Mindy Hargesheimer (00:00:00):
Welcome to the podcast, Dr. Jay Joshi. Thank you
Jay Joshi (00:00:02):
For having me. You
Mindy Hargesheimer (00:00:03):
Are so welcome. I'm excited to
Jay Joshi (00:00:05):
Have you here. I am
Mindy Hargesheimer (00:00:06):
Too. I'm very excited. We have a wealth of really fun, um, topics that we're gonna talk about. And I say
fun because we're talking about orthodontics and we are going to make it fun. For sure.
Jay Joshi (00:00:14):
And
Mindy Hargesheimer (00:00:14):
Entertaining. So, um, well, welcome to the podcast. So let's talk today, let's give kind of like, for the
people that are listening, kind of an overview of some of your favorite topics that we're gonna go over
today to get people excited. Yeah.
Jay Joshi (00:00:25):
Start there. You know, when, obviously, I'm in the profession of creating great smiles. Yeah. And so we're
gonna definitely talk about smiles, what makes a great smile. I also think what's the deeper meaning
behind smiles, and that's really about how you feel about yourself, how you feel, how it makes you feel
and self-confident. And so I think that's another deeper layer that I wanna, you know, touch base on.
Yeah. Um, I think the hot topic in orthodontics and all, everything pediatrics right now is airway. So I
think talking about airway stuff is really, um, something that we can touch about. And then anything else
you have.
Mindy Hargesheimer (00:00:58):
All the, uh, so as I told you, all the things that, uh, people don't even know to ask about. That's right. All
the things that they would never even comprehend. So when we were talking about you coming on the
podcast, well, first of all, I should mention that our daughter got braces - Yeah. Through you and your
team. So we've been working together for the last couple of months and getting to know each other,
which has been really, really fun. Um, and so of course we were like,
"You have to come on the podcast.
"
And I think some people might be like,
"Oh, you're gonna bring an orthodontist on the podcast. What are
you possibly gonna talk about?" Well, I told you, I have listened to so many podcasts between dentists
and orthodontists, and I have picked up so much knowledge - uh-huh. That I never knew about.
(00:01:31):
And I was like,
"If I'm learning all of these things, so many people here in KC can learn it from you as
well.
" And of course the whole idea is for them to come in and see you guys and we'll talk about like
where you're located and everything. Um, but I couldn't believe how many different things there are thatPage 1 of 55
we could talk about that I think everybody could gain something from, whether you're literally seven
years old or 67, right? Probably across the
Jay Joshi (00:01:52):
Board. My, my youngest patient is probably about five. Okay. My oldest patient's 81, so.
Mindy Hargesheimer (00:01:57):
There you go. There you
Jay Joshi (00:01:57):
Go.
Mindy Hargesheimer (00:01:58):
All right, perfect. Okay. So you are with Stay Smiling Orthodontics. Um, let's talk about that. So first of
all, let's get into your background first. Let's go back. Where are you from? What's your background?
Let's talk about how you got here.
Jay Joshi (00:02:11):
Thank. Yeah. So I was born and raised in St. Louis, Missouri. Um, my parents, um, they were physicians
growing up, so I really got to see what the life of a physician was, the call schedule, always having to go
into work. Um, I would spend a lot of my time at the hospital when my parents would get called. Really?
We though it was so cool to see like their, their cotton bed that they'd sleep at in between their evening
patients. And so, um, we got to know all the staff and the team very well growing up. And so, you know,
it did influence me a little bit because I love anything science, medical, uh, math. That was kind of left
hemisphere, like, geared that I was as a kid. Yeah. And so, um, you know, when I was looking at that,
everything about medicine I think is so great, but I think the quarrel that a lot of people have is the
schedule, the, how it affects your, you know, your time with your family and, um, kind of the, we'll call it
like trauma from like just the work.
(00:03:04):
Like how much can you sustain that over time, you know? Yeah. No kidding. So.
Mindy Hargesheimer (00:03:08):
Yeah.
Jay Joshi (00:03:08):
So that, I mean, that had some influence for me to go into dentistry. Um - What
Mindy Hargesheimer (00:03:12):
Kind of doctors were your parents? My parents
Jay Joshi (00:03:13):
Were, they're anesthesiologists. BothMindy Hargesheimer (00:03:15):
Of them?
Page 2 of 55
Jay Joshi (00:03:15):
Mm-hmm.
Mindy Hargesheimer (00:03:16):
Okay.
Jay Joshi (00:03:16):
And my dad did a little bit more with pain management, but that's part of anesthesia, so. What
Mindy Hargesheimer (00:03:20):
Were you doing at the hospital at that young age, just playing around? Did they let you kind of run
around?
Jay Joshi (00:03:24):
Yeah, my, my mom - What did the kid do? My mom would get called in quite a bit. So me and my sisters,
we would go into the staff lounge. I always remember it was cool because we get free Cokes and things
like that. Yeah. Free fresca as a kid. And, uh, you know, we would just basically be killing time there. It
led me to when I was a little bit older, you know, I did the candy stripe volunteering at the hospital. Yeah.
So I did that every, every summer from like middle school-ish time, um, until middle of high school
when, when I was able to work, you know, so.
Mindy Hargesheimer (00:03:53):
Yeah. I love it. Okay. So you graduated high school in St. Louis? Mm-hmm. Where'd you go from there?
Jay Joshi (00:03:57):
So first of all, subsi - when you're in St. Louis, everyone asks you where you went to high school. I don't
know if you knew that or not. No. But yeah, if you're from St. Louis, if people in Kansas City, whenever
you're like,
"Oh, I'm from St. Louis,
" they'll always say,
"What high school did you go to?" That's
Mindy Hargesheimer (00:04:09):
Like you get grouped in. That's
Jay Joshi (00:04:10):
Where you get grouped in from St. Louis. Got it. I don't know if that's the St. Louis community. It's just
something unique. They don't care where you went to college. It's where you went to high school.
Interesting. Yeah.
Mindy Hargesheimer (00:04:17):
Learn something new. Okay.Jay Joshi (00:04:18):
So I went to a school called Whitfield School. Okay. It's a, it's a private school. Um, pretty similar to like
something like Pembroke or, um, Barstow out here. Yeah. Um, but really focused on like college prep and
education. So that kind of, I think it gears you to think a certain way when you're at a college prep school,
like in terms of how much academia you have to do and things like that. But, um -
Page 3 of 55
Mindy Hargesheimer (00:04:40):
Did you know that you wanted to get into orthodontics then?
Jay Joshi (00:04:42):
I actually didn't. So - Okay. The funny story about that is, so my, I had an older sister. Mm-hmm. And
when she was in college, uh, she was at WashU in St. Louis and she kind of flip-flopped back and forth
between medicine and business and she kind of changed her degree several times back and forth. Mm.
And had to take, you know, double the classes and kind of that confusion of what you wanted to be.
Yeah. Funny story, she graduated with a business degree, but ended up going back and taking post-grad
classes and went to, to medical schools. Oh my gosh. It's funny. It just took a lot. In the end, that's what
Mindy Hargesheimer (00:05:13):
She
Jay Joshi (00:05:13):
Wanted. Yeah. But my parents, you know, being Asian, East, East, A- Asian Indian parents, they were
like,
"You know what? With our second child, we're gonna sit you down and we're gonna have this open
dialogue as a, probably like a junior in high school and we're gonna figure out what you wanna do.
"
Mindy Hargesheimer (00:05:28):
Were they like,
"You have to be a doctor, an attorney or something.
" I've had this friend, this conversation
with, um, one of my Indian friends in the neighborhood and she said just that. Yeah. She's like,
"We all
got into the medical field because we were told that's what we have to do.
"
Jay Joshi (00:05:39):
They, they didn't force me down anything. Yeah. But I think they were definitely gearing that. If I said I
wanted to be an artist, there would definitely be some protests for them. Right. So, but, um - Not to
Mindy Hargesheimer (00:05:47):
Profile, just
Jay Joshi (00:05:48):
Having
Mindy Hargesheimer (00:05:49):
Conversations about it, I've heard that, so.Jay Joshi (00:05:50):
And there's a lot of Indie committees. They'll say it's like a doctor, an engineer, like - Yeah.
Mindy Hargesheimer (00:05:54):
If,
Jay Joshi (00:05:54):
Page 4 of 55
If you're doing that, like, the communities are like,
"But I chose comedy.
" And then they get, they get a
lot of laughs from that one. Yeah. But, um, no, I, I knew, like, I didn't wanna be a doctor based on what
my parents did. I love everything medical in terms of what it is as a profession and how you can help
people. Yeah. I just didn't love, like, what the lifestyle is and what that meant after hours and the kind of -
The schedule and everything. Yeah. And the time away from family. I think, I think a lot of doctors,
dentists, everyone all agrees that at the end of the day, we do this because we love it, but we also wanna
be there for our family and spend time with them. You
Mindy Hargesheimer (00:06:24):
Literally need that balance.
Jay Joshi (00:06:25):
Yeah. Yeah.
Mindy Hargesheimer (00:06:26):
So - Well, it's good that
Jay Joshi (00:06:26):
You
Mindy Hargesheimer (00:06:26):
Knew that early on. Yeah.
Jay Joshi (00:06:28):
And you didn't
Mindy Hargesheimer (00:06:28):
Get into it and then you went,
"Oh my gosh, I knew I
Jay Joshi (00:06:30):
Didn't wanna
Mindy Hargesheimer (00:06:31):
Do that.
" Yeah.Jay Joshi (00:06:31):
But in that conversation with my parents, you know, I, I was trying to think of things that I would like to
do. And it came back to my experience in, as, as an orthodontic patient. You know, I had everything. I
had the headgear, the expander. Did you? I had two phases of treatment. It probably lasted five or six
years of my life, you know? Oh my gosh. Um, I had all kinds of stuff. And even through all that, I still
loved everything about it because at the end of the day, when I got my smile, I was so self-confident
about it. Like I felt the minute you get your braces off and you see your smile, it, it kind of flips a switch
there for you. And like - Yeah. I do think, um, you know, growing up, you know, in, in grade school,
middle school, even early high school, there's that element of shyness.
(00:07:10):
Page 5 of 55
Like you don't wanna be called on by a teacher.m. You're not like open to like do, you know, to speak up
like at the assembly or anything like that. Yeah.That is a very - Oh, I hear that so much. Yeah. Yeah. It's a
nerve-wracking, uh, experience, but I do think, like, things change. Like, I think when I got my brace off,
I was probably a sophomore in high school. Um, you know, in school, I would be, like, when people.
And, like, not calling on you, but they would be in a lit class and they'd ask, like,
"Okay, what did you
think of this?" I would be open to, like, raising my hand and talking about what I did, because I though
my, my thoughts had value at that point, you know? Yeah. So,
Mindy Hargesheimer (00:07:43):
Yeah. So when did you finally have the smile that made you feel really confident? What age?
Jay Joshi (00:07:47):
I was, I was a sophomore in high school. Okay. Oh, like, I was probably feeling that. I think you feel this
a little bit in treatment, even though you have braces on - Yeah.
'Cause you're seeing the changes lie, but
the minute you take it off, it flips a switch, for sure.
Mindy Hargesheimer (00:07:57):
I should have asked you to bring in photos of you in headgear. I
Jay Joshi (00:08:00):
Should have done that. Didn't even
Mindy Hargesheimer (00:08:01):
Think about it.
Jay Joshi (00:08:01):
Yeah, I know. I should have done, you know?
Mindy Hargesheimer (00:08:03):
Do they even still do that? We
Jay Joshi (00:08:04):Still do it on some cases, not often. Yeah. There's like, and it's funny thing, there's a couple different types
of headgear. Yeah. And I, for every single type, I have a replacement for. Okay. And headgear's actually
easy because it's something you can put on. Yeah. You can take off. It's something you can do at home.
You don't have to do it in public. See,
Mindy Hargesheimer (00:08:18):
It just reminds me of, like, every '90s movie or something where they would have the kid in school that
had the headgear and
Jay Joshi (00:08:23):
You're
Mindy Hargesheimer (00:08:23):
Just like, oh, that poor kid.
Page 6 of 55
Jay Joshi (00:08:24):
Yeah, like, uh, 10 things I hate about YouTube. Yeah, exactly. Yeah. The one that we referenced that
most kids understand is finding Nemo. There's a - Oh yeah.
Mindy Hargesheimer (00:08:30):
The girl that
Jay Joshi (00:08:31):
Has the headgear, um, that has negative for soda from that, right?
Mindy Hargesheimer (00:08:35):
Yeah. Oh, that's so funny. Yeah, I had braces, um, like sixth through eighth grade. And didn't have the
headgear. Mm-hmm. Um, always loved changing the rubber bands, the colors.
Jay Joshi (00:08:44):
Yeah.
Mindy Hargesheimer (00:08:45):
Um, remember getting my braces off and it feeling real slimy, and then it was great from there on up.
Yeah. But what I didn't do was wear my retainer for the rest of my life. Yeah.
Jay Joshi (00:08:52):
Those are two things. Which you learn. Yeah. Those are, that's a big thing. We try to, I try to stress when
they get the brace off, because I have that foresight. I try to say, please, if this is the most important phase
of your braces is the retention. Yeah. Because things have muscle memory. They want to go back to
where they came from. So - They
Mindy Hargesheimer (00:09:07):
Really do.Jay Joshi (00:09:08):
Yeah.
Mindy Hargesheimer (00:09:08):
Oh, okay. All right. So you got a degree in psychology. Mm-hmm.
Jay Joshi (00:09:12):
Did
Mindy Hargesheimer (00:09:12):
I read that right?
Jay Joshi (00:09:13):
Yeah, I did.
Page 7 of 55
Mindy Hargesheimer (00:09:13):
Okay. So where did that come from?
Jay Joshi (00:09:15):
So I was actually, I went into dental, um, to college as a pre-dental student. Okay. And so, um, by
definition, I was like, most of my classes are gonna be science. So I was with a bio major, you know?
And my freshman year, first semester, just as part of the general education, I took a psychology class, and
I was just blown away. I just though it was so cool. Yeah. Like I, um, I, I knew I wanted to, like, get a
little bit more exposure. So I took a couple more psy- psych classes before I switched. And I was just like,
you know what? This is such a fascinating thing, thinking how the brain works, how we interact, um, how
we- Were you
Mindy Hargesheimer (00:09:46):
Thinking about it in relation to orthodontics at that point? I,
Jay Joshi (00:09:49):
I wasn't. Or just
Mindy Hargesheimer (00:09:49):
More personally?
Jay Joshi (00:09:50):
I wasn't. I was thinking more personally. Yeah. I do feel like every day there's some element of
psychology that I use, you know. Yeah. I think we all do that actually. We just don't know we're doing
that. I would agree with that. But definitely how we do behaviors when we talk about bands and talk
about, um - Yeah. Retainers and things like, these are all trained behaviors, you know? And so it's
fascinating to me. I, I learned a lot of different things I though were interesting. I kind of, I think the part,
the science part that I was really drawn to was there was some neuroscience, uh, psychology, likeneuropsychology that I thought was really fascinating when you talk about, like, the neurons and how we,
you know, sense - I would wanna
Mindy Hargesheimer (00:10:22):
Take that course now. Yeah.
