was mainstream, [00:33:45] it would be different, right? There would be the kind of specialists that are trained [00:33:50] in 2 or 3 of these disciplines, for instance. But I’m kind of interested in, [00:33:55] you know, you as an expert by its very nature, if you’re at the tip [00:34:00] of the spear, you’re you’ve got opinions, you’ve got [00:34:05] you’re trying things that aren’t in the sort of the research [00:34:10] and the teaching. How do you how do you balance that with when you’re talking to [00:34:15] a patient, explaining that this is, you know, this is your opinion [00:34:20] and you, you and your group’s opinion, let’s say and not and not what’s [00:34:25] out there, you know, in the in the research because the research is 20 years behind generally. Yeah. [00:34:30]

[TRANSITION]: The thing is what.

Steffen Decker: Happens is parents [00:34:35] nowadays, they’re very well educated.

[TRANSITION]: Yeah.

Steffen Decker: They get the information [00:34:40] on social media. So their gut feeling says something is [00:34:45] not right. Yeah. They’re going to professional and they’ve been told [00:34:50] there’s nothing we can do for your child. Now come back when they’re in secondary [00:34:55] school Every day I have this story. Then you start explaining [00:35:00] what is the link between this and this and this, and they [00:35:05] get emotional. They said, hold on a minute. I went with [00:35:10] these problems to the professionals. They all told me I’m there. There’s nothing there. [00:35:15] You overthink things you do, but you are telling me I was right. So [00:35:20] I don’t even talk about that. I’m one in a lot of things. We don’t [00:35:25] think like that because they know. They know.

Payman Langroudi: They feel it in themselves.

Steffen Decker: They feel they [00:35:30] know when a child is not feeding. Yeah, there’s an issue. Why is my child not taking [00:35:35] my. There is something wrong with me. They’re asking the question. They’re going on social media. What’s wrong with me? [00:35:40] And they’re getting answers. So if I give them an answer where the potential link is be, [00:35:45] they say, you’re right. This happened before, for example.

Payman Langroudi: And that’s a massively growing [00:35:50] area. But but does it not keep you up at night that something could go wrong [00:35:55] with one of these kids?

[TRANSITION]: No, because.

Payman Langroudi: Then some expert who’s an NHS trained orthodontist, [00:36:00] who’s now the expert legal advice says this isn’t the normal way of doing it. [00:36:05] And and something.

[TRANSITION]: I look.

Steffen Decker: I give you an example. I [00:36:10] have a kid in treatment with down syndrome. Yeah. [00:36:15] Down syndrome children have a very low muscle tonus. Yeah. And [00:36:20] they tend to have a big tongue. Or you could say they don’t have a big tongue. [00:36:25] They have a small jaw to fit the tongue. Yeah. This child has a CPAp [00:36:30] machine since he’s four years old. Wow.

[TRANSITION]: Poor thing.

Steffen Decker: And [00:36:35] the mum hates the machine because the child maximum one hour a night. He [00:36:40] uses it because he can’t cope with it. The mum came to me for advice [00:36:45] and I said to them very clearly. Look, there’s not a lot of [00:36:50] research there, but I can try my very best to create [00:36:55] space for this tongue to work better. Are you with me in [00:37:00] this? And the mom gets emotional. Please help my son. We [00:37:05] are texting nearly every day. She keeps me updated how the child is changing. What [00:37:10] am I doing wrong? At this point in time when [00:37:15] the mom wants me to do this, she’s aware of everything I do. I keep in close communication [00:37:20] with the mom and she tells me everything. If something would go in a not the right direction, [00:37:25] I would remove it immediately. She knows that and she knows as well as I would [00:37:30] do 2 or 3 rounds of expansion if I need to. And guess what? I’m not charging her for the extra [00:37:35] rounds because I want this. This is the emotion. This is connection between [00:37:40] me and my patient. I don’t care if I get attacked for that, if I get attacked [00:37:45] for helping a child, for potentially changing [00:37:50] their life. God, mark my word.

Payman Langroudi: I felt the same. [00:37:55] You know, when we started teeth whitening, it was illegal. And, uh, people [00:38:00] kept asking me this question. What if. What if, you know, for 12 years, we sold it illegally [00:38:05] to dentists. And I felt the same. If the if the alternative is to [00:38:10] drill teeth and stick veneers on, and someone wants to attack me for selling bleach, [00:38:15] then I’m up for that fight, you know, so but I get I get what you’re saying. [00:38:20]

[TRANSITION]: And I also.

Steffen Decker: Don’t like what’s happening now because I have a lot of podcasts, [00:38:25] a lot of, um, messaging I have out there. Sometimes [00:38:30] I get dentists coming to me with their children.

[TRANSITION]: Sure. Yeah.

Steffen Decker: Because [00:38:35] their child is looking like this. Yeah. And guess what? She’s suffering. [00:38:40] So I’ve heard you, you know, I don’t know anything about it. Can you help [00:38:45] my daughter? I helped their daughter. Suddenly these dentists become my biggest [00:38:50] referring practice because they’ve seen it with their own eyes. What I’ve [00:38:55] done changed their kids life and hence their parents life. Look, I get emotional. [00:39:00] What am I doing wrong? I’m helping. Research needs to happen. But [00:39:05] how do you get control? Research with control groups. It’s impossible [00:39:10] because you cannot do proactive. Say this. I want to control fine twins. [00:39:15] And one you treat and one you don’t. One has sleep apnoea. One doesn’t. Where do you make the difference? [00:39:20] It’s really hard to get the research and talk to saga. In US talks a lot about it to get high level [00:39:25] evidence. It’s very difficult. Also airway topic is not [00:39:30] just okay let’s see. We expanding a pallet. Does the airway change. You get [00:39:35] this port of 3040 patients. If not everyone change. Why? Because they [00:39:40] all had allergies for lactose or whatever. You didn’t look at that point. You [00:39:45] didn’t look at the rest of it. It’s too complex that you can just say, we do one thing [00:39:50] and something.

Payman Langroudi: Changes early on as.

[TRANSITION]: Well. It’s too.

Steffen Decker: Early. So, um, but if [00:39:55] you talk to a mum, we have dry lips. We know this child is mouth breathing. [00:40:00] You ask them, how is the child sleeping? Is it dry now? Does it need to wake [00:40:05] up at Night-Time to get some water? One says yes. Then you know, mouth breathing. Hence [00:40:10] more bacteria through the mouth. Hence I expect infections. Ask [00:40:15] them, did you have any problems with adenoids? Tonsils? Ear infections? Eventually [00:40:20] you get the answer. Oh yeah, we have ear infections all the time. We have tons of infections. [00:40:25] Four times five times a year. We get told to get antibiotics. What [00:40:30] does antibiotics do to your child’s gut? Kills [00:40:35] it down. So again fire is on symptom. Fire out. [00:40:40] But where’s the smoke of this? Where we need to see the smoke. So, [00:40:45] um, you see signs and after when you do that for, you see a lot of signs. [00:40:50] Speech. Yeah. Dry lips, face structure, tired [00:40:55] eyes. There’s so many signs which we can learn. There’s a list of ten signs [00:41:00] you can learn that tick box, any of these signs. Then we have a high risk for sleep disordered breathing. [00:41:05] It’s easy. You can learn. That’s research study published this this new research. [00:41:10]

