What follows is the first of two interviews with Ricardo Mitrani from Mexico, who runs a successful private dental practice and is a thought leader in the topic of terminal dentition, what to do, how to do, what to expect, how to deal with these patients. Christian talks to Ricardo about his background and how to be a successful mentor.

This interview was originally taken from Coffee Break With Coachman, a series of interviews with the best dental brains and the best personalities, in short, the most influential people in our dental industry today. From business to marketing to clinical to research, academics, laboratory technology and digital, each of the interviews is a conversation with a thought leader in their field, sharing their knowledge and experiences. 

CHRISTIAN: Before we go into this topic, I want you to explain to us, who is Ricardo Mitrani? Where do you come from, what is your background as a professional? Tell us your great story as a teacher, where did you study, and how did you become one of the best dentists I know today?

RICARDO: Well, that's very generous of you to say, being that you know so many. I'm a very simple guy, and the more I grow, the simpler I get! I finished dental school nearly 30 years ago, and my older brother's a dentist, so everything was pretty much set for me. It was very simple for me to go through dental school, and then finish and start practice, or join a practice. Then one day I realized that, after five years of being in practice, I realized that I had too many questions unanswered, and I had to go look for some answers.

So after being in practice for five years, I decided to put my life on standby mode, and I was phenomenally fortunate enough to be accepted at the University of Washington cross program. It was the craziest and most incredible time in my life. I was just surrounded by incredible educators and thinkers in dentistry. You know how cool it is when you are the dumbest guy in the room? You learn from everybody! I was taught not only about interdisciplinary management, but I was also taught to teach.

Some of the greatest minds in dentistry have been our mentors. You know, Ralph Yuodelis, Keith Phillips, Frank Spear, Vince Kokich, John Kois, to name a few. Being inspired by those guys back then, not only were you learning dentistry, but you were also learning how to communicate dentistry.

CHRISTIAN: Since you mentioned Seattle, I already asked this question, I believe, to Tom Moore that went to Seattle with you and other guys. Try to explain to me, what happened in Seattle when it comes to dentistry that this powerhouse, we have the generation above you? You mentioned a couple. In the same city having people like John Kois, Frank Spear, Vince Kokich, Michael Cohen and others, and ideas and principles and articles and publications. Then you have this program at Washington University, where the people that came out of it just conquered the world. I have, as friends, you, Tom Moore, so many others. It's a huge list. Why do you think that happened during those two decades, I would say, with two generations, with such an amazing amount of amazing dentists?

RICARDO: The answer is very simple. Back in the '70s to '80s, the heyday of interdisciplinary dentistry was pretty much between Boston University, with Nevins and Kramer and that group, you had Pennsylvania, with Gordon Amsterdam, Walter Cohen, and that group, and then Ralph Yuodelis and Saul Schluger at the University of Washington, who had very close ties with them. This is back in the day where the perio cross movement was at a point in time in which all the world was looking at these guys. Of course, there are many other universities, but I would say that in the forefront, back then you had BU and the University of Washington.

All it takes for these things to happen is to have a mentor, somebody that believes in a concept and surrounds himself with good students and good teams.

For us, it was Ralph Yuodelis. He started lecturing around the world, and essentially what he was doing was showing the work of his grad students. And you mentioned a few in the list, but the list goes on and on. You could add Steve Chu, who's a powerhouse in New York. Today you can add Greg Kinzer, who's Frank Spear's partner in the practice, and now is directing part of the Spear Education platform, where of course I'm part of as well. Again, you have tremendous clinicians, but not only tremendous clinicians, but also people who were taught to teach. Back in the day, we had a class that was pretty much geared to teach us how to put together a lecture and how to share information. As you know in today's world, you can have incredible clinicians that don't know how to communicate, and then you can have incredible communicators that don't know much about how to practice.