Jay Joshi (00:10:24):
In fact,
Mindy Hargesheimer (00:10:24):
I want somebody to come on the podcast and talk about all that stuff - Oh, yeah.
Jay Joshi (00:10:26):
Because
Mindy Hargesheimer (00:10:27):
I would, like, get so into it too.
Page 8 of 55
Jay Joshi (00:10:28):
Yeah. I think, I think it's so fascinating. There's so many things, side, side tangent. There's so many things
in the world that I think is just unreal that we don't really have much exposure to, like, how the brain
works, how we - Yeah. Send signals. Things like, you know, how we behave. There's a deeper meaning to
that. Mm-hmm. There's obviously spirituality that we don't understand. Yeah. There's things that, you
know. There's just some really cool stuff psychology wise that you can really go into a rabbit hole on, you
know? You're speaking
Mindy Hargesheimer (00:10:53):
My language, trust me. Yeah. I'm like, I want all those people to come on and talk about all the different
things. Yeah. Yeah. So anyway, okay. So you got a degree -
Jay Joshi (00:10:59):
Uh-huh.
Mindy Hargesheimer (00:11:00):
In it. And then where did you go from there? How did you decide to
Jay Joshi (00:11:02):
Bring
Mindy Hargesheimer (00:11:02):
This all together?
Jay Joshi (00:11:03):Yeah. So actually, if we step back, when I, my parents had that conversation with me - Okay. I knew, I
was thinking about different professions that I would like, and orthodontics was one. And I wasn't saying,
like, I was 100% gonna be set to it, but I felt pretty good at that conversation. Fast forward about a year,
I'm applying to colleges, and I do some research, and there's a couple colleges that offered kind of like
this eight year, um, program where you go four years of undergrad, four years of dental school. Okay.
And you're basically in the dental school as long as you maintain the minimum grades, minimum test
scores, things like that. Yeah. Like you gotta be able to be competitive with someone who's applying, but
you're basically in the program. Yeah. So I applied to that and it's very competitive. There's like three
spots for like thousands of applications.
(00:11:41):
Oh, really?
Mindy Hargesheimer (00:11:42):
And
Jay Joshi (00:11:42):
That's what, I got into one. So that's what, how I end up at Temple University. Great to you. Yeah.
Mindy Hargesheimer (00:11:46):
Nice. Okay.
Page 9 of 55
Jay Joshi (00:11:46):
So I went there. So I didn't have the pressure when I was like going as a psych major. I already knew I
was into dental school. So I was still gonna take all my pre-dental courses and things like that, but I felt I
could explore something different, you know? And that's why I think psychology is something you apply
to everything. Mm-hmm. So it was something that was nice, you know, that I could do. I still got my
minor in biology. I had all the coursework I needed for dental school, but - Got it. Um, I got into that
program and, um, and what ended up happening was I did, I still, I'm the type of personality, and I think
most dentists are, were very, like, motivated people. And even though I was in school, I still wanted to do
the best I could. So I still try to get the best grades I could study hard for all the exams.
(00:12:24):
Yeah. And so when it came down to going to dental schools, um, I applied to everything, even though I
was already in. Mm-hmm. It was, I didn't have to go to that school. I was just in the program, right?
Okay. But I got into a lot of different dental schools, including some Ivy League schools and - Yeah. My
state school, which is UMKC. Mm-hmm. Um, and then when I was in dental, or when I was prepping to
go to dental school, I think the hardest decision I ever had to make in my life was where to go to dental
school. Really? Because, yeah, more than getting married, more than having kids. There's so many life
changing decisions. How
Mindy Hargesheimer (00:12:53):
So or why? Was it choosing between, like, Ivy League,
Jay Joshi (00:12:55):
Staying near? Yeah.Mindy Hargesheimer (00:12:56):
My
Jay Joshi (00:12:56):
Dream school, you know, you always have this dream school. Yeah. My dream school was University of
Pennsylvania. Um - Okay. Which is, um, in Philadelphia. Yeah. When I was already in Philadelphia. It
was a perfect transition. Um, it's a really great school. It's like the first dental school I ever created. Okay.
Mindy Hargesheimer (00:13:08):
It's
Jay Joshi (00:13:09):
Very prestigious. The alumni association's so strong. Mm-hmm. Um, a, a lot of people who go to those
Ivy League schools, they end up getting to specialty residencies. I don't know if that's connected to, like,
connections with people or if it's just you have highly motivated people, but there was a lot of. I knew I
wanted to be an orthodontist at that time. Yeah. But when I got my scores, I had good, good grades. I got
into all these schools, and then I, I talked to several orthodontists locally in, in Missouri. Mm-hmm. And
unanimously, almost everybody said,
"You know what? If you wanna be an orthodontist, you'll make it in
no matter what school you go to. You got this far. So choose the school that's the best.
" And they all
recommended staying home, closer to home. Interesting.
(00:13:45):
Page 10 of 55
State tuition. Schools were, at that time, were very expensive. Now it's even more crazy, you know? I can
imagine. Yeah. And so, you know, when I think back of where my journey ended me up, I got into
orthodontics just like I wanted to. I went through my state school, saved a ton of tuition money, then
going to a private Ivy League school. Yeah. Um, there's sometimes you always wonder, like, what it been
like if you had - What if. Like a Harvard degree or a UPenn degree or something like that, you know?
And, but it's not, it doesn't matter, right? Just buy the
Mindy Hargesheimer (00:14:09):
Sweatshirt. Yeah,
Jay Joshi (00:14:10):
Exactly. Just wear it. Who
Mindy Hargesheimer (00:14:11):
Cares? I have
Jay Joshi (00:14:12):
One thought. Y'all do it anyway.
Mindy Hargesheimer (00:14:13):Yeah.
Jay Joshi (00:14:14):
It, it doesn't really matter though. It, it just, I got to where I wanted. And right now, if I was advising any,
you know, young professional trying to go into dental school, I would say, you know, with the cost of
tuition these days, you know, you'll make it. If you wanna be an orthodontist, you wanna be an oral
surgeon, you wanna be whatever, especially medical specialties - Yeah. Um, you can get there. You just
have to work hard and you'll get there. Well,
Mindy Hargesheimer (00:14:33):
That's kinda why I was asking. I had, um, Dr. Justin Grabowski, who's a chiropractor on, and we talked
about that too. Like, what would you recommend to people who are interested in getting into that field?
So I think it's good for you to offer that advice or even if people wanted to reach out to you.
Jay Joshi (00:14:45):
Yeah. I'd be happy to talk to anyone. Yeah. That's, I'm really well connected with, like, trying to help
people - Yeah. Get to where they wanna get to, so. Yeah.
Mindy Hargesheimer (00:14:51):
We talk a lot on this podcast and episodes about, um, the importance of connections - Yeah.
Jay Joshi (00:14:55):
In
Mindy Hargesheimer (00:14:55):
Page 11 of 55
This world. So, yes. All about that. Okay. So you decided to stay, never looked back. Mm-hmm. And
then where did you go? So how many years were you at UMKC? So
Jay Joshi (00:15:04):
Four years in dental school. Okay. And then, then you, to get into orthodontics, orthodontics is probably
one of the more competitive specialties. That and oral surgery were, like, the hardest ones to get into. And
so - And
Mindy Hargesheimer (00:15:15):
Why is that? Just because of the extensive work that it requires?
Jay Joshi (00:15:21):
I think oral surgery's popular because there's a certain mindset, like, that wants to go that route. Mm
hmm. And so there's not infinite amount of oral surgeons out there. Yeah. And so there's limited spots on
what you can do. There's limited hospitals that you can, you can go to residency programs in. Yeah. And
so I think it eliminates a lot of people because people are like,
"I don't wanna do surgery. I don't wanna
deal with all the blood and all that stuff.
" Yeah. But it, so it takes a certain mindset for an oral surgeon.
For orthodontics, I think it's something that, like, how I was thinking growing up, how the experience Ihad as a patient, like, I really respected my orthodontist and the team that he worked with, how they were
able to build those connections with people. Yeah. And so, for me, I wanted that same ability.
(00:15:57):
I'm very much a personal person. I like, as you know with your daughter - Yeah. I don't make it about
teeth. I try not to. I try to make it about the actual patient, how they feel, but how they, you know, we're -
Mindy Hargesheimer (00:16:07):
Well, and you and your wife who bring her into this because she's there too, and I'll be, obviously, all the
other team members too, but from the jump are, like, very welcoming, so warm - Appreciate it. So
conversational. I mean, we sat there and talked about Florida. We've talked about Colorado. We talked
about where to eat - Yeah. Schools for kids, all that kind of stuff. So, I mean, that's definitely something
that we have experienced firsthand, which I always love to share. I
Jay Joshi (00:16:29):
Think, I, I think in the medical dental world for the longest time, even today in 2026, you call medical
office and it's very serious. It's very not, no, no leniency. If you're late, you can get your appointment
canceled, you have to reschedule, or you're gonna have some kind of shame for it. Yeah. You know, we,
we really made it to be different. Yeah. Like, we really wanted to make sure that, you know, we
understand things happen. You get stuck in a traffic accident, you know, you get sick. Yeah. We never get
upset about any situation. We really try to hone in on our culture that, you know, we're positive, we're
upbeat. Yeah. I think it helps build good rapport, and it kind of is truer to what we want. If I was in the
same scenario, I would want that empathy for my doctors too, you know?
Mindy Hargesheimer (00:17:10):
Yeah. Well, we've all experienced the waiting forever. I had a dentist appointment, um, no names to be
mentioned, but I was wondering that morning if I could reschedule it, and they said it'll be $100 fee to
cancel it. Yeah. And I was like,
"Forget it. I'll come in. You know, I'm not gonna pay $100. Like I can
make it.
" It was just kind of a crazy day. Um, and a lot of, like, you call in, they're like,
"Birthdate,
" you
Page 12 of 55
know, it's just like, get straight to the information - Right. Like you're a number. So - Right. Again, totally
appreciate that being a differentiator.
Jay Joshi (00:17:34):
I think one thing that my wife and my front desk team does so great is when they answer the phone, it's
like, like a little warm up first. Mm-hmm. Like, oh, how did, you know, we're so happy you called us.
Like - Yeah. How do we, how did you hear about us? Like, we wanna make a conversation, make you
feel more at ease and comfortable. Yeah. So you don't have to walk on eggshells when you call a dental
office, you know? Which
Mindy Hargesheimer (00:17:52):
I just wanna shout out myself for a second - <laugh>. Because when we were in there with Liv, um, your
wife had told me that she got a call and she said,
"How did you guys hear about this? How, how'd you
hear about us?" And the person said,
"Oh, social media. Um, Kansas City bucket list.
" And I was like,
"Yes.
" There you go. This is why we do it, right? There you go. To get people in there, the call to action,so. There you go.
Jay Joshi (00:18:08):
There you go.
Mindy Hargesheimer (00:18:09):
Yeah. Um, okay. So back to, you go through, like, you finish school. Mm-hmm. And then you decided to
stay in Kansas City. What, what was kind of, like, your path from there?
Jay Joshi (00:18:18):
Well, actually, I went to dental school here, but I had to do my residency, and I did that in Nevada, in La
Vegas. Oh okay. I missed that. Yeah, I did three years of orthodontic residency. So - Got it. What makes
the difference between a dentist and an orthodontist. So all orthodontists are dentist. No dentist is an
orthodontist, if that makes sense. Noted. Okay.
Mindy Hargesheimer (00:18:33):
I didn't know that. Yep. So
Jay Joshi (00:18:34):
You have to go - We'll get into
Mindy Hargesheimer (00:18:35):
The difference.
Jay Joshi (00:18:36):
Yes. You have to go to dental school to go to a specialty program. Okay. Uh, but you don't have to, what's
different in medical and, and dental is I think most medicine, uh, you have to at least go into a residency
that's for family practice or internal medicine. Yeah. You have to do some kind of further training from the
four years of medical school. Mm-hmm. In dental school, you don't have to, you can go straight out and
be pra - a practicing dentist, you know? Got it. Okay. So I went to, I went to Las Vegas for three years to
do my ortho degree where I also got my MBA in my program. So - Okay, that's
Page 13 of 55
Mindy Hargesheimer (00:19:00):
Where the MBA is.
Jay Joshi (00:19:01):
Yeah, that's where my MBA's from. And so I thought that was a really unique program. Um, it's the only
one that has an MBA is associated with your orthodontic. Where in Nevada?
Mindy Hargesheimer (00:19:09):
It
Jay Joshi (00:19:09):
Was in Henderson, Nevada. Okay. It's a suburb of Las Vegas. Yeah. And so I did that. I came back toKansas City for a job, actually. Okay. I think my overall, being from St. Louis, my, you know, you tend
to wanna go back to where you're from. Yeah. We came back to Kansas City. I was gonna practice for
about a year or two and then move to St. Louis and start my own practice. Got
Mindy Hargesheimer (00:19:25):
It.
Jay Joshi (00:19:26):
Um, but my wife, she was very influential on this. I loved it too. I knew it the whole time, but it's really
her calling the shots on this is that, you know, we really loved Kansas City. There's so much cool culture
and excitement about Kansas City. And this is pre, you know, World Cup, pre-draft, pre-airport, all that
stuff. Right. You know, we, uh, we really felt connected. And it's funny, there's so many people in Kansas
City that are from St. Louis also. Yeah. And everyone we'd pull would be a waitress here, a barista here,
and we would say like,
"Yeah, they're from St. Louis, but they live in Kansas City.
" I will kid you not,
nine times out of 10, they said they prefer Kansas City. Yeah.
Mindy Hargesheimer (00:19:59):
So <laugh>.
Jay Joshi (00:20:00):
I believe
Mindy Hargesheimer (00:20:00):
It. Yeah. I mean, I'm not from St. Louis. Yeah. I don't have any connection to it, but, um, obviously I'm a
big hype girl for Kansas City. Yeah. So of course I totally believe it. And we were in St. Louis a couple
months ago for a volleyball tournament for our daughter. Um, and we had a good time there, but it's no
KC. St.
Jay Joshi (00:20:14):
Louis is an amazing city. Yeah. They're very similar. It's just St. Louis a little more spread. Yeah. Kansas
City has a little bit more younger energy. Yeah. Um, you can see what they've done downtown and
crosswords. Sports world. Sports worlds. Yeah. The arts, the arts are amazing in Kansas City now. Arts
are
Page 14 of 55
Mindy Hargesheimer (00:20:26):
Incredible. Yeah. Absolutely.
Jay Joshi (00:20:27):
So,
Mindy Hargesheimer (00:20:28):
Uh,
Jay Joshi (00:20:28):Speaking of which, a little side tangent. Yeah. There's, uh, one of the Casey Art, um, Plaza art shows, we
came across, um, some artists that really cool. His name is Riff Raff. Um, and so he, uh - Yeah, he was on
the podcast. He was on the pod - Yeah. He was on the podcast. Yeah. And so -
Mindy Hargesheimer (00:20:42):
He was one of the first.