Steffen Decker: But as a professional, I think we have to be open to [00:41:15] accept new research and to say, okay, you know, everyone’s talking about maybe [00:41:20] there’s something to it. Yes. It’s not black and white, but what I want [00:41:25] is to people be open, say, just ask some questions. Because if this is your [00:41:30] princess in the chair, struggling with breathing, [00:41:35] with bullying trauma, how would you feel as a parent, not as a dentist [00:41:40] who knows all the research? Would you not say, I want to try this. There’s [00:41:45] nothing wrong with trying. And guess what? If I am the one who changed [00:41:50] that? What makes me? I am the hero forever. So they will never [00:41:55] leave my sight and they wont. Dentistry eventually on the side because they say I [00:42:00] trust you and I have patients flying in from Hong Kong, Norway, Portugal [00:42:05] to me to Amersham. Old Amersham clinic is close to Heathrow for [00:42:10] advice. I don’t actually want people flying into me because that’s [00:42:15] a lot of responsibility, a lot of pressure. How about I trained local dentists [00:42:20] or orthodontists in that community, what they should do, and I helped the children [00:42:25] in their community.

Payman Langroudi: So let’s get to that. Are you happy with a dentist, a GDP treating [00:42:30] seven year olds, eight year olds with orthodontics, bearing [00:42:35] in mind the airway? Or is that really a specialist area? Well, it is number one. Number [00:42:40] two, what should a dentist look out for at those ages?

[TRANSITION]: Okay, there.

Steffen Decker: Are two aspects orthodontists [00:42:45] should do that.

[TRANSITION]: For sure.

Steffen Decker: They should do because they [00:42:50] have the fundamental training in growth and development. There are a lot of steps [00:42:55] ahead of a general dentist in terms of growth and development. Yeah, but [00:43:00] dentists seem to invest more [00:43:05] professional time in their education than orthodontists. Orthodontists [00:43:10] go to an orthodontic conference. Dentists go everywhere to educate them. [00:43:15] So end of the day, if you have the right education, [00:43:20] you can do kids. It comes always back to education. [00:43:25] That’s why I’m training. Good education. I have a one year [00:43:30] course, one year a diploma course certified by the University of Luxembourg, [00:43:35] which gives them good idea about growth and development, About [00:43:40] biomechanics. About clear aligners. Clear aligners is not a magic wand. It’s a plastic [00:43:45] and how to treat children. And I offer them me as a mentor [00:43:50] to four questions the whole way through. So if they would have a question, they [00:43:55] would come to me. If it’s too challenging for them, guess what? They refer to me. Good, [00:44:00] because they know their limitations a dentist. What I see [00:44:05] nowadays a lot is they go to a course maybe two days.

Steffen Decker: They may believe [00:44:10] you can do alignment, forget functional occlusion, forget all the rest. Eventually [00:44:15] they fail. They are out of their limit zone. They don’t know what to do. Bite [00:44:20] is open. Functional occlusion is all over. They didn’t have the CR [00:44:25] position before they moved the teeth so it failed. They don’t know why. So they [00:44:30] thought they have to go to education. They didn’t and they’re doing it on adults. Now we [00:44:35] talk about kids. It’s the same thing if you know what you’re doing and you have someone you can ask [00:44:40] for help if you need to. Maybe yes, because end of the day, we need [00:44:45] to prevent. My mission is to help children. If it’s [00:44:50] a paediatric dentist or a dentist or an orthodontist, which I still believe we should be [00:44:55] our job. But when do we get our patients referred to? When they’re teenagers? Because [00:45:00] the dentist don’t see it. But if dentists recognise it and we talk about it now, in a minute, [00:45:05] the signs and they would start referring to an orthodontist. And what’s happening right now? The [00:45:10] orthodontist is too early.

[TRANSITION]: Yeah.

Payman Langroudi: The right orthodontist is going to have to be right now.

[TRANSITION]: It needs to be the right orthodontist [00:45:15] again with the right training because.

Steffen Decker: It falls down again. I have a lot of patients who went to a dentist. [00:45:20] The dentist seen a problem, refer to an orthodontist, said, no, come back in secondary [00:45:25] school. We might have to extract four teeth or double jaw surgery. This is not good [00:45:30] enough. If the dentist recognise it and refer to an orthodontist, they should be able to [00:45:35] say thank you so much for this amazing referral and write a nice letter back [00:45:40] and give them back the restorative. That’s how it should be. Back to where we used to be 20 years ago. [00:45:45] We got referrals from dentists or dentists were not interested in alignment. Why [00:45:50] can we not do that again? Have a nice work relationship instead of everyone from us looking for ourselves. [00:45:55]

Payman Langroudi: For the same adult patients? Right? Right. Yeah.

Steffen Decker: And what are the signs? There [00:46:00] are ten things we need to look out for in children. Mouth breathing.

Payman Langroudi: This is at seven [00:46:05] years old. Yeah.

[TRANSITION]: Yeah.

Steffen Decker: Paediatric disordered breathing. [00:46:10] Yes. Sleep disordered breathing. Doctor Sagi Ferris six. It’s called. [00:46:15] Yeah. You can download it online lah. Mouth breathing. Tension [00:46:20] in the muscle. In the mentalis muscles. Tonsil infections. Increased. [00:46:25] Tonsils more than 50%. Tongue tie. Tongue tie is [00:46:30] not. Just untie your tongue to where the tip is. Tie which everyone should [00:46:35] recognise. It’s also a tongue restriction, which is the back of the tongue, kind [00:46:40] of which is hard to diagnose. Narrow arches, really [00:46:45] easy grinding if if kids are [00:46:50] grinding. Yeah. And face structure. Tired eyes, venous pooling. [00:46:55] There are a few things which are easy to detect in adults. It becomes a [00:47:00] bit more complex because we see imprints of the teeth on the tongue, because the tongue [00:47:05] is too big for the jaw. So that’s called tongue overflow. Then we can [00:47:10] do simple exercise to ask the kids to lift their tongue up when their mouth is open.

[TRANSITION]: That’s [00:47:15] the tip of the tongue.

Steffen Decker: Touch the tip of the teeth. Then you see anterior restriction. Then [00:47:20] you can ask them to suck their tongue up.

[TRANSITION]: To the palate.

Steffen Decker: To the palate. Can they do [00:47:25] that? And you will be astonished that a lot of them can’t. And guess what [00:47:30] the parent is doing in the corner.

Payman Langroudi: Same thing.

[TRANSITION]: And they say to me, hold [00:47:35] on a minute.

Steffen Decker: I can’t do that. I’m snoring at night. I’m struggling. There’s your [00:47:40] next patient. So A-Rod is a big topic because it’s a lot [00:47:45] of awareness. And we have look, we treat a lot of symptoms. We have these sleeping devices [00:47:50] now moving the jaw forward. Yeah. Big industry. Yeah. But it’s [00:47:55] symptomatic treatment moving the jaw forward, which means posture. Open the airway. [00:48:00] What does it do to the teeth? Because there’s a force. Think [00:48:05] about it. It’s short term. Okay. But should we not go to the source of [00:48:10] the problem? Also, what does sleep do to the mental health of an adult? [00:48:15] Ask these questions. How are you sleeping? Or. I sleep only three four hours a night. [00:48:20] And do you take any medication? Oh, yeah. I take antidepressants and [00:48:25] I drink at night. I’ve had it all in a chair.