Two different things. This is, I guess, why University of Washington was such a powerhouse back then, and still today. We have a lot of pride in it because not only was it a true mecca of interdisciplinary treatment planning. Again, sitting in a treatment planning session with Vince Kokich there giving you shit about what he thought you were doing wrong, and then having all these gurus, as I'm saying, from the perio world, from the cross world, I mean, it was next to impossible not to grasp the energy that was coming from that treatment planning room. We had therapy seminars, we had treatment planning seminars, we had short and long-term recall seminars. From a learning experience, it couldn't be any better than that.

CHRISTIAN: Definitely  a special moment and a special place in the history of our profession. When you went to Seattle, were you already into restorative prosthetics, implants? When did you realize, in dentistry, what you love most?

RICARDO: My calling was prosthetics. That's what I used to love. In fact, I was teaching as an assistant professor at the University of Mexico the undergraduate curriculum, and I loved doing that. Of course, people saw me as somebody that knew what he was doing, but I always felt that I had no idea what I was doing. And so of course that was my calling, and like I said, when I went there and I was exposed to all these wonderful, incredible minds, it just shaped my mind in a way that it was totally permanent.

What the program did was teach us to think. You can be taught techniques, you can be taught a lot of information. But when you're taught to have critical thinking, then essentially they teach you how to fish. How to think about fishing in different waters, you know what I'm saying? It was awesome.

CHRISTIAN: Many of these guys are also mentors for me. I always call all of them thought organizers, you know? You're completely right. Being a great clinician doesn't mean you know how to teach what you do. Actually, when you do something very well and you say, "I'm going to start teaching this because I do this so well," when you try to put a simple presentation together, that's when you realize how much you don't know. How much you don't know about the procedure, but how much you don't know how to explain why you do it well. Usually when you do something well, you enter automatic mode, and it's hard to stop and try to understand the process that you went through to become good. You need to research your own personal path on how you got there and try to organize in bullet points and in a straight storyline that you can actually teach others.

I went through that when I was in a lab and I wanted to grow the lab. I was pretty good doing what I was doing, and I wanted to teach other people to do what I was doing. That's when I realized that teaching others was completely different than doing that very well. That's why I always mention, I've been working more nowadays with Kois, but always inspired by Spear. Even in a simple topic, you could have these guys on stage talking about something simple in 15 minutes, and you would come out with so much information, because they were thought organizers, and they would come with bullet points and take-home messages. They really give you a gift, you would change your Monday morning.

RICARDO: You bet. Especially in today's world, I was just lecturing on this last week, we are bombarded through social media since we wake up with volumes of information that it's almost impossible to reconcile, at the speed of light. In fact, how do we go through our feed, how do we go through Instagram? Well, you just go like this. You're scrolling and scrolling and scrolling. So again, velocity, and then complexity, because there is a lot of complexity in that information. And so you put together volume, speed, and complexity, as being bombarded, it's so tough to put together solid information that can be helpful on Monday morning for those that are listening to us. And so as educators, we are really challenged to be able to do this in a non-threatening way, and through the right channels. And then part of the problem is, in dentistry many people want cookbook recipes. Cookbook recipes are great because they give us guidelines to follow a technique. But the problem is that every clinical situation is different, and if it's different, then your cookbook recipe doesn't apply to all clinical situations. And so you have to think if and when and how you modify the recipe. The recipe will give you guidelines. You will have things to think about, that you can interchange and you can go more in depth. But at the end of the day, when you're in the chair, there's a lot of clinical calls you have to make clinical decisions.

To make it even more complex, when you're working on a patient, and we're going to be talking about communicating with patients and conflicts of interest in selling or not selling dentistry later on, but what we do is pretty complex.

What's funny is when you have people in the circuit, or on Instagram or on Facebook or any social media, claiming that dentistry is something straightforward. It is not.

