Episode #358: How can digital occlusion tools transform dentistry and help practices deliver care while reducing insurance?

Intro: This is the Less Insurance Dependence podcast show with my good friend Gary Tackacs and myself, Naren Arulrajah.

Intro: We appreciate your listenership, your time, and most of all, we appreciate your intention to reduce insurance dependence in your practice. Our goal is to provide information that will help you successfully reduce insurance dependence and convert your practice into a thriving and profitable dental practice that provides you with personal, professional, and financial satisfaction.

Lester De Alwis: Hello everyone. Welcome to another episode of The Less Insurance Dependence podcast, your trusted source for insights, strategies, and expert advice to help you take back control of your dental practice and career. I’m Lester De Alwis, your co-host, and I’m thrilled to bring you another value-packed episode with a very special guest. And that is Dr. Robert Kerstein. On this episode, our mission is to help dental professionals reduce their reliance on insurance and create thriving, profitable, patient-centered practices.

But before we dive into today’s discussion, a quick word from our sponsors. Ekwa Marketing is offering a complimentary marketing strategy meeting where you could basically—the experts will basically look at your, um, your marketing and give you a report on how you could attract high-value new patients, rank number one on Google locally, and also help you consistently grow your new patient calls.

So if you want to learn more about how you’re doing on your digital marketing presence or your online visibility, you can visit lessinsurancedependence.com/marketing-strategy-meeting  to book your session now. And if you’re looking for coaching to create a thriving fee-for-service practice, schedule a complimentary coaching strategy meeting with Gary at thrivedentist.com/csm. 

Now onto today’s episode. I’m excited to welcome Dr. Robert Kerstein, a pioneer in digital occlusion and one of the foremost experts on T-Scan technology and occlusion time reduction therapy. Dr. Kerstein has spent decades advancing the way we diagnose and treat occlusal issues, helping dentists improve patient outcomes and grow their practices with cutting-edge technology.

Today, he’ll share how digital occlusion analysis, T-Scan, and DTR therapy are transforming dentistry and how these tools can help practices deliver better care while moving towards greater independence from insurance. Dr. Kirsten, we are excited to have you here. Thank you so much for being part of the podcast.

Dr. Robert Kerstein: Oh, it’s my honor to participate, so thank you for having me.

Lester De Alwis: So let’s start here. How has digital occlusion analysis changed the way you approach diagnosing and treating occlusal issues compared to traditional methods?

Dr. Robert Kerstein: Well, I have to say it’s greatly improved how I’m able to diagnose and treat patients’ occlusal problems over paper, ink, foil, shim stock, and scanning technology, which has come on today as a sort of occlusal diagnostic tool, a spatial tool, but it can’t be used—its information can’t be used—to really treat patients. So the T-Scan technology has sophisticated high-definition electronic sensors that pressure map, and it allows you to see incredible detail—so much occlusal function, force, and timing data that really is changing in fractions of seconds that can’t be obtained in any other way.

And that’s because it occurs between the teeth, right? So you can mark the teeth with ink, but that doesn’t measure anything timing-wise or force-wise, actually. So what’s interesting is T-Scan sensors are highly sought out all over the world in industries that require machining of surfaces that may mill, mesh, rub up against each other, require high tolerances to survive—like brake pads, engine gasket seals, suspension springs, tire tread—just some examples from the auto industry.

And companies like Michelin and Amazon and Beautyrest mattress fabricators—they rely on these sensors daily to control pressures and create high tolerance outcomes. So that same force and timing information can be captured from between the teeth and then used to machine the occlusion to high outcome tolerances that can’t be reached with traditional occlusal indicators in any way.

And what we’ve discovered is it’s really the timing aspect that has the most impact on diagnosing and treating occlusal abnormalities, which can’t be seen, as I said, in any other way to measure between the teeth. Ink and foil and shim stock pull and all of that doesn’t measure those things. And scanners, as I said—all the teeth are out of contact when people get scanned—so there’s no force of impact being measured by the data that scanners produce.

