Log In
Join Today

What If Your Anesthesia Worked Every Single Time?

We’ve all experienced it. You’re ready to go, rubber dam is on, and handpiece in hand, then your patient says the dreaded words: “I’m not numb.”

If that phrase shows up in your operatory even once a week, it’s wrecking your schedule, adding stress, and lowering your production. Fortunately, it doesn’t have to be that way.

In a recent DSN-exclusive webinar, Dr. Aaron Nicholas, founder of Monday Morning Dentistry, broke down how to get reliable, effective anesthesia every time (especially for those hard-to-numb mandibular molars). His approach is built on decades of hands-on clinical experience and teaching other dentists how to avoid common anesthetic pitfalls.

Key Clinical Takeaways

Gow-Gates are Your Secret Weapon: If you’re still relying solely on IAN blocks for lower molars, it’s time to upgrade! Dr. Nicholas showed how the Gow-Gates technique, when performed correctly, offers deeper and more complete anesthesia—especially when traditional blocks fail. It targets the mandibular nerve before it branches, resulting in a more profound block that minimizes failures and supplemental injections.

Sequence and Technique Matter: Using the Gow-Gates as a first-line block (not just a rescue option) can help you eliminate “chase” injections. Combine this with a well-positioned bite block and adequate wait time (5 minutes. If not numb then move on to supplemental injections.  If extracting third molars, use the other block you didn’t use this time and give a long buccal infiltration. Possibly also a lingual infiltration), and you’ll notice more consistent results.

Infiltrations Still Play a Role: Dr. Nicholas emphasized pairing the Gow-Gates with buccal and lingual infiltrations when needed, especially in multi-quadrant procedures or cases with inflamed pulps. For some, a bit of articaine infiltration is the final step in predictable pulpal anesthesia.

Know When to Switch Techniques: If the initial anesthesia isn’t effective within 5 minutes, don’t wait! Have your assistant ready with alternative setups (Gow-Gates, intraosseous, PDL injections, etc.) so you’re not burning valuable chair time or patient trust.

Monday Morning Action Steps

Watch the Replay—Now on DSN!

This clinical masterclass is just one resource available to DSN members. Inside our community, you’ll find:


Join today with a 7-day free trial and get access to this webinar and more!

For your success,

The Dental Success Network Team

Where Do You Learn About Efficiency?

Every morning at 6 a.m., my day kicks off with two things: cats and coffee. Specifically, feeding my two hyper-punctual Bengal cats (who will perish if breakfast is five minutes late) and making coffee for my wife (an fresh ground Americano with oat milk, crafted from one of those fancy machines).
I’m not just a cat wrangler and barista; I’m a diehard efficiency nut. So naturally, I started looking at how I could systemize and combine these morning rituals. What I discovered applies far beyond the kitchen—it’s the same logic that makes dental appointments run smoothly and keeps your practice profitable.
In any process, there’s a rate-limiting step: the part where you’re waiting on something to happen. With coffee, it’s the grind-brew-dispense cycle. With cats, it’s waiting for them to finish eating so I can pick up the bowls. At first, I handled each task separately. Then I had a lightbulb moment—why not tackle both in parallel during those wait periods? Boom! I saved time, scored points with my wife, and avoided hangry cats.

So What Does This Have to do with Dentistry?

Plenty!
Most dentists when they ask about efficiency are thinking of the procedure itself—how fast they can prep a crown or complete a root canal. But there’s another level of efficiency hiding in plain sight: the appointment.
Think of all the steps that go into a one-hour molar root canal, buildup, and crown. I count at least 18. And, they don’t all need to happen in a straight line. Financial arrangements? They can be done while the room’s being set up. Waiting for the patient to get numb? That’s prime time to get impressions, hygiene checks, or scanning done.
The real key is identifying those rate-limiting steps (financial consent, topical placement, anesthetic onset, setting impression material) and pairing them with tasks that keep things moving. Not only does this cut down on chair time, it increases productivity without sacrificing quality.

