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Dr. Jeff Horowitz: Clinical Mistake
40 Plays1 month ago
We're excited to welcome Dr. Jeff Horowitz to the Dental Fuel Podcast! Join us as he sits down with Tanya Sue Maestas to dive into a real orthodontic case that taught him a tough but valuable lesson: Don’t let your confidence cloud your judgment!
Dr. Horowitz explains how overlooking TMJ and airway issues can lead to significant functional problems, highlighting the need to prioritize long-term stability over cosmetic solutions. In this episode, he shares a case where he missed a critical foundational issue by not fully utilizing the information he had gathered. His key message? Always evaluate all the data before creating a treatment plan. Key Takeaways:
- Importance of Functional Diagnosis: Jeff emphasizes that overlooking functional problems, especially in orthodontic and cosmetic dentistry, can lead to significant treatment failures.
- Professional Humility: He shares his personal journey from confidence to humility, highlighting that a cocky attitude in dentistry can result in missed diagnoses and patient harm.
- Advanced Training Value: Education at institutions like the Kois Center and Piper Education and Research Center is crucial for mastering complex dental issues such as TMJ and dynamic occlusion.
- Real-World Case Study: Jeff recounts a poignant case that demonstrates the consequences of missing a TMJ diagnosis and the lessons learned from it.
- Triple Focus Practices: He talks about his unique practice setup focusing solely on sleep, TMJ, and orthodontics, showcasing the importance of specialized care.
About the Guest:
Jeff Horowitz is a distinguished dentist based in the Myrtle Beach area of South Carolina, with practices in Myrtle Beach and Murrells Inlet. Originally from New Jersey, Jeff moved to South Carolina for dental school and planted his roots there, developing a reputation for his expertise in functional dentistry, specifically focusing on TMJ, airway, and orthodontics. He is a graduate of the University of Pittsburgh and Charleston’s Dental School and has advanced training from various prestigious institutions, including the Kois Center and the Piper Education and Research Center.
Connect with Dentists in the Know: @dentistsintheknow
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Connect with Tanya Sue Maestas: @tsmaestas.dds
Learn more about 90 Day JumpStart : https://ignitedds.com
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Transcript
00:00:00
Speaker
Dental Fuel, the podcast that focuses on what no one else is talking about. Mistakes. The dental world is full of before and afters and no one is talking about the middle. Dental Fuel brings you the unspoken in-between. Welcome back to another episode of Dental Fuel. Dental Fuel is brought to you by 90 Day Jumpstart, a program to help you increase production and break free from financial stress.
00:00:25
Speaker
You met Chad, you met JB, and today you're gonna meet Jeff Horowitz. To close out the Dennis in the know, Jeff Horowitz is based in the Myrtle Beach area of South Carolina, and we talk about his passion for orthodontics and airway management. Jeff transitioned from general to specialized dentistry, and he reveals his experiences and the critical mistakes that he has learned from. In our first conversation, we talk about a clinical mistake that he's made and what he learned from it.
00:00:54
Speaker
Let's check it out. Jeff Horowitz, welcome to Dental Fuel. How are you doing today? I am so great, and I am so excited to see your face today. Oh, I'm i'm just as excited, and I'm really excited because I had the opportunity to speak with JB and Chad on Dental Fuel, and we are rounding out the Dean's Trio with you on our podcast today.
00:01:16
Speaker
Well, you always save the best for last, isn't that right? That's right. That's right. They may be a little bit jealous after listening to our conversation today. I know. I hope I don't disappoint. Oh, you won't. You won't. I think we're going to have a lot of fun with our with our convo today. Jeff, please tell me and our listeners where are you coming to us from today?
00:01:33
Speaker
So I'm in the Myrtle Beach area of South Carolina, live in Conway, which is about 14 miles to the northwest of Myrtle Beach. And I have two practices, one in Myrtle Beach proper and one in Merle's Inlet, South Carolina. Very cool. And are you born and raised from South Carolina?
00:01:53
Speaker
Do I, they don't grow Horowitz in South Carolina. Horowitz are imported. Yeah. No, we're imported now. I'm originally from New Jersey and, um, ended up in dental school down here in Charleston and tried to go back for a year and that one gonna happen. So yep. Um, I'm almost a local here. And when I go home, they say I sound like a redneck and down here, they say I sound like a Yankee. So I have no home.
00:02:22
Speaker
yeah you're You're a boy from the South now. Yeah, i really really, I probably am more Southern than I am New Jersey anymore. Except when I drive. Yeah, I hear you.