So most importantly, multiple treatment research-validated protocols exist. In other words, treatment was rendered on subjects using T-Scan data in the implant world or the TMD world, and protocols have been developed that any dentist can learn to improve their outcomes—whether it’s analyzing occlusion time reduction to see if a patient’s TMD is being caused by their occlusion, or to quickly analyze an emergency patient that shows up on Monday morning with a sore tooth they can’t chew on. The information is readily attainable with training and incredibly diagnostic and used to treat.

Lester De Alwis: Amazing, amazing. That’s fascinating to hear. And I mean, digital occlusion really changed the game compared to the traditional methods. Now, coming back to therapy, could you explain how occlusion time reduction therapy benefits patients with TMJ disorders or chronic headaches and what outcomes dentists typically see?

Dr. Robert Kerstein: Well, um, so occlusion time reduction is a high precision occlusal therapy. And what it does physiologically for the patient is it rapidly decreases muscle hyperactivity in a wide range of face, head, and neck muscles. And these muscles are all involved with swallowing and moving food into the digestive tract, which I’ll talk about in a second. So what happens to these muscles is lactic acid builds in them from excess tooth function, and the inundated muscle fibers then lose their capability to contract so well, and they become tighter and sore.

And what DTR does is it quickly allows the lactic acid to be metabolized away, and then muscle fibers re-oxygenate and strengthen, and function returns, and pain goes away. And the muscle groups that are affected are actually many. They’re the masticatory muscles, the submandibular muscles, muscles associated with swallowing in the cervical region, the muscles of facial expression, the airway and the pharyngeal muscles, the inner ear—which is why when you’re on a plane and you kind of want to clear your ear, you swallow—and the tongue and the soft palate muscles.

So all these muscles are being controlled actually by the teeth. And what dentistry doesn’t realize, and even medicine doesn’t realize, is that the molar and premolar tooth nerves directly communicate with a large area in the center of the brain known as the reticular formation. And the reticular formation then has nerves that leave there, and these outgoing nerve transmissions go back to all these muscle groups and structures associated with chewing, eating, and swallowing.

So we humans can, without thinking, basically chew food and breathe, swallow the food, and keep breathing, and then push the food into our digestive tract—rather than down into our lungs, which would asphyxiate us and kill us, right? And we don’t think about it at all. We’re just eating and chewing, and then suddenly we’re swallowing, and then suddenly we’re done chewing, eating, and swallowing, and we’re breathing through it all, right?

Lester De Alwis: Mm-hmm.

Dr. Robert Kerstein: Well, that’s all controlled by the teeth. But the excess output from the teeth causes those same muscle groups to lose their capability because it goes on thousands of times a day. It’s not something that the patients can control. It has to do with how their teeth rub and mill and mesh, putting all this excess output into the brain, and then the brain putting it out into these muscle groups.

What’s fascinating about all this is we now have discovered through airway CT that DTR opens the airway physiologically—actually 30 to 50% increases in airway volume in multiple dimensions, with height, shape. And there’s no snore guard needed. It’s a permanent airway widening that results because the region of the oropharynx then muscle-relaxes physiologically.

And of course, snore guards and sleep appliances that pull the mandible forward and CPAP—those don’t fix the airway. They pull the airway apart or push more air into it. But when the person’s done using them, the airway is the same dimensions. With DTR, the airway is markedly more open, and it improves sleep. And again, this is because DTR works from within the central nervous system. So it rapidly reverses many physical problems and also brings about emotional benefits because people live in less chronic pain.

So to answer the second part of your question—what dentists can expect to see when DTR is properly rendered—and I say that because it’s not your grandfather’s bite adjustment. It has incredibly high numerical tolerances to control brain function, right? That’s what it’s doing. It’s controlling brain function. And so, you know, it’s not something people just kind of do like they learn in an occlusion course without the T-Scan. It’s not the same thing at all.

Dr. Robert Kerstein: And we’ve proved that in literature, actually. But what a dentist can expect to see when it’s properly accomplished—DTR mitigates pain, it improves chewing strength, speed, and motion patterns. So people chew taller, wider, stronger, faster, with less soreness. It reduces chronic headaches, which can include migraines. It reduces bruxism and clenching.

It’s also been shown to improve forward head posture because the reticular formation controls posture as well. And because people live in less pain, it lessens emotional depression and improves patient emotional well-being. And this has been studied using psychometric markers and psychological testing before and after DTR treatment—and publishing that. So there are actually three or four papers about that.

