June 4, 2026 • 36 mins
Drill and fill is not the only story dentistry can tell anymore. We sit down with Dr Roumiana Tzvetkova, a dentist and practice owner with a prevention-first philosophy, to talk about what it looks like to preserve natural teeth in the real world, especially when patients arrive carrying years of delay, anxiety, and limited dental benefits. If you’ve ever wondered whether modern dentistry can be gentler, clearer, and less reactive, this conversation brings practical answers.
We dig into two game-changers reshaping clinical decisions and patient trust: AI in dentistry for earlier, clearer radiograph interpretation, and enamel regeneration for non-cavitated lesions. Roumiana explains how she uses the VIDIA AI platform as an aid, not a replacement, to spot small lesions the human eye may miss and to show patients what the clinician sees through colour-coded visuals. That transparency matters because it reduces suspicion, supports informed consent, and often improves treatment acceptance without turning care into a sales pitch.
Then we get scientific and practical about prevention-focused dentistry, including Curodont by vVardis (Vivardis) and how enamel remineralisation works by rebuilding hydroxyapatite using minerals from saliva. We also tackle common oral health myths, from “I stopped flossing because my gums bleed” to the belief that implants are a simple cosmetic upgrade. On the business side, we talk dental practice ownership challenges, rising costs, the limits of insurance incentives, and why dental fear still drives no-shows and last-minute walkouts.
If you care about minimally invasive dentistry, early cavity detection, better patient communication, and a future where healthcare prevents disease instead of managing it, you’ll get a lot from this one. Subscribe for more conversations on innovation in healthcare, share this episode with someone who avoids the dentist, and leave a review with your biggest question about AI-assisted diagnosis or tooth preservation.
Guest Biography
Dr Roumiana Tzvetkova, DMD is a dentist and practice owner at Aspen Dental in Long Island, New York. Originally from Sofia, Bulgaria, she has over a decade of clinical experience and is passionate about minimally invasive, prevention-focused dentistry.
A graduate of Tufts University School of Dental Medicine, Dr Tzvetkova is recognised for her work with AI-assisted diagnostics and regenerative dental technologies. She has become one of Aspen Dental's leading providers of Curodont, a groundbreaking treatment designed to regenerate enamel and reverse early-stage tooth decay.
Her mission is simple: preserve natural teeth whenever possible and help patients avoid unnecessary and costly dental procedures through early intervention and education.
Links
- Website: https://www.aspendental.com/providers/roumiana-tzvetkova/1508426123/
- LinkedIn: https://www.linkedin.com/in/roumiana-t-55b97119a/
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About the podcast
Voices in Health and Wellness features conversations at the intersection of medicine, lifestyle, and human potential, with clinicians, scientists, and thinkers shaping the future of care.
About Dr Andrew Greenland
UK-based medical doctor and founder of Greenland Medical, specialising in Integrative and Functional Medicine. Trained in both conventional and root-cause approaches, Andrew helps people optimise health, performance, and longevity, with a focus on cognitive resilience and healthy ageing.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr Andrew Greenland (00:00):
So, welcome back to Voices in Health and
Wellness.
This is the podcast where weexplore the people, ideas, and
innovation shaping the future ofhealthcare.
Today we're diving into afascinating area of dentistry
that challenges the traditionalapproach of drill and fill and
instead focuses on prevention,regeneration, and preserving
natural tooth structure.
We'll be discussing how newtechnologies are helping
(00:20):
clinicians detect problemsearlier and how artificial
intelligence is changingdiagnosis and treatment
planning, and why the future ofhealthcare may be less about
managing disease and more aboutpreventing it altogether.
I'm delighted to welcome Dr.
Roumiana Tzvetkova to the show.
Roumiana is a dentist andpractice owner based in Long
Island, New York, with more thana decade of clinical experience
helping patients achieve betteroral health through minimally
(00:43):
invasive and prevention-focusedcare.
So, with that, Rumiana, I'dlove to welcome you to the show.
Thank you so much for joiningus today.
Dr Roumiana Tzvetkova (00:50):
Good morning, Dr.
Greenland, and thank you somuch for having me.
It's a truly a pleasure.
Dr Andrew Greenland (00:56):
So let's start with your story, if we
may.
Could you um tell us a littlebit about what attracted you to
dentistry in the first place?
It's probably a while ago, butit's always helpful and
interesting to hear about thecontext and the background of
our guests.
Dr Roumiana Tzvetkova (01:09):
Uh yes, um, sure.
I um I grew up in in Sofia,Bulgaria.
Um, and uh my my mom is aretired oral surgeon.
So I was exposed to dentistryum ever since I was a little
girl.
So uh I do vividly remember Iwas 13 years old, uh, school had
(01:29):
finished, and I had nothing todo during the summer.
So my mom's dental assistantgot sick, and I had to step in,
um, had to start working as adental assistant, and I uh I
remember when she extracted awisdom tooth and um she mounted
(01:50):
that on a on a stone, and Idrilled and removed the amalgam
filling back in the days.
That's that was the material weused to use and filled the
cavity, and I think that was themoment when I had decided that
this is the path uh for me.
Dr Andrew Greenland (02:10):
Lovely, thank you.
And how has your kind ofjourney eventually led you to
become a practice owner?
Dr Roumiana Tzvetkova (02:16):
That's an excellent question.
I uh yeah, I went I came to theUnited States when I was 15
years old and went through highschool um and college, and um I
got homesick, um, went back toBulgaria and decided that I will
enter dental school there.
So that's what I did.
I graduated dental school in2008, um, opened up my own
(02:38):
practice in Bulgaria and workedas a dentist for six years
before I moved back to theStates again because something
was feeling very small, and Iwanted to come back for good
this time and explore how theAmerican way is when it comes to
training patients.
So I graduated Tufts Universityin 2019 and joined Aspen Dental
(03:05):
uh that same year.
Worked as a clinical directorin Rhode Island um for four
years, and then the opportunityto have my own practice came in
2023.
So I moved from Rhode Island toNew York, where my parents
live, and became an owner.
Dr Andrew Greenland (03:25):
Amazing.
So would you mind giving us alittle bit of an overview of um
Aspen Dental, what your practicelooks like today in 2026?
Dr Roumiana Tzvetkova (03:34):
Well, Aspen Dental is um is a um DSO
that is mainly for people whoyou know haven't seen the
dentist in in such a long time.
Those are the people who havebarriers on emotional and
financial level.
So we deal with those types ofpatients.
(03:56):
Uh I was trained to be a veryconservative, minimally invasive
dentist back from fromBulgaria, uh, because in Europe
I I trust and I and I stillbelieve that there is a
discrepancy between the UnitedStates and Europe of the
approach.
So when I when I first started,there was a lot of extract and
(04:20):
insert cases, a lot of hopelessteeth that I had seen.
But as I had built myself as adentist, I realized that there
is always an opportunity to saveeight, ten teeth, because
nothing can replace the naturaldentition.
So when I moved to New York, Iguess the population is just
(04:42):
slightly a little bit, a littlebit different than the
population in um in New England,in terms that uh when you work
in a big city, even though we'rein the suburbs, it's still very
close to Manhattan, people aremore self-conscious about their
teeth.
Their emotional and mental umhealth, I feel, and and as I as
(05:04):
I work with them, is a lot moreum stable.
So to them, losing all of theirteeth is non-negotiable.
So I guess in a way, the thepatients that I work with help
me be the dentist that I'vealways wanted to be.
Dr Andrew Greenland (05:23):
Thank you.