Want to Boost Efficiency in Your Practice Starting Monday Morning? Ask Yourself:

Too many dentists are burning time between steps, not realizing it’s time they’ll never get back. Find those gaps, fill them with purpose; suddenly your schedule runs smoother, your team’s happier, and you’re not stuck digging out of a backed-up operatory at 5:30 p.m.
Efficiency isn’t about rushing. It’s about aligning your steps so every minute counts. Sometimes it starts with cats and coffee.

Until Next Time,

Aaron Nicholas, DDS
DSN Faculty
Founder, Monday Morning Dentistry

P.S. Want to get some practical training to improve your efficiency? Check out my hands on upcoming courses:

These courses offer hands-on experiences to build up your clinical skills!

Has Your Office Ever Been a Ghost Town? – Dealing with an Empty Schedule

The Story of an Empty Schedule

Not too long ago, I walked into the office to find an almost completely empty schedule—crickets. Zero productivity planned for the day. Nothing on the books.

I’ll admit it—I had one of those “Why didn’t I just stay home?” moments. But time is time, and once it’s gone, you don’t get it back. So, I decided to flip the script and try something different. Here’s how I played it:

Look for Hidden Opportunities

First, I pulled up all the treatment plans for that day’s hygiene patients. There’s always something hiding in plain sight if you take a closer look.

Get the Team on Board

At the morning huddle, I laid it out: “Guys, I know the schedule looks rough, but we’re going to make $8K today. Here’s the game plan: we’re setting up rooms for restorative, oral surgery, and endo. Let’s be ready for anything.”

Speed Up the Slow Stuff

Financial arrangements are always the bottleneck, right? So, I told my team to call me for exams as soon as X-rays were done or the patient was seated. That gave the front desk at least 30 minutes to get financials worked out before the cleaning was finished.

Make the Ask

During the exam, I presented treatment in plain, no-nonsense terms: “Here’s why you’ll be better off doing this today while you’re already here.”

Then I followed up with: “If you’ve got the time and we’ve got the time, do you want to take care of it now?”

When they said yes—and most did—I handed off the “Same-Day Treatment Form” to the front desk.

Move Fast, Don’t Break Things

By the time the hygienist wrapped up, everything was ready to go. Financials were handled, the treatment room was set, and we kept the day moving.

The Results?

We closed out the day just shy of $8K in production—not bad for a day that started with a whole lot of nothing.

The team? They were pumped. There’s something about turning a tough day into a win that fires everyone up. And, of course, I showed my appreciation the next morning with the universal motivator: coffee for all.

What I Learned (Again)

Here’s the thing—it’s easy to write off an empty schedule as a loss. But with a little hustle and a lot of teamwork, you can turn it around.

The key is having a system that works no matter what the day throws at you. Whether it’s a packed schedule or a ghost town, the game doesn’t change. Hygiene is your lifeline. Treat it like it is, and you’ll keep finding ways to win—even when the deck feels stacked against you.

And let’s be real—those turnaround days? They taste a little sweeter when you’re sipping that coffee the next morning. Cheers to that.

Finally, if you’re ready to dial in your systems and boost your efficiency, the next 90-Day Clinical Accelerator kicks off February 3rd. It’s a great way to turn strategies like this into habits that will transform your practice.

Until Next Time,
Aaron Nicholas, DDS
DSN Faculty
Founder, Monday Morning Dentistry

Are You Strategic with Your Sedations?

Dr. Aaron Nicholas here! I recently had a conversation with Dr. Cody Boals of Kissing Camels Dentistry, and we dug into a few topics that have made big impacts in our practices: sedation, case flow efficiency, and best practices that can really dial up patient satisfaction and practice profitability. I wanted to share some key takeaways from our chat that you might find useful, whether you’re looking to streamline your day or considering how sedation could add a little extra calm (and profit) to your practice.

Here’s the Rundown:


1. Sedation as a Patient Pleaser (and Practice Builder)
Cody and I talked about the power of offering sedation for larger or complex cases. He shared how oral conscious sedation has been a game-changer in his practice, especially for wisdom teeth and cases with more anxious patients. If you’re considering sedation, it’s all about creating a smoother patient experience without overwhelming yourself. The good news? In most cases, oral conscious sedation is plenty effective, and it’s usually easier on everyone than IV sedation.