Payman Langroudi: There’s a lot of it about. [00:48:30] There’s a lot of it about.

[TRANSITION]: If adults.

Steffen Decker: Struggling, they might have [00:48:35] really big issues and then they work in the city 24 over seven. I had these patients in my chair in Harley [00:48:40] Street. Antidepressants, ADHD medication, drinking themselves to sleep most nights. [00:48:45] What is your life expectancy? Not very well. So [00:48:50] it comes back to one thing prevention. So this ferry six [00:48:55] or adults, it’s called the ferry six plus four because we have ten points you can [00:49:00] download. I have Ferris. Ferris.

[TRANSITION]: Like Ferris. How do you.

Steffen Decker: Spell functional airway [00:49:05] resistance assessment?

[TRANSITION]: Oh I see okay. Yeah.

Steffen Decker: So it’s doctor Tsurusaki Institute [00:49:10] and Breathe Institute. Com download it. It’s an easy assessment since. [00:49:15]

Payman Langroudi: You’ve moved on so much from your original training. From [00:49:20] ortho training? If you were the king of the world now, would you change ortho [00:49:25] training? I mean, for instance, this thing about getting everyone to class Plus one.

[TRANSITION]: Would [00:49:30] you change that?

Steffen Decker: John Coy is teased about function. [00:49:35] How do these jaws move when you speak and when you do? What [00:49:40] is an angle? Class one it’s a static situation, a [00:49:45] scenario in one position in time. This is not.

[TRANSITION]: Real, but.

Payman Langroudi: Also sometimes [00:49:50] you’re forcing people into class one when it’s not. When when it’s constricting.

[TRANSITION]: Amazing. [00:49:55]

Payman Langroudi: Is that correct?

[TRANSITION]: Look, we.

Steffen Decker: Have a class two skeletal. A lot of Asians Indians [00:50:00] have class twos, right? Yeah. So now we’re using a line of biomechanics. [00:50:05] We’re doing sequential digitalisation moving into a static angle [00:50:10] class one. But unfortunately the jaw movement didn’t change [00:50:15] it still coming forward because we still need to to be able to function. So what’s [00:50:20] the what the brain is going to do. You hit the front teeth. The brain’s going to fire up back [00:50:25] clench. You get a lateral open bite.

[TRANSITION]: Which [00:50:30] is common.

Steffen Decker: Which is common, yeah. Common side effect of a line. [00:50:35] Orthodontics. Nothing to do with the line. Orthodontics. Wrong plan. It’s [00:50:40] your planification. So functional occlusion all over. So [00:50:45] this exactly comes back to education. You cannot [00:50:50] move everything into class one. It might work well in some cases, but it might [00:50:55] fail dramatically in other cases. And when we see cases for second opinion this [00:51:00] is always the case. They’re going to the left, to the right, forward, backward. And [00:51:05] they can’t bite anymore. So then we have a complaint patient there. [00:51:10] And then we have to protect the dentist and says okay dentist, [00:51:15] did you do de-programme the bite? Did you assess CR before you moved these teeth? No, [00:51:20] I didn’t. So that was a lack of education. So then we have to fix it without [00:51:25] causing the dentist any trouble. Yeah, so. But what a lot of [00:51:30] my. Sometimes it even happens to people I train when their dentist that at the end [00:51:35] of the training they say to me, you know what, Stefan? I will not do orthodontics. And [00:51:40] I say to him, that’s very brave of you, but I understand it because you understood [00:51:45] this is too complex, especially adults, for me to make this. [00:51:50]

Steffen Decker: Now, let me just refer to you the orthodontics. And I do the veneers, the bonding, [00:51:55] whatever I need. This is a very better relationship, I think, before [00:52:00] it comes to complain. And now we have clinics hunting for this biggest [00:52:05] discount number. It’s a number game when you treat three, [00:52:10] four, 500 kids adults with aligners, it’s just a matter of [00:52:15] time that it fails. Yeah, that you get the complaint. [00:52:20] Yeah. So then you as a business you have to deal with the complaint. Is that what you [00:52:25] want to do in your business, dealing with complaint patients all the time, or do you want to have a kid coming [00:52:30] into your clinic says, hi, Stefan, can I give you a hug? What [00:52:35] do you want in your business? You want a happy mind or you want this suing [00:52:40] mentality? You need to be a damn good dentist to do adult orthodontics [00:52:45] and restorative. You need to be good. You need to know your stuff. So that comes back [00:52:50] to diagnostic. Gandhi said. Three quarters is diagnostic. The rest is easy. [00:52:55] But unfortunately now it feels like diagnostic is a quarter and the rest is AI. [00:53:00]

Payman Langroudi: Well, look, we’re at that point. Yeah. I mean, at the same time, if that hadn’t have [00:53:05] happened, you wouldn’t now be using aligners on these kids. You know, it’s just [00:53:10] it’s you know, you’ve got to understand that that’s the sort of the natural [00:53:15] history of a product here. I know what you’re saying about manufacturers are looking for profit the whole time [00:53:20] and and you know, you as the as the specialist needs to translate [00:53:25] that into treatment options and and clear things. But you know, [00:53:30] it’s it’s just the way. I mean, we’ve both been around long enough to see trends [00:53:35] come and go. Are you still stuck on lingo for adults? [00:53:40] Like, if I was an adult coming to see you, would you? And I wanted invisible.

[TRANSITION]: What [00:53:45] I would say to you is I.

Payman Langroudi: Took lingual.

[TRANSITION]: Number one.

Steffen Decker: Let’s do diagnostics. Yeah. [00:53:50] If we. The main problem is, for example, a [00:53:55] curve of spee. Yeah. Where we physically need to extrude move teeth [00:54:00] out of the bone. We know aligners is the worst tool. Yeah. [00:54:05] So if that would be the case. So we have a deep bite curve for spee. Lower [00:54:10] teeth are reclined crowd. That’s a classic aligner case. Yeah. You will fight [00:54:15] a long time with an aligner with this case if you get it managed at [00:54:20] all and correct the bite with a lingual. You don’t need to do anything because you put [00:54:25] a straight wire in. The wire will lift the bite. So in my consultation, [00:54:30] I will tell the patient, this is your problem. This is the best tool for the problem. [00:54:35] But I understand from a comfort point of view from a you [00:54:40] coming physically to me to make adjustment. It’s inconvenient because your tongue will suffer. [00:54:45] You need to physically come and see me for me to make the adjustment. If you want to travel the world, never [00:54:50] come and see me. I can do remote monitoring. I have an aligner case. You don’t need to come in, [00:54:55] but it might take double the time. And it requires [00:55:00] your commitment the whole way through. [00:55:05] So now we are not in Asia. We are in Western Europe, my colleagues in Asia, [00:55:10] orthodontists. They can do whatever they want complexity wise because Asians, [00:55:15] you tell them what to do.

[TRANSITION]: They will do it No.