Jay Joshi (00:20:43):
Yeah. Him and, and one of his friends. And we, my wife became friends with them and he actually did,
um, uh, a s - at our cocktail hour in our wedding, he did like a spray paint art lives. That is
Mindy Hargesheimer (00:20:55):
Incredible. Live for us. Yeah. So she actually brought that up when we were in the office, um, a couple
weeks ago because she saw, your wife saw him on the podcast and I was like,
"Oh my gosh, how do you
guys know each other?" Yeah. And then she, we were trying to pull up pictures and then somebody came
in. So I totally wanna see what he did for you. Oh. Because that is the coolest idea. I love that you
Jay Joshi (00:21:10):
Have. He did a really cool job in that. And then one of his close friends we met also, hi name's Sebastian
Coolidge. He, uh - Yeah. He does a lot of art as well. And so at our wedding reception, he did all these
really funky, uh, installations that you see on like wall art, downtown Casey, Crossroads stuff. Yeah. It
was very, uh, a unique experience. It was like an art show of a wedding reception. So
Mindy Hargesheimer (00:21:28):
How did you know about Riffraf and have the idea to reach out to him to do that? So my
Jay Joshi (00:21:33):
Wife, I mean, she met him at, it was one of those like pre-pods events. And we, they just hit it off. They
became friends. Okay. And we started following them. We went to some of their events and - Yeah. Um,
stayed in touch with them and stuff like that. So it was really cool. So cool.
Mindy Hargesheimer (00:21:44):
Okay. You'll have to show me pictures of that
Jay Joshi (00:21:46):
Page 15 of 55
After this too. For sure. For
Mindy Hargesheimer (00:21:47):
Sure. Um, well, speaking of, when did you and your wife meet?
Jay Joshi (00:21:51):
So we met, I was actually a fourth year dental student. Okay. And she was in grad school and we met
through mutual friends. And we were doing long distance for a little bit because she's in grad school inFlorida. That's what I was wondering. And I was here.
Mindy Hargesheimer (00:22:01):
Okay.
Jay Joshi (00:22:01):
I was going to Las Vegas and she went to a job in New York City. So - Ah.
Mindy Hargesheimer (00:22:05):
We
Jay Joshi (00:22:05):
Traveled a little bit, but it wasn't till I moved back to Kansas City that we were actually like, we're
making home base here. Yeah.
Mindy Hargesheimer (00:22:10):
So. Yeah. Okay. Perfect. Yeah. Um, okay. So should we get into the difference now - Yeah. Between a
dentist and an orthodontist? Yeah. What is the difference? You just mentioned, um, you can kind of
repeat it if you want to, but you can be, when you're an orthodontist, you're definitely a dentist, but you
can be a dentist without being an orthodontist. Yeah. So then what's the difference between the two? I
Jay Joshi (00:22:29):
Think of, if you think of the medical world, that's a good analogy. So you have your primary care doctor
or your pediatrician if you're a child. Like they're essentially kind of like the quarterback. They're the first
person that you see if you have any issues. Yeah. Like if you have an issue that's related to your, your
heart, they'll see you f - you can't just go into a cardiology office usually. Yeah. You'll have to go to your
general practitioner and they'll send a referral out and then you'll get your heart checked or whatever it is,
right? Right. Um, so a general dentist is kind of like that first line that they usually see you every six
months for cleaning. Mm-hmm. So they can screen you for certain issues or if there's things that, that are
happening wrong with your bite or smile. Yeah. I think one thing that is different about orthodontists
versus specials in the medical world is you don't necessarily need a referral to see an orthodontist.
(00:23:10):
You can cold call an orthodontic office like ours and we're happy to see you. Yeah. We might help
coordinate you, like if you call us and you don't have a general dentist, we might suggest that, you know,
if you haven't had your teeth cleaned or you might have cavities there, that we, we can help connect you
with a general dentist. Yeah. But essentially, you know, we, we're different in the sense that my field of
focus is really specific and niche to certain things such as your smile, such as your bite. Sometimes we
deal with TMJ issues. Mm-hmm. Uh, we deal with airway issues, expanders, things like that. A general
Page 16 of 55
dentist is gonna be more like, okay, they're gonna be doing your cleanings every six months. They're
gonna make sure that you don't have cavities. Mm-hmm. Um, there's some cool technology with AI that's
coming out to help diagnose those things and things like that.
(00:23:49):
Interesting. Of courseMindy Hargesheimer (00:23:50):
There is. Yeah.
Jay Joshi (00:23:51):
And, and they'll do other things too. Like they'll do like s- simple extractions. They'll do some simple
orthodontics. They can do some simple endodontics. All the different specialties, they can do some simple
stuff. Teeth
Mindy Hargesheimer (00:24:00):
Whitening.
Jay Joshi (00:24:01):
Yeah. Some, some stuff like that. Yeah. And they can do. General dentists can, if you train a lot, you can
do more and more advanced procedures. Okay. What makes the difference though is like I always think
of what makes an expert? They always say you need to do something 10,000 times to be an expert in your
field, right? Or whatever task that is. Yeah. It's all habitual. So what's different about orthodontists is we
went to three years extra school where all I did was orthodontic cases. I really, I really learned the
foundation. There's a lot of physics involved with it. There's a lot behind the scenes that people don't
think. Like orthodontics, what's different about that versus some of these other professions is you very
much have to like connect the dots like in your brain on how teeth move, how biology works. You're
connecting biology, physics, chemistry, all those sciences together - Yeah.
(00:24:42):
In different aspects, you know? And so it's really important. Like that's what orthodontist is like the
journey to get there. You learn so much that, that isn't there for general dentists. They're not doing that.
Now sometimes general dentists might do like a, a couple weekend courses or continue education courses
so they can get familiarized and they can do some simple cases certainly. But I would say, you know, if I
was a parent and I have a child that needs orthodontics, I certainly would want to see an orthodontist for
that. Yeah. You know? Yeah. Just like I would say like if I had a cardiology issue, I would want the, the
most trained professional to deal with that because they're gonna know the most, they're gonna have the
most experience, right? Yeah.
'Cause not only the education on the forefront, but if I'm doing orthodontics
on every patient, I can get to 10,000 a lot faster than if you're just doing a couple cases a year,
Mindy Hargesheimer (00:25:24):
You know? Yeah. Are you able to kinda like dive in the, you talked about like the physics behind it or
things that like, are you, can you give any kind of cool examples of things that kinda like maybe you get
most excited about - Yeah. Or that you learn that you're like,
"I would never have thought of this and this
helps me understand,
" you know?
Jay Joshi (00:25:37):
Page 17 of 55
Yeah. When you're moving teeth, um, so like there's three planes, you know, you have a front to back
plane, a side to side plane, and we call it like a Z plane that goes like diagonal through. Okay. And so
when you're moving teeth, there's different types of movements where you might need to move a tooththis way or that way, you might need to move it out or in. So - uh-huh. Knowing how to, first knowing
what, diagnosing what type of movement you need is important. Yeah. And then knowing how to do it is
another way. So there's some - uh-huh. So tactical skills in that too, but a lot of it, I think a lot of things in
the medical and dental world that when things don't go right, it's because they weren't, they're
misdiagnosed or they're underdiagnosed maybe, you know? Yeah. And so I also think on, in terms of like
talking about physics on a, like on a bone or skeletal level, like when we talk about expansion and things
like that is sometimes we think a problem is there and the easy solution is to think of it in one way.
(00:26:27):
Mm-hmm. When in reality, like you have to think of it differently. Like it's actually, maybe we though it
was a front to back problem. Yeah.
'Cause it's showing like the teeth are pushed out or something like
that. That it's pretty obvious that was a front to back problem. Yeah. But reality, it was actually a
transverse or widening problem. Like if we actually widen this, this would get better. So it's like - Things
that the
Mindy Hargesheimer (00:26:45):
Everyday person would never be able to figure
Jay Joshi (00:26:46):
Out. Yeah, exactly. Exactly. So - Yeah.
Mindy Hargesheimer (00:26:49):
It's
Jay Joshi (00:26:49):
Fun, it's fun. I think what's great about orthodontics is you constantly have to use your brain on like
thinking deeper than what the issue showing up as, you know? Yeah. Problem solving, things like that,
you know?
Mindy Hargesheimer (00:26:58):
Yeah.
Jay Joshi (00:26:59):
So.
Mindy Hargesheimer (00:26:59):
Um, okay. So what's the earliest age that you would recommend somebody coming to an orthodontist?
You said you have a patient at the age of five. Mm-hmm.
Jay Joshi (00:27:07):
Is
Mindy Hargesheimer (00:27:07):
That the norm?
Page 18 of 55Jay Joshi (00:27:07):
I'd say, okay, so we go by the guidelines from the American Association of Orthodontics. Mm-hmm. And
so they guide us to start seeing every child for screens around the age of seven. Okay. And the reason why
is so you have your first molars or permanent teeth, they start coming in around six. Mm-hmm. There's a
little bit of variability with that. You start to lose your front teeth around seven. So at the age of seven -
Yeah. Is a good time to diagnose. We like to screen every child if we can by seven. Okay. That doesn't
mean every child needs an orthodontic treatment. It just means we can start looking for certain problems,
start monitoring their growth and development. Yeah. And so my goal is for every seven year old, if we
can start putting them on a growth in, in a, you know, a watch cycle for a couple years - Yeah.
(00:27:45):
By the time they're at the age that they need orthodontics, if they even need orthodontics - uh-huh. The
parents are really well, you know, informed and knowledgeable about the plan because we are, there's no
surprise at that point. Yeah. When someone comes in at 12 or 13 thinking that, okay, now I'm ready for
braces, there's things that if everything was f - if everything worked out fine, it doesn't change anything.
But if there's things that maybe there could have been something done at an earlier age, we kind of missed
that boat. What would
Mindy Hargesheimer (00:28:09):
Those be? Like
Jay Joshi (00:28:11):
The expander?
Mindy Hargesheimer (00:28:12):
Yeah,
Jay Joshi (00:28:12):
Expander is just one example. If someone is really narrow and doesn't have enough room for their teeth or
their tongue and they're having breathing issues or they're grinding their teeth or - Yeah, we're gonna get
into
Mindy Hargesheimer (00:28:22):
All the
Jay Joshi (00:28:22):
Issues. Yeah. All, whatever the issues are. Yeah. You know, expansion is a time sensitive thing. You
wanna do that at an earlier age. When I'm looking at seven year olds, there's probably a checklist about
four or five things that I'm looking for. Okay. Um, expansion is just one of them. It could just be
something that's just like their bite is really off, they're super crowded, you know, they have a lot of wear
on their teeth. Um, they have - And grinding probably. Yeah. Grinding and that could be related to
expansion or narrow mouths and things like that. Yeah. It could just be sometimes it's just like a
psychosocial issue. Like they are not smiling and their, their mood is different because they're, maybe
they're, they're subconsciously embarrassed about their, their, their smile. And if you just change a little
bit, you know, especially, you know, in the day, ages of bullying, you see that a lot.
(00:29:05):Page 19 of 55
Okay. Like that's been a topic of discussion for the last 10 years is like, you know, unfortunately with
social media, it really accentuates it and highlights it. So - uh-huh. You know, sometimes just having a
little bit of change, if that's what they would need, it can make a big difference, you know? Yeah. Like in
those growing years, that, that middle school era is so like important to developing your self confidence
and things like that. Yeah.
Mindy Hargesheimer (00:29:25):
Big time. So. So let's kind of talk about then the, the smile. Yeah. Like that being the ultimate goal. Yeah.
And you have a psychology background. Yeah. And you guys have such a un - like a positive, friendly,
warm approach. Like how do you br - how do you incorporate this into the work that you do every day in
terms of like bringing up the importance of the smile and building confidence? Yeah. Like
Jay Joshi (00:29:46):
How
Mindy Hargesheimer (00:29:47):
Do you talk to your kids or older, I guess, people as well about it? Yeah.
Jay Joshi (00:29:52):
I think kind of taking a step back when we're talking about the difference between a medical and dental
office and like even in 2026, it's very like bland or cut. And dry or there's no like leniency or excitement,
right? I think that can create anxiety. It can create, um, negative experiences. It can, you know, if you
have that negative experience psychologically, you're like, are you gonna wanna go back there in six
months for your cleaning or for your checkup or whatever it is, you know?
Mindy Hargesheimer (00:30:17):
And the mouth is a tricky place.
Jay Joshi (00:30:18):
The mouth is a tricky place. People get
Mindy Hargesheimer (00:30:19):
Real scared to go to the dentist -
Jay Joshi (00:30:21):
Yeah.
Mindy Hargesheimer (00:30:21):
Because of the like poking and prodding and everything.
Jay Joshi (00:30:23):
Yeah. SoMindy Hargesheimer (00:30:23):
Yeah, I mean, we all know that.
Page 20 of 55
Jay Joshi (00:30:25):
And it starts at the young age. You already naturally are gonna have a little bit of anxiety as a - Yeah. As
a young child going in through. I think there's that white coat syndrome as well. You know, I, I wear my
white coat very infrequently. Um, I usually try to be more casual with weather, like a classic top, like a,
you say polo or scrub top. Oftentimes we wear t-shirts in the office - Yeah. That have, you know, some
fun branding. Like when we created Stay Smiling Orthodontics - Yeah. The name was actually created
like not as a corny thing, but like actually what we believe. Like we really want our, our patients to feel
confident in their smiles forever. Right. Like we want you to like, if you're never smiling in photos and
you start smiling, that's amazing. That's such a huge psychological change, you know?
(00:31:02):
It is
Mindy Hargesheimer (00:31:02):
Such a defining feature for people in such a positive way.
Jay Joshi (00:31:06):
Oh yeah. If
Mindy Hargesheimer (00:31:06):
You feel great with it, it's gonna show.
Jay Joshi (00:31:08):
For sure. You
Mindy Hargesheimer (00:31:09):
Know, and it's, I mean, all the things, yeah that you're gonna answer.
Jay Joshi (00:31:11):
And that energy, you're talking about like interviews for maybe college - Yeah. Prom photos, job
interviews, you know, with Zoom, people, so many people, adults were looking at their smiles in their
Zoom calls. Yeah. And they're like, oh my God, I need to do something about this, you know? Right. Oh
Mindy Hargesheimer (00:31:25):
Gosh, those days. Bringing us back, yeah. Yeah. Um, well, yeah. And it's like you can't avoid going
through life without speaking. Yeah. And your teeth are gonna show. Yeah. So just make all of it work
for you. So. Yeah.
Jay Joshi (00:31:36):
So I think at that early age, it's really important to build rapport with patients when we talk about sevenyear olds or even five year olds. The reason why I have a five year old is because that, that patient had a
really severe underbite. Yeah. And so we're, we're trying to elect to do something earlier. I don't love to
treat really, really young kids because I feel like sometimes the flip side of it is people treat kids too
young. Yeah. There's a big push in the airway world for doing expanders in three or four year olds, which
I think is a little bit extreme. I think there's, you're asking a lot for a child. Are you gonna get any
substantially better results at three or four than you would at six to nine? Sure. I don't think so. There's
more chance that things can relapse back at a younger age.
Page 21 of 55
(00:32:10):
Are they, you know, it's hard enough to get an older kid to wear a retainer. Imagine a young child wearing
a retainer for 10 years of their life, you know? And the
Mindy Hargesheimer (00:32:15):
Parents,
Jay Joshi (00:32:16):
The
Mindy Hargesheimer (00:32:16):
Difficulty of the parents, I'm gonna get them to do that too.