CHRISTIAN: It's not. It's anything but straightforward. That's one of the reasons why I still believe that it's one of the last professions that the corporate world took over. It didn't even take over completely yet because it's not a production line, you cannot scale in an easy way. You can scale an aligner company to produce aligners, but you cannot scale treatment planning, you cannot scale decision-making process. I believe dentistry is one of the most complex things we have, and that's why it's hard for a businessman to buy a dental office and keep the level of care, keep the level of high-end dentistry, because it's a situation where it's multifactorial, and it depends on the deep brainstorm about several principles that we will mention a couple. That's why it's so fascinating, that's why it's so beautiful. That's why I love teachers like you that teach about treatment planning, about decision-making process, about risk assessment, about the algorithms of the options, and how do you make the decisions that we need to do every day to deliver the best treatment to the patient. Because of those skills, you were invited to be one of the main guys at the Spear Education and Spear Center.

Can you talk a little bit about this. Great honor, first, and I already congratulated you several times, but it's a great honor to be part of such an institution.

RICARDO: I say this quite a bit. I still pinch myself to see if this is really happening. I honestly believe that Spear Education is at the forefront of interdisciplinary teaching in the world. It is a platform where we have over 200 people working there. We have an online component, which is huge, and we have a campus component, which is also phenomenal. We have seminars, we have workshops. And so yeah, for me to be considered, then invited by Greg Kinzer, who was my classmate at Washington, and of course Frank Spear, who was my mentor, to be a part of that, that's just unbelievable. And to being able to hang out with them, and again, to be challenging each other and picking on everybody's brain, to be able to figure out what is the best way to educate.

You know, it's funny, there are many people in education out there, and you mentioned a few. The other day, having dinner with Frank and Gary DeWood and Greg, Frank said something that really struck a chord. He said, "You know, if you're in dental education, the only enemy is ignorance."

You can have many people that are competing to have the spot or get the spotlight, but at the end of the day the only true enemy is ignorance. Somebody like you, Christian, understands this probably better than most people out there, because you're such a giver, you know? People that know you well know exactly what I'm talking about.

This is where education is really about. It's about giving, and giving with your best intention of helping those in the receiving end, but also understanding that those of us that teach, we have fringe benefits, because every time you teach you get something back. Our students happen to be the best teachers sometimes, in so many ways and shapes and forms.

One of the seminars that I teach at Spear is called Treating the Terminal Dentition. I teach a two-day seminar with Darin Dichter, who is a phenomenal prosthodontist, also at the resident faculty at Spear. We put together that program because it was missing from that curriculum.

CHRISTIAN: What are your roles? Before you go into that specific topic, what are your roles in the Spear Education, and which courses and programs you are teaching there right now?

RICARDO: Spear education, as I said, is a platform that has different aspects of it, or different platforms within the platform. We have on-campus teaching, people that go and sit in a seminar, or sit in a workshop. I take part right now in two seminars. I'm part of The Art of Treatment Planning and Case Presentation seminar. I do that with Frank Spear and Greg Kinzer. I run the Terminal Dentition course with Darin Dichter. Then I'm also responsible for putting content together for our digital platform, which we have a subscription-based platform in which there are tons and tons of amazing content of all different topics.

Then we have a network of close to 850 study clubs. And so what I do is I put together content for those study clubs. We put modules together. The way it happens is that the study club will receive that module, and it's a tutorial that walks the study club through a case or through a concept, and it's pretty interactive.

Essentially, my role is half presence on the campus, but more importantly now in the digital part. It's totally true, and you raise this better than anybody else. You understand that being in the digital world, you're able to touch and to reach so many others.

We do modules for study clubs, and lo and behold, now 800 study clubs can see a module that I put together. If in every study club there are 20 people, you can already see how ... ramifications, the exponential nature of this. It's just phenomenal. It's about understanding and enjoying this, the digital platform, the digital possibilities of reaching out.

CHRISTIAN: It's really amazing to be able to connect this way. Inside this process, how many times you have to go at Spear, or how many days a month you are there?