Steffen Decker: Here. Different mentality, [00:55:20] different area. So for an adult, my personal experience is after eight [00:55:25] months, ten months, they lose the interest. Complaint drops. So [00:55:30] hence you might not get the end result. But then a restorative dance [00:55:35] has good options because he can cover it. He can cover. He can increase [00:55:40] the bite. He can cover my malalignment with bonding. So the picture [00:55:45] on social media looks great. Me as an orthodontist, I [00:55:50] don’t have that. I’m not restorative dentist I need to refer on. So for me the expectation I need to have alignment. [00:55:55] So I will tell a professional, what do you want? Do you want efficiency? Which [00:56:00] means discomfort. And you need to physically come and see me. But it’s discreet. [00:56:05] You don’t see any lingual is completely discreet. Aligners is not [00:56:10] completely discreet. You have attachments. You have a plastic. Or do you want [00:56:15] comfort? What do you want? And my opinion is if I talk to professionals, singers, [00:56:20] actors, businessmen. No, Stefan, you know what? You should do your job. I [00:56:25] will deal with it. And I’ve treated over 1800 lingual cases now. I’ve done a fair. [00:56:30]

[TRANSITION]: Bit of 1800. Yeah.

Payman Langroudi: My goodness.

Steffen Decker: So I’ve done a fair bit of reading. And to answer [00:56:35] your question, most adults choose lingual. In my [00:56:40] clinic, the only adults I would opt for an aligner is easy [00:56:45] alignment, moving out, spacing, or where the kids [00:56:50] have the liners already and they want to do it with their kids together. But I will tell them [00:56:55] everything. And now comes the power of an orthodontist. Again. How [00:57:00] about combining techniques? Why not choose the best of [00:57:05] each world? Why not align the upper with the aligner? No speech impact, [00:57:10] nothing. No very discreet. And the lower curve of spee. U [00:57:15] do a lingual for four months.

[TRANSITION]: How interesting.

Steffen Decker: Take it out. Finish [00:57:20] with a liner. We call this hybrid approach. Why do you not use your strength [00:57:25] as an orthodontic specialist to combine techniques? Why do you need to do everything with [00:57:30] lines when you have rotated teeth? Very rotated teeth? Why would you try [00:57:35] that with an aligner? Put three brackets on. Rotate the tooth, take [00:57:40] it away and finish it. Easy. It’s easy because [00:57:45] it’s efficient. But for some reason we get pushed into this world. Everything [00:57:50] can be done with lines, I agree. You can do every malocclusion with an aligner, [00:57:55] but is it the most efficient device for that problem? [00:58:00] No, not all the time. But I love it for finishing. I [00:58:05] love it for certain movements. And I have this frank conversation with the patient. Who are you? Teenagers? [00:58:10] The same teenager. Who are you? What is important to you? I [00:58:15] do. Contact, sport. I’m very disciplined. I’m a professional. Or junior [00:58:20] tennis player? I know they do what they want to do. And a line up. Please do a line up. But [00:58:25] a lot of kids says. You know what? I can’t be bothered wearing that thing. [00:58:30] Put braces on, please. Because it will be a disaster. And the minute the parent pays, [00:58:35] they have expectations.

[TRANSITION]: So what.

Payman Langroudi: You’re saying is it’s very dependent on both the clinical and the social [00:58:40] situation in that particular.

[TRANSITION]: Case. Do you need to have that conversation? You need to actually ask.

Steffen Decker: It cannot be [00:58:45] an online questionnaire. Alina, Alina, Alina, it’s not like that. You need to have a conversation, [00:58:50] you know.

[TRANSITION]: What are you.

Payman Langroudi: I had one of my kids went through buckle, going every month [00:58:55] to the orthodontist, and my other kid had Invisalign with remote monitoring. And [00:59:00] my God, what a difference. What a brilliant experience that second one was for for [00:59:05] the kid.

[TRANSITION]: 100%.

Payman Langroudi: I mean, I when my son had the buckle, [00:59:10] I knew my daughter wouldn’t be the kind of person to put up with that. And I said to my wife, [00:59:15] I’m not sure, you know, she’s not going to be able to do it. And then she happened to go to an orthodontist who went the other direction, [00:59:20] and she just managed it so easily.

Steffen Decker: But isn’t that beautiful that we have options?

[TRANSITION]: Yeah, yeah. [00:59:25]

Steffen Decker: But we need to understand the needs of a patient. I have a lot of kids in [00:59:30] boarding school. Harrow on the Hill, Eton that I can’t do. Fixed braces. How is it possible [00:59:35] for a parent who lives in Hong Kong to take their kid out of school? Bring it to me for five minute appointment. [00:59:40] It’s not possible. Hence, I have to do aligners. I have to do remote monitoring. [00:59:45] But I make it very clear if you don’t do it, it’s not going [00:59:50] to work. You patient, you need to be able to commit. Can you do that? [00:59:55] And they say yes or no. If I’m if I’m not sure, I say to the parent, I’m not [01:00:00] sure if it will work. So plan B is fixed. If he doesn’t do that I will put fix on immediately. [01:00:05] So the beauty is the options. But if you a lot of orthodontists now [01:00:10] they focus completely on aligner world, no lingual, no buckle. They lose their skill. [01:00:15] They lose their differentiation between an orthodontist and a dentist. So [01:00:20] they are not different anymore. So they limit themselves to one technology, [01:00:25] even though they knew the technology. But lingual lives and breathes with [01:00:30] experience.

Payman Langroudi: A lot of lot of orthodontists don’t do lingual, right. They know how to do lingual.

[TRANSITION]: Why? [01:00:35] Because they.

Payman Langroudi: Didn’t. Lingual is difficult.

[TRANSITION]: It is bad.

Steffen Decker: Luck. End [01:00:40] of the day, Lewis Hamilton didn’t become a Formula one driver with one car. It’s again [01:00:45] and again and again and again.

Payman Langroudi: I’ve got a question for you. You must be positioned at the higher end. [01:00:50] Right. Like how much do you charge for a lingual case. A typical.

[TRANSITION]: One between.

Steffen Decker: 8 and £12,000.

[TRANSITION]: Yeah. [01:00:55]

Payman Langroudi: And you don’t you say you don’t do any marketing. No. So is it just [01:01:00] your passion that comes through and then word of mouth. Yes. Is that it. Is that. Yeah. And [01:01:05] it’s quite an interesting lesson isn’t it, that, you know, you’re charging £12,000 for something that [01:01:10] potentially people can get for 3500, and yet you’re busy [01:01:15] as hell. Yeah, yeah. And and it comes. It comes out in your voice. You adore [01:01:20] it. You’re so passionate about it. Yeah. And that rubs off on patients and patients. Tell patients. [01:01:25] Go and see my guy. You know, it’s so interesting. I’ve got another question for you. You obviously love learning. [01:01:30]

[TRANSITION]: Yeah.

Payman Langroudi: So why can’t you learn to do the bonding?

[TRANSITION]: Or [01:01:35] is that. Or is that. No.

Payman Langroudi: Is that a red line?

[TRANSITION]: Absolutely. Look, [01:01:40] you know.

Steffen Decker: What? I had this discussion with Coleman, my wife. A lot of time, I [01:01:45] said, why am I not doing the bonding? Yeah. Because I love cosmetics, I love [01:01:50] it.