00:02:33
Speaker
Well, Jeff here at Dental Fuel, we are dedicated to learning from each other's mistakes and and growing after we learn from those mistakes. And so that way, hopefully we won't make those mistakes along the way. And I'm really excited to just tell your story. But before we dive into the different mistakes that we have to feature on our conversation. Oh, I could talk all day on mistakes. Oh, I'm right there with you. I make a lot of mistakes every day. I would love if you would tell us a little bit more about yourself. Who is Jeff?
00:03:01
Speaker
Oh gosh, how much time do you have? I've had all day. No, um you know it's it's interesting. Just a ah a guy from New Jersey that probably outkicked his coverage in a lot of facets of life, um knew I wanted to be a dentist and went to the University of Pittsburgh, hoping I would get into the dental school there as well.
00:03:21
Speaker
Got accepted early admission to Fairleigh Dickinson back in New Jersey Ended up transferring to Charleston, South Carolina and pretty much never looked back fell in love with South Carolina um Did have a job offer went back to New Jersey for a year did a residency thought I was gonna take that job and One year in New Jersey. I'm like, nope not doing this. I am I am planning my roots in South Carolina and So open a practice in a small town called Conway, just west of the Myrtle Beach area, kind of part of that Myrtle Beach proper area. And, um you know, it it started out basically as a practice with a lot of children started from scratch, one pediatric dentist, one orthodontist in the entire county.
00:04:06
Speaker
and I figured if I'm gonna build a practice I might as well learn how to take care of kids and and learn how to do ortho well didn't realize that that was gonna reshape my entire career um because during that time learning orthodontics got into functional appliances learned a lot about airway and the joint and we started growing children at an early age and I I never looked at my dentistry the same way ever again.
00:04:36
Speaker
everything in dentistry was about this larger cause of having people grow into healthy adults and so my practice ended up maturing we grew a lot of kids we helped a lot of airways even before it was kind of a vogue thing to do.
00:04:54
Speaker
ah And then like a lot of practices in the late 90s and early 2000s, this cosmetic revolution came about. And so got really into the cosmetics because all those kids were now adults and starting families and they're all wanting this cosmetic dentistry and um you know kind of earned my chops a little bit at the Koi Center and and a lot of other aesthetic continuums as well.
00:05:22
Speaker
um But in all of that, I always had this passion to kind of go back and and focus on the functional side of dentistry. I love cosmetics, don't get me wrong, and I love you know giving people new confidence, but I always would go back to, is this going to function and is this going to last?
00:05:44
Speaker
and And so that's always kind of ruled my world. And and so after finishing, um I'm becoming a mentor out at Cois and yeah I said I really need to revisit the whole TMJ thing again and and really ah really you know get my skills down pat where I'm very, very comfortable with the joint.
00:06:07
Speaker
So I went and did the Piper continuum and and got really close with with Dr. Piper and Jim McKee and that whole study group. And and and really, you know, that that's really where I earned my chops in in TMJ, even though I've learned from so many other great mentors. but You know everything for me and and what i became passionate about was that you know as i was bringing associates on. These people were really good at the dentistry and so my patients didn't really need me to perform the the general dentistry anymore cuz i had people who are just as good if not better than i was at performing those.
00:06:48
Speaker
ah You know the those procedures that were needed but where i was needed was you know what's going wrong with this case or how should we be diagnosing this case to realize. You know where are we getting in trouble when we get into these large cases like did they have an airway problem did they have a foundationally based problem.
00:07:11
Speaker
and And that became my passion i i started two satellites which are just sleep tmj and orthodontics and that's where my my primary focus is though i still own one of my practices but um you know ah really you know where my passion is is on the functional side of dentistry.
00:07:32
Speaker
I love that Jeff and I love listening to you speak and in your passion behind you know these areas and these topics. But speaking on you know function and and knowing if things are going to last, I'm curious if that has anything to do with any clinical mistakes that you have made in your past.
00:07:48
Speaker
ah Yeah, I mean, if we we we could probably do a one-day um conversation just on on mistakes made. So I know when we had talked earlier, you know you asked me to come up with one big mistake that really stands out in my mind, and it's one um that I always share in in my lectures, and it was missing a functional problem.
00:08:13
Speaker
um prior to getting into treatment. Now in this case it happened to be an orthodontic patient but it just as easily could have been somebody coming to me for another cosmetic procedure and missing this functional problem really should have gotten me sued.