And the beauty of DTR—because it is a neurologic treatment—is it’s accomplished without night guards, splints, orthotics, jaw repositioning, getting Botox every three months. You don’t need to TENS anyone before you treat them. You don’t need medications—actually, studies show medication use goes way down. And you don’t need physical therapy.

So it’s really an amazing therapy because what it does is it controls the amount of excess electricity directly pumped into the brain coming off posterior teeth. That occurs with every chew, clench, swallow, rubbing your teeth together in the car when you’re stressed out in traffic, grinding your teeth when your kid drops their homework in the disposal—inadvertently, right? Or your mother-in-law moves in, right? And you start clenching and grinding.

And this tooth information is ongoing all day long, all night long. Of course, you can wear a splint, which kind of cuts into it, but the electrical output itself can only be controlled at the occlusal surface by reducing the time teeth rub back and forth against each other. And that’s the occlusion time. And all of those things I mentioned it does are all in published studies.

Lester De Alwis: Wow. Wow. I mean, I learned so much in this episode. I think most of our listeners will actually learn a lot of good nuggets about DTR therapy—DTR and, you know, all these new things that you just mentioned and all the mechanics that you just mentioned between the muscles and the mouth. That’s really interesting to hear. So, I mean, those outcomes are very powerful.

But beyond patient health, many dentists also wonder how this affects the way they run their practice. So let’s talk about the role of data-driven tools like T-Scan in improving efficiency. What role do you see data-driven tools like T-Scan play in helping practices improve both clinical outcomes and operational efficiency?

Dr. Robert Kerstein: Well, it’s a great question, because T-Scan, once someone understands how to use it properly, rapidly improves efficiency because it cuts way down on these extra bite adjustment visits that go on after people get new crowns or fancy implant work done. They get their teeth and they have to go back 5, 6, 7 times—even quadrants of fillings and single teeth.

People often tell me—patients have told me many times—they had one tooth crowned, their bite was thrown off. After the dentist ground with the paper, choosing what they think are the bite forces, that whole process is completely streamlined. Not only the insertion deliveries, where you actually send the patient out the door with measurably optimized—as I used the word earlier—machined, high-precision occlusal outcomes that control the longevity and improve the longevity of the restorations, but also rapidly bring about patient comfort with their new teeth.

So the efficiency goes way up once the dentist learns how to use the T-Scan properly. And that’s, again, the necessary part. It doesn’t work just because you own one.

And so the beauty of it from the restorative standpoint is it—you know, it can’t make your steps of impressioning and your scanning and your drilling teeth—it doesn’t impact that. But it impacts how well the provisional holds up in the middle of treatment. For example, instead of having to resubmit a bunch of provisionals breaking from bad forces or coming loose from bad force distribution, you eliminate that.

You deliver the provisionals with the T-Scan. You do the same thing at the end of the case with the new real restorations, and it cuts way down on this problem. And I know that because my practice was prosthodontics and TMD, and I made a lot of prosthetic dentistry. And I would pretty much install most of it with the T-Scan and see the person once or twice more to optimize it.

But coming into my practice seeking help were patients from all over the world who would say, “I had these three crowns made five years ago, my bite got lost. They ground on all my teeth in other places. Now I have TMJ. No one can help me.” Or, “I had a few teeth extracted and I went through Invisalign, and my bite changed. And since Invisalign, I’ve gotten all these migraine headaches. And it’s been four years, five.” Right?

So the aftermath of doing dentistry is a huge problem that’s really not talked about in dentistry. It’s kind of swept under the rug. And T-Scan greatly shortens the treatment times and then enhances the longevity of the restorations because you send a person out the door with a force-controlled outcome.

And then on the other side of that, DTR itself rapidly speeds up TMD. Usually, it takes about a month for the person to feel markedly better and have minor symptoms. And six to eight months later, they’re living with either no or very marginal TMD symptoms that they struggled with for years—wearing splints and getting PT, getting shot up with Botox, getting TENS and massages, and taking medications.

So the efficiency in an office can go way up once the dentist understands how to use the T-Scan. That’s an essential part of it.