Payman Langroudi: If you’re learning new things every day anyway, you might as well learn this.

Steffen Decker: I can do it. But [01:01:55] now, financially speaking, I’m charging what I charge.

[TRANSITION]: Yeah.

Steffen Decker: Hourly [01:02:00] rate. Bonding with the competition. We charge about For [01:02:05] £500 for bonding. Yeah.

[TRANSITION]: Doesn’t work.

Payman Langroudi: It doesn’t? Does [01:02:10] it interest you?

Steffen Decker: I am really good in what I do. I could do it, but [01:02:15] my skill is too high to do bonding. So I let the people do [01:02:20] it who have the passion for bonding. But as a business speaking, their day [01:02:25] rate is very limited. There’s only so much bonding. How many.

[TRANSITION]: Cases? [01:02:30]

Payman Langroudi: How many case starts do you do a year? Do you do a month?

[TRANSITION]: Well. [01:02:35]

Steffen Decker: We have now a new business, but the new business still has potential [01:02:40] to grow, especially with Dental monitoring. So I would say I treat about uh, [01:02:45] with kids now 180 kids with aligners. No, I don’t even [01:02:50] know how many per year. Yeah, yeah, I do probably then I do a lot of, um, removal [01:02:55] armies, like rapid maxillary expansion for bone expansion, a lot of them maybe 80 [01:03:00] a year. Then I do buccal braces, very limited. Maybe 1% is buckle [01:03:05] and most adults have lingo. But the.

[TRANSITION]: Adults? How many of those [01:03:10] do you do?

Steffen Decker: Now? Probably 30 only, but I used to do over 300 a year. But [01:03:15] my target changed. I focus on the kids and prevention and I have the parents. [01:03:20] But am I? Am I sad about it? No.

[TRANSITION]: I can change. I don’t look [01:03:25] sad.

Steffen Decker: I can change tomorrow to go to adults again. And I was thinking about again. [01:03:30] But I’m in a stage of my career. I want to train my associates to be me, [01:03:35] so I want to train even a dentist. Coming back to your training, I can train [01:03:40] a dentist to put lingual braces on. I can because you have also passive self-ligating [01:03:45] with lingual. I have a dear friend in Rome. I can do anything because my [01:03:50] my associates, my students, they know the benefit curve of spee [01:03:55] extrusion and so on, says Stefan. I want to do lingual. I said, okay, do it. Yes, they really struggle at the beginning [01:04:00] because my girls are used. I put braces on lingual in 20 minutes. Upper. Lower. Done. [01:04:05] Really? When my associates are coming, it’s two hours, so my girls go crazy. This. [01:04:10] Stefan. Why? Why is it two hours? Well, because they’re not me. I’ve done it long enough, but I’m at the stage. [01:04:15] I want to share my experience in anything. To make others think [01:04:20] differently, to do what they love, to do what they deserve to do. And when you get [01:04:25] messages from your students saying you changed my life, that makes me happy. And I helped the [01:04:30] kids. So, um, I love what I do, so. But I grow [01:04:35] only with word of mouth and it’s enough for me. Yes, [01:04:40] if I would have a running business with nine chairs and 2030 associates, I would have to do marketing. [01:04:45] But do I want that stress, or do I want to focus on getting [01:04:50] this mission out there, doing podcasts, doing training to get more help for [01:04:55] other people? Because I’m limited to maybe nine chairs, I can have a second business somewhere else, but that’s more headache [01:05:00] franchise thing, but I feel my mission, my [01:05:05] meaning now is to share it.

Payman Langroudi: Now this is what’s energising you. Yeah.

[TRANSITION]: Yeah, I love [01:05:10] it.

Steffen Decker: I love to make sure that people understand my why. My passion for [01:05:15] prevention now. I’ve done it all to help the children, to get them what [01:05:20] they deserve to do. And the that orthodontist. Because I believe [01:05:25] a lot of orthodontists are struggling. I know they’re struggling with getting patients NHS [01:05:30] contracts running out. They’re struggling to survive. [01:05:35] You might need to think about this. Be courage and have the courage to change. [01:05:40] Change is not comfortable. Sometimes it needs education. I’m here for you, [01:05:45] but I can share. I had to change. Why not change? You know, and [01:05:50] I think the year courses.

Payman Langroudi: How many days is it?

[TRANSITION]: Pardon?

Payman Langroudi: Ten days. Ten days?

Steffen Decker: No. My, [01:05:55] my one year course is 12 full days.

[TRANSITION]: 12 full days plus.

Steffen Decker: Mentoring plus exam. [01:06:00] And then I have what does it cost? £13,000 for one year.

Payman Langroudi: Do you [01:06:05] have to pay it in one go?

[TRANSITION]: No, no we do.

Steffen Decker: In instalments and we have orthodontic courses as well. And I would [01:06:10] love that more. Orthodontists are taking that opportunity to at least explore [01:06:15] this revenue of using this beautiful technology of clear aligners in kids, [01:06:20] and eventually make a different revenue stream for their business. And you [01:06:25] will see, I am completely private. The minute I stepped on UK soil it [01:06:30] was working. Yes, we for for phase one we’re charging about £3,000, [01:06:35] which is.

[TRANSITION]: Does phase one.

Payman Langroudi: Mean seven year olds?

[TRANSITION]: Seven year olds? [01:06:40]

Steffen Decker: So that is okay for most parents, especially if they can pay and so on. [01:06:45] That’s not a huge amount of money and they don’t need a lot of phase two. Generally [01:06:50] speaking, they might need to move some teeth, but we have enough space for the teeth. So [01:06:55] it is a lot of Benefit.

Payman Langroudi: Listen, man, you guys, I actually, when I took my son to the [01:07:00] orthodontist, I. Suddenly I felt so jealous of you guys, man, because [01:07:05] he he took a scan. He took a few photos, and then he started talking about [01:07:10] the face. Yeah. The minute he said face, I forgot I’m [01:07:15] a dentist, I forgot I know 100 orthodontists. I forgot all of that. And I was just like, take my money. Because, [01:07:20] you know the face when someone says your child’s face will be [01:07:25] like this or like that, or you’re going to just find the money for that, you know, it’s a beautiful thing [01:07:30] from a business perspective. I encourage, I encourage all orthodontists and dentists to mention [01:07:35] the face 100%.

[TRANSITION]: It’s emotional dentistry.

Steffen Decker: Christian Coachman talks all about [01:07:40] emotional. What more emotion do you want?

[TRANSITION]: Your child’s face.

Steffen Decker: You [01:07:45] change a kid’s smile. You change the way they live their life. You make them more healthy, better, breathing better. What? [01:07:50] What is more emotional than that? And the money you spend on that is so well spent [01:07:55] instead of late on, you go on social media. 25 years old, 30 years old. Can [01:08:00] cover ten teeth with bonding. Cost you £4,000, and two years later you do it [01:08:05] again, or five years later, or they start chipping away because it wasn’t done properly in the first place. So [01:08:10] what do you want? And you said that if you are good [01:08:15] in your diagnostic, you can create value. And what I always say [01:08:20] to my students, when you get emotion in the parents, you need to stop talking [01:08:25] because you have them. That is what you said to me. Match the face. Where [01:08:30] do I sign? This is the state where you have to say now it’s not about you anymore. To create value, [01:08:35] you have it. All they have to do is the mums. Go speak to the finance minister at home. [01:08:40] I bet the mum wants this, the child wants this. So the dad says sometimes [01:08:45] we have a zoom with the dad. But then I say it again, the same thing. This is your princess now this [01:08:50] can happen to your princess.