Jay Joshi (00:32:18):
Yeah. But I, I think building the relationship, I always make a point to kind of, in a softer way, talk to
every child like an adult. Like just talk straight to them. Yeah. And like, like really let them express
what's bothering them. If there is anything bothering, let them come out of their shell. Yeah. And I feel
like that respect really goes a long way, so.
Mindy Hargesheimer (00:32:34):
What have, what are some things that like kids have said to you that kind of stand out? One, when you
ask them like,
"Hey, is anything bothering you?" Yeah. And then two, do you have any kind of standout
stories of people maybe getting their braces off and just being like,
"Oh
Jay Joshi (00:32:48):
Yeah.
Mindy Hargesheimer (00:32:48):
You changed my world.
"
Jay Joshi (00:32:49):
You know, you'll, you'll hear all kinds of stuff. Yeah. Obviously you'll also hear like the shy kid won't say
anything and you have to kind of like peel back the layers of onion and things like that. But you know, it
could be anything from something as simple as I just want my straight teeth. Sometimes it's just like, I
want braces. It's not even about the teeth at that point. Yeah. They're so excited for braces.
Mindy Hargesheimer (00:33:07):Which I think was a thing a couple years ago on TikTok that
Jay Joshi (00:33:10):
Like
Mindy Hargesheimer (00:33:10):
Page 22 of 55
These kids, do you know what I' talking about? Like these kids, I didn't see it because I don't check
TikTok. Um, but evidently they were like,
"I want braces just for the sake of having braces.
" And I was
like,
"What?
Jay Joshi (00:33:20):
I haven't heard
Mindy Hargesheimer (00:33:21):
About this.
"
Jay Joshi (00:33:21):
I've had, I've had some patients where the smile looks great, we're done with our treatment and they don't
want to get their braces off. That is so funny. Like it's not the, it's not the norm, but it happens more
frequently than you think.
Mindy Hargesheimer (00:33:31):
Yeah.
Jay Joshi (00:33:32):
Go
Mindy Hargesheimer (00:33:32):
Figure.
Jay Joshi (00:33:33):
Yeah, the TikTok trend is fun because, um, actually there's different types of braces. We have like
ceramic braces that can blend it in. We have aligners that are like more aesthetic, uh, trays that you can
like hide. I can make movements in the aligners. Each treatment modality has pros and cons to it. The
traditional metal braces - uh-huh. Really got repopularized - Yeah. In the last few years from TikTok
trends. That's what I' talking about. I'm like - People are coming in and like - Colored
Mindy Hargesheimer (00:33:53):
Rubber bands and everybody has their story
Jay Joshi (00:33:55):Behind it. Yeah. I think people have gotten like, it's funny how social media can change things, right?
Like -
Mindy Hargesheimer (00:34:00):
Instantaneously.
Jay Joshi (00:34:01):
Yeah. The trends, the virality of trends, right?
Mindy Hargesheimer (00:34:03):
Page 23 of 55
Yes. Okay. So actually, can we talk about the different types of braces - Yeah. To fully understand, like,
do people. I'm sure you educate people on the different options. Sure. Or do you suggest, like, this is what
I would recommend based on what I think you would want? Or do you just go, what would you rather
have?
Jay Joshi (00:34:18):
Yeah, so I have a couple different models in my. There's different types of braces. And I think the most
general way to think of it is metal, ceramic, maybe gold are the three types of braces. And then there's
aligners, which are, like, clear trays that you take in and out. Um, braces, as far as those three, first three
are concerned, they're all just the same. They work the same. They're just aesthetically different. What is
Mindy Hargesheimer (00:34:37):
Gold?
Jay Joshi (00:34:37):
Gold's like, you can get, like, a gold color brace. Like - Really? Like, usually, I use, like, a light. I use,
like, a white gold type color, not - Ooh, I
Mindy Hargesheimer (00:34:44):
Don't think I've ever seen
Jay Joshi (00:34:45):
That interesting. Oh, they're, they're really - I
Mindy Hargesheimer (00:34:46):
Don't mean ooh. I mean, like, oh,
Jay Joshi (00:34:47):
I don't
Mindy Hargesheimer (00:34:47):
Think I've ever seenJay Joshi (00:34:48):
on each one. Yeah.
That. They're really pretty. I think it, it kind of suits when you're looking at the model, how the colors pop
(00:34:53):
There's other types of braces. Like, I have different types of braces that are more suited for someone
who's, like, really crowded or really narrow - Okay. That I wanna do something different that might not
rely. The colors are fun. There's a function of the colors. They kind of do things as well for the braces.
Okay. So I have a different type of brace that doesn't rely on colors that helps us with expansion and
things like that. If someone's really narrow, I might suggest that type of brace over that one. Um, but most
of the time I just let people pick what they want. Okay. They'll ask us what's the difference, and I'll
explain it, and things like that. The aligners are wild too, because aligners - Yeah. Basically how it is, it's
using technology. We're really customizing movement on software. Mm-hmm. And then we're printing
Page 24 of 55
aligners. And so we're kind of retroactively, we're, we're kind of getting to the final result by, by
backtracking.
(00:35:36):
Each aligner kind of builds on each other. Got it. So aligners work amazing as well, but it does rely on
compliance. And that's a factor that you can't control. So it's for a certain type of personality. If you have
that personality that you're pretty regimented, and most of the time the parents know for their kids - Yeah.
That my child is gonna do great with this. Yeah. You know, because people come in asking for aligners
too, you know? I would be
Mindy Hargesheimer (00:35:56):
Like,
"My child is not gonna keep up with that. Let's go with the metal.
"
Jay Joshi (00:35:59):
Yeah. It, it works great. But if you don't. Yeah. If you don't wear them like you're supposed to, it's not
gonna work. It, you're gonna be better off with braces, you
Mindy Hargesheimer (00:36:04):
Know? Yeah. What's the average time that, um, people are wearing braces, metal
Jay Joshi (00:36:09):
Braces? Yeah. I'd say for the average child, full comprehensive case is somewhere around 18 to 24
months. Okay. You know, a year and a half to two years is pretty standard. There are cases that are
outside of that. Some more simple cases that might be a year. There's some more complicated cases that
might be - Yeah. Two to three years. You know, there, every once in a while we'll get a case that's more
extended, that usually has some kind of complication, like an impacted tooth or something that is like
we're talking about in the consultation that we, we really try to stay within that two year range. Yeah. But
it might go longer, you know?
Mindy Hargesheimer (00:36:39):
What about. I feel like I don't remember this when I was a child, but I have seen this in the last, like, 10years where kids are getting braces twice.
Jay Joshi (00:36:47):
Okay. That's a great question. Okay. So when, when we're talking about seeing people at s - age seven,
we're really screening for certain kinds of problems. We're, we're gonna find problems in almost every
child. There's gonna be some kind of crowding, some kind of rotations, maybe spacing. Mm-hmm.
Something like that. If it's something that's not urgent, our preference is to then put them in a growth and
monitoring stage where we'll check them every year until they kind of grow into an older age. We're
guiding what teeth are coming out. We're helping parents understand what's going on at each
appointment. And so by the time they're probably around the age of 12 or when they've lost all their
permanent teeth, or their primary teeth, they're ready for braces. Mm-hmm. We'll guide you. We'll say,
"I
think in six months we're gonna be ready for braces.
" Okay. Or aligners or whatever it is.
(00:37:25):
So that's called one stage treatment. Mm-hmm. We're just doing braces one time. Yeah. Sometimes when
we are at that seven year age, we're diagnosing, okay, there's a narrow jaw. There's some severe
crowding. The permanent teeth are twice the size of the baby teeth and it's eating up space really quickly.
Page 25 of 55
Yeah. Um, you're, you're having some kind of shifting of your jaw. The kid can't bite on the same spot
because they're shifting their jaw. Yeah. Um - I'm like moving my mouth as you're talking. Yeah, you
might bite and you can't find your bite. You know, there's reasons that there might benefit from some kind
of earlier interventional treatment. Mm-hmm. And so we call that, we break the orthodontics into two
phases, a phase one and a phase two. Okay. The function of the phase one is really to kind of go with
those, those main concerns.
(00:38:06):
If it's hitting one of these check marks, let's take, for example, a narrow mouth, you're not enough room
for the teeth. You have a crossbite or something like that, right? Yeah. And we need to do an expander.
So the goal is to fix those problems as fast as we can. Mm-hmm. And we do some, maybe some partial
braces with that for aesthetic reasons. But, um - Okay. Essentially that treatment is gonna have a really
defined time. Usually for us, it's somewhere around nine to 12 months.
Mindy Hargesheimer (00:38:27):
Okay.
Jay Joshi (00:38:27):
Um, at the end of those nine to 12 months, we'll give some kind of retention and we'll go back into that
growth and monitoring phase like all theother kids. Got it. And we'll check them every year until they've
lost all their baby teeth, of which then they're ready for their second phase, which is their full braces. So
they
Mindy Hargesheimer (00:38:40):
Have to lose all the
Jay Joshi (00:38:41):
Teeth to get there. Yeah. And, and the reason why is because the braces will be on the shortest amount oftime if you have all your teeth in. Right. You're not waiting on baby teeth to fall out while you're in
braces. So I try to wait till all the teeth have come out. Which
Mindy Hargesheimer (00:38:51):
Makes sense. Okay. Okay, good.
Jay Joshi (00:38:53):
that, you know.
But not every child needs that phase one. It's just, if there is something needed, that's when we wanna do
Mindy Hargesheimer (00:38:58):
Is that a newer thing or did they do that and I just didn't know?
Jay Joshi (00:39:00):
I had that grown up. So when I had the head - Oh you did? Okay. Like headgear and all these things -
Yeah. Those are better suited at younger ages, right? Yeah. So we've always had it. There's, it's funny
when we talk about dogma and philosophies. Yeah. Like I think there's a, it still happens today, but there's
this philosophy where a patient might not be referred till they're 12 when they've lost their baby teeth and
they get sent over by the dentist. Mm-hmm. Or the parent might think, okay, now we need braces. And
Page 26 of 55
they come over and it's like at that point we might have missed the growth window on certain things. So
that's just natural thinking. So that's - So it
Mindy Hargesheimer (00:39:26):
Could potentially be more extensive in terms of like
Jay Joshi (00:39:29):
How long
Mindy Hargesheimer (00:39:29):
They might have to wear them or?
Jay Joshi (00:39:31):
Or it could be some kind of, um, sequela that you didn't want. Yeah. Like maybe they need permanent
extractions because we didn't make enough room at an earlier age, you know, or things like that. Yeah. So
there's all kinds of things. I think that's why early screening is important. Screening does not mean
treatment. Screening just means we're kind of ruling out certain things and we're giving you the
confidence to know that we can make a good plan if that means waiting till a later age or starting
something right now.
Mindy Hargesheimer (00:39:53):
So at the end of the day, would you recommend any seven year old to come in?
Jay Joshi (00:39:58):I would recommend any seven year old to see an orthodontist. Okay. And most orthodontist, including
myself, um, we do these screenings complimentary for the most part. Oh really? Yeah. We do these
things really complimentary - Okay. Because we're here to be an aide for parents. Yeah. You know, we
take rec - I take, not everyone takes records, but I take full records, photos, x-rays, and I don't charge
anything for that. I like let - That's
Mindy Hargesheimer (00:40:16):
Really good to know. That's, that was gonna be my question. If people are like,
"I don't really have the,
the budget right now to do this without knowing for sure that we need that next step.
" So.
Jay Joshi (00:40:24):
And it's really like I do that because I wanna reduce the barrier. I don't want you to think that
orthodontists, we're not there to like make money off of you or anything like that. We're trying to screen
you to help educate you for your future plans. Yeah. So if there's something that we can do to help you -
uh-huh. We wanna be a resource for you, so.
Mindy Hargesheimer (00:40:37):
Okay. Good to know. Um, and then I was gonna ask too, like, just out of curiosity, like what percentage
of your patients are new to you that are maybe older and looking to go back and straighten their teeth
again because they forgot to wear their retainer? Not forgot, just chose not to wear it for the next couple
decades.
Page 27 of 55
Jay Joshi (00:40:54):
That's great question. You know, I think, um, as far as orthodox for my practice, I'd say we're still
majority pediatrics, but we see a lot of adults. I'd say my split's probably at least 70 / 30. Okay. 70% kids,
30 adults. Yeah. Um, I think the, the amount of adults that we're seeing in 2026 is much higher than it was
10 years ago, 15 years ago. Um, I think adult treatment's becoming more popularized. Yeah. You know,
insurances are now starting to cover adults more, which traditionally they would only cover kids. Um,
you're seeing yourself in Zoom, you're seeing, you know, you're having things like - Yeah. We're living
longer,
Mindy Hargesheimer (00:41:28):
So- Social media, any of it. I mean, I literally, my mom -
Jay Joshi (00:41:31):
Yeah.
Mindy Hargesheimer (00:41:32):
Who will listen to this, is 78 and she wants Invisalign. And I'm like,
"Why? You're almost 80.
" Yeah.
Jay Joshi (00:41:38):
"WhatMindy Hargesheimer (00:41:38):
Difference does it make?" And it bothers her.
Jay Joshi (00:41:40):
Yeah. She
Mindy Hargesheimer (00:41:41):
Looks 70
Jay Joshi (00:41:41):
Every day. 81's my oldest patient, but she was 79 when she started. So - Yeah. I have several, I've, I didn't
have, I've never started someone in their 80s. Yeah. I finished someone in their 80s, but I've, I have
several 70s. 70s like the new 50, right? Yeah. Like people are living a lot longer. I like that. Mm-hmm. So
I think if you were 50, I would think that's very reasonable to get orthodontics. And if 70, if you're living
longer, you know, you wanna be confident with your smile. And like, what do you live for? You wanna
live to - Yeah. Like enjoy your life, right? So. And we're
Mindy Hargesheimer (00:42:07):
Taking so many photos all the time. Yeah. And even your grandkids are getting you on video for
snapping or whatever. But again, going back to the original point of all of this, I think that's such a
testament to, till the day we die. Yeah. Our smile is going to be a defining factor of our confidence -
Jay Joshi (00:42:21):
Yeah.
Page 28 of 55
Mindy Hargesheimer (00:42:21):
In what we want. So that's all about what you're doing.
Jay Joshi (00:42:24):
And speaking of trends, like not to go on a tangent here, but speak of trends. Please go on a tangent.
Mindy Hargesheimer (00:42:28):
I love tangents.
Jay Joshi (00:42:28):
Speaking of trends, like on social media, like veneers are very popular now too. Oh yeah. So veneers are
basically when, um, a dentist might cover the front surface of your teeth. Um - So it's
Mindy Hargesheimer (00:42:37):
A dentist, you don't do -
Jay Joshi (00:42:39):I don't do them myself, but, um - Okay. Usually they'll call it like a cosmetic dentist will do it or so. And
veneers are pretty expensive. Like you're talking about a couple thousand dollars per tooth, right? Yeah.
So it's something, there's a cost element to that. Also, sometimes veneers, you need to shave your teeth
down to fit the veneer. And so that, that can compromise your tooth structure. Yeah. Sometimes people
resort to veneers over orthodontics because of the speed aspect of it because they can, you can get
instantaneous smile. I've never loved that because I think there's nothing more b - like in any part of your
body. Nothing's better than the original. The original's always better. So if you can get your teeth in a
better spot - Yeah. It's gonna be a long term, you're gonna have better longevity. It's not something you
have to maintain as strong.