Now, when you look at dentistrytoday compared to when you
first entered the profession,what changes stand out for you
the most?
Dr Roumiana Tzvetkova (05:32):
A lot of changes.
Not I can't pinpoint only one,uh, but the the recent ones that
have um uh aligned with my umethical and moral beliefs as a
dentist um are two products thatI've been utilizing in my
practice and and within Aspen,of course, because I do work
(05:52):
under the umbrella of Aspen.
One of them is an AI tool, it'sa platform by VIDIA.
It enhances our diagnosisbecause um it shows what the
human eye cannot detect uhmajority of the time, because
sometimes the lesions they donot, cavities don't form
(06:13):
overnight.
It takes time for that smalllesion to enter the bulk of the
tooth called the dentin andreach to the nerve, right?
It's not something that happensovernight.
Uh, however, the human eye isuh is very interesting, it can
only detect to a certain degree.
So the uh the platform that weuse at Aspen Dental helps us um,
(06:36):
I wouldn't say detect, but itenhances our diagnosis.
It is more visual and it makesum it makes the transparency uh
more clear, I would say.
What we see is what patientsare able to see now because it's
color um coordinated, um, andit helps a lot when we have to
(06:59):
build that trust with thepatient.
And the other one that werecently have launched in Aspen
um is something called Curedont.
It is by um this firm calledVivardis, based in Swiss.
It remineralizes the enamel andit regenerates the enamel.
It's pure science, and uh, I'min awe of what dentistry um has
(07:24):
um come up with.
Dr Andrew Greenland (07:27):
Amazing.
And in terms of um clientexpectations, patient
expectations, how have thosechanged in the last 10 years in
your experience?
Dr Roumiana Tzvetkova (07:38):
I uh do see that a lot of the time um
people who had implants um andyou know a lot of teeth being
extracted back in the in thedays 10, 15, 20 years ago when
implants um were and still arethe best way to restore missing
teeth.
Uh, they do come with, let'ssay, a full arch of um implants
(08:02):
and and something fixed, andthey do have they still have
their natural dentition on thelower for some reason.
Um their approach is completelydifferent.
Uh, I would say that majorityof the time they would say dog
to something to save those teethbecause I feel that they at
this point realize that nothingcan replace the natural
dentition.
And again, it those type ofmentalities do help me um to be
(08:28):
the dentist that um I am today.
Dr Andrew Greenland (08:33):
Thank you.
Are there any other um bigmisconceptions that patients
still have about oral healththat you've kind of picked up on
the misconception?
Dr Roumiana Tzvetkova (08:43):
I think one of one of the biggest ones
is um when they say I stopflossing because my gums are
bleeding, and then we go intothat vicious circle again of
explaining why the gums arebleeding and why they need to
floss, and the more they floss,uh, the less the bleeding.
Um and uh the othermisconception is again, we're
(09:04):
going back to implants.
Um I'm going to replace all ofmy teeth with implants so I can
have a better smile.
But there's so much more intoextracting teeth and replacing
them with um with implants.
There is anatomy, there is softtissue, there's heart tissue
that we all need to think aboutand treatment plan before we
(09:27):
start um taking out teeth and Iwould say crippling those
patients.
So when it when a patient likethat comes to my office, I do
spend over an hour explainingthe pros and the cons.
Um, there is a lot ofmisconceptions about uh
overdentures and all on X.
Um, and both treatment plantsare expensive, but there is a
(09:51):
component which in which theystill don't understand how an
overdenture is still somethingthat they need to take in and
out, even though they haveimplants.
And this is where we sit downand the discussion is extremely
thorough.
Dr Andrew Greenland (10:08):
Now, one thing that stood out from an
earlier conversation we had wasyour focus on minimally invasive
dentistry.
So, for listeners that may notbe familiar with that
philosophy, what does itactually mean in practice?
Dr Roumiana Tzvetkova (10:18):
Minimally invasive dentistry um is a term
that I use for everything thatI can do in order to prevent um
future um extensive andexpensive dental treatments.
For instance, uh when I see asmall lesion that is still
within the enamel, which againum the um AI platform that I use
(10:40):
by VIDIA in my uh in mypractice helps me um enhance in
visual diagnosis.
Um I would rather prevent thecavity to extend to the bulk of
the tooth by applying curidont.
Um, and then if I see a smallcavity, my prevention would be
(11:03):
let's do a filling before itbecomes a deeper filling where I
need to do pulp indirect, forinstance.
This is a medication that weput on the top of um uh the
dentin that is very, very thin.
Uh, this way we can prevent uhthe um the hypersensitivity in a
future root canal treatment.
(11:23):
If somebody comes that needs aroot canal treatment, I would
prefer to do a root canaltreatment versus extracting the
tooth.
So, see, this is when I sayminimally invasive, it doesn't
mean that I would see a big,huge lesion that is um, you
know, class four.
Uh, for those of you who don'tknow what a class four is, this
is when the incisal edge is inis included, and you need to do
(11:46):
um, you know, a crown or aveneer.
Uh that's that's not the case.
The case is to prevent the moreextensive, painful, and
expensive dental treatment downthe road.
Dr Andrew Greenland (12:01):
Really interesting.
Um, I'm really fascinated bythis curidon.
And you you've just mentionedit, but what's um happening
biologically when this treatmentis used?
Give the listeners a little bitof the scientific background
just to understand a little bitmore about this.
Dr Roumiana Tzvetkova (12:14):
Yes, so curidont is a um is a treatment
um that regenerates the enamelfrom within.
But again, it works onnon-cavitated lesions.
Those are the white lesions andwhite spots that we see on the
facial aspects of teeth whenpeople had worn prices, for
instance.
(12:34):
And who hasn't had those whitelesions?
We all know that back in thedays we would just do amnesial
facial distal filling, right?
Um, or it had happened in thefuture, in the past, when um you
see that white decalcificationand you go with the ultrasound,
and then the ultrasound goesstraight into the dentin, and
(12:55):
there you are, you've cavitatedthe tooth.
So when I see those types oflesions, Curiton, I apply
curadon, and curidon is atreatment uh that is being
attracted uh by the lesionbecause it has a more acidic
environment.
Um, and then it attracts thecalcium and the phosphate from
(13:18):
your saliva, from the patient'ssaliva, uh, and rebuilds the uh
hydroxyapatide, uh, which is thethe bulk of the of the of the
enamel.
Dr Andrew Greenland (13:29):
Thank you.
Dr Roumiana Tzvetkova (13:31):
I've had I've had a great uh results.
Sorry to cut you off.
I've had great results so far.
Uh, and I am um monitoring anddocumenting uh those patients
that are coming for theirsix-month periodic exam.
And it's nothing but pure joyto see that uh we've been able
to safety without the needle andwithout the trail.
Dr Andrew Greenland (13:55):
Fantastic.
So I'm both hearing about theresults is fantastic.
What results have surprised youthe most?
And have there been any patientstories that really stand out
for you since you started usingthis?
Dr Roumiana Tzvetkova (14:06):
Uh I would say um 16-year-old girl.
Um, she and her mom came to mypractice, and the lesions were
were on from premolar topremolar, not to mention um
molars as well.
Um, we um we my hygienist umdid the scaling and the root
(14:27):
planning because she had a lotof buildup in between the gum
and the bone level.
Um, and then a few weeks laterthey removed the the braces and
we applied curidon.
Um I would say six weeks afterthat, we saw that the lesion
started to become the colorstarted to become more of the
(14:47):
color of a natural tooth.