Lester De Alwis: Amazing, amazing. Again, great points about efficiency. Now, when we get that part covered, there’s another key factor, and that’s patient experience. How do they feel during and after care?

Let’s dive into how these technologies impact comfort, trust, and long-term results. How do technologies like T-Scan and DTR therapy enhance the overall patient experience in terms of comfort, trust, and long-term results?

Dr. Robert Kerstein: Well, it’s another great question. So DTR was discovered in the 1989–1990 era. T-Scan I—exclusion time itself—was discovered with T-Scan I. And so we’ve had many chances to do long-term recall studies. We have one-year, five-year, nine-year—different people doing them around the world. And they all show long-term that once the exclusion time is corrected, the muscle activity is markedly less. And we know that because we use EMG simultaneously—electromyography.

So these recall studies show patients without splints, they use far less pain, headache, and anti-inflammatory medications. They don’t use anywhere near as much migraine medication. So they’re not medication-dependent or splint-dependent. They no longer need Botox—this every-three-months getting this poison shot into your face in different places. You know, it is a poison. Botox—when I was growing up, people died from Botox, botulinum toxin, being in canned goods, right?

Lester De Alwis: Mm-hmm.

Dr. Robert Kerstein: So it’s not a good thing, despite what you see on TV—there are all these ads about how great Botox is, right? DTR fixes all that stuff physiologically.

So the essence of long-term is that patients live with much less chronic head, face, and neck pain, and they are emotionally far better because they don’t have chronic pain to deal with.

The other aspect of that is, you know, the patient experience—you asked about that. Patients love seeing the T-Scan data on the screen, and it takes away from them the idea of, "Is my bite good? Is it correct? Like, does it feel okay?" Right?

So I never ask the patient if it feels okay until after I’ve fixed it all up—made it T-Scan-wise, high-precision optimized. Then I ask how it feels. And then I might have to adjust a little bit for feel. But it’s all controlled by the data, and patients really love that aspect of it.

And they also love seeing the graphics in play—like how the bite changes on the screen as it improves. And what’s fascinating about that is most who experience T-Scan for the first time, when it’s used effectively, wonder why more dentists aren’t using it.

Lester De Alwis: Amazing. Again, I think it really highlights how patients benefit. You just highlighted how this could benefit the patients. Now, for practices to fully realize those results, training is something that’s very critical. Can you share why proper training makes such a big difference?

Dr. Robert Kerstein: Well, in essence, it’s a very good question also. The T-Scan doesn’t work because you buy one. It doesn’t work because you take it out of the box. You have to learn how to record properly with it, which is a skill set that dentists don’t have when they purchase a T-Scan.

Then you have to learn how to understand what it’s showing and analyze how to use that information to improve the existing circumstance—whether that’s by doing DTR, for example, or by adjusting high pressures on an area of an implant case. And none of that actually can be accomplished without getting good data.

So you have to learn the sequence of things, which is really to record well, then to understand what to analyze and how to analyze, and then how to apply that to make force-wise and time-wise targeted, precise occlusal adjustments.

So those are all learned clinical skills. Just because someone buys one or puts one on the shelf and uses it once a month when a big implant case comes in—they’re never going to be good with it, right?

So company onboarding—T-Scan’s onboarding—is helpful, but it’s not clinical. It doesn’t teach you how to be a dentist at the chair using the T-Scan. So the best way is these one-on-one, in-office, live patient training sessions, which are an amazing learning experience for the doctors.

Many who’ve had the T-Scan for a while—they’re surprised at how little they really applied or understand, and their technique for gathering data from the patients is markedly improved, which is the most essential step. You can’t make high-precision machined outcomes without getting great data from the patient.

So all these skills are learned. And when we do the in-office trainings, the staff is there, so they see how the patients respond to the T-Scan. They learn how to use the T-Scan and EMG, if we’re using EMG, and we all work together through these implant, restorative, and TMD cases.

So the doctor—finally, if they own one or have just bought one—really understands what’s involved to be effective when using the T-Scan technology. And because that day, the doctor does all the work involved—and I’m, you know, they have continuous guidance from me step by step—but they’re doing all the work. They’re learning to record, they’re learning to analyze, they’re learning to make the adjustments with the data.

