Airway, Wellness, and the Patient-Centered Private Practice (w/Dr. Trevor Nichols) [Ep.161]
The DOC PodcastShow Notes
Episode Summary
Dr. Trevor Nichols returns to The Doc Podcast for his second appearance, and a lot has changed. Since opening Nichols Orthodontics and Aesthetics in Gilbert, Arizona, in August 2024, Trevor has grown from a two-person operation to a team of 20, with a waitlist. In this rich conversation, Dr. Mike and Dr. Nichols cover the full journey: the leap from corporate/DSO orthodontics to private practice ownership, the vision and systems that fuel their growth, the personal wellness habits that keep them grounded, and, most passionately, the case for early airway-focused, craniofacial orthodontic treatment. This episode is a must-listen for any orthodontist, dentist, or healthcare professional who wants to treat the whole patient, not just the teeth. Timestamps
3:29 — Welcome back: Dr. Nichols returns to the show after ~2 years 4:33 — "Probably the best two years of my life" — Dr. Nichols reflects on opening his practice 5:27 — Starting with just two people, leasing space from a general dentist 6:29 — "Fight for your dreams" — the case for private practice ownership 6:53 — Why private practice better protects patients and the profession vs. corporate/DSO models 22:03 — Building the vision: how to define what orthodontics truly fulfills you 23:29 — "Do a true audit of what in orthodontics brings you happiness" 29:34 — The three pillars of Nichols Orthodontics: patient experience, culture, and results 40:24 — Why Dr. Nichols hired a CEO (formerly at Crumbl Cookies) to run the business side 50:44 — Balancing plates: weekly date nights, gratitude practices, and intentional reflection 57:32 — Shifting to the clinical: why diagnosis is what separates orthodontists from OTC aligners 1:00:57 — "We're not just orthodontists — we're craniofacial orthopedists" 1:02:58 — "I don't really care about the teeth right now" — diagnosing profile, growth, and airway first 1:11:06 — Treating 3- and 4-year-olds: when early intervention is warranted and how to screen for it 1:17:44 — 45% of Nichols Orthodontics' practice is now airway-focused treatment 1:27:43 — The key to phase one braces success: bond ALL the primary teeth + disarticulate 1:29:00 — The tongue as nature's expander: ~400g of force at swallow — why we don't need more 1:37:18 — "Early adopters take the most scrutiny — and then we find out they were right all along" LINKS Register for the In-person Early Treatment Comprehensive ($1000 off if register by June 30): https://www.earlyorthotreatment.com/ Episode 50 w/Dr. Nichols: https://podcasts.apple.com/us/podcast/finding-living-your-purpose-w-dr-trevor-nichols-ep-50/id1689703392?i=1000655038062 Connect w/Dr. Nichols: https://www.nicholsortho.com/?utm_source=GBP Instagram: @dr.trevornichols Join The DOC Community on Facebook for more great content and discussions: https://www.facebook.com/share/g/1Cb9rkQVde/ Check out the DOC CE Courses: https://theorthocoach.com/ce-courses/ Enroll in one-on-one coaching w/Dr. Mike: https://theorthocoach.com/doc-coaching/ If this episode resonated with you, please take a moment to share it with a colleague, friend, or fellow healthcare professional who would benefit from hearing it. Word of mouth is the single most powerful way to grow this community and spread this message. Leave us a rating and review on Apple Podcasts or Spotify; it makes a huge difference! And if you haven't already, subscribe so you never miss an episode of The Doc Podcast. Thank you for your support! Together, we're changing lives, one conversation at a time.
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Episode Summary In this episode, I sit down with Dr. German Ramirez for an in-depth conversation about early orthodontic treatment, craniofacial growth and development, bone biology, and the critical role of nasal breathing in facial development. Dr. Ramirez shares his remarkable training journey from Colombia to Australia to Tufts University, his pioneering research on the mandibular condylar cartilage, and his passionate case for treating children early rather than waiting until age seven. We dig into the six dimensions of diagnosis, the connection between bruxism and airway, why AHI is a flawed metric for pediatric sleep-disordered breathing, and how collaborating with ENTs and sleep physicians can transform patient outcomes. This is a must-listen for any orthodontist or dentist who wants to understand the biology behind proactive, functional orthodontic care. Timestamps 0:00 — Introduction & Guest Background Introducing Dr. Ramirez and his credentials. 2:07 — Dr. Ramirez's Training Journey From Colombia to Brazil to early ortho training. 6:25 — Mandibular Condylar Cartilage & Bone Biology Growth potential persists into the 90s. 8:41 — Why Early Treatment Matters Mandible grows more in first five years. 10:55 — Sleep, Breathing & the Orthodontist's Role We normalize anatomy, not treat airway. 15:06 — Responding to "No Need to Treat Before 7" Six-dimension diagnosis vs. isolated single-problem studies. 21:05 — Functional Evaluation: Mouth Breathing & Nasal Breathing Identifying mouth breathers and cellular hypoxia effects. 26:47 — The Tongue as Palatal Expander Nasal breathing first, then tongue positioning. 29:57 — Collaborating with Medical Colleagues CBCT, ENTs, and a cleft palate story. 37:27 — Tonsils, Adenoids & Post-Surgery Relapse Why habits persist and relapse rates soar. 41:38 — AHI Limitations & Study Design Problems AHI is a flawed pediatric sleep metric. 47:47 — Bruxism & Airway Connection Tongue protrusion causes grinding — here's how. 51:47 — Resistance to Change in Orthodontics Technology-driven vs. biologically-driven education disconnect. 56:17 — Genetics vs. Environment in Craniofacial Growth Epigenetics and the genetic window concept. 64:56 — Muscle, Bone & Diet Muscle stimulation drives bone growth over time. 72:02 — Communicating with Child Patients "Nose for breathing, mouth for eating." 81:28 — Closing & Contact Info Books, courses, and upcoming lectures worldwide. LINKS: Airway videos: https://www.youtube.com/watch?v=3h0JgmmLj_Q&ab_channel=TMJ%26SleepTherapyCentre Dr. Ramirez’ website: https://www.kidsmalocclusions.com/ Pediatric Airway-focused Myofunctional Orthodontics: https://a.co/d/b1wQhD9 Dr. DeLuke’s Early Treatment Course: https://theorthocoach.com/courses/phase-i-arch-development/?portfolioCats=99
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