Payman Langroudi: And I think people are ignoring private child author [01:08:55] at their peril. Because, you know, if I mean these days you can target ads. [01:09:00] I know you’re not interested, but you can target ads to to a radius around [01:09:05] private schools. Yeah. And the ad can say, hey, mum, the NHS isn’t paying [01:09:10] for your orthodontist anymore. You know, some simple thing like that can start a whole child ortho, [01:09:15] private business. You know, I’m surprised more people aren’t doing.

[TRANSITION]: It’s. [01:09:20]

Steffen Decker: It’s surprised me as well. And when you teach and you see that they’re not [01:09:25] taking this opportunity, I think to myself, how can you not how can you not [01:09:30] see the bigger picture of what it does to the community, to yourself, [01:09:35] to your business, to the dynamics? It’s clear as [01:09:40] anything in front of me. And the beauty is now.

[TRANSITION]: What percentage.

Payman Langroudi: Of your business is referral [01:09:45] and what percentage is patient referral?

[TRANSITION]: Oh.

Steffen Decker: 95% [01:09:50] is patient word of mouth.

Payman Langroudi: Oh, really? Really? I’ve noticed that with some orthodontists. [01:09:55] You know, some orthodontists really manage well on that.

Steffen Decker: I like because I [01:10:00] create connection, I love it, I love passion, I love emotion, and I [01:10:05] have the backup of one of the best dentists in the world. John Cox is a big idol [01:10:10] to me. Like he knows everything under the sun, every research, he knows it and [01:10:15] that he has my back. It’s something which is so [01:10:20] valuable to me because it gives me strength. Confidence, courage, confidence. [01:10:25] And. And that he gave me the opportunity. And Christine, we together giving [01:10:30] this course at his centre in Seattle next year, which is the [01:10:35] first of a kind, shows us we’re doing the right thing and this [01:10:40] is eventually the way forward. And my mission is to do that more and more and to spread the word. [01:10:45] So this gives me the strength also to fight eventually some people who might [01:10:50] want to attack me because they feel threatened. I don’t know what the reason is, but my core intention [01:10:55] is out of love and to help. So I don’t want to fight any orthodontist. I don’t want to fight any [01:11:00] dentist. Everyone has the right thing. But let’s work together in this relationship.

Payman Langroudi: It’s the nature of our [01:11:05] profession. Ego. Ego is a big. I’ve noticed orthodontic egos are even bigger than. Absolutely. [01:11:10] On this part, we like to talk about mistakes. Have [01:11:15] you. Have you heard of Black Box thinking? No. So it’s a book about airline crashes? [01:11:20] Yeah. And what happens when a plane crashes? They look at the black box, and then they [01:11:25] find out what went wrong and immediately tell the whole pilot community what went wrong [01:11:30] without blame. Blame isn’t the main point of it, is to try and stop it happening [01:11:35] again. And then it sort of segues into medical. When something goes wrong, [01:11:40] let’s say something bad. Someone dies. Yeah. It comes, first of all, to whose fault was [01:11:45] it? And blame. And in medical. We’re encouraged in a way, because of the system [01:11:50] to hide our mistakes. And then by by its very nature, then we don’t all learn [01:11:55] from each other’s mistakes. So on this pod, we like to say, go against that. What [01:12:00] would you what comes to mind when I say clinical mistake that you made?

Steffen Decker: Or I [01:12:05] made so many mistakes, but I’m a guy. I take a picture [01:12:10] of the mistake, think about it and teach about it. What [01:12:15] you should do different, try a different approach. Maybe that helps and share it.

[TRANSITION]: Because [01:12:20] what was one that.

Payman Langroudi: Was almost like an aha moment for you?

Steffen Decker: The aha moment, [01:12:25] um, was meeting my wife.

[TRANSITION]: The mistake. I know that [01:12:30] was.

Steffen Decker: The best decision.

[TRANSITION]: Of my life, but I think in this.

Steffen Decker: Static university [01:12:35] thinking anger class one, I need to move in this perfect. [01:12:40]

[TRANSITION]: Bite. The functional.

Payman Langroudi: Occlusion.

[TRANSITION]: Part that to.

Steffen Decker: Miss this function, the dynamic makes [01:12:45] so much sense that we are much more complex than just. That’s not how we do work. [01:12:50] So this was.

Payman Langroudi: Just tell me about the mistake then.

Steffen Decker: Well, I extracted [01:12:55] teeth. I didn’t need to extract teeth. Yeah, I moved, I tried [01:13:00] to push back with mini screws. Everything plus one. And they failed. Eventually. Later. [01:13:05] Which I might not even know because they never came and see me. And there’s no relationship that I [01:13:10] might have made some kids sleep worse by, [01:13:15] for example, when they have big space because there’s a big tongue thrust [01:13:20] and I move everything back and their tongue is, where’s it going? So that I could [01:13:25] have had an impact in their health. Um, that makes me emotional. And [01:13:30] of course, I shave. Maybe too many teeth. Yeah, destructive. So [01:13:35] a lot of things I know now, I would do completely different nowadays, but [01:13:40] I.

[TRANSITION]: Can kind of.

Payman Langroudi: Not going to let you get away with that, you know.

[TRANSITION]: Because mistake.

Payman Langroudi: That’s the other class that as a mistake, [01:13:45] you know that what you knew at the time. I’m talking about a mistake. Another way you can look at it. I [01:13:50] don’t like the. I dropped something down the page. Yeah. Another way you can look at it. Who is your most difficult [01:13:55] patient?

[TRANSITION]: Um.

Steffen Decker: Psychology. Yeah. [01:14:00] Like, I really struggle, um, when [01:14:05] when I get emotionally attacked by patients who might not be happy [01:14:10] with themselves and they see the problem in the Dental work I [01:14:15] might have done, and I can’t understand because my first intention, [01:14:20] every intention of evidence is to do the best. Yeah. And if you have this criticise [01:14:25] on your work, it hurts and it hurts. And because you try and you try your [01:14:30] very best and I just, I literally can’t handle this emotion. [01:14:35] And there were times where I literally just did my job and I ignored it. [01:14:40] I turned my back on that patient which caused the complaint not [01:14:45] because of the clinical work, but because a patient felt I didn’t talk enough. [01:14:50] Yeah. So I the mistake is that even [01:14:55] so, some patients are not on our wavelength. We have to give them the time, [01:15:00] the dedication, the attention they deserve. Because if you would take [01:15:05] time to get to know them a bit more, there’s much more behind that facade which [01:15:10] impacts their life. And I know that now, more and more with airway, [01:15:15] they might really struggle to sleep, which has impact on their mental health, which impacts their behaviour. Brilliant. [01:15:20]

Payman Langroudi: Brilliant lesson. It’s a brilliant lesson because you know that the chairside manner of a dentist [01:15:25] is not only important in not getting sued. Yeah, that’s [01:15:30] a sort of a fear thing. It’s important in understanding that patient’s goals [01:15:35] and habits and compliance and everything that you just said. I mean, you know, you said [01:15:40] to me, based on the social situation of the patient, you may switch from [01:15:45] lingual to aligner. And they’re totally different treatments, right?