She is about to follow up withme at the end of July, and I'm
dying to see the results becauseI've documented the before, and
I will um take pictures um fromthe after uh we have applied uh
and treated those lesions withuh curidont, and I'm so excited
because I trust and I know thatthe results will be phenomenal.
Dr Andrew Greenland (15:11):
Amazing.
So, I mean, with yourpreventative focus, do you think
healthcare in general spendstoo much time treating disease
and not enough time preventingit from what you see?
Dr Roumiana Tzvetkova (15:21):
Yes, I would say that uh unfortunately
um insurance companies uh wouldrather pay for the damage when
it's done versus paying for thepreventative for the preventive
dentistry.
And it works in almost everymedical field, I feel that uh
they're more willing to pay forthat uh versus screening and
(15:45):
preventing problems that couldbe avoided on 100%.
Dr Andrew Greenland (15:51):
Thank you.
So coming back to the AI thatyou were talking about earlier
on, um there's a lot of feararound AI in replacing
clinicians, a lot of it'sunfounded, and you clearly have
a different perspective.
How do you kind of treat thenew technologies coming in
dentistry, particularly withreference to things like the AI
that you were talking aboutearlier on?
Dr Roumiana Tzvetkova (16:12):
I think that the most important thing
for clinicians out there who arejust um starting to utilize AI
in their practice is to knowthat AI is not here to replace
the clinical decision.
The clinicians are the ones whoput the diagnosis and the
treatment.
AI is here to help us.
(16:33):
Because AI has so the way theway I utilize this in my
practices, before I see apatient, the first thing that I
(16:55):
do is I always open the regularx-rays that we take.
I never rely on the AI to giveme what the diagnosis is going
to be.
And it it is kind of a battlebetween the AI and myself
because I say, you know, this isa true cavity, this, this,
this, and this.
And I'm like, let me see whatAI has to say.
(17:16):
And to my surprise, of course,as I've said it before, the
human eye can detect only to acertain degree when when the
damage is already done.
And I would be surprised to seethat AI had um detected those
small lesions that the human eyecannot see.
And again, it is totally up tome to decide whether to do a
(17:41):
cavity on that tooth.
I mean, to do a filling on thattooth or to uh apply a curidon
based on my clinical judgment,because we all know that
diagnosis is based on yourclinical judgment and the
radiographs that you take.
Dr Andrew Greenland (17:58):
So you have obviously a very balanced view
about the AI technology.
Um the patients trusting thetechnology, the ones that you're
using and uh using AI to helpyou with the diagnosis and
treatment?
Dr Roumiana Tzvetkova (18:10):
On a hundred percent.
I would say 200%.
They do trust us, they do trustme.
Uh, and I feel that people cansense when people uh when when
when doctors are are being umyou know more on the sales part,
which um I don't appreciate.
Um they they see the colors,they see the colors, they see
(18:33):
what a small lesion looks like,they see what a big lesion looks
like, they see the radiolucencyum on the apex of the of the of
the root if they have aninfection.
Uh it's something that beforeutilizing AI, they couldn't see
what I saw.
(18:53):
And that was more uh that put alot of um restrictions um and
and boundaries.
Uh the shield was was there andit never it never went away.
And the moment I startedutilizing AI and started
explaining um what they'reseeing uh and how it translates
(19:15):
to what I see on the other onthe other end, the the my
treatment acceptance got throughthe roof.
And I'm so so so extremelygrateful.
And again, AI is being whenwhen put in the in the hands of
good people, uh it could dophenomenal things for for for
(19:35):
the population.
You give AI to the hands ofpeople who don't have good
intentions, then maybe theirresults are going to be bad.
But in my in my situation, mypatients trust me, I feel more
confident explaining um what thetreatment plan is going to be.
Um, and I have a lot of trustthat continues to build as time
(19:59):
goes by.
Dr Andrew Greenland (20:01):
Thank you.
So you're obviously embracingAI in your work.
Um, where do you think AI isgoing to have the biggest impact
in dentistry over the next fiveyears or so?
Dr Roumiana Tzvetkova (20:13):
That is an excellent question.
Um I again I don't think thatAI is going to fully replace or
will ever replace the clinicaljudgment.
Uh, the only thing that I cansee AI implementing it in the
future is to continue to enhancethings that we can miss as
(20:39):
clinicians and just pinpoint acouple of things because just
like anything else, if you lookback in the days when we first
started using or placingimplants, people would place
implants based on a panoramicx-ray.
But we all know that this is atwo-dimensional image versus a
three-dimensional um implantthat you need to place within
(21:03):
the bone.
And we know that the bone is athree-dimensional structure.
So, what happened was as we hadadvanced, the CBCT scan became
the standard of care when itcomes to placing implants
because it gives you thatthree-dimensional image of where
the nerve is, where um wherethe arteries are.
So uh, same thing here.
AI is being launched in thedental field and in the medical
(21:28):
field right now.
Um, and the future, who knowswhat the future will hold, but
all I know is that it's going tocontinue to help not only
clinicians, but patients aswell, because it does show to
the patient what we asclinicians see, but the patients
(21:48):
cannot.
Dr Andrew Greenland (21:50):
Thank you.
Are there any riskspractitioners should be mindful
of in the AI era?
Dr Roumiana Tzvetkova (21:55):
The only thing that I would say for young
dentists is to be careful.
Careful, yes, because it couldmake them um I wouldn't I would
I wouldn't like to use the wordlazy, but the eye could become
lazy if you are not asexperienced.
Solely take a look at thex-rays, have a mentor um by your
(22:17):
side with whom you can discussthose x-rays, and then do the
clinical exam and then take alook and open up the uh AI so
your eye can be trained to lookat both um both x-rays.
Dr Andrew Greenland (22:34):
Thank you.
So switching gears slightly,I'd love to talk a little bit
about the business side ofdentistry.
Um, what are some of thebiggest challenges facing dental
practice owners today?
Dr Roumiana Tzvetkova (22:46):
Um that's that that is an excellent
question because there's therethere isn't only one challenge
that we face.
We face um a lot of a lot ofthings that um dentists back in
the days did not, and that comeswith mental, emotional
barriers, um, and a financialburden, I I trust, especially
(23:10):
here in the United States, is uhtremendous because people have
insurances, and unfortunately,by the time they need to do a
scaling and a root planning orone filling, they exhaust their
benefits for the year.
And this, as we all know,dentistry is um is an expensive
(23:35):
field, and a lot of the timepeople are on a fixed income,
and that makes it hard for themto continue their treatment.
And I feel that this is whenpeople fall into that vicious
circle, I'll do one thing at atime, but by the time they come,
the problem has become biggerand deeper.
(23:56):
And I feel that back in thedays, comparing to what you
know, how my mother used to workbecause she had her own
practice in Bulgaria, um she, Idon't think she had ever faced
those those problems becauseeverything was a lot less
expensive back in the days,materials, um just anything, and
(24:18):
I mean everything, the way theway things have changed for the
last even five, ten years.
Um, it's it's the the gapbetween um I would say the rich
and the poor is getting biggerand bigger, and that's the
biggest challenge that we facethese days.
Dr Andrew Greenland (24:37):
That's really insightful.
So um which challenges orbottlenecks are most impactful
to you right now, or if notright now, have been on your
journey to where you are today?
Dr Roumiana Tzvetkova (24:48):
I again just repeat that question, I
couldn't hear you.