So it’s incredible for them. It’s actually the only way to learn—is one-on-one. It’s not something like you can take a class in T-Scan and watch what’s good about T-Scan and how you, you know, you observe like, “This is what you do,” or you see me record on someone. But it doesn’t make you good at it, right? You have to do all those things—just like drilling teeth, right?

We could watch a video in dental school, but when we took out those ivory teeth on the D-form, many of them didn’t come out so well, right? We had to learn how to do it. Right? So T-Scan is a learned skill, and the training one-on-one is essential. No question.

Lester De Alwis: Exactly. Exactly. So we think it just doesn’t happen if you just bought this technology right out of the box. You need to train, and you need to go through that one-on-one session, just like you mentioned. So yeah, excellent advice—just as you mentioned.

So before we wind up, I want to ask you this question—I mean, this is very important, I think. Can you explain about a patient story about how T-Scan was implemented and its follow-through?

Dr. Robert Kerstein: Well, I can give you a really great example of what happens when the T-Scan is used for the patients. I travel all over the world, and I do a lot of these demonstrations where I’m given a patient that has occlusal problems I’ve never met, and then I help the doctors who are with me to help that person.

So, one time, I was giving a course in Brazil—2014—at a wonderful office, APRA Dental in Goya. Dr. Giselle Elias—an incredible office. And every hour and a half or so, we would leave the lecture or the hands-on, whatever we were doing as a group—we probably had 20 people—and we’d go to her clinic. We’d have a new patient—not a new patient to her—but a new patient to look at with the T-Scan who was having problems in her practice.

You know, they might have had a denture that was hurting them or they might have been chipping porcelain. Anyway, the third or fourth person was this middle-aged woman, probably 50 years old. She sat down in the chair, she was crying and she was speaking in Portuguese and crying. And I didn’t understand what she was saying, but she was using her hands and she was talking—she was touching her face, and she was doing all this stuff.

And what she essentially said—translated to us (I was the only one who needed the translation because everyone else understood Portuguese)—was that three years prior, she had had her mouth rebuilt with 28 units of crown and bridge. And since the time she got them—the first day—she was unable to just bite down in MIP—you know, just go like that—without hurting herself.

And literally, just every time, she would get pain. She went to see many Brazilian bite experts over those three years, and no one was able to help her, and the pain persisted. And of course, she’s emotionally labile—this whole thing is being said with tears and facial expressions.

What I noticed, before we even used the T-Scan on her, was how beautiful her restorative dentistry was. I’m a prosthodontist, and I was, if not taken aback, just amazed. I thought, “Wow, this is incredibly artistic prosthodontics.” At the time—2014—it was probably a mixture of some fused metal in the back and a lot of anterior all-ceramic restorations. Top and bottom: 28 units.

And I commented to the group about how beautiful it was. But what mattered—it didn’t matter at all. The patient wasn’t saying things like, “I love my smile; I just wish it felt better.” She could care less about the aesthetics, even though they were incredible.

So we take the T-Scan out. The patient—all she had to do was bite down and it hurt her. So that’s what we recorded. And we made one recording, and we found that there were two extremely high-force contacts on the upper second molar that were preceding everything else—the rest of the teeth coming together.

Now, you couldn’t see that when she bit down, right? But, as I mentioned earlier, the timing feature is incredible. She would rise to maximum pressure on these two teeth and then have to fit her teeth together past them. And she really couldn’t do it well because it hurt her. But I made her bite down hard—and it hurt her—and then we got the real information.

Then we marked the teeth—the upper right second molar, let’s say—and there were two little paper marks. Two small paper marks aligned with the force data. One was in the mesial fossa and one was in the distal fossa. And you could see this on the T-Scan. On the upper right 7, there were two high-force areas aligned linearly across the tooth mesiodistally.

So I showed the doctors the paper marks, and everybody looked at them like, “Wow.” They wouldn’t have treated them. No one would have treated them. And this is exactly what happened to her for three years—no one treated those little paper marks.

So I had the dentist—the host dentist—adjust those two spots with a medium-grit diamond. And I said to the patient—well, the host, in Portuguese, said—“Now bite down.” And the patient bit down. And she looks up at us, and she hugs the female dentist—the host, Dr. Elias—and she’s crying now because she can tap her teeth together.