2. Clear Communication: Manage Patient Expectations
One tip that kept coming up was how important it is to set patient expectations early and clearly. When patients know they’re in for a comfortable, minimally invasive experience, it doesn’t just build their trust—it keeps them coming back. Cody uses a blend of straightforward language and patient reassurance to ensure that even parents of young patients feel at ease.

3. State Regulations: Navigating the Red Tape
For anyone looking to add sedation to their services, be sure to check your state’s specific requirements. Some states have tighter regulations on who can administer sedation and what equipment you need to keep on hand. Cody and I agreed: it’s worth the investment in CE and practice setup, but knowing the rules inside-out helps you avoid any headaches down the road.

4. Efficiency Tips: “Your Quality is Your Quality”
My rule of thumb is that “your quality is your quality.” Efficiency doesn’t mean cutting corners—it means finding ways to maintain your quality at a faster pace. Slowing down strategically, like using proper elevation techniques during extractions or an effective instrumentation protocol for endo, often means you’re finished faster and without the stress.

5. The Right Cases for Sedation: Not Every Case is a Fit
Cody has a clear approach: sedation is for patients who are older than 14, at least 100 pounds, and without complex medical issues. This way, he avoids risky scenarios, keeping the procedure—and his team’s workflow—manageable. Identifying the right patients for sedation not only helps them feel at ease but also makes your day flow much smoother.

In short: Building Trust + Strategic Sedation = Win-Win

Sedation is a powerful tool that, when used wisely, can significantly expand your service offerings and make patients feel at home in your practice. And if you’re interested in efficient techniques that preserve the quality of your work while improving your practice’s rhythm, this could be worth exploring further.

As always, the goal is to keep quality high, streamline your day, and keep those post-op calls to a minimum. Looking forward to seeing how this applies in your practice, and always here for questions!

Until Next Time,
Aaron Nicholas, DDS
Dental Success Blackbelt Coach
Founder Monday Morning Dentistry

P.S. Looking to get your CE in for 2024? Join us for the final HANDS ON course of the year in Burtonsville, MD. DSN members shoot me a message for a special discount! Not a DSN member? Get a 7-Day free trial!

What Makes Our Time Slow and Inefficient?

For the over 12 years I’ve been coaching doctors, one question I often get is: “How do I get faster?”

Now, obviously, this question is a bit loaded, and the answer is tricky, but we’ve all had those days. You’re 10 minutes behind before you even start, you can’t find that one instrument you know is on the delivery tray somewhere, or you’re halfway through a crown prep and realize your assistant needs to run across the office to grab something. Sound familiar? Let’s dig into what’s really slowing us down and how we can fix it.

1. We Don’t Time Our Procedures

Let’s be honest—most of us have no idea how long things actually take. We think we’re faster than we are (guilty as charged). If you start timing your procedures, you’ll notice where time gets wasted. Sometimes, it’s something as simple as not having everything laid out before you start. Fixing that “one thing” can shave minutes off your procedure and allow you to add that one extra same-day procedure to your day.

2. We’re Doing Too Much Ourselves

I know some of you think, “It only takes a second for me to grab this or do that.” But, all those “seconds” add up, and suddenly, you’re 15 minutes behind and wondering how it happened. Or, you’re asking how someone can do a procedure in less time than you. The secret? They get their team involved! Your assistants are there to help, so let them. They can handle setting up rooms, placing rubber dams, or fabricating temporaries. Free yourself to focus on the things only you can—or are allowed to—do.

3. Our Workflow Is All Over the Place

Ever find yourself staring at your tray like it’s a scavenger hunt? I used to lose track of more time than I’d like to admit just hunting for instruments or materials. If you standardize your setups—making sure everything is in the same place every time—you’ll cut out a lot of wasted time (and frustration). Trust me, there’s nothing worse than searching for an explorer while the patient just stares at you.