(00:43:16):
Like you have to wear a retainer, but you don't have to wear - Sure. Worry about replacing veneers or
crowns in your future, like every 10 years or whatever it is, you know?
Mindy Hargesheimer (00:43:23):
Yeah. Well, I'm just gonna say it.
Jay Joshi (00:43:25):
Yeah.
Mindy Hargesheimer (00:43:25):
Whether people like it or not. But like, I mean, my teeth are clearly imperfect and whatever, and so I don't
have veneers. And I love the idea of veneers, but some people have gone so far - uh-huh. With them that
it's like clearly not natural. And I'm like, maybe - Yeah. Can we tone it back a little bit? Nobody asked my
opinion, but I'm just, just wondering, you know - For sure. It's just like it's gotten really far. So.
Jay Joshi (00:43:47):
I think what's really cool about orthodontics that you see, like, really, like, really great orthodontist that I
admire. I do the same thing as it's not just about straightening the teeth. There's some elements of
aesthetics that go at the end of your treatment. Such as, it could be, we call it contouring, like, shaping the
Page 29 of 55
edges of your teeth. Oh. Where you had wear and things like that. So we create these, like, natural
veneers. We call them natural veneers. Mm-hmm. Literally your natural teeth look like veneers, but
they're, they're the normal shade. Okay. They're the shade that you are balanced to get. Yeah. Now maybe
you need to do a little bit of whitening to, like - Yeah. Brighten it up a little bit. Sometimes we'll do a
little bit of gum plasty and kind of change the shape or heighten your thing. I like that though.
(00:44:21):
Yeah. I
Mindy Hargesheimer (00:44:21):
Didn't know that was a -
Jay Joshi (00:44:22):
Oh, yeah. Those a lot in orthodontics. Perfect. And really, it really sets, like, a case from, like, a really
good finish to an excellent finish, you know?Mindy Hargesheimer (00:44:29):
And a fraction of the cost?
Jay Joshi (00:44:31):
Um, you know, it just depends on the orthodontist. Okay. A lot of times we're not, like, I don't charge on
a lot of these procedures. Okay. I just do it as part of being, being a good orthodontist. Yeah.
'Cause I
want, at the end of the day, I want you to have the smile that you dream for, you know? Yeah. And so,
Mindy Hargesheimer (00:44:43):
You know. Okay. And speaking of which, so coming to you, you have two offices.
Jay Joshi (00:44:47):
Mm-hmm.
Mindy Hargesheimer (00:44:47):
Right? Um, is the Lennoxa one new?
Jay Joshi (00:44:49):
The Lennoxa one's newer, yeah.
Mindy Hargesheimer (00:44:50):
Okay. So, um, you took over.
Jay Joshi (00:44:53):
Yep.
Mindy Hargesheimer (00:44:54):
Stay smiling.
Jay Joshi (00:44:54):
Page 30 of 55
Yep. So
Mindy Hargesheimer (00:44:54):
You wanna talk a little bit about that?
Jay Joshi (00:44:56):
Yeah. So typically, what used to happen a lot was you graduate and you'd rather go open up a shingle
somewhere, like, typically, particularly if you're, like, from a small town or whatever. Mm-hmm. Or you
buy a, a practice for a doctor that's retiring. So - Okay. I bought my practice from a really, you know, a
respectable, um, really revered orthodontist here, out here in Overland Park. Mm-hmm. And so it was a
really match made in heaven because his, I think what's really important when you buy a practice is you
have to make sure your personalities kind of, or your core values kind of match, you know? And so, like,do we still value the same things for our patients, for our team, for ourselves? And so it worked out really
great for that. Mm-hmm. So it was a good foundation. I did that first and we really - Okay.
(00:45:38):
Now we have to make some changes because I have, you know, more training on newer technologies that
might not be implemented in the practice. Sure. You can't always implement change right away. You kind
of have to gradually do it, otherwise it'll spook people off and team members. Yeah, because you're
Mindy Hargesheimer (00:45:50):
Acquiring -
Jay Joshi (00:45:51):
Yes.
Mindy Hargesheimer (00:45:51):
Many of those patients.
Jay Joshi (00:45:52):
Yeah. Yeah. And not just the patients, this team. Like they're used to doing it a certain way. So if I start
saying,
"Okay, now we're gonna do it this way, this way, this way,
" because I had that training in
residency, it, they're gonna get overwhelmed. Yeah. And so we kind of do slow changes over the years.
So that's what we've done. We've done some slow changes to kind of modernize the practice. Yeah. That
might be with technology, that might be with techniques and things like that. Yeah. Um, when I did stay
small, one thing about the practice that I acquired is it's in an office layout and setting that was designed
by him. And it, it works great. It's amazing. Yeah. When I built the Lenexa one, it was kind of fun
because it's like building your own house or building - You got to design
Mindy Hargesheimer (00:46:26):
The whole thing?
Jay Joshi (00:46:27):
Design the whole thing. Yeah. Materials, the layout, the flow. We really valued bright lights. We have
windows and natural lights. It is so
Mindy Hargesheimer (00:46:34):
Page 31 of 55
Bright and beautiful. Yeah.
Jay Joshi (00:46:35):
It's almost too bright sometimes, right? Yeah, for you
Mindy Hargesheimer (00:46:37):
Guys.
Jay Joshi (00:46:37):Yeah, yeah. It's, it's really great though. Trees, natural trees everywhere. We really try to make this fun ex
- like remember this all ties back to the same thing. Yeah. We want our patients to feel comfortable and
like conversational and it's not, it doesn't have to be your typical office where you go in a room, they shut
the door, you're waiting there for a doctor. It's taking forever. Then they come in. Yeah. It's a transactional
type, um, treatment appointment. Like our visits are not transactional. Yeah. It's really like getting to the
core of like connection with people, you know?m. It's really important for me. Like I don't want, this is
not, I didn't become an orthodontist just to straighten your teeth. Yeah. I meant to build relationships
because ultimately at the end of the day with our team, with our patients, we're, we're creating like family
bonds.
(00:47:18):
Like you see the orthodontist for a couple years. Yeah. And then if you have other siblings, like with the
parents and the kids, like we're seeing younger kids at their older, their older siblings' appointments.
Yeah. Then they graduate, they're ready to get treatment. Yeah. So it's kind of this full circle moment and
like we really get to connect with families.
Mindy Hargesheimer (00:47:33):
Well, let's also talk about the fact that like you're going in there and your mouth is like, like you gotta be
real comfortable with the team that's there because you're in a vulnerable position.
Jay Joshi (00:47:41):
Yeah, for sure. For sure. So, yeah. I think it's really fun. Honestly, like, you know, sometimes we have to
catch ourselves because we're having conversation when their mouth is open, they can't talk. Yeah. You
know, things like that. But, uh - Yeah. No, I think it's really important to make this a really good
experience. The journey's equally important as the result. At the end of day, the result is the most
important, because that's what you got in, into it. But we wanna make sure that every patient and parent
enjoys the experience. We wanna make it - Yeah. You know, reduce the barriers of negativity, right?
Mindy Hargesheimer (00:48:07):
So how did you decide on Lenexa and do you have a vision to keep growing
Jay Joshi (00:48:10):
Busy? Yeah. So I actually practiced, before I bought my practices, I was an associate doctor at a couple
different, uh, clinics. Okay. And one of the clinics was in Lenexa. So I was there for about nine years. So
I was very integrated with the community there. Yeah. I decided to open up there. Um, there's a pediatric
dentist that asked me. She owns the building. And so - Yeah. Pediatric dentists and orthodontists, we
share a lot of the same patient age, ages. And we can do a lot of education with the pediatric dentists and
their teams, what to look for for different things that might be something that can help them in their
practice field. Mm-hmm. That could be something as simple as like a habit, like, you know, a thumb
Page 32 of 55
sucking habit or something like that. Yeah. Or we're not ready to do orthodontics, but they can diagnose
those problems early and try to see if we can change the behavior.
(00:48:51):
Like it's all coming back to the same thing. Yeah. Psychology, things like that. Yeah. And sometimes they
need to send over for that screening at seven so we can start to watch them. So I think orthodontists and
pediatric dentists go really hand in hand a lot, a lot of the times. DoMindy Hargesheimer (00:49:02):
You work with basically any dentist who refers somebody to you or do you have
Jay Joshi (00:49:05):
Like
Mindy Hargesheimer (00:49:05):
Certain relationships or partnerships?
Jay Joshi (00:49:07):
No, I work with all dentists and stuff. Obviously we have some dentists that we work with more because
we have that relationship - Yeah. That we built, but we're always building new relationships with new
professionals. Yeah. And there's new dentists coming into the field. There's dentists exiting and retiring.
So it's constantly this change. Yeah, that's true. One thing that I do is I'm part of different study clubs. I'm
on the board of a couple study clubs where we - Okay. Me and some other specialists, we actually give
lectures out. Oh. So we're really about educating the field on different topics that could be mine's
obviously the field of orthodontics, but we learn, I learn from other specialist things too that are really
cool. So.
Mindy Hargesheimer (00:49:38):
And podcasts. We talk about you listen to podcasts
Jay Joshi (00:49:39):
As well. That's right. That's
Mindy Hargesheimer (00:49:41):
Right. Great. Okay. So you mentioned thumb sucking. So can we get into, um, so I had here, what are
some of the earliest signs in a baby toddler or school aged kid that a parent might miss that signal a
breathing or airway problem? So what are some of the things that could trigger? Like what does thumb
sucking or a pacifier or a straw, I don't know.
Jay Joshi (00:49:59):
Yeah. All
Mindy Hargesheimer (00:49:59):
The things that we should know about if you have a kid at that age.
Jay Joshi (00:50:02):
Page 33 of 55
Those are great, great questions. So let's start with the sucking habit. Yeah. When you're sucking, you
have a force going in this direction. Mm-hmm. And so what can happen is your, your maxilla or your
upper jaw is really developing in those, that first 10 to 12 years of life. You know, they say it takes about,
at the age of 12, 90% of your maxilla is, is done growing, right? Okay. And so, but there's so manyformative years there. So if you have this sucking habit, what tends to happen is your, your maxilla tends
to narrow in. You tend to get a more vaulted or deeper palate. Mm-hmm. And that makes it harder to kind
of breathe. Basically, when you have a deep palate, your tongue is really important to kind of close off the
mouth when you're at rest. Yeah. Your tongue can't get there because the palate's too deep.
(00:50:43):
Yeah. And so you end up mouth breathing. Mm-hmm. So I think it's important to talk about mouth
breathing versus nasal breathing. Why is - Yeah. Why, why do you want to nasal breathe, right? There's a
lot of different factors. Mm-hmm. First and foremost, when you nasal breathe, um, you're breathing
through your nose. I, I subscribe to a theory that is basically when you're running from a bear, your fight
or flight response kicks in. Mm-hmm. And you're really trying to breathe really heavily. Like you have,
you can get more efficiency or you can breathe faster if you're breathing through your mouth, right?
Right. And so you're breathing heavily to run from the bear. You need to get more oxygen to your body,
you know? Mm-hmm. Um, that's a heihtened state, you know? If you're mouth breathing at night when
you're sleeping, if a child's doing it, they're not really relaxed in their sleep.
(00:51:23):
Yeah. They're kind of a little bit on edge. And so I don't think that sleep is proper sleep, you know? Right.
I think you would want, much be in a more relaxed state, breathing through your nose. Also, when you
breathe through your nose, there's like, there's like different scientific things that are better. Like you kind
of pick up nitrous ox - nitric oxide from some of your other sinuses. That's really important for like
dilating your veins - uh-huh. And like getting more oxygen flow. Ultimately it's about getting more
oxygen flow to the rest of your brain, your organs, you know?
Mindy Hargesheimer (00:51:49):
So I think Elin, when we talked about her, I think she is a mouth breather. Okay. She's our daughter who's
nine. So what has led up to that and what do we need to do in that situation?
Jay Joshi (00:52:02):
Yeah.
Mindy Hargesheimer (00:52:02):
Or how do we know that she is mouth breathing without me literally sitting next to her
Jay Joshi (00:52:06):
As she's sleeping? I think the first thing you can do is just silently try to observe her at rest during the day
and also peeping in her at night. Okay. Like you can tell if someone's mouth breathing through their nose.
They might have their, their chin back. You can almost see that like long face that is created because
they're breathing through their mouth, right? Okay. Um, other signs is you can, you can tell by maybe
some like effects such as if the palate narrows in or deepens or, and you have that vaulted shape. Mm
hmm. That's kind of, it could be a sign that you're getting some of that, that mouth breathing habits, you
know? But
Mindy Hargesheimer (00:52:37):
Ultimately you're gonna identify that.
Page 34 of 55
Jay Joshi (00:52:38):I'll determine that. That's why I was seeing at seven. Yeah. Sometimes you can see some bags form
around the eyes. Sometimes you can just pay attention to their like attention during the day. Like
oftentimes ADHD is so overdiagnosed and medicated to, for these things. I think there's a large, there's a
correlation between, you know, airway and ADHD. Like not causation, but - Right. Correlation. So like
you might wanna check if someone's having ADHD, like, do they have enough air that they're getting
night? How, how good is their quality of sleep? Because
Mindy Hargesheimer (00:53:05):
It's affecting the quality of sleep, which is affecting how they operate,
Jay Joshi (00:53:08):
Function during the day hours. Yeah. I can, can you imagine if someone's like tired and more irritable the
next day? Yeah. Like they're not gonna wanna focus at school. They're gonna wanna like - Yeah. Go into
a different place or head space, you know? It's
Mindy Hargesheimer (00:53:18):
A really good point. I just think that there's probably a lot of people, including myself, who would not
have associated ADHD with, are you sleeping well at
Jay Joshi (00:53:24):
Night?
Mindy Hargesheimer (00:53:25):
So I think that's good.
Jay Joshi (00:53:26):
And there's oth signs. Sometimes kids can, like if bedwetting might be more or less, um, something that is
relatively normal for a certain age, but if you're going to an older age and you're still bedwetting, you
could, you might be concerned that - Okay. Maybe you're not getting enough air at night. They're not be -
their body's just working on a different level, you know? Um, I think, I think just sometimes, oftentimes
kids know if they mouth breathe, you know? Yeah. Um, are they constantly stuffy? Are they. I mean,
allergies is something that we all go through. So just because you have allergies or stuffy doesn't mean -
Where we live. Yeah. It doesn't mean you have an airway issue or anything like that. But, um - But
Mindy Hargesheimer (00:54:01):
Nonetheless, it
Jay Joshi (00:54:01):
Affects - I think these are, in, in part of my seven-year-old check is we do a, a pretty extensive
questionnaire, and we try to ask these questions, and then we kind of have these discussions. And
sometimes you don't know. Sometimes it's just something that we need to monitor. Like we see them at
seven, doesn't mean we're treating anything. We wanna start asking the right questions and start looking
out for the right
Mindy Hargesheimer (00:54:18):
Page 35 of 55Things. Get ahead of it, right? Yeah. Or preventative and not have to go back and do more work - Yeah,
exactly. Than it's necessary. Um, okay. So ultimately, we don't wanna suck a thumb. Mm-hmm. We
ideally don't wanna suck a pacifier or is it, is that really just - I think there's a
Jay Joshi (00:54:32):
Certain age that's normal. Okay. Like I'd say by the time the child is two or three, you wanna start
breaking these habits, you know? Yeah.