RICARDO: I'm probably once a month there. Either for seminars or to film content. We have a spectacular, state-of-the-art facility to film, with green screen and white screen and a whole production crew, so I go there also to film. Once a month, I would say. I've cut down significantly. You know how it happens, you reach 50 and you start to learn to say no sometimes so that you can have a better quality of life. Years and years ago, I used to love escaping from practice, and to tell you the truth, now I really enjoy being in practice. I enjoy mentoring my group here. We have more than one practice now. Now we have four practices.

CHRISTIAN: What is the balance for you? Besides Spear, how many conferences per year?

RICARDO: There are some meetings you cannot say no to, again, because of the type of people that go there, your friends. I'd say it varies from year to year. I don't have a magical number. Probably you're asking a question that you'd like to answer yourself, right?

CHRISTIAN: I'm always asking that, because it's hard to find a balance. But you would say like once or twice a month you're leaving for a conference?

RICARDO: Probably. I would say that would be the sweet spot.

CHRISTIAN: I'd say that's a good balance, because we go through phases where it's like almost every weekend. That's crazy.

RICARDO: You end up compromising too much. It's a flexible system until you flex it too much, you know?

CHRISTIAN: It's a decision you need to make whether you're going to have as your main profession education or your clinic. You can have your clinic as your main business, and maybe once in a while go to conferences to break the routine, to meet friends, to refresh, to reconnect and update your connections. But if your business is coming from your clinic, you once told me a story, as soon as your lecturing career exploded and it's hard to say no, you were traveling all over, super excited with the feedback. Our pleasure is being on stage, looking at people admiring you, it's very addictive, right? Then you told me once that you were destroying your own clinic. You realized that your team was not having fun, you were not caring about all the details, and that suddenly a few years ago you made this drastic shift where you placed your team at the center of everything you do.

RICARDO: There's a saying in Spanish here which means, "The lightness of the street but the darkness inside the house." Here I was lecturing all over the world, and I would come back to have the most unmotivated team you could imagine. It was not even a team. That's when it hit me, you know? I thought that people that worked with me would get the knowledge through osmosis. We would connect with each other like the Avatar. It doesn't happen that way. You need to give them love, you need to give them time, you need to spend the right hours with them and empower them.

This is why, the only reason why today I can be sitting with you, and although we have five chairs with five patients, I know that my team is doing dentistry at the level I would be doing it, if not even better. But that's because I will spend the time, the right amount of time to actually. And only imagine what a dream it is for them as well to realize that we're putting together content to teach the world. What we're doing here, again, through the challenge of Spear Education, we're going to a ton of study clubs, we're going to a ton of people through Spear online. One of the things that Ralph Yuodelis taught me back when you were talking about the U-Dub magic. Ralph Yuodelis used to go around the world lecturing on what his grad students did. He would always acknowledge the work of his grad students. Again, this is something you know very well, but as you and I know, this is something that others in the circuit don't know that well, and they claim authorship in what they show. What Ralph did was teach me and teach us, how he would put our names in the circuit.

And so essentially I do the same. I will not lecture anywhere without acknowledging my team. For me, this is a true win-win situation. Again, you know this better than anybody else. You've got out of the way helping people.

CHRISTIAN: So we all go through certain moments where we have a mentor, who we admire, and we give so much to them. A mentor is a mentor, but he's a human being. He has issues as well, ego as well. Then at one point, that mentor disappoints you, because you feel like he didn't give you the credit you deserve, something like that, and then you get away from that mentor, and you look for another mentor, and it happens again. Then you realize that everybody is not black and white. Everybody, we are all humans, we make mistakes, right?  Then you become the mentor of others, and you need to exercise this every day, otherwise you do make the same mistakes. What I see is that it's very easy to be fair and to help people when that doesn't threaten your ego or your position. We say, "Oh, I'm a great mentor because I help all my students." And that's great, but you really see if you control your ego and if you're really a mentor, when you're mentoring somebody that you know is probably going to become better than you, more well-known than you, and is probably going to get more invitations than you. You still are a teacher, you still are a master, and you still share and you still promote this person that is taking over your position. That's when I see the huge majority of the mentors messing up, you know? They're not ready for that person.