And she’s going like this [tapping], and she’s crying. And she wasn’t able to do that for three years because no one had the data. They were using ink and paper, right?

That experience—I have had experiences like that all over the world. Different examples of that. That woman left as happy as she could be. We didn’t have to do anything else. We could have played with her bite, we could have tried to optimize it—but I left that to Dr. Elias to do in the follow-up.

But the group—the attendees—they were blown away. They were like, “How powerful this tool is.” One recording. One adjustment to two places detected by the technology. Remember, the sensors are really amazing, high-precision pressure-mapping devices.

Dentistry doesn’t understand that. Dentistry thinks the paper is good enough for the public. And it’s a terrible standard, actually. Dentists guess at the ink and choose what they think is forceful. They can’t see any timing. And the public is the loser, right?

Here’s a perfect example of that. If I had the T-Scan—if I was her prosthodontist—28 units I was putting in—and I made that recording at the day of delivery, I would’ve seen that that day. I would’ve mitigated it right then and there. And the patient would’ve gone home with comfort. Instead, she was in agony for three years.

So that’s the beauty of the T-Scan. Nothing can replace the T-Scan for finishing the micro-occlusion. See, the micro-occlusion is the part the patient wears. The macro-occlusion—like we have all these technologies for the digital workflow—they make the macro-occlusion in a modern machine-fabrication kind of way. But the macro-occlusion doesn’t guarantee the micro-occlusion.

If you want a good micro-occlusion, you need the T-Scan. And this was one of the best examples ever. It was amazing to see the patient crying, hugging Dr. Elias, tapping her teeth together for the first time without pain, saying, “I’m not in pain. I’m not in pain.” Instantaneous correction.

So I hope that gives you a sense of how powerful the T-Scan is and how much it can help patients in any dental practice and improve efficiency.

I’ll just add one element to that story. Let’s say I made those 28 units and the patient said, “Yeah, it feels okay.” And then they came back a week later and said, “I can’t bite down—it hurts me to bite down.” So I’d go back with the T-Scan, and I’d find those spots, and then I’d mitigate them. And I wouldn’t have a three-year follow-up lost patient—traveling all over Brazil looking for someone to help them—while every time they saw the little paper marks, no one treated the area, right?

So it’s really amazing how powerful the T-Scan is. And it’s a great advantage for patient well-being—and certainly for doctor and office efficiency. No question.

Lester De Alwis: Exactly. I think that real-life example you just mentioned at the end of this episode is the game changer to this episode—of how T-Scan and DTR therapy have been a revolution that has been helping not just the doctors, but the patients, which is most important. Which is all of our dentists—their prime motive is to basically enhance patient experience. So that’s basically the idea behind this.

So Dr. Kerstein, thank you so much for joining us today and sharing your activities on digital occlusion, T-Scan technology, and DTR therapy.

Dr. Robert Kerstein: It’s my pleasure to be here, and thank you for the opportunity to educate whoever’s listening. I’m grateful for the chance to alert patients that there’s a much better way to be treated occlusally—and certainly dentists, there’s a much better way for them to work day-to-day in their occlusal practices.

Lester De Alwis: Exactly. So the key takeaway from today’s episode is that embracing advanced data-driven technology doesn’t just improve patient care—it also helps practices differentiate themselves, attract patients who are willing to invest in quality, and reduce their dependence on insurance.

And as always, this podcast is all about taking action.

First off, if you want to attract more high-quality patients and reduce reliance on PPOs, schedule a complimentary marketing strategy meeting with Ekwa Marketing at lessinsurancedependence.com/marketing-strategy-meeting  

Secondly, if you’d like mentorship or personalized coaching to build a thriving insurance-independent practice, schedule a complimentary coaching strategy meeting with Gary Takacs at thrivingdentist.com/csm. 

Both of these complimentary resources are there to help you take meaningful steps toward the practice and the life you truly deserve.

If you found value in today’s episode, please share it with a colleague or a friend who could benefit. Together, we can help more dentists take control of their future.

Thanks for joining us, and I look forward to connecting with you again on the next episode of the Less Insurance Dependence Podcast. Until then, keep moving towards a thriving, independent practice.