[TRANSITION]: 100%.

Payman Langroudi: So the [01:15:50] chairside manner, I don’t think we enough of us have understand. [01:15:55]

[TRANSITION]: How.

Payman Langroudi: Important that is.

Steffen Decker: The most time of my treatments is on a consultation, because [01:16:00] I need to get to know this individual.

[TRANSITION]: Lingual in.

Payman Langroudi: 20 minutes. Right?

[TRANSITION]: Right. So and [01:16:05] and.

Steffen Decker: What’s happening there now with the social marketing to a tick box. [01:16:10] Then we know what you need. You come in in a box, you get a scan, you get a liner sent home. [01:16:15] Where’s your patient communication in this. And now [01:16:20] I see it again the value of it. Because you get to know [01:16:25] an individual with all the different facets of life of business they’re doing, the [01:16:30] struggles they’re having you connect in an emotional basis. And what will be the biggest [01:16:35] problems for our children with a virtual reality world? The connection.

[TRANSITION]: By the.

Payman Langroudi: Way, I [01:16:40] stopped practising 1213 years ago and that is the bit I missed the most.

[TRANSITION]: By.

Steffen Decker: Interaction. [01:16:45] It’s. And this is why I love to teach now because I get this interaction [01:16:50] again and we did the professor. So if we go more into technology and [01:16:55] AI, we lose the the touch to the human being [01:17:00] and our kids. I see with my own eyes now my kids talking to a virtual person [01:17:05] on an app. Wow. Where is reality? Vr glasses? Where is this all going? When [01:17:10] they’re walking around in these glasses, this personal touch mannerism. [01:17:15] Take the time. And yes, there might be scenarios where you think you [01:17:20] don’t align and that’s fair enough. Nobody needs to align. But take [01:17:25] the time to invest in your patients and then you make a decision together. And this is what [01:17:30] I do now. Everything we do I learned from these mistakes, I will communicate. [01:17:35] Says I’m not a magician. That might go wrong. This can go wrong if it goes wrong. This is the [01:17:40] next solution and we have a nice relationship all the way through. And that gives you nice feedback. [01:17:45] And so I think because but that was also for my private experience [01:17:50] and my past relationships, is when I’ve seen a crazy person in [01:17:55] my mind, I stepped away, I was running away. But sometimes you need to face it [01:18:00] and change your manners and how to deal with it because it makes you a bigger, stronger [01:18:05] person as a clinician as well. So I think this is one of the main mistakes, is my communication, [01:18:10] taking the time to get to know this individual what they want. And with [01:18:15] kids, it’s absolutely the same stuff.

Payman Langroudi: Where does it go back to this sort of [01:18:20] high achieving, always curious, [01:18:25] uh, passionate sort of where what are the origins of [01:18:30] that?

[TRANSITION]: I mean, me.

Steffen Decker: As a person, I wear my heart on my sleeves like I am emotional, [01:18:35] I love helping, I did neighbourhood help. My whole life I was caring [01:18:40] for elderly people, taking care of the gardens, the dogs, whatever they had. I love [01:18:45] helping people and the interesting bit of my wildlife is next to me. In my mom’s [01:18:50] house there is a children’s psychiatrist. She knows me since I’m a kid. Really? And [01:18:55] when it came to A-levels, I didn’t know what to study. I was always good at school. She said to me, Stefan, you [01:19:00] need to do either medicine to help or to teacher to teach. [01:19:05] Now I do both. And, um, [01:19:10] I am always. The thing is, I’m a very logical. My father is a [01:19:15] informatics. My brother is a physicist. Professor. So very logic mindset in [01:19:20] the family. We talk about physics on the dinner table in Christmas. Boring for me, but that’s the way [01:19:25] it is. So I’m a very logical guy. So it means if someone tells me something, I try to [01:19:30] see their point and if it makes sense in my head. And that is what [01:19:35] helps me now to link all of these problems together. So okay, he says this. He says [01:19:40] where could be the cross link. And to be open. And when you do neighbourhood help, [01:19:45] you are open to different needs to different personalities because you [01:19:50] deal with a lot of elderly. They tell you a story about World War two and then you deal with other people. [01:19:55] They tell you a different story. But that’s for me, very interesting. So I had always had a passion for people [01:20:00] and had always the passion to know about their stories.

Steffen Decker: And I tell [01:20:05] stories all the time. And because my academic background is physics, so [01:20:10] orthodontics is easy physics. So, um, and I get [01:20:15] bored super quickly. So 2017 was lingual. I [01:20:20] wanted to become the best in what I do in adult market. I did it then five [01:20:25] years ago. I wanted to be best in kids in aligners, I did it. What’s [01:20:30] now now is it’s John Kois education and this whole messaging, and [01:20:35] I want to be good in it and spread the word. And I want to think maybe the [01:20:40] next few years teach and create, change somebody’s mind. Dentist, orthodontics, [01:20:45] paediatrics, and God knows what I do when I’m 50. I don’t know, maybe do a different [01:20:50] business because I’m generally interested in I have so many pages with different businesses and I [01:20:55] go out for dinner with them. It’s interesting to me. I am not the guy who can stick around in [01:21:00] one thing for a long time. I get bored too easily, which is to the detriment of my [01:21:05] wife because I’m running all the time. I get ideas every week and [01:21:10] my wife sometimes says to me, you’re too quick in going forward. We need to get this established [01:21:15] first, because if we don’t have this established, the other one will not work neither. So it’s nice to have someone [01:21:20] by your side who says to you, why slow down? Yeah, let’s get this right first, [01:21:25] and then we go to the next step.

[TRANSITION]: Keeps your feet.

Payman Langroudi: On the floor while your.

[TRANSITION]: Head’s in. It’s super important. [01:21:30]

Payman Langroudi: In the sky.

[TRANSITION]: Yeah. Your kids.

Steffen Decker: You know, for your kids, your dad, my my [01:21:35] kids said to me the other day, oh, you see, quite famous people said, yeah, I [01:21:40] didn’t have any idea what you do because for your kids you’re dead. You want to play, dedicate time [01:21:45] with your kids and play with them. And my kids are my biggest supporter. Like when [01:21:50] kids ask my kids, why do you have a license? Or my daddy is the best, they don’t even know what they are my best [01:21:55] in. But for them, I’m their hero. And that’s from a father point [01:22:00] of view. My dad was my idol. He did a lot for me and [01:22:05] I want to be that for my children. And, um, I just have so [01:22:10] much in me and passion and I think now [01:22:15] it’s the time for me to share this and my time to shine, [01:22:20] to share this passion and to make other people become better in what they do if [01:22:25] they want to do that. So that is what I feel now. That’s why I also [01:22:30] came to you. Because I want this so hard to share this passion [01:22:35] for orthodontics again. And as an orthodontist, [01:22:40] please listen to at least be open for new things. And this [01:22:45] is about working nicely together and kids is for me a blessing. Treating kids now and [01:22:50] adults is for me now is just for fun. I do it because I still my root. My [01:22:55] main reputation a few years back was lingual. I became a big name in the world. [01:23:00] Now it’s something different. In five years there might be a good educator. Let’s [01:23:05] see what’s happening.