Dr Andrew Greenland (24:50):
You should be asking about um which
challenges or bottlenecks aremost impactful for you in your
business right now, or if notright now, you know, at some
point along your journey alongthe way.
Dr Roumiana Tzvetkova (25:02):
I would say um I wouldn't say that it's
so much um the financial aspectbecause at Aspen Dental we do
have different payment planplans that people utilize.
Um it's more um the emotional,the emotional state that they
(25:25):
when they especially when theyhave to um extract all of their
teeth.
The terminal dentition, that'swhat I call that.
Um and they postpone itpostpone, and it takes a lot for
me to convince them thatthey're better off um having
full dentures, and then down theroad we can think about getting
(25:45):
more implants and getting overdentures or all on X versus
staying with um roots that arefilled with infection and uh and
etc.
And I did have a very badexperience uh with a patient a
few a few years ago when theyrefused.
And again, you know, if I takeout all of my teeth, which were
(26:06):
just root tips, um, it's justI'm going to be completely
identalist.
And I'm like, you are alreadyidentless.
So the patient postponed thatand ended up in the hospital.
Thank God they're still alive.
Uh, but I would say the mentaland the emotional component is
the biggest challenge indentistry these days that we
(26:28):
face.
Dr Andrew Greenland (26:29):
Yeah.
Um, I think you mentionedpreviously that new patient show
rate has been an ongoingchallenge.
How do you think about thattoday in your practice?
Dr Roumiana Tzvetkova (26:40):
This, so thank God we have uh a great
marketing team uh and uh thathelp us a lot with uh new
patients.
Um at this point in mypractice, I do have a lot of um
word of mouth.
So uh patients are bringingtheir parents, patients are
bringing their, you know, theirwhole families.
(27:01):
So it's getting better andbetter with um new patients um
show rate.
Uh but again, when thatdeclines, there is nothing in
the world that can convince methat it's not fear.
Fear of the dentist.
That is what makes the patientcome to the door.
(27:21):
And I've had patients that theywould come to the door, they
would see me, and they wouldjust walk away.
I'm sorry, Doc, it's not you,it's me.
I've had patients when I wasworking in Rhode Island sitting
on the chair, big abscess, Ihave to take out the tooth.
Uh, the moment they saw theneedle, and I I tend to believe
I'm very gentle when Iadminister the lidocaine, he's
(27:43):
they saw the needle and theyjust jumped out of the chair and
and ran away.
So fear is the number one umbarrier when it comes to new
patients show rate.
Dr Andrew Greenland (27:56):
That's really interesting.
And I guess that's an age-oldproblem, but is there anything
innovative in the in this in thedental space that's been able
to kind of solve or help withthat?
Because I I guess it's beengoing around for years and years
and years.
Dr Roumiana Tzvetkova (28:09):
If there is someone who's gonna invent a
painless way of administeringlidocaine or anything in
dentistry that's sweet, I thinkthey will be millionaires,
billionaires.
Unfortunately not.
Um, I don't think that uh atthis point we have anything.
We, I mean, I do try differenttechniques uh to ease um that
(28:33):
infiltration and to make thingsum less painful.
Because if they have thatexperience uh as a good
experience, everything else isjust a piece of cake.
And and I hear that a lot.
Dr Andrew Greenland (28:49):
So you're a practice owner, you obviously
wear lots of hats in the workthat you do, clinical,
operational, business,administrative.
What is your biggest time drainfor you as a practice owner
that takes you away from thethings that you prefer to do?
Dr Roumiana Tzvetkova (29:03):
Long hours.
You have to be when you're anowner, you think about
everything.
You think about every singleperson that works with you, um,
your office manager, yourpractice coordinator, um, your
dental assistants, your labtechnician if you have one, your
hygienist, um, your assistantoffice manager, you think about
(29:24):
all of them.
And uh you spend you tend tospend a lot of hours in the
office, which to be honest withyou, I still don't mind.
Uh, but I wish those hourscould be a little a little less
than what it is right now.
Dr Andrew Greenland (29:40):
And is there anything that's um in the
things that you've justmentioned that keeps you up at
night?
What's as a practice owner,what's the kind of the biggest
worry that would keep you up atnight or wake you up?
Dr Roumiana Tzvetkova (29:51):
My biggest worry is always the
patient.
A patient who um I did a rootcanal treatment but swelled, who
knows why.
Um, a patient that I placed animplant but uh is in pain uh
three, four weeks since the daywe've planted that implant.
(30:12):
Um patients are my biggest uh,I wouldn't say nightmare, it's a
sweet nightmare, but uh if I ifI could if I could have a magic
wand, it would be all of mypatients are free of pain,
happy, and come back just for aperiodic exam.
That would be the perfectscenario.
(30:32):
And I would say that majorityof the time I I have achieved
that, and that is because of theum hundreds of hands-on courses
that I had attended.
That gives me the stability.
Stability comes when you havesolid knowledge because you
connect the dots and you knowwhen to worry and when not to
(30:54):
worry.
So um patience will always benumber one priority in my life.
Dr Andrew Greenland (31:01):
Thank you.
You mentioned a moment ago yourvarious team members that you
have.
What's your approach tobuilding a team that shares your
values and your patient-firstphilosophy?
Dr Roumiana Tzvetkova (31:12):
Oh, that's a tricky one.
Um, so I uh do have umstandards that I hold up myself
up to, and this is how I choosemy team, teammates.
And um, it is hard.
It is hard because uh peopledon't have the same work ethic
(31:32):
as I do, especially the thenewer generation.
Um, and um that makes thingsdifficult for the majority of
the people that I've beenworking with.
Um and um we I choose very,very carefully.
I prefer to work alone versushaving people who are going to
(31:53):
disobey what I um have built,uh, the rules and the
regulations, not to mention thatthere are still rules and
regulations that I live by uhbecause I'm still under the
umbrella of Aspen.
And I I give that as an exampleso many times, especially to
the younger generation when theyjust want to come to work and
look at their phones and um andthe lack of accountability and
(32:18):
the the lack of uh not beingable to have a normal
conversation without somebodygetting offended is very, very
hard.
And uh and that's why I preferto work alone sometimes, but
have the right people by my sideuh versus having 20, 30 people
who are just there to exist.
Dr Andrew Greenland (32:41):
Got it.
So where do you think you'regonna be in the next 12 months?
Any particular goals oraspirations you have for Aspen,
your your career in your careerpath in the next 12 months?
Dr Roumiana Tzvetkova (32:53):
Next 12 months, I will continue as we
speak.
I'm in uh North Carolina umtaking a master class in general
dentistry bonding, which is myum bread and butter.
I uh I love restoring um teethwith uh with composite.
Um and um in the next 12 monthsI will take master classes in
(33:14):
restorative work when it comesto implants.
I've done the Maxi course lastyear with the American Academy
of Implantology.
The surgical part will alwaysbe something that I am thriving
to improve.
My incisions, my my suturingtechniques, um, and um restoring
those implants to me is one ofthe most important things
(33:37):
because of the um biomechanicalaspect of that.
So um hands-on courses ahead ofme and uh continuing to deliver
um impeccable uh dental care tomy patients, minimally
invasive.
Dr Andrew Greenland (33:54):
Wonderful.
And what do you think the widerworld of dentistry is going to
look like in say 10 years fromnow?
Dr Roumiana Tzvetkova (34:00):
I hope for the better.
I hope for if I if I have topicture dentistry in 10 years, I
would picture contemporarylook.
Um everything is in uh beigeand in white colors.
Um, there is no rushing.