4. Hygiene Exams Are Killing Our Flow

We’ve all been there—you’re in the middle of a tough procedure, and bam, your assistant tells you it’s time for another hygiene exam. You jump up, do the check, and by the time you’re back, they’re calling you for another exam. Instead, try batching those exams. Check a few hygiene patients at once, then get back to work. It’ll save you time and keep you from feeling like you’re playing whack-a-mole with your schedule.

5. We Resist Change

Nobody likes change; but sometimes, what used to work isn’t cutting it anymore. Whether it’s trying a new technique, reordering a procedure, or switching up your instruments, it’s worth making some tweaks if it helps you get the same results faster or at a lower cost. And hey, who doesn’t like finishing early and making more money?

At the end of the day, efficiency isn’t about rushing through things or cutting corners. It’s about working smarter. So, time your procedures, delegate more, standardize your setups, and quit fighting the changes that’ll make your life easier. Trust me, your stress level—and your team—will thank you!

Until Next Time,

Dr. Aaron Nicholas
Dental Success Blackbelt Coach
Founder Monday Morning Dentistry

P.S.Looking for more efficiency tips? Join DSN with a 7-day free trial and chat with me and other coaches on Workplace, and be sure to check out our online and upcoming courses at MondayMorningDentistry.com and DSN!

Want the Secret to Surgical Extractions?

Sectioning teeth can be essential when the root configuration prevents straightforward extraction. Roots may be dilacerated, widely splayed, or curved, making it impossible to extract the tooth in one piece. When a tooth is broken down to the bone with no structure to grasp, sectioning becomes necessary.

Key Techniques for Sectioning and Extraction

  1. Evaluate the Root Configuration: Before sectioning, assess the tooth’s root structure using radiographs. Look for any dilacerations or curvatures that could complicate the extraction.
  2. Section Early: It’s often better to section a tooth early rather than later in the extraction process. This can prevent complications and make the extraction smoother.
  3. Create Space by Removing Bone: Remove bone up to two-thirds of the root’s length to create enough space to push the roots into. Ensure you’re aware of anatomical structures like the sinus and the buccal and lingual plates.
  4. Sectioning in the Lower Jaw: When sectioning in the lower jaw, be mindful of the buccal and lingual plates, especially near the mental nerve. Use a bur tipped towards the center of the tooth to avoid damaging these structures.
  5. Sectioning in the Upper Jaw: In the upper jaw, consider the sinus proximity. Section through the tooth carefully, ensuring you don’t perforate the sinus. Use a sharp elevator or luxator to expand the bone around the tooth after sectioning.
  6. Using the Right Instruments: Not all elevators are suitable for every situation. Ensure your 301 elevators or luxators are thin enough to slide down the periodontal ligament (PDL) space effectively. Sharpen or replace old, worn instruments regularly.

Practical Tips for Sectioning

  • Feel the Difference: Get accustomed to the tactile differences between cutting tooth and bone. This helps prevent “over-sectioning” and ensures precise bone removal.
  • Elevator Techniques: Use sharp elevators to slide down the PDL space. If the roots are still encased in bone after sectioning, use the bur to remove additional bone around the roots.
  • Dealing with Root Tips: When root tips break off, create space by removing or condensing the bone around them. Use luxators or thin elevators to wiggle down the PDL space and loosen the root tips.

These techniques can significantly enhance your efficiency and success rate with surgical extractions. Practice these tips, and you’ll notice a smoother, quicker extraction process, leading to better patient outcomes and increased confidence in handling complex cases.

If you found this helpful and want more insights on advanced techniques, feel free to reach out or check our resources on the Dental Success Network. Join me in Ocala, FL, on October 5th for our Efficient Extractions Hands-On Course.

Sincerely,

Dr. Aaron Nicholas
Dental Success Blackbelt Coach
Founder Monday Morning Dentistry

P.S. Are you looking to elevate your dental practice? Join Dental Success Network today and connect with a community of over 1,000 dentists. Gain access to exclusive resources, continuing education, and vendor discounts to help you run a more profitable practice and become a better clinician.