RICARDO: My opinion is that they should not be called mentors, then. They should be called teachers. A mentor is a pact that has essentially one principle behind it, which is continuity. You know what I'm saying?

As dentists, we have a shelf life. We have a life that we can grow, and then it depends on how much you take care of your body, of your back, of you physically, of your diet, how long you're going to be in the dental chair. But at the end of the day, what you know, the knowledge that you've been able to put together, is going to go away, to waste, if you don't share it. Now, you can share it with a lot of people, and in a classroom, you're going to have a lot of students, but you're going to have a few that are mentees. You will become the mentor of only a few. That's where there's a pact, a pact which means that it's a circle that has to do with the student not only honoring the mentor but bringing things to the next level.

CHRISTIAN: But usually the mentor, the teachers, they like great students, right? They like people that are excited, intelligent. But it gets to that point, that moment in time, that among a few students, you have that one that is so good that, from a great student, they become a partner and it starts to threaten the status quo of teacher-student. That's when you need to learn with that experience.

We are not immune. And this is a daily exercise, because of course we have our egos, and we get used to, as we teach, of people saying, "Wow, that's great, I love your work." Suddenly, the same people can start looking at somebody else, and you need to feel good with that.

RICARDO: If you want to be in the game, mentor somebody and be in the game, there is a fundamental rule. You got to make sure you're playing your A game continuously, because the day that you relax and you're not playing the A game, somebody will play the A game for you. The mentor has to be a source of inspiration that doesn't stop. When you stop being that source, then of course that mentee is going to look for somebody else, or is going to feel it has the energy, the information, the content, the contacts, to fly on his own. As you very well know,

I mean, you've created a movement, and every time you talk about the movement, you don't make it about you, you make it about the movement.

Essentially, that's exactly what I'm trying to say here. It works the same way with me. I shouldn't be surprised, if I'm not playing my A game and I'm not deliberately inspiring my team, for one of them to say, "Bye bye, I had enough of you. I'm going to open shop anecdote, and I'm going to be better than you." Sure enough, they have the right to do that. We cannot hold them. We have to let them free. Again, it's a mindset issue. It changes during different phases of your life. You cannot be the best forever. You need to reinvent yourself as a mentor, you know?

CHRISTIAN: And keep inspiring people, it doesn't mean that you're not going to have people becoming better than you in several different things.

RICARDO: Well, let me give you an example. As I said, Frank Spear is my ultimate mentor, because in fact, I'm now working in a company called Spear Education. We had our summit last week. 1,200 people in that summit. He started, in the opening lecture, saying, "Okay, guys ..." This is, by the way, 1,200 people that are part of our faculty club. These are 1,200 people that are registered to be part of the faculty clubs. It's almost like on invitation. He starts the lectures saying, "Guys, we realize we don't know everything. We realize that as time goes by we know less and less. This is where we want you all to know that we're looking for these answers." He never said, "I, Frank Spear, is looking for these answers."

When you start using the we, that's when you become a powerhouse, when you have a true team where everybody praises each other, and you don't have to shove your contributions. You're there for a reason. Then it's a snowball. It just keeps on growing and growing.

CHRISTIAN: You just mentioned one of the key things for me, a key suggestion for people listening to us. Identify if you're in front of a real mentor or just a super-smart person. When we see a mentor speaking, it doesn't matter if that concept, idea, was 100% created by him, he's going to always say we. People will ask, "But why you're talking we? That's you." He says, "No, it's we. Even if I don't know the we completely, there is we always, because you never build something alone."