Uh, people are more united onpreserving the natural dentition
(34:21):
and uh not destroying, if andwhen possible.
Uh, and more united society,more united dental society, less
criticism, um, more um studyclubs, uh, more vulnerability
between dentists, because I feelthat majority of the time we
(34:44):
don't talk about our failures,and they do exist uh maybe
because of shame, I don't know.
Uh, but I would like to see thedental community more united in
10 years.
Dr Andrew Greenland (34:57):
Wonderful.
And finally, if you werestarting out again tomorrow,
starting your career againtomorrow, would you do anything
differently with the benefit ofhindsight?
Dr Roumiana Tzvetkova (35:06):
Yes, I would start more slowly.
Yes.
I would invest, I will continueto invest in my education, but
I would master one thing at atime.
That's something I starteddoing six years after I
graduated, dental school fromBulgaria.
(35:28):
And uh I trust that if I hadstarted that since day one, I
would have become the version ofmyself a lot sooner.
Dr Andrew Greenland (35:40):
Amazing.
Rumiana, this has been afantastic conversation.
Thank you so much for joiningme today.
I think what stands out is thatyou're showing what healthcare
looks like when we combineprevention technology and
clinical expertise rather thanwaiting for disease to progress.
So thank you for sharing yourexperiences, your insights
around minimally invasivedentistry, and your perspective
on where the profession isheading.
(36:01):
I really appreciate it.
Dr Roumiana Tzvetkova (36:02):
Thank you so much, Dr.
Greenland.
It was truly a pleasurespeaking with you today.
So, welcome back to Voices in Health and
Wellness.
This is the podcast where weexplore the people, ideas, and
innovation shaping the future ofhealthcare.
Today we're diving into afascinating area of dentistry
that challenges the traditionalapproach of drill and fill and
instead focuses on prevention,regeneration, and preserving
natural tooth structure.
We'll be discussing how newtechnologies are helping
(00:20):
clinicians detect problemsearlier and how artificial
intelligence is changingdiagnosis and treatment
planning, and why the future ofhealthcare may be less about
managing disease and more aboutpreventing it altogether.
I'm delighted to welcome Dr.
Roumiana Tzvetkova to the show.
Roumiana is a dentist andpractice owner based in Long
Island, New York, with more thana decade of clinical experience
helping patients achieve betteroral health through minimally
(00:43):
invasive and prevention-focusedcare.
So, with that, Rumiana, I'dlove to welcome you to the show.
Thank you so much for joiningus today.
Dr Roumiana Tzvetkova (00:50):
Good morning, Dr.
Greenland, and thank you somuch for having me.
It's a truly a pleasure.
Dr Andrew Greenland (00:56):
So let's start with your story, if we
may.
Could you um tell us a littlebit about what attracted you to
dentistry in the first place?
It's probably a while ago, butit's always helpful and
interesting to hear about thecontext and the background of
our guests.
Dr Roumiana Tzvetkova (01:09):
Uh yes, um, sure.
I um I grew up in in Sofia,Bulgaria.
Um, and uh my my mom is aretired oral surgeon.
So I was exposed to dentistryum ever since I was a little
girl.
So uh I do vividly remember Iwas 13 years old, uh, school had
(01:29):
finished, and I had nothing todo during the summer.
So my mom's dental assistantgot sick, and I had to step in,
um, had to start working as adental assistant, and I uh I
remember when she extracted awisdom tooth and um she mounted
(01:50):
that on a on a stone, and Idrilled and removed the amalgam
filling back in the days.
That's that was the material weused to use and filled the
cavity, and I think that was themoment when I had decided that
this is the path uh for me.
Dr Andrew Greenland (02:10):
Lovely, thank you.
And how has your kind ofjourney eventually led you to
become a practice owner?
Dr Roumiana Tzvetkova (02:16):
That's an excellent question.
I uh yeah, I went I came to theUnited States when I was 15
years old and went through highschool um and college, and um I
got homesick, um, went back toBulgaria and decided that I will
enter dental school there.
So that's what I did.
I graduated dental school in2008, um, opened up my own
(02:38):
practice in Bulgaria and workedas a dentist for six years
before I moved back to theStates again because something
was feeling very small, and Iwanted to come back for good
this time and explore how theAmerican way is when it comes to
training patients.
So I graduated Tufts Universityin 2019 and joined Aspen Dental
(03:05):
uh that same year.
Worked as a clinical directorin Rhode Island um for four
years, and then the opportunityto have my own practice came in
2023.
So I moved from Rhode Island toNew York, where my parents
live, and became an owner.
Dr Andrew Greenland (03:25):
Amazing.
So would you mind giving us alittle bit of an overview of um
Aspen Dental, what your practicelooks like today in 2026?
Dr Roumiana Tzvetkova (03:34):
Well, Aspen Dental is um is a um DSO
that is mainly for people whoyou know haven't seen the
dentist in in such a long time.
Those are the people who havebarriers on emotional and
financial level.
So we deal with those types ofpatients.
(03:56):
Uh I was trained to be a veryconservative, minimally invasive
dentist back from fromBulgaria, uh, because in Europe
I I trust and I and I stillbelieve that there is a
discrepancy between the UnitedStates and Europe of the
approach.
So when I when I first started,there was a lot of extract and
(04:20):
insert cases, a lot of hopelessteeth that I had seen.
But as I had built myself as adentist, I realized that there
is always an opportunity to saveeight, ten teeth, because
nothing can replace the naturaldentition.
So when I moved to New York, Iguess the population is just
(04:42):
slightly a little bit, a littlebit different than the
population in um in New England,in terms that uh when you work
in a big city, even though we'rein the suburbs, it's still very
close to Manhattan, people aremore self-conscious about their
teeth.
Their emotional and mental umhealth, I feel, and and as I as
(05:04):
I work with them, is a lot moreum stable.
So to them, losing all of theirteeth is non-negotiable.
So I guess in a way, the thepatients that I work with help
me be the dentist that I'vealways wanted to be.
Dr Andrew Greenland (05:23):
Thank you.
Now, when you look at dentistrytoday compared to when you
first entered the profession,what changes stand out for you
the most?
Dr Roumiana Tzvetkova (05:32):
A lot of changes.
Not I can't pinpoint only one,uh, but the the recent ones that
have um uh aligned with my umethical and moral beliefs as a
dentist um are two products thatI've been utilizing in my
practice and and within Aspen,of course, because I do work
(05:52):
under the umbrella of Aspen.
One of them is an AI tool, it'sa platform by VIDIA.
It enhances our diagnosisbecause um it shows what the
human eye cannot detect uhmajority of the time, because
sometimes the lesions they donot, cavities don't form
(06:13):
overnight.
It takes time for that smalllesion to enter the bulk of the
tooth called the dentin andreach to the nerve, right?
It's not something that happensovernight.
Uh, however, the human eye isuh is very interesting, it can
only detect to a certain degree.
So the uh the platform that weuse at Aspen Dental helps us um,
(06:36):
I wouldn't say detect, but itenhances our diagnosis.
It is more visual and it makesum it makes the transparency uh
more clear, I would say.
What we see is what patientsare able to see now because it's
color um coordinated, um, andit helps a lot when we have to
(06:59):
build that trust with thepatient.
And the other one that werecently have launched in Aspen
um is something called Curedont.
It is by um this firm calledVivardis, based in Swiss.
It remineralizes the enamel andit regenerates the enamel.
It's pure science, and uh, I'min awe of what dentistry um has
(07:24):
um come up with.