'Cause then - Two or three.
Mindy Hargesheimer (00:54:38):
Okay.
Jay Joshi (00:54:39):
Yeah. I don't think you're gonna have substantial changes to your jaws or anything or from the younger
age. They sometimes need that for comfort at a certain age, but I think once you can start weaning off of
that - Yeah. Certainly by the time they have their permanent teeth, you definitely wanna be, you know,
out of any habits, you know?
Mindy Hargesheimer (00:54:53):
Okay. So sometimes we talked about snoring, uh, mouth breathing, dark circles, bedwetting, ADHD.
Mm-hmm. Anything else to look for that might be a sign for a parent to see or that you would ask about?
Jay Joshi (00:55:04):
Yeah. Sometimes grinding your teeth or clenching your teeth. I think a lot of kids, it's a normal, normal
sequela because you have teeth coming in, teeth coming out. You can't quite get the perfect bite. So when
kids are losing teeth, they oftentimes will be grinding. It's important to know, are those habits kind of
subsiding and going away on their own? If they're continually grind into their, from seven, eight, nine,
you might be concerned that they're not getting enough air and they're having that par- parafunctional
activity at night. Yeah. And so that's something else we look at. We look at not just asking you if, you
know, if you're, if you can hear it. Yeah. But there's signs on the teeth. You can tell like if the teeth have
really worn down, they have like wear and, and they have like shorter heights and things like that that we
look for.
Mindy Hargesheimer (00:55:42):
Which is me, by the way. I'm definitely a night mouth grinder. Um, okay. So I wanted to talk about, um,
if a child doesn't do anything to address that or if they don't see you - uh-huh. How could that show up
10, 20, 30 years later? Yeah. How would that affect them physically, health wise, anything? Yeah.
Jay Joshi (00:56:02):
And
Mindy Hargesheimer (00:56:03):
You - To try to avoid.
Jay Joshi (00:56:04):
Page 36 of 55I think you can hone- honestly see this in a lot of adults that were never treated with orthodontics. Okay.
So, you know, part of my practice is we see a lot of adults that have TMJ issues too. Yeah. And so TMJ is
your joint right up here. And sometimes that can create pain in your muscles right here when you open
and close. Like these are quality of life issues. And so one, one kind of correlation that I've seen in my
practice is o- oftentimes people who have TMJ issues have narrow maxillus. So I always wondered if they
had expansion at a younger age, would that help avoid or maybe at least reduce one risk factor for TMJ
issues, you know? Yeah. Um, adults that come in, you know, they're getting poor sleep, they're having a
bite, um, misalignment. These are things that can cause, um, you know, clenching, grinding, TMJ issues.
(00:56:48):
There's certain medications that can create issues. Um, like if you're taking, you know, an SSRI or
something that, you know, that's meant for depression or something that can create some - I was
Mindy Hargesheimer (00:56:59):
Like,
Jay Joshi (00:56:59):
What's an SSRI? SSRIs are old drugs for antidepressive drugs, I'll say. Yeah. Okay. You know, um,
alcohol, tobacco, caffeine, they can all affect how you sleep and how you're, you're on edge a little bit,
you know?
Mindy Hargesheimer (00:57:09):
Yep.
Jay Joshi (00:57:10):
Um, definitely airway is just one component. You know, it's not the, the overall stating thing for
clenching or grinding.
Mindy Hargesheimer (00:57:15):
Yeah. Okay. What is your take on mouth tape?
Jay Joshi (00:57:20):
So I think it's interesting. I just saw a post from a pediatric ENT and mouth tape is one of these viral
things as well, you know? Oh yeah.
Mindy Hargesheimer (00:57:27):
Yeah.
Jay Joshi (00:57:27):
So -
Mindy Hargesheimer (00:57:28):
I listened to a podcast and, uh, the wife of the podcast is all about it. She created her own line of it.
Jay Joshi (00:57:33):
Yeah. IPage 37 of 55
Mindy Hargesheimer (00:57:33):
Haven't tried it. But I wanted to ask you.
Jay Joshi (00:57:36):
You know, I think, I think a lot of these trends that we do, we don't really have a great research idea.
Yeah. Like research is tough because sometimes trends or doing action precipitates change to look into
this with research. So when people put mouth tape on there, they're really trying to prevent you from
mouth breathing, right? Right. And so you, you're trying to force yourself to breath through nose because
you need to get air in a gas at night. I thought it was interesting from the pediatric ENT is really not
recommending doing that in children. Because, you know, children are changing. Their, their, their nasal
structures, their oral structures are constantly changing where mouth breathing, like you need to get
oxygen. You don't want, and you wanna promote nasal breathing, but you don't wanna force it into that
maybe you're not getting enough oxygen at night.
(00:58:19):
Yeah. And so for a growing child, I would never try mouth tape on them, you know? No.
Mindy Hargesheimer (00:58:23):
I mean, I can imagine that could cause some, for lack of a better word, trauma.
Jay Joshi (00:58:26):
Yeah. Somebody
Mindy Hargesheimer (00:58:26):
All of a sudden is like feeling like they
Jay Joshi (00:58:28):
Aren't
Mindy Hargesheimer (00:58:28):
Getting enough air, you know?
Jay Joshi (00:58:29):
But there are people that, like, there are providers, like, that subscribe to some of these trends and they
will, they'll do things on kids. And I don't, I don't like that, you know? Yeah. I think on an adult, I, you
know, I, I guess I don't really have enough, like, concrete evidence - Yeah. To say it's good or bad. I
would think in terms of breaking habits, it could be a, a good thing short term, maybe. I don't think
anybody wants a mouth tape for the rest of their life, but if you can somehow figure out a way to nasal
breathe, I, I could see it being positive, you know?
Mindy Hargesheimer (00:58:56):
If I were to start it now - uh-huh. What would it do for me, I guess, ultimately? Is it gonna change the way
my face looks? I don'tJay Joshi (00:59:03):
Think so. Is it going to
Page 38 of 55
Mindy Hargesheimer (00:59:03):
Change my health?
Jay Joshi (00:59:05):
Yeah, I don't think it changes the way your face look. Okay. I think it just forcing you to breathe through
your nose, right? And the whole idea is if you use mouth tape for a certain amount of time - Yeah. You
breathe through nose. This goes back to that psychology. There's this theory called, uh, classical
conditioning. Basically, there's a scientist, his name was Pavlov, and he had a dog, and so every time he
would come in with a piece of meat, he would ring a bell and the dog would salivate, right? Right.
'Cause
the dog was looking at the meat and saliva. You bring me back
Mindy Hargesheimer (00:59:27):
To, like,
Jay Joshi (00:59:28):
Middle school or elementary
Mindy Hargesheimer (00:59:29):
School. I don't remember which one.
Jay Joshi (00:59:30):
Yeah, you take, you take the, you take the, the meat away and you just ring the bell and he still salivates.
Yeah. So the whole idea is to, like, train your body to breathe your nose so that way you take the mouth
tape off. Right. And then now you brea through your nose still. I'm like,
Mindy Hargesheimer (00:59:41):
Am I gonna wake up prettier - Yeah. Because of my mouth tape? I don't know. Let's talk about that. Um,
any other, any other, uh, topics related to mouth breathing that we haven't talked about? Um, things like
deviated septum. We talked about allergies, enlarged tonsils, adenoids, anything to know with that?
Jay Joshi (00:59:59):
Yeah. I think G - um, I think one thing is that's really important when you talk about mouth breathing
airways, this, there's not, there's a lot of people in different fields that have some kind of ties to airway.
Mm-hmm. <affirmative>. Um, that could be an ENT, it could be a pediatric, uh, ENT, it could be a, um,
primary care pediatrician. It could be the orthodontist or a dentist, you know? We all, all, at the end of the
day, we all want, want what's best for the child. Yeah. But we might be looking at different lenses. And so
I think the communication between different fields is really important. I don't think every child that has an
airway issue needs an expander. Actually, I would actually caution people not to do that. Okay.
'Cause
sometimes people come in looking for expanders and I have to actually pump the brakes a little bit and
say,
"You know, I think we need to do some deeper diving.You might need to see an ENT to look at yourseptum or even if your turbinates, if they're too inflamed.
" Yeah.
(01:00:46):
Sometimes, oftentimes - Just because
Mindy Hargesheimer (01:00:47):
Page 39 of 55
The influencer or your neighbor had an expander doesn't
Jay Joshi (01:00:50):
Mean that
Mindy Hargesheimer (01:00:50):
You probably need one,
Jay Joshi (01:00:51):
So. Right. I mean, I, I think when I, when I look at it, that's why I love these diagnoses at seven or eight.
Yeah. Because I'm looking at it on a whole picture. Airway's just one component. Yeah. Sometimes what
we do is oftentimes when we need the expander, it's not, I will never, I will never start with an expander
for just an airway concern. Okay. It's usually tied to something else. Like if it's like that deep palate we're
talking about. Yeah. Or if they have a crossbite or if they just don't have enough room for their teeth.
Mm-hmm. And what I'll tell parents is like, when we expand, we have our scope of orthodontics is
looking at space evaluation, looking at the, the amount of space we can create for the tongue. Yeah. Um, I
hope that when we expand, we're increasing the nasal passages, we're increasing the volume of, of air you
can get.
(01:01:35):
Is that gonna be clinically relevant to fixing your airway issues? We don't know. Mm-hmm. Um, airway
issues can be up here. Yeah. But they can also be down here. And, and expander isn't gonna fix it down
here, right? Right. And so I think that I like to do, if I say like, you know, we're creating more space for
your teeth and we're fixing your crossbite, and if we can get an airway improvement, that would be
amazing, right? Right. But that's not our, our, that's not what we're getting. We're not doing the expander
to fix the airway issue. Oftentimes I'll find anecdotally - uh-huh. That usually you do see positive effects
on the airway. You know, it's almost in every patient. I, it, it, it can't get worse. It can only get better,
right? Yeah. So.
Mindy Hargesheimer (01:02:11):
Well, and you and I had talked about like the airway thing has become more of a hot topic. Uh-huh. What
do you think kind of has made that a hot topic? What has sort of triggered that to be more of a
conversation point? Or is it more findings that people. Is it social media? Is it.
Jay Joshi (01:02:24):
I think, I think it's a trend, social media. I think, you know, parents have always probably been concerned
about their kids. Like if you have a child that's struggling to breathe at night you can hear them huffing
and puffing. Mm-hmm. Or you can hear them like you see their energy down. There's. It's just. I think
parents are such good, specifically moms, are such great caretakers that they care so much about their
kids. Yeah. You gotta do something. And it's a really hard conversation for me. If you're talking aboutsomeone providing treatment on a three-year-old versus a seven-year-old, that's a big difference. Sure.
Sometimes it's hard to tell someone that I think if we can manage symptoms a little bit right now, we can
wait. Mm-hmm. Sometimes they, you'll see this a lot. Like they're guided so much that they'll see an ENT
and they'll have to get their tonsils or adenoids out.
(01:03:04):
Yeah. But at the minute they get that obstruction removed, the child is breathing so much better. Yeah.
Um, something else I wanted to talk about real quickly before we move on from airway is - Yeah. I kind
of make this analogy for patients that like you're at a party and the party's getting too overcrowded and
Page 40 of 55
there's just not enough room for everyone. So you gotta do something about it. You can rather tell some
people to leave to make more room for the rest of us, or you can move to a different room and have more
space for everybody. So when I think of expansion, I'm thinking about moving to a different room. Mm
hmm. I'm trying to change the structure of the jaw to make more capacity for air, make more room for
your teeth, to make a wider arch, which is actually more aesthetic when you talk about - Yeah.
(01:03:43):
Different things with a smile. A wider spile is more desirable. Um, and then if you talk about on the flip
side, if you're removing structure, you know, you might be removing adenoids to create more room in the
air right here. You might be removing teeth to fix crowding or to, um, kind of resolve. There's just not
enough room for everything. Yeah. And so that's like a, another reactive type treatment. I think the
expanders are more proactive treatment. One's not better than the other always. Sometimes it's, they're
both at the end of the day creating a, a result that's gonna help you with more space, right? Yeah. It's just,
I wanna try to avoid taking out structures if we can. We
Mindy Hargesheimer (01:04:19):
Don't wanna lose any people at the party. Yeah.
Jay Joshi (01:04:21):
Absolutely. I, I would ra - I'd rather, I'd rather have everybody there and having a good time, right? And
so - Absolutely. I, I just think sometimes you need both. Yeah. Sometimes you need both. Sometimes
you can get away with one. And my preference is, if there's an ability to make more space, um, I'd
rather, I like to do that at a younger age. Yeah. Versus waiting till you're 12 and it's too late and then you
have to like take teeth out, let's
Mindy Hargesheimer (01:04:40):
Say, you know? Yeah. I love all the kind of preventative topics and that falls in line with that. So that's
perfect.
Jay Joshi (01:04:44):
Yeah.
Mindy Hargesheimer (01:04:44):
Um, okay, perfect. Another thing that's kind of a hot topic right now are GLP-1 drugs, like Ozempic and
everything. Are you seeing any effects from those drugs on people's smiles, teeth, anything that people
might wanna be aware of? Or is that even a topic?Jay Joshi (01:04:58):
No, I think that's a great topic. I think taking a step back actually, this is not really, I'm not really talking
about orthodontics specifically, but there are a couple of drugs that can create your gums, can get really
inflamed and red and puffy. I actually have a funny story. My sister-in-law actually has dealt with that.
We call it gingivitis or - Okay. Inflamed gums, right? Mm-hmm. She's dealt with that her whole life.
They've always been a little bit more pl - puffy and inflamed. They've been a little bit more red. Um, and
so she's recently saw me, like I'm an orthodontist, I'm in the family. Yeah. We wanna help her with her
teeth, but because her gums aren't in a great state, it's, you wanna kinda get that resolved before. Yeah. So
when I saw her, we started asking some questions why. We never. No one ever thought her dentist and her
doctors when she grew up, never thought to ask questions beyond why are my gums inflamed?
(01:05:43):
Page 41 of 55
As a child - Interesting. As a child. Like you'd think that - Yeah. Maybe if you're an adult and you're not
taking care of your teeth, that's one thing, but is there some genetic component? Right. Is there some
environmental component? So we'd start doing some digging in and some investigation. And then we
started thinking. I was working with a periodontist friend of mine because I wanted him to check her out
for the inflamed gums. And we started talking. We're like,
"You know what? What medications are you
taking?" Mm-hmm. And we found out that she was taking some blood pressure medication. Um, and
there's, there's different types of blood pressure medications. One's, there's a type, it's called calcium
channel blockers. Okay. It's a commonly used thing for blood pressure. And that is a known thing to
create gingival hyperplasia inflammation, right? And so there's a couple drugs, like that's one, you know,
if you're taking those antidepressive drugs that can do it.