00:08:31
Speaker
and And so this is what I preach when I lecture, which is you know don't ignore function because that's what's going to take your cases down. It's not your dentistry, especially if you're well-educated and you know you care and you're using good materials and good labs and and performing you know in a way you know above the level that many other dentists do, but yet cases will fail if we miss function.
00:08:58
Speaker
So this young lady comes to me with her mom. She's about 10 years old. I was doing a lot of ortho at the time. And she plastered to open bite. And it was probably one of the worst times in my career looking back at it it. At the time, I thought it was one of the best times in my career because I had become a little bit cocky.
00:09:25
Speaker
And Kaki and dentistry just don't go together in any way, right? The second you think you're good, something will bring you down, like something will take you down a notch. And so this young lady was that case, and I purposely show her in every lecture I do to say, look, this happened to me with all the functional knowledge that I have. So here are some of the things you need to look for. Well,
00:09:51
Speaker
So going back, class two, open bite, obvious signs of a mouth breather. And um because I was in this little cocky phase and how good of ah how good I was with orthodontic mechanics and how good I felt like I was, I said, oh, no problem. Class two.
00:10:12
Speaker
Open by I got this I know I know all the tips and tricks and I got this I can do it and you know went through all my orthodontic protocols took our four pictures ah excuse me, eight pictures, took our, um you know, our Ceph, our panoramic at the time. This was before I was even doing cone beam. So took all of that data, got that all in, and started the case. Well, what didn't I do? I didn't review all those records that I had taken.
00:10:44
Speaker
It was an exercise in doing what I was supposed to do, but not really using the data to make good sound clinical decisions. And several things that I missed that had I seen it right away, I would have known this was a TMJ case that was ah really going to blow up in my face She actually had a facial asymmetry. um Her posterior occlusion was only on one side. um And so she had an ah really an open bite, three quarters of the way around. The only place she was occluding was like on the posterior right. and And that's just a dead red flag. Chin asymmetry, occlusion and in you know one quadrant of the mouth.
00:11:31
Speaker
Guess what? I mean, this is a foundational problem. And if you don't address that while the child is growing, this bite will never be stable no matter what you do. Well, four or five years of orthodontics later and still fighting the open bite and things are getting worse as I'm going along. And all I could think is, I'm going to get sued over this. I'm going to get sued over this.
00:11:55
Speaker
And, you know, it's a little easier to catch those things now with cone beam. I would have caught the asymmetry right away, even when it first flashed on the screen. I would have seen the difference in Ramis Heights, but she had fallen off a horse the year before she came to me.
00:12:12
Speaker
and um had an injury to the growth plate. And and the condyle on the right side was almost 10 millimeters shorter, or the ramus height was almost 10 millimeters shorter on the right than it was on the left. and And so she was never going to grow properly. The occlusion was never going to settle. ah In fact, her joint situation got worse and worse. And she was truly a joint surgery case, which is what we had to do at the end.
00:12:38
Speaker
But yeah, it still haunts me to this day. um and What was the result? She she was fine after the yeah yeah so i mean surgery? in a Yeah, so five years of orthodontics. My finish would get me laughed out of you know most orthodontic meetings. Although for what it was, you know now looking back at it, I'm like, dang, I can't believe I even got that you know as bad as the joint was. But it was never going to be stable.
00:13:06
Speaker
So the fact that I had gotten her arches leveled aligned and and gotten her to a pretty close to ideal occlusal relationship um allowed it for to become a surgical case without a lot of other pre-orthodontic treatment needed before that. Wow. Thank you for sharing that case. That's ah that's a wild case. yeah Yeah. I'm sure you learned a ton from that. too ah Always and that's why I put it in every lecture even if I'm not specifically talking about the joint It's just a reminder of how important the other things that we're not always looking at our airway the joint, you know everything about function Dynamic occlusion not just how the teeth fit together, you know when when they're in maximum intercost patient Thanks for tuning into this first episode with Jeff Horowitz. Be sure to check out Jeff and our friends at Dennis in the Know every Wednesday evening where they have a new guest and interview them live on YouTube. With Jeff doesn't stop here, be sure to tune in next week where we talk about a financial mistake that Jeff has made.
00:14:15
Speaker
If you're looking to grow your practice and need some help along the way, be sure to check out 90 Day Jumpstart. You can start for free by contacting Dr. David Rice. Check out the link to his Calendly in the show notes.