Dr Andrew Greenland (07:27):
Amazing.
And in terms of um clientexpectations, patient
expectations, how have thosechanged in the last 10 years in
your experience?
Dr Roumiana Tzvetkova (07:38):
I uh do see that a lot of the time um
people who had implants um andyou know a lot of teeth being
extracted back in the in thedays 10, 15, 20 years ago when
implants um were and still arethe best way to restore missing
teeth.
Uh, they do come with, let'ssay, a full arch of um implants
(08:02):
and and something fixed, andthey do have they still have
their natural dentition on thelower for some reason.
Um their approach is completelydifferent.
Uh, I would say that majorityof the time they would say dog
to something to save those teethbecause I feel that they at
this point realize that nothingcan replace the natural
dentition.
And again, it those type ofmentalities do help me um to be
(08:28):
the dentist that um I am today.
Dr Andrew Greenland (08:33):
Thank you.
Are there any other um bigmisconceptions that patients
still have about oral healththat you've kind of picked up on
the misconception?
Dr Roumiana Tzvetkova (08:43):
I think one of one of the biggest ones
is um when they say I stopflossing because my gums are
bleeding, and then we go intothat vicious circle again of
explaining why the gums arebleeding and why they need to
floss, and the more they floss,uh, the less the bleeding.
Um and uh the othermisconception is again, we're
(09:04):
going back to implants.
Um I'm going to replace all ofmy teeth with implants so I can
have a better smile.
But there's so much more intoextracting teeth and replacing
them with um with implants.
There is anatomy, there is softtissue, there's heart tissue
that we all need to think aboutand treatment plan before we
(09:27):
start um taking out teeth and Iwould say crippling those
patients.
So when it when a patient likethat comes to my office, I do
spend over an hour explainingthe pros and the cons.
Um, there is a lot ofmisconceptions about uh
overdentures and all on X.
Um, and both treatment plantsare expensive, but there is a
(09:51):
component which in which theystill don't understand how an
overdenture is still somethingthat they need to take in and
out, even though they haveimplants.
And this is where we sit downand the discussion is extremely
thorough.
Dr Andrew Greenland (10:08):
Now, one thing that stood out from an
earlier conversation we had wasyour focus on minimally invasive
dentistry.
So, for listeners that may notbe familiar with that
philosophy, what does itactually mean in practice?
Dr Roumiana Tzvetkova (10:18):
Minimally invasive dentistry um is a term
that I use for everything thatI can do in order to prevent um
future um extensive andexpensive dental treatments.
For instance, uh when I see asmall lesion that is still
within the enamel, which againum the um AI platform that I use
(10:40):
by VIDIA in my uh in mypractice helps me um enhance in
visual diagnosis.
Um I would rather prevent thecavity to extend to the bulk of
the tooth by applying curidont.
Um, and then if I see a smallcavity, my prevention would be
(11:03):
let's do a filling before itbecomes a deeper filling where I
need to do pulp indirect, forinstance.
This is a medication that weput on the top of um uh the
dentin that is very, very thin.
Uh, this way we can prevent uhthe um the hypersensitivity in a
future root canal treatment.
(11:23):
If somebody comes that needs aroot canal treatment, I would
prefer to do a root canaltreatment versus extracting the
tooth.
So, see, this is when I sayminimally invasive, it doesn't
mean that I would see a big,huge lesion that is um, you
know, class four.
Uh, for those of you who don'tknow what a class four is, this
is when the incisal edge is inis included, and you need to do
(11:46):
um, you know, a crown or aveneer.
Uh that's that's not the case.
The case is to prevent the moreextensive, painful, and
expensive dental treatment downthe road.
Dr Andrew Greenland (12:01):
Really interesting.
Um, I'm really fascinated bythis curidon.
And you you've just mentionedit, but what's um happening
biologically when this treatmentis used?
Give the listeners a little bitof the scientific background
just to understand a little bitmore about this.
Dr Roumiana Tzvetkova (12:14):
Yes, so curidont is a um is a treatment
um that regenerates the enamelfrom within.
But again, it works onnon-cavitated lesions.
Those are the white lesions andwhite spots that we see on the
facial aspects of teeth whenpeople had worn prices, for
instance.
(12:34):
And who hasn't had those whitelesions?
We all know that back in thedays we would just do amnesial
facial distal filling, right?
Um, or it had happened in thefuture, in the past, when um you
see that white decalcificationand you go with the ultrasound,
and then the ultrasound goesstraight into the dentin, and
(12:55):
there you are, you've cavitatedthe tooth.
So when I see those types oflesions, Curiton, I apply
curadon, and curidon is atreatment uh that is being
attracted uh by the lesionbecause it has a more acidic
environment.
Um, and then it attracts thecalcium and the phosphate from
(13:18):
your saliva, from the patient'ssaliva, uh, and rebuilds the uh
hydroxyapatide, uh, which is thethe bulk of the of the of the
enamel.
Dr Andrew Greenland (13:29):
Thank you.
Dr Roumiana Tzvetkova (13:31):
I've had I've had a great uh results.
Sorry to cut you off.
I've had great results so far.
Uh, and I am um monitoring anddocumenting uh those patients
that are coming for theirsix-month periodic exam.
And it's nothing but pure joyto see that uh we've been able
to safety without the needle andwithout the trail.
Dr Andrew Greenland (13:55):
Fantastic.
So I'm both hearing about theresults is fantastic.
What results have surprised youthe most?
And have there been any patientstories that really stand out
for you since you started usingthis?
Dr Roumiana Tzvetkova (14:06):
Uh I would say um 16-year-old girl.
Um, she and her mom came to mypractice, and the lesions were
were on from premolar topremolar, not to mention um
molars as well.
Um, we um we my hygienist umdid the scaling and the root
(14:27):
planning because she had a lotof buildup in between the gum
and the bone level.
Um, and then a few weeks laterthey removed the the braces and
we applied curidon.
Um I would say six weeks afterthat, we saw that the lesion
started to become the colorstarted to become more of the
(14:47):
color of a natural tooth.
She is about to follow up withme at the end of July, and I'm
dying to see the results becauseI've documented the before, and
I will um take pictures um fromthe after uh we have applied uh
and treated those lesions withuh curidont, and I'm so excited
because I trust and I know thatthe results will be phenomenal.
Dr Andrew Greenland (15:11):
Amazing.
So, I mean, with yourpreventative focus, do you think
healthcare in general spendstoo much time treating disease
and not enough time preventingit from what you see?
Dr Roumiana Tzvetkova (15:21):
Yes, I would say that uh unfortunately
um insurance companies uh wouldrather pay for the damage when
it's done versus paying for thepreventative for the preventive
dentistry.
And it works in almost everymedical field, I feel that uh
they're more willing to pay forthat uh versus screening and
(15:45):
preventing problems that couldbe avoided on 100%.
Dr Andrew Greenland (15:51):
Thank you.
So coming back to the AI thatyou were talking about earlier
on, um there's a lot of feararound AI in replacing
clinicians, a lot of it'sunfounded, and you clearly have
a different perspective.
How do you kind of treat thenew technologies coming in
dentistry, particularly withreference to things like the AI
that you were talking aboutearlier on?
Dr Roumiana Tzvetkova (16:12):
I think that the most important thing
for clinicians out there who arejust um starting to utilize AI
in their practice is to knowthat AI is not here to replace
the clinical decision.
The clinicians are the ones whoput the diagnosis and the
treatment.
AI is here to help us.