(01:06:23):
Yep. Any immunosuppressant drugs, they can do it. If people have seizures, they take like Dilantin. Mm
hmm. That can also create. So there's some things that you see these puffy gums in dental school, you
look at different things like Dilantin, you know - Yeah. Puffy gums, you always ask the questions like,
"Are you taking any of these medications?" So - But
Mindy Hargesheimer (01:06:38):
Nobody had ever
Jay Joshi (01:06:38):
Asked her. No one had asked her. So we - That's wild. Yeah. So her cardiologist, we talked to them about
it and they're like,
"Oh yeah, I, that could be a thing.
" So we changed to a different, um, type of blood
pressure medication that wasn't calcium channel blocker. And magically, the gums have thinned out.
They've turned more pink - All these years later. They' turned more pink and more better. So -
Mindy Hargesheimer (01:06:55):
Wow.
Jay Joshi (01:06:55):
That kind of goes into like, like, that's what's pretty cool. Like just kind of fi- finding a problem, trying to
like - Yeah. Take a step back. Um -Mindy Hargesheimer (01:07:01):
What a good feeling too.
Jay Joshi (01:07:02):
It's a great feeling. And
Mindy Hargesheimer (01:07:03):
She's probably like living her best life now being like,
but yeah.
"Finally.
" I don't know if it bothered her before,
Jay Joshi (01:07:08):
But in f - in terms of GLPs and Ozempic and things like that - Yeah. I think one thing that, a couple
things that I know, I think one of the side effects it does is it, it can reduce your saliva production. Mm
hmm. And when you don't have enough saliva production, that can create a lot of issues. Like you have
Page 42 of 55
more of a dry mouth. Yeah. You're more prone to get bacteria. Saliva's very important to like washing off
the bacteria off your mouth and kind of cycling out. Think of it like a, like a water filtration system. Yeah,
can you talk about that?
Mindy Hargesheimer (01:07:32):
'Cause I do wanna know. These are things that I like to nerd out about. I'm like -
Jay Joshi (01:07:35):
Oh yes. What
Mindy Hargesheimer (01:07:36):
Does it do? And we'll get into mouthwash I think too.
Jay Joshi (01:07:38):
Yeah. Saliva's really important for you. Like it's, it's naturally, we have it. It's like a buffer. Yeah. So
basically every time you eat food, the pH in your mouth changes. PH is seven at neutral, right? Mm-hmm.
If you eat something that's really acidic or have like coffee or something, your pH in your mouth is gonna
drop. If you have something more basic, milk or something, it's gonna raise up. Okay. So you wanna be
around that, that pH of seven to be a neutral level, right? Mm-hmm. In the acidic environments, like
bacteria thrive. So if every time you eat, your pH drops - uh-huh. And it takes about 20 minutes or so for
the saliva to buffer it up, b- buffer it back up to seven, right? Well, if you don't have enough saliva
production, you're kind, you're hanging out in that acidic environment longer. You're gonna be more
prone for cavities, more prone for gingivitis, things like that.
(01:08:17):
Okay. So if you're taking Ozempic and you're having lesser, um, saliva production - Saliva production.
You'll be creating some problems. I think another thing - Just
Mindy Hargesheimer (01:08:24):Things to be aware of if you notice it. Yeah. It could be that to go check with, yeah.
Jay Joshi (01:08:28):
Well, I think also, um, I think Ozempic or because you're digesting slower, um, on these, on these, um,
GLP drugs, you're, the whole point is to digest slower so you feel fuller for a longer period of time. Right.
So if you're not digesting correctly, you could get more acid reflux from that because your body wants to
produce acid to digest. That's not fun. Yeah. And so acid reflux can be, can show up in signs in, in the
teeth. Like you can get more changes on your teeth because the acid coming up and things like that.
Mindy Hargesheimer (01:08:56):
Okay, got it. Yeah. Um, mouthwash. I think I told you I was listening to a dentist. Um, and there's, you
can use mouthwash too much. Is that correct? I don't think - Like does it, can it kill off good bacteria that
you want? Or what's your take on that? Because I heard that through a podcast and was like,
"Uh-oh,
maybe I'm using mouthwash too much.
" Yeah.
Jay Joshi (01:09:18):
Page 43 of 55
I think, I think there's so much bacteria in your mouth. I'm, I' never worried about killing off too much
bacteria. I think one misnomer that I always had growing up is I would always use listerine, because I
would always think that burn from the alcohol - That burn.
Mindy Hargesheimer (01:09:29):
Yeah.
Jay Joshi (01:09:29):
It's killing things off. And what we've learned is it doesn't actually, it probably does more damage than
help because you're not killing off bacteria with the, with the alcohol. Yeah. What you are doing is drying
your mouth out. And we talked about saliva production, things like that. So when we recommend
different, you know, mouth rinses, we prefer things that have like, you know, I know there's a healthy
topic about fluoride or not fluoride. Yeah. Fluoride's really important for kind of strengthening your
enamel. And I think for me, my philosophy is I like fluoride because you're not swallowing or ingesting
it. Yeah.
(01:09:58):
You're flushing your mouth and then you're spitting it out. Yeah. So the little trace amounts of fluoride
that's your mouth is not gonna cause any damage. Okay. But it's gonna cost more help. That, whether
that's with toothpaste - Okay. Or mouth rinse. Now, if you're eating your toothpaste, that's a different
story. So for like my daughter, when the kids are so young and they just swallow toothpaste, I didn't use
fluoride for her. I would use hydroxyapatite, which is like an, an alternative, um, kind of mineralizing -
Okay. Agent that you can use in toothpaste, which is really popular with like holistic dentists and - Yeah.
Families that are concerned about fluoride. But definitely I think if you get a fluoride, fluoride-based
mouth rinse, it's better. You're
Mindy Hargesheimer (01:10:31):Fine.
Jay Joshi (01:10:31):
Yeah.
Mindy Hargesheimer (01:10:31):
Okay. Well, while we're on the topic, what is the proper order? Should you floss, brush, rinse?
Jay Joshi (01:10:38):
Yeah. That's a great question. And I think there's, in my opinion, I don't think there's a right or wrong. I
think for me, I like to floss first because I feel like I can knock out -
Mindy Hargesheimer (01:10:50):
Can loosen.
Jay Joshi (01:10:51):
Yeah. I can get things out that were stuck in there first and the brush kinda helps brush it off. Right. So I
think I try to use common sense in everything I do. So flossing first for me. Yeah. And then brushing. I
think most people intuitively just brush and then they'll put a piece of floss in there after.
Page 44 of 55
Mindy Hargesheimer (01:11:04):
It just makes me think of like how many things we might be doing incorrectly every day that we can
improve upon. So.
Jay Joshi (01:11:10):
For me as a dentist, if you're flossing before and after, I'm happy. Yeah. Yeah. So I'll take either way.
You're good to go. I think, uh, we also talk about, like, brushing. Do you brush your teeth before you eat
breakfast? Do you brush your teeth after you eat breakfast? I think I subscribe to brushing before. Yeah.
First and foremost on a psycholog - or on a, just a ease thing. Mm-hmm. A child's more likely to brush
right when they wake up, and then they go on with their days. If they eat breakfast, what are the chances
that they forget to brush or they don't come back? So I like brushing
Mindy Hargesheimer (01:11:35):
Before.
Jay Joshi (01:11:35):
Yeah. I also think you have morning breath, you have a lot of bacteria. I was gonna say,
Mindy Hargesheimer (01:11:38):
That's my thing. I'm like, just get rid of that.
Jay Joshi (01:11:40):
Yeah.Mindy Hargesheimer (01:11:40):
Especially for kids who
Jay Joshi (01:11:41):
Are,
Mindy Hargesheimer (01:11:41):
They're like less self-aware.
Jay Joshi (01:11:42):
Yeah,
Mindy Hargesheimer (01:11:43):
Exactly. So. Okay. Let's talk about what is myofunctional therapy?
Jay Joshi (01:11:47):
Okay. I
Mindy Hargesheimer (01:11:47):
Hear about this. What is it? How does it pertain to what you do?
Page 45 of 55
Jay Joshi (01:11:50):
Yeah. So myofunctional therapy, sometimes when we're talking about those narrow maxillas, right? The
deep palates. Mm-hmm. Your tongue, if your tongue at rest should seal the roof of your mouth, and that's
what lets your lips close and lets you mouth br - or lets you nose breathe. Mm-hmm. If you're unable to
put your tongue up there, it could be due to structure. It could be due to, like, a deep pal - we're not able
to. It could be due to, like, tongue mo- mobility. Mm-hmm. Like, are you able to stretch your tongue out
enough? It could just be knowing where to place your tongue. You place your tongue in different different
spots. So what myofunctional therapy is targeting the actual habits of the tongue. Mm. So we target the
structure. And what I hope for most of the time is when we improve the structure of widening out, you
can naturally create, break those habits, right?
(01:12:33):
Mm-hmm. But not always. Sometimes kids need some kind of formal training, or even adults. Sometimes
we need some formal training on how to position your tongue in the right spot. Yeah. So myofunctional
therapy, they go through different exercises with the kids. They work with them and they teach them
where you can place your tongue. And you have to kind of work from something of a small step to a
bigger step to a bigger step until you can kind of do it naturally. And I think a lot of this comes down to
that same classical condition I was talking about. Like training your tongue to do it. So that way when
you're at rest and not thinking about it, it's more of a long-term change, you know?
Mindy Hargesheimer (01:13:02):
Yeah. Okay. So then does that mean that you would refer somebody on to a myofunctional specialist,
therapist?Jay Joshi (01:13:09):
I think, I think it goes both ways. Okay. Sometimes, sometimes families find the myofunctional therapy
faster. Like we said, everything's on social media and TikTok and, and reels and things like that. And so
people might see a myofunctional therapist speaking and they're like,
"Oh, I need this for my child and I
want to go that route.
" Sometimes they'll see us. I think for me, I think the better route would be to see the
orthodontist at seven help start diagnosing things. Sometimes it could be earlier. Yeah. I'm happy to see
any child before seven, by the way. We might not wanna, we might do a little longer interval in between
things so it's easy for the parents, but - Yeah. I think, uh, in my feeling, if you make the structure wider
and they still need myofunctional therapy, the myofunctional therapist will be better suited to break those
habits with wider, with a wider palate, you know?
Mindy Hargesheimer (01:13:54):
Okay. All right. Good to know.
Jay Joshi (01:13:55):
Yeah.
Mindy Hargesheimer (01:13:55):
Um, okay. Anything else on all the topics that we've just talked about that we haven't covered? So we've
done the mouth breathing. We've talked about, um, what else have we talked about? Palate expansion,
um, airway. What else do we need to know about overall health and how you and your practice of
orthodontics is doing the work to impact overall health? Anything else?
Jay Joshi (01:14:23):
Page 46 of 55
Yeah. I, I think one more thing I wanna talk about expanders is - Okay. We're treating expanders as a
widening aspect to create more space for the teeth, let's say, right? Mm-hmm. Well, what I always tell
parents is, when you have that phase one, remember we talk about phase one versus phase two treatment.
Yeah. If you have the phase one treatment, the plan is that we're gonna have a phase two treatment. Like,
we're gonna need to do braces to get things straightened out and everything. But you don't always need a
phase two. Like, things can magically find a way. If you create space, the human body has a fun way of,
like, figuring it out, right? Yeah.
(01:14:53):
Now, there might be some mild cosmetic concerns that you still wanna address, but in terms of by doing
the phase one, I think it's designing to set you up better for phase two or the rest of your life. So I think it's
just important to know that just because you have phase one doesn't mean you need a phase two. Okay. I
think it's designed. We never know when you're in phase one if you're gonna need it or not. So we just
plan like you're going to have it. Sure. But we have those conversations. Expanders, by the way, have
been around since, like, 1860. Really? It was first created in 1860. It got popularized in the 1960s,
actually. Okay. So the expander, the mechanism of the expanders is the exact same from 1960 than it is
today. Yeah. I think what's different, or at least in my practice, what's different is how we make them
using technology.
(01:15:33):
We use 3D printing, we use scanning, as you've seen. Mm-hmm. And so that makes the process. Like Ithink a lot of parents would be like,
"I remember having an expander and we had to get the impression,
the goopy, goopy putty in my mouth. Oh yeah. Yep. I had to get the spacers in between my teeth.
" Uh,
like all these appointments that weren't necessarily fun. We were able to eliminate that with technology -
Awesome. And make the process to get expanders really easy. Yeah. I
Mindy Hargesheimer (01:15:52):
Think a lot of people are having like a visceral reaction going into their childhood or
Jay Joshi (01:15:56):
Teenager. Oh, 100%. You talking
Mindy Hargesheimer (01:15:57):
About that. Yeah.
Jay Joshi (01:15:58):
And the kids, what's great for them is they never, they never knew that, they never knew that they, that
thing existed,
Mindy Hargesheimer (01:16:03):
Right?
Jay Joshi (01:16:04):
Right,
Mindy Hargesheimer (01:16:04):
Right. Yeah. Okay. All right, good. Um, and then I, you know, for somebody who's listening, who's
trying to consider,
"I don't love my smile. Should I go to the extent to come in for a consultation, spend
Page 47 of 55
the money, spend the time?" What would you tell them? Because your ultimate focus is giving people that
amazing - Yeah. Aesthetic smile. Like, talk about that a bit more.
Jay Joshi (01:16:29):
I think, I think one thing that's nice, like, for me specifically, because we don't charge for consultations,
right? Mm-hmm. It's just something that we wanna have a discussion for you and educate you on the
different things. Yeah. You might have a chief concern that is driving you to want to do something about
your teeth. Mm-hmm. But we wanna get the whole, uh, an extent of the whole picture, right? And we
wanna do a full diagnosis on that, right? And so I think just educating on your issues doesn't mean you
have to do treatment. Like, it's just meant to, like, say, like, is this, is the juice gonna be worth the
squeeze? Yeah. Like, is it me going through the time and the investment to, to make my smile worth it?
And that's not something I can answer. Sure. But what I can do is show you how things can be better.
(01:17:07):
I can show you similar cases to yours to see, like, how this patient started and where they finished. And
you can, like, seen it real. Yeah. Remember I told you, like, the minute you get your braces off, it's like a
flip of a switch. Yeah. So, it's hard to have that in the beginning, but if we can do, like, a digital mock-up,which we've done on certain patients, or if we can show you a simpler - I was
Mindy Hargesheimer (01:17:24):
Wondering. Okay, that's
Jay Joshi (01:17:25):
Good to know. Yeah. Yeah. Or, like, a case that's similar to yours - Yeah. That can kind of reignite that
energy, like, yeah, I wanna do this for myself. Or it could just be like, you know what? I heard all the
things that I have to do in orthodox, and this is not for me, right? Yeah. And that's okay. There's no. Just
because you're getting the information doesn't mean you have to do it, you know? Sure.
Mindy Hargesheimer (01:17:41):
Sure. Okay, good. I meant to ask you too, um, I always love talking to people on the medical field about
this. Have you seen any crazy, um, narratives or stories or anything to debunk from social media that
people talk about with orthodontics in any way, shape or form? Um,
Jay Joshi (01:17:58):
Okay. There's a couple things. So, one is, um, we talked about expansion, right? Yeah. On the upper jaw.
Well, people don't realize that I have to. I do this in my education, my consultations is, you can only
expand, truly expand. Like we're talking about the bone, the upper jaw. You can't expand the lower jaw.