There's always inspiration that you don't remember. There's always insights that you don't recall. There's always conversations that helped you to create or develop something that are there on the back of your mind. Then when you come up with something, it doesn't matter if it's simple or complex, you're so proud of what you did that the I takes over. I see a few very important guys that really have the egos under control. It's always we. It's we.

RICARDO: If you look at the movers and shakers of today's world, if you look how they inspire, they all use the we. Today, the world is so complex. If there's one guy that would shine out, it's that one guy that has to surround himself with people that are better than him. Again, going back to Ralph Yuodelis, that was his signature statement. He was receiving a life achievement award from Seattle Study Club network in the year, I want to say, 2000. He was one of the first recipients of the life achievement from Seattle Study Club. It was a packed room in Seattle's 5th Avenue Theater, a standing ovation. He goes up and he says, "Let me share with you the secret of my success." He said, "My mentor, Saul Schluger, taught me, "Ralph, always surround yourself with people that are better than you, and that's what I did." Dropped the mic, done.

If you look at the industry today, you look at the powerhouses in industries, you have one guy that's running the show, but he has to be outsmarted by all his people around, his circle of influence. Every CEO that has a CMO, a COO, a CFO, they all have to be smarter. I mean, I'm sure it's happening to you in your DSD company. You have to have smarter people around you. At the end of the day, a treatment planning session with my group, and I say, "Okay, who has to be the dumbest guy in this room?" One of the boys says, "That would have to be you." I said, "Bravo. Exactly. I have to be the dumbest guy in this room." When you create that energy, it's just crazy. Now, the problem is, the dental gene, the gene in dentistry, is so personal. It's a lone journey.  And so you have to use the me so that people will see your hand.

CHRISTIAN: But don't you agree this is changing? Dentistry is becoming more fun and more enjoyable, because dentistry is changing, finally. We have our mentors, so Kois, Spear, these guys, Kokich, and then the guys before them, talking about interdisciplinary dentistry, Rick Roblee and all these guys. It was always something to go for, but now I think this concept of interdisciplinary dentistry is maturing. It's becoming the thing, and people are kind of born into that.

It's so much more fun to do dentistry today than it was, for example, my grandfather inside four walls doing the same thing for 40 years, almost zero interaction, you know? I can't imagine the difference between working in an office like yours, or like here with my dad. You have 10 top guys discussing, and having fun discussing from the simple to the complex.

I think it's such an amazing moment of dentistry right now, where this is becoming real, not for a special case for a lecture, but becoming real in your office for every single case that you do today.

RICARDO: It may, but it's always a choice. I know you had Kyle Stanley a couple of weeks ago, and he was talking about the emotional component, and how tough it is for dentists, particularly in the US, but I could say in the world, as far as that the pressure, the debt, the finances and everything. And so yeah, there's this fun component, but you have the fun component only if you have settled the rest. It is so multifactorial, and the day is so short that you have to make sure that you are able to build your day in such a way in which there's a learning process. There's also an execution process, and you're able to deliver the goods that the patients want you to deliver.

Just to close this idea of growth and interdisciplinary management, of how Frank was talking the other day about how we have to fill in the pieces of the puzzle that we don't have yet, one great component that is here to stay is the airway piece. We have now also Jeff Rouse at Spear, who is, I think, a beacon of light in the world of airway. He's actually reteaching how we should think orthodontist, how we should think pediatric dentistry, how we should think restorative dentistry.

And so again, going back to an idea of how I do dentistry today, there's so much to grab. It's so easy to neglect one piece, you know what I'm saying? And we should see, you and I, that we inspire people to see it this way, we have to let them know that there's another piece of the puzzle and not only that one piece. Because the problem with weekend courses or techniques is that you end up neglecting the big picture.

I hope you enjoyed this interview with Dr Ricardo Mitrani and were inspired and challenged, as we were, to keep on considering conflict of interest and pursuing the right solutions for every patient.

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