(16:33):
Because AI has so the way theway I utilize this in my
practices, before I see apatient, the first thing that I
(16:55):
do is I always open the regularx-rays that we take.
I never rely on the AI to giveme what the diagnosis is going
to be.
And it it is kind of a battlebetween the AI and myself
because I say, you know, this isa true cavity, this, this,
this, and this.
And I'm like, let me see whatAI has to say.
(17:16):
And to my surprise, of course,as I've said it before, the
human eye can detect only to acertain degree when when the
damage is already done.
And I would be surprised to seethat AI had um detected those
small lesions that the human eyecannot see.
And again, it is totally up tome to decide whether to do a
(17:41):
cavity on that tooth.
I mean, to do a filling on thattooth or to uh apply a curidon
based on my clinical judgment,because we all know that
diagnosis is based on yourclinical judgment and the
radiographs that you take.
Dr Andrew Greenland (17:58):
So you have obviously a very balanced view
about the AI technology.
Um the patients trusting thetechnology, the ones that you're
using and uh using AI to helpyou with the diagnosis and
treatment?
Dr Roumiana Tzvetkova (18:10):
On a hundred percent.
I would say 200%.
They do trust us, they do trustme.
Uh, and I feel that people cansense when people uh when when
when doctors are are being umyou know more on the sales part,
which um I don't appreciate.
Um they they see the colors,they see the colors, they see
(18:33):
what a small lesion looks like,they see what a big lesion looks
like, they see the radiolucencyum on the apex of the of the of
the root if they have aninfection.
Uh it's something that beforeutilizing AI, they couldn't see
what I saw.
(18:53):
And that was more uh that put alot of um restrictions um and
and boundaries.
Uh the shield was was there andit never it never went away.
And the moment I startedutilizing AI and started
explaining um what they'reseeing uh and how it translates
(19:15):
to what I see on the other onthe other end, the the my
treatment acceptance got throughthe roof.
And I'm so so so extremelygrateful.
And again, AI is being whenwhen put in the in the hands of
good people, uh it could dophenomenal things for for for
(19:35):
the population.
You give AI to the hands ofpeople who don't have good
intentions, then maybe theirresults are going to be bad.
But in my in my situation, mypatients trust me, I feel more
confident explaining um what thetreatment plan is going to be.
Um, and I have a lot of trustthat continues to build as time
(19:59):
goes by.
Dr Andrew Greenland (20:01):
Thank you.
So you're obviously embracingAI in your work.
Um, where do you think AI isgoing to have the biggest impact
in dentistry over the next fiveyears or so?
Dr Roumiana Tzvetkova (20:13):
That is an excellent question.
Um I again I don't think thatAI is going to fully replace or
will ever replace the clinicaljudgment.
Uh, the only thing that I cansee AI implementing it in the
future is to continue to enhancethings that we can miss as
(20:39):
clinicians and just pinpoint acouple of things because just
like anything else, if you lookback in the days when we first
started using or placingimplants, people would place
implants based on a panoramicx-ray.
But we all know that this is atwo-dimensional image versus a
three-dimensional um implantthat you need to place within
(21:03):
the bone.
And we know that the bone is athree-dimensional structure.
So, what happened was as we hadadvanced, the CBCT scan became
the standard of care when itcomes to placing implants
because it gives you thatthree-dimensional image of where
the nerve is, where um wherethe arteries are.
So uh, same thing here.
AI is being launched in thedental field and in the medical
(21:28):
field right now.
Um, and the future, who knowswhat the future will hold, but
all I know is that it's going tocontinue to help not only
clinicians, but patients aswell, because it does show to
the patient what we asclinicians see, but the patients
(21:48):
cannot.
Dr Andrew Greenland (21:50):
Thank you.
Are there any riskspractitioners should be mindful
of in the AI era?
Dr Roumiana Tzvetkova (21:55):
The only thing that I would say for young
dentists is to be careful.
Careful, yes, because it couldmake them um I wouldn't I would
I wouldn't like to use the wordlazy, but the eye could become
lazy if you are not asexperienced.
Solely take a look at thex-rays, have a mentor um by your
(22:17):
side with whom you can discussthose x-rays, and then do the
clinical exam and then take alook and open up the uh AI so
your eye can be trained to lookat both um both x-rays.
Dr Andrew Greenland (22:34):
Thank you.
So switching gears slightly,I'd love to talk a little bit
about the business side ofdentistry.
Um, what are some of thebiggest challenges facing dental
practice owners today?
Dr Roumiana Tzvetkova (22:46):
Um that's that that is an excellent
question because there's therethere isn't only one challenge
that we face.
We face um a lot of a lot ofthings that um dentists back in
the days did not, and that comeswith mental, emotional
barriers, um, and a financialburden, I I trust, especially
(23:10):
here in the United States, is uhtremendous because people have
insurances, and unfortunately,by the time they need to do a
scaling and a root planning orone filling, they exhaust their
benefits for the year.
And this, as we all know,dentistry is um is an expensive
(23:35):
field, and a lot of the timepeople are on a fixed income,
and that makes it hard for themto continue their treatment.
And I feel that this is whenpeople fall into that vicious
circle, I'll do one thing at atime, but by the time they come,
the problem has become biggerand deeper.
(23:56):
And I feel that back in thedays, comparing to what you
know, how my mother used to workbecause she had her own
practice in Bulgaria, um she, Idon't think she had ever faced
those those problems becauseeverything was a lot less
expensive back in the days,materials, um just anything, and
(24:18):
I mean everything, the way theway things have changed for the
last even five, ten years.
Um, it's it's the the gapbetween um I would say the rich
and the poor is getting biggerand bigger, and that's the
biggest challenge that we facethese days.
Dr Andrew Greenland (24:37):
That's really insightful.
So um which challenges orbottlenecks are most impactful
to you right now, or if notright now, have been on your
journey to where you are today?
Dr Roumiana Tzvetkova (24:48):
I again just repeat that question, I
couldn't hear you.
Dr Andrew Greenland (24:50):
You should be asking about um which
challenges or bottlenecks aremost impactful for you in your
business right now, or if notright now, you know, at some
point along your journey alongthe way.
Dr Roumiana Tzvetkova (25:02):
I would say um I wouldn't say that it's
so much um the financial aspectbecause at Aspen Dental we do
have different payment planplans that people utilize.
Um it's more um the emotional,the emotional state that they
(25:25):
when they especially when theyhave to um extract all of their
teeth.
The terminal dentition, that'swhat I call that.
Um and they postpone itpostpone, and it takes a lot for
me to convince them thatthey're better off um having
full dentures, and then down theroad we can think about getting
(25:45):
more implants and getting overdentures or all on X versus
staying with um roots that arefilled with infection and uh and
etc.
And I did have a very badexperience uh with a patient a
few a few years ago when theyrefused.
And again, you know, if I takeout all of my teeth, which were
(26:06):
just root tips, um, it's justI'm going to be completely
identalist.
And I'm like, you are alreadyidentless.
So the patient postponed thatand ended up in the hospital.
Thank God they're still alive.
Uh, but I would say the mentaland the emotional component is
the biggest challenge indentistry these days that we
(26:28):
face.
Dr Andrew Greenland (26:29):
Yeah.
Um, I think you mentionedpreviously that new patient show
rate has been an ongoingchallenge.
How do you think about thattoday in your practice?
Dr Roumiana Tzvetkova (26:40):
This, so thank God we have uh a great
marketing team uh and uh thathelp us a lot with uh new
patients.