So people will always talk about lower expansion too. Hmm. I use the term expansion, but I always
qualify what that means. Mm-hmm. So for kids, when we expand the upper jaw, you're creating more
space for the bottom teeth to be uprighted because they're kind of smoshed into the top jaw. So we expand
out, like we'll use bottom expanders, but I call that, we're actually moving the teeth out. We're not moving
the bone out. Yeah. The lower jaw, it fuses at like six months of age. Like you can't change it.
(01:18:39):
Interesting. Yeah. Okay. You can't change it unless you're having surgery or something like that. I've
heard it here. So that's a myth that sometimes people say I had upper and lower, not a myth, but they're
using the word incorrectly. Like they'll say I had upper and lower expansion. Yeah. Like, you know, the
more you expand the teeth out, the less stable it can get. Mm-hmm. But if teeth were starting from a bad
position, you just upright them into the proper vertical dimension - Yep. That's actually better for you
Page 48 of 55
long term. Okay. So that's one. I think another funny like trend that we see that's really hit stride in the
last year is this term called looks, look max - looks maxing.
Mindy Hargesheimer (01:19:10):
Oh yeah. Yes.
Jay Joshi (01:19:11):
I've heard it in many
Mindy Hargesheimer (01:19:12):
Forms.
Jay Joshi (01:19:13):Yeah. And they have it like soft maxing or making something maxing. Yeah. Like you're trying to do
things and it's really for s - the, the demographic is usually that young adult male is actually what's worth,
they're looking for look maxing. I mean, anyone can look for locomaxing, but - Sure. We've seen a lot of
adults, um, coming in wanting to change, like getting a different jaw shape or, um, they, there's some fun
things. Like I think soft maxing they say is like, you can do some simple things like skincare routine is
soft. And we're all doing some, a little of this, right? Yeah. Skincare routine or maybe you're going to the
gym more and trying to get buff and, um, work out more. Yeah. Um, there's this, this thing that's kind of a
trend that's actually, it's called mewing. It's like where you try to like suction your tongue on your mouth.
(01:19:56):
And like when we talk about suction in the mouth isn't gonna do anything. Right. They're trying to get
more of a - Oh, like a contour. Chisel base and stuff like that. I don't recommend, uh, trying to do
mowing. And there's a lot of stuff - Interesting. That debunks that mowing actually happens and things
like that. Um, in terms of like hard max, the, soft maxings are things that are like, like you said, soft,
right? Yeah. Hard maxing would be doing like surgeries or doing peptides or doing GLPs, doing
something more, um, I guess aggressive - Yeah. To kind of get to that result. And so what's kind of fun
for us is we talked about expansion. Mm-hmm. Typically you have to expand before the age of 12. And
we like to expand around like, you know, six to nine is my ideal sweet spot, right? Yeah. But we can
expand on adults.
Mindy Hargesheimer (01:20:36):
Okay.
Jay Joshi (01:20:36):
There's a way to do it where we can do it. It's not surgical, um, but it's a way that's more invasive than just
a regular expander. We call them marpies, right? Okay. And so a lot of these, um, these adults, young
adults are coming in looking for marpies. And they're very well researched. Like they've researched a lot
of it. Mm-hmm. And so sometimes if you're having this thing where you talk about airway ad nauseum,
but like, if you're having a poor quality life from your sleep, like you're looking for solutions and that can
be a good solution for a step. Yeah. But I think there's this, we need more research on a lot of different
things before people tend to act before, before knowing if it's really working. Right. From an anecdotal
story, like, my friend had this happen and it looks great or something like that.
(01:21:12):
Yeah. Yeah. You know, we gotta be careful going down - It's
Page 49 of 55
Mindy Hargesheimer (01:21:14):
Not apples to apples. Slippery slope. Yeah. Yeah. Okay. Yeah, I was just curious because that's always
kind of fun to know. Um, okay. And then anything else that we have not covered that, uh, we need to
know?
Jay Joshi (01:21:24):
Um -
Mindy Hargesheimer (01:21:26):
Covered a lot.Jay Joshi (01:21:27):
We covered a lot. I, I'm trying to think. Um,
Mindy Hargesheimer (01:21:32):
No. We did. I
Jay Joshi (01:21:34):
Think, I think one thing that I, I didn't cover that I think is important is we talk so much about like young,
young age for orthodontics. But the bread and butter of orthodontics is when you're like 12 or 13 all the
way into adulthood. Okay. And so I think we should talk about like what makes a good smile, right? And
so there's different things. Obviously straight teeth is something that we all want. Mm-hmm. Uh, we don't
wanna have crowded, we don't have rotations. I think there's a thing, like we call this smile arc, I think it's
really important. It's how the teeth flow with your lower lip. So when you smile, you almost want a little
curvature to your smile. You don't want it to be straight across. Yeah. You want it to curve across. So
that's a, like we talk about different factors or what makes a great smile.
(01:22:13):
Yeah. Straight teeth is a given, but you want to have a little curve to follow your lower lip. You also want
that broader smile. So when you smile, you don't want to see a lot of space in the corner of your lips.
Right. You want your teeth to kind of sail into the corner of your lip or sail into the symptom. We're
gonna have to
Mindy Hargesheimer (01:22:25):
Get a lesson in how to smile.
Jay Joshi (01:22:26):
I know, right?
Mindy Hargesheimer (01:22:27):
Properly from you. Um, I guess I did have one other question. Are there anything else that, are there any
other things we are doing as adults, like grinding your teeth or otherwise that we should try to focus on,
um, as adults? Are we doing anything else wrong? Like kids are sucking their thumb. Is there anything
else that we can control that I'm not thinking of that might help us or?
Jay Joshi (01:22:46):
Page 50 of 55
Yeah. You know, as adults, it's a little bit different because you're not growing, right? Yeah. There's
different things you can do. Like sometimes I think, um, sometimes the best treatment is not the most
practical treatment. Like, you know, we don't always wanna go into surgery to fix something, right? It's
not practical. It's, it's not something we wanna do, right? Um - Yeah. So there's some things that you can
do that would help you as an adult that might not be ideal. So we have to try to find the medium of what
can we do that will help you? It won't make it 100% go away, but we can reduce that. Mm-hmm. And I
think that's what's important in that consultation. We really look at things, like when I was talking about
TMJ issues. Yeah. Or grinding. Can we, can we do something? Can we shift your bite around to makethat biting aspect of it make it better?
(01:23:28):
And oftentimes we see the grinding habits go away or they at least, at least lessen. Yeah. There's also
times when you can't control it. If you're under stress or under the gun a lot, you're gonna be grinding.
Who's not under stress?
Mindy Hargesheimer (01:23:36):
Jay Joshi (01:23:37):
Maybe grind your teeth no matter what then, right? Yeah. So.
Mindy Hargesheimer (01:23:39):
Very true. Yeah. Okay. Um, well, let's get into some fun questions.
Jay Joshi (01:23:43):
Okay.
Mindy Hargesheimer (01:23:44):
Rapid, rapid fire, lifestyle.
Jay Joshi (01:23:45):
Let's do it.
Mindy Hargesheimer (01:23:46):
Um, do you have recurring weird dreams about your teeth falling out or otherwise?
Jay Joshi (01:23:51):
I've never had that dream.
Mindy Hargesheimer (01:23:53):
I've never had that dream either. I would love to have
Jay Joshi (01:23:54):
A dream in life. I've had people, I've had people who've said that though.
Mindy Hargesheimer (01:23:57):
Page 51 of 55
Yeah. It's really funny. I, someone just talked about this on a podcast that I listened to, and they were like,
"It's really boring.
" They think that that, all that means is that you're grinding your teeth. Interesting. Like
in real life, you're grinding your teeth and so you have. But I grind my teeth. I wear a mouth guard. Um,
but I don't have that dream. I
Jay Joshi (01:24:11):Could, I could see that correlation though. Yeah. I could see people having that fear because they're
Mindy Hargesheimer (01:24:14):
Grinding. I mean, it kind of takes the fun out of it, right? Yeah.
'Cause you're like,
"What does this really
mean?" Yeah. But yeah, you're grinding your teeth. So, um, okay. So what is currently on your Kansas
City bucket list for you, your family? What do you guys wanna do around Casey?
Jay Joshi (01:24:25):
You know, I actually really enjoy, um, all the new things that are happening. Like, and what's great is all
the local influencers, including yourself. Yeah. Like when you highlight that and you bring it to, to life on
social media, but like, I know we've been dying to try the Big Grove. I think that's a - Oh, it's great.That's
a big popular game. Yeah. The Casey Beer Cow that's opened up in Lenexa. I think
Mindy Hargesheimer (01:24:43):
Have you - We love Casey Ber Crow. Are they
Jay Joshi (01:24:44):
Open now, or? I
Mindy Hargesheimer (01:24:45):
Think they might have had like a soft opening. I mean, today this will come out later. So it's definitely
open. Yeah. Yeah. But I, the Dunkel is my favorite beer. Yeah. Like absolutely love it. So -
Jay Joshi (01:24:53):
We love also what's really cool is, um, there's been a couple, like, um, Jay's Beard finalists, um, from
Kansas City. So if everyone's ever tried the restaurant, of course. It's amazing. Amazing. Um, and it's
probably pretty hard to get on the list from a suburban restaurant. Not even talking about Kansas City,
which is hard enough. Right. But to talk about Overland Park, that's a pretty big deal.
Mindy Hargesheimer (01:25:11):
Yeah. Chef Swetha, she's
Jay Joshi (01:25:13):
Amazing.
Mindy Hargesheimer (01:25:13):
Yeah.
Jay Joshi (01:25:13):
Her food
Page 52 of 55
Mindy Hargesheimer (01:25:14):
Is so good. Yeah. And luckyJay Joshi (01:25:15):
For
Mindy Hargesheimer (01:25:15):
Us it's close to where we live, so.
Jay Joshi (01:25:17):
Yeah. And we're big Yoli tortilla fans.
Mindy Hargesheimer (01:25:18):
Oh yeah. Okay, good. Um, what is an ideal day for you when you're not working? You're not working
today, thank you for coming on the podcast. Yeah. Um, but when you're not here, when you're not
working, what is an ideal day for you?
Jay Joshi (01:25:28):
Yeah. I like to go to the gym early. Okay. I'm a, I'm an early gymmer, so I do F45 classes sometimes.
Sometimes I go to the regular - Nice. You know, weight lifting gym. Yeah. Um, I, I really do prize when
we talk about family lifestyle, it's really important for me to have a really strong bond with my daughter,
which I do. So I try as much as I can to take her to school every day. She's how old? She's four now.
Okay. So, so we try to take her to camp. We took her to camp this morning and we'll pick her up today.
Um, on days that I can't, we'll have, you know, her grandparents and sometimes a nanny come pick her
up, you know? And so - Yeah. You know, spending time with her in the morning, like, I, I get, though it's
nice on my days off is I get that extra 30 minutes to an hour with her in the morning before she goes in.
(01:26:07):
So - Yeah. That's really important. Um, and then, you know, just catching up on a lot of stuff, you know?
Yeah. There's so much stuff that goes on in the dental office that's behind the scenes that you don't realize
that - I'm sure. We just need time to do it. So it's not really a day off. It's really more - Yeah. Like a -
Mindy Hargesheimer (01:26:20):
Yeah.
Jay Joshi (01:26:21):
Uh, it's a lighter day in the sense that I don't have to be there at, like, 7:30 to 5:30 or anything like that.
But it's something that I'm putting time into, for sure. Yeah.
Mindy Hargesheimer (01:26:29):
Love it. Okay, good. Well, this has been great.
Jay Joshi (01:26:31):
Yeah, thank you. Well,
Mindy Hargesheimer (01:26:32):
Page 53 of 55Like I told you, I had so many ideas that we coul talk about, and I love, like, getting into the weeds of all
the details of the things you don't know to ask about, whether you're a parent or you're older and you're 78
and you wanna think about getting, you know, braces, whatever. I think there's just so much that we can
learn from you. So many sound bites from this that I think people will pick up on. And obviously, the
most important thing, how do people find you? How do they get in touch with you? Where do they follow
you? All the things that call to action.
Jay Joshi (01:26:58):
Yeah. You know, um, our, our practice name is Stace Mine Orthodontics. Yes. Um, so they can just
Google Stay Spine Orthodontics, or they can go to www.staysmineorthodontics.com. Yeah. I'll link all
that to you. Yeah. You can find us on Instagram too. We respond to direct messages as well. Yeah. Um,
and people can check out, like, you know, Google reviews to see. All our reviews are pretty, um, genuine.
We don't do anything to get reviews. We just have people who have good, good experiences share what
they have. And so - Yeah. You know, they can read us, read about us, and there's, it's really fun. I think,
um, there was one question you asked me that I never answered, which was, like, a fun story or something
from a patient. Oh, yeah. Yeah. And so, uh, I had a patient who we scanned for his expander, and
everything went great.
(01:27:41):
He did great. He had a little bit of anxiety, but he did great. So on the day of delivery of the expander, he
was, he was so anxious that he was hiding underneath the bench where parents sit. Like, he would not
come out of there. And I was like, it was a, I was like, okay, this is gonna be a little bit of a problem,
right? Yeah.
'Cause he was that, that's an extreme level of anxiety. So - Yeah. Um, you know, we, we
never forced him into it. We kinda eased him into it. Mom, mom was really appreciative of how
understanding we were. It definitely took, like, three times as long for every appointment - Yeah. Than it
probably did. Well, it should've. But essentially, we got him comfortable. We got the expander in. He
went through those app - like, not that day. We did it another day.
(01:28:15):
We got him really prepared for it. We really tried to, like, tell show do. We got him really, like I said, this
is not about teeth at this point. Yeah. This is about managing personalities and building rapport and
connection. And so, at the end of the day, he was like, he was a champ about everything. Got his braces
off, his expander off, and he did great. So I think that kind of story really resonates m- more with me than
- Yeah. The perfect smile created because it was something that we were able to, to change something for
him for the better, for. Hopefully he's got that - He's
Mindy Hargesheimer (01:28:42):
Overcoming a fear.
Jay Joshi (01:28:43):
Yeah. Right?
Mindy Hargesheimer (01:28:44):
And being -
Jay Joshi (01:28:44):
And hopefully with other dentists he's gonna have easier times or doctors - Yeah. Or, or whatever's
serious in life. You can always come back to that - Yeah. Thing. Whenever you have a hardship, you can
remember that I accomplished it through there. I can do this now. Yeah,Page 54 of 55
Mindy Hargesheimer (01:28:54):
He'll remember that forever, too. Yeah. I love that.
Jay Joshi (01:28:57):
Yeah.
Mindy Hargesheimer (01:28:57):
Well, good. Um, well, I mean, generally for me, everything is like a firsthand referral. And as I
mentioned, our daughter has been going to you guys and will be for the next, you know, year and a half.
So, uh, big shout out for me for everyone to come see you guys. So thank you for coming on and for
sharing all of your wisdom.
Jay Joshi (01:29:12):
Thank you for having me on the podcast. Appreciate it. All
Mindy Hargesheimer (01:29:14):
Right. Take care.
Jay Joshi (01:29:15):
Thank you.
Mindy Hargesheimer (01:29:16):
Thank you so much for tuning in and finding inspiration in these incredible stories. If you love what you
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