Payman Langroudi: And can you give me I mean, it sounds like John’s become one of your mentors [01:23:10] now, but a list of a couple of mentors that sort of changed [01:23:15] the way you thought about privately.

[TRANSITION]: My wife.

Steffen Decker: Like she did [01:23:20] a lot of Tony Robbins live coaching before I met her. So when I met her [01:23:25] as a as a private person, she was the best version of herself. Happy with [01:23:30] herself. And she helped me enormously through my struggle, my life and guide me into [01:23:35] emotion. How to handle it, how to handle my private struggles. So [01:23:40] my wife definitely. Then professionally. John. Yeah, he [01:23:45] inspires me. He supports me. Um, then my kids, [01:23:50] my friends. Like, I really got to understand the importance of friends, [01:23:55] good friends in your life.

[TRANSITION]: But other.

Payman Langroudi: Mentors in orthodontics.

Steffen Decker: In [01:24:00] orthodontics.

Payman Langroudi: Courses you went on or.

[TRANSITION]: I like, obviously.

Steffen Decker: Um, Giuseppe [01:24:05] Guzzo, he’s one of the main lingual persons in Rome. He developed several [01:24:10] systems. He’s one of my biggest friends. Then Benedict Willems in Dusseldorf. He’s the [01:24:15] skeletal Anchorage guy. I work with him in 2008. Then there’s [01:24:20] Ben Lopatka University of Ulm. He does a lot about lip pressure and function [01:24:25] occlusion by Professor Jonas at Freiburg University. Because she was teaching me about lips [01:24:30] and tongue and breathing already dead back then and for my education point of view, [01:24:35] my boss in Germany, in your speciality training, you are allowed to do two years [01:24:40] in private practice and one year in hospital. So I had the luxury of [01:24:45] spending two years in a private practice, and my boss at that time didn’t pay me [01:24:50] a lot of wage, but she sent me on every course to enrich [01:24:55] my skill set. And at that time, I was 25. I didn’t understand what she’s [01:25:00] doing, but very quickly I was running her business because I could do lingual, I could do [01:25:05] skeletal, and I did buccal. Everywhere. She sent me to us, to England on her [01:25:10] costs. She paid everything for me.

[TRANSITION]: Well done.

Steffen Decker: And I was only 25. And my dad always [01:25:15] used to say to me, you have to invest in yourself first, and the money will come [01:25:20] later on in your career. So that she had to believe in me at that time [01:25:25] of my career was now hindsight for me. Wow. Because [01:25:30] I would be doing the same now. If I have an associate now and believe in, I would [01:25:35] do the same. Because eventually this can be your left hand who is running your business [01:25:40] for you and you can do other things. So as a business owner now together with [01:25:45] my wife is we invest in our stuff. So we send them to courses because we want [01:25:50] them to be happy, to be the best version of themselves. And ultimately it helps the business as well. [01:25:55] Whereas a lot of other clinics I worked in, they didn’t do that. They didn’t care if their nurses [01:26:00] are doing this or this. So they never progressed as a business. So [01:26:05] because I had the luxury of having this mentors in my life and people privately [01:26:10] who helped me in my life, I want to give back. So if I have orthodontists [01:26:15] who struggle, I will hold out my hand, says, I can help you. I can connect you with clinics [01:26:20] If I have people who want professional help, I’m here to help. I love students. [01:26:25] Text me every day and I help them. I think when you have met these certain [01:26:30] people in your life, you want to give back the same feeling. And [01:26:35] because I think that’s how we should work together and behave, [01:26:40] that’s me. So I have a few people in my life, but obviously the biggest is [01:26:45] my dad.

[TRANSITION]: Oh.

Steffen Decker: Because he gave me everything. [01:26:50]

Payman Langroudi: Is he still with us?

[TRANSITION]: No. I’m sorry.

Steffen Decker: So he unfortunately passed away [01:26:55] in the hardest time of my life, but he sees my [01:27:00] success. So he was my biggest idol.

Payman Langroudi: Let’s [01:27:05] get to the final questions. Yeah.

[TRANSITION]: Sorry.

Payman Langroudi: That’s all right. Fantasy [01:27:10] dinner party. Three guests. Dead or alive. [01:27:15]

[TRANSITION]: Dead or alive. Um.

Steffen Decker: Um, [01:27:20] Giuseppe Guzzo, my dear friend [01:27:25] and mentor. Um. Maybe [01:27:30] the Backstreet Boys.

Payman Langroudi: Well, [01:27:35] there was one guest as the entertainment at the dinner party. It’s just.

[TRANSITION]: I. [01:27:40]

Steffen Decker: Used to love them, and I was singing a lot of nice memories about that. And, um. [01:27:45] And who else is [01:27:50] going to be good? And probably my best friend Dean for action. Part of things. [01:27:55] That would be a nice dinner and just a nice chat. [01:28:00]

[TRANSITION]: Excellent.

Payman Langroudi: And the final question is a deathbed [01:28:05] question. If you’re on your deathbed surrounded by [01:28:10] loved ones. Um, by that time, it would be the great grandchildren or whatever [01:28:15] it is. You have to give them three pieces of advice. What would they be?

[TRANSITION]: What [01:28:20] would it.

Steffen Decker: Be? Um. Love with your heart. Um. [01:28:25] Treat everyone with respect and try [01:28:30] your hardest. Whatever you can achieve. If my kids do [01:28:35] that, I’m happy. Yeah. Have respect. [01:28:40] Try your hardest and love with your heart. And surround yourself with people [01:28:45] who are good for you. And that’s the hardest bit, I [01:28:50] think.

Payman Langroudi: Stefan Decker.

Payman Langroudi: It’s been a massive, massive honour to have you. [01:28:55] Thank you so much for coming.

Steffen Decker: Thank you for this time and to give me the opportunity to share [01:29:00] my passion. I hope I can.

Payman Langroudi: Best way to get to you.

Steffen Decker: Gateway is the [01:29:05] orthodontic specialist. It’s my Instagram account or the orthodontic specialist academy. [01:29:10] But just text me on Instagram. I’m available. Yeah, it’s someone is in charge [01:29:15] of that, but I’m always there to help. So if you reach out for the courses, it’s also the website [01:29:20] the Orthodontic Specialists UK in the course section, but just follow me on Instagram [01:29:25] and whatever I do and hopefully I meet you all one day. Thanks a lot. [01:29:30]

[VOICE]: This is Dental Leaders the [01:29:35] podcast where you get to go one on one with emerging leaders in dentistry. [01:29:40] Your hosts Payman Langroudi [01:29:45] and Prav Solanki.

Prav Solanki: Thanks for listening guys. If you got this far, [01:29:50] you must have listened to the whole thing. And just a huge thank you both from me and pay for actually [01:29:55] sticking through and listening to what we had to say and what our guest has had to say, because I’m [01:30:00] assuming you got some value out of it.

Payman Langroudi: If you did get some value out of it, think about subscribing. [01:30:05] And if you would share this with a friend who you think might get some value out of it [01:30:10] too. Thank you so so, so much for listening. Thanks.

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