Um at this point in mypractice, I do have a lot of um
word of mouth.
So uh patients are bringingtheir parents, patients are
bringing their, you know, theirwhole families.
(27:01):
So it's getting better andbetter with um new patients um
show rate.
Uh but again, when thatdeclines, there is nothing in
the world that can convince methat it's not fear.
Fear of the dentist.
That is what makes the patientcome to the door.
(27:21):
And I've had patients that theywould come to the door, they
would see me, and they wouldjust walk away.
I'm sorry, Doc, it's not you,it's me.
I've had patients when I wasworking in Rhode Island sitting
on the chair, big abscess, Ihave to take out the tooth.
Uh, the moment they saw theneedle, and I I tend to believe
I'm very gentle when Iadminister the lidocaine, he's
(27:43):
they saw the needle and theyjust jumped out of the chair and
and ran away.
So fear is the number one umbarrier when it comes to new
patients show rate.
Dr Andrew Greenland (27:56):
That's really interesting.
And I guess that's an age-oldproblem, but is there anything
innovative in the in this in thedental space that's been able
to kind of solve or help withthat?
Because I I guess it's beengoing around for years and years
and years.
Dr Roumiana Tzvetkova (28:09):
If there is someone who's gonna invent a
painless way of administeringlidocaine or anything in
dentistry that's sweet, I thinkthey will be millionaires,
billionaires.
Unfortunately not.
Um, I don't think that uh atthis point we have anything.
We, I mean, I do try differenttechniques uh to ease um that
(28:33):
infiltration and to make thingsum less painful.
Because if they have thatexperience uh as a good
experience, everything else isjust a piece of cake.
And and I hear that a lot.
Dr Andrew Greenland (28:49):
So you're a practice owner, you obviously
wear lots of hats in the workthat you do, clinical,
operational, business,administrative.
What is your biggest time drainfor you as a practice owner
that takes you away from thethings that you prefer to do?
Dr Roumiana Tzvetkova (29:03):
Long hours.
You have to be when you're anowner, you think about
everything.
You think about every singleperson that works with you, um,
your office manager, yourpractice coordinator, um, your
dental assistants, your labtechnician if you have one, your
hygienist, um, your assistantoffice manager, you think about
(29:24):
all of them.
And uh you spend you tend tospend a lot of hours in the
office, which to be honest withyou, I still don't mind.
Uh, but I wish those hourscould be a little a little less
than what it is right now.
Dr Andrew Greenland (29:40):
And is there anything that's um in the
things that you've justmentioned that keeps you up at
night?
What's as a practice owner,what's the kind of the biggest
worry that would keep you up atnight or wake you up?
Dr Roumiana Tzvetkova (29:51):
My biggest worry is always the
patient.
A patient who um I did a rootcanal treatment but swelled, who
knows why.
Um, a patient that I placed animplant but uh is in pain uh
three, four weeks since the daywe've planted that implant.
(30:12):
Um patients are my biggest uh,I wouldn't say nightmare, it's a
sweet nightmare, but uh if I ifI could if I could have a magic
wand, it would be all of mypatients are free of pain,
happy, and come back just for aperiodic exam.
That would be the perfectscenario.
(30:32):
And I would say that majorityof the time I I have achieved
that, and that is because of theum hundreds of hands-on courses
that I had attended.
That gives me the stability.
Stability comes when you havesolid knowledge because you
connect the dots and you knowwhen to worry and when not to
(30:54):
worry.
So um patience will always benumber one priority in my life.
Dr Andrew Greenland (31:01):
Thank you.
You mentioned a moment ago yourvarious team members that you
have.
What's your approach tobuilding a team that shares your
values and your patient-firstphilosophy?
Dr Roumiana Tzvetkova (31:12):
Oh, that's a tricky one.
Um, so I uh do have umstandards that I hold up myself
up to, and this is how I choosemy team, teammates.
And um, it is hard.
It is hard because uh peopledon't have the same work ethic
(31:32):
as I do, especially the thenewer generation.
Um, and um that makes thingsdifficult for the majority of
the people that I've beenworking with.
Um and um we I choose very,very carefully.
I prefer to work alone versushaving people who are going to
(31:53):
disobey what I um have built,uh, the rules and the
regulations, not to mention thatthere are still rules and
regulations that I live by uhbecause I'm still under the
umbrella of Aspen.
And I I give that as an exampleso many times, especially to
the younger generation when theyjust want to come to work and
look at their phones and um andthe lack of accountability and
(32:18):
the the lack of uh not beingable to have a normal
conversation without somebodygetting offended is very, very
hard.
And uh and that's why I preferto work alone sometimes, but
have the right people by my sideuh versus having 20, 30 people
who are just there to exist.
Dr Andrew Greenland (32:41):
Got it.
So where do you think you'regonna be in the next 12 months?
Any particular goals oraspirations you have for Aspen,
your your career in your careerpath in the next 12 months?
Dr Roumiana Tzvetkova (32:53):
Next 12 months, I will continue as we
speak.
I'm in uh North Carolina umtaking a master class in general
dentistry bonding, which is myum bread and butter.
I uh I love restoring um teethwith uh with composite.
Um and um in the next 12 monthsI will take master classes in
(33:14):
restorative work when it comesto implants.
I've done the Maxi course lastyear with the American Academy
of Implantology.
The surgical part will alwaysbe something that I am thriving
to improve.
My incisions, my my suturingtechniques, um, and um restoring
those implants to me is one ofthe most important things
(33:37):
because of the um biomechanicalaspect of that.
So um hands-on courses ahead ofme and uh continuing to deliver
um impeccable uh dental care tomy patients, minimally
invasive.
Dr Andrew Greenland (33:54):
Wonderful.
And what do you think the widerworld of dentistry is going to
look like in say 10 years fromnow?
Dr Roumiana Tzvetkova (34:00):
I hope for the better.
I hope for if I if I have topicture dentistry in 10 years, I
would picture contemporarylook.
Um everything is in uh beigeand in white colors.
Um, there is no rushing.
Uh, people are more united onpreserving the natural dentition
(34:21):
and uh not destroying, if andwhen possible.
Uh, and more united society,more united dental society, less
criticism, um, more um studyclubs, uh, more vulnerability
between dentists, because I feelthat majority of the time we
(34:44):
don't talk about our failures,and they do exist uh maybe
because of shame, I don't know.
Uh, but I would like to see thedental community more united in
10 years.
Dr Andrew Greenland (34:57):
Wonderful.
And finally, if you werestarting out again tomorrow,
starting your career againtomorrow, would you do anything
differently with the benefit ofhindsight?
Dr Roumiana Tzvetkova (35:06):
Yes, I would start more slowly.
Yes.
I would invest, I will continueto invest in my education, but
I would master one thing at atime.
That's something I starteddoing six years after I
graduated, dental school fromBulgaria.
(35:28):
And uh I trust that if I hadstarted that since day one, I
would have become the version ofmyself a lot sooner.
Dr Andrew Greenland (35:40):
Amazing.
Rumiana, this has been afantastic conversation.
Thank you so much for joiningme today.
I think what stands out is thatyou're showing what healthcare
looks like when we combineprevention technology and
clinical expertise rather thanwaiting for disease to progress.
So thank you for sharing yourexperiences, your insights
around minimally invasivedentistry, and your perspective
on where the profession isheading.
(36:01):
I really appreciate it.
Dr Roumiana Tzvetkova (36:02):
Thank you so much, Dr.
Greenland.
It was truly a pleasurespeaking with you today.
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