Dentistry Uncensored with Howard Farran
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1139 Dr. Russell K. Kirk DDS, Oral & Maxillofacial Surgeon, Founder of Business of Dentistry Podcast & ownR Magazine : Dentistry Uncensored with Howard Farran

1139 Dr. Russell K. Kirk DDS, Oral & Maxillofacial Surgeon, Founder of Business of Dentistry Podcast & ownR Magazine : Dentistry Uncensored with Howard Farran

2/13/2019 11:45:37 AM   |   Comments: 0   |   Views: 207

Dr. Russell Kirk was born in Union City, Tennessee, and lived in West Tennessee throughout his childhood. After graduating from Obion County Central High School in 1985, he completed his undergraduate training at The University of Tennessee-Martin in 1990. Dr. Kirk attended The University of Tennessee College of Dentistry and graduated with honors in 1994. Immediately upon completion of dental school, Dr. Kirk accepted a commission as a dental officer in the United States Navy. He became interested in the Naval Services after being awarded a Health Professions Scholarship his last year of dental school. During his senior year, he was also selected by the Navy to participate in a one year post graduate residency in general dentistry. 

VIDEO - DUwHF #1139 - Russell Kirk

AUDIO - DUwHF #1139 - Russell Kirk

Dr. Kirk received his Certificate for General Practice Residency from Naval Hospital Great Lakes in 1995. After completing his Navy residency, Dr. Kirk served as the Dental Officer and Department Head for Naval Mobile Construction Battalion Four Zero (NMCB 40). During his tour with the Seabees, he was based out of Port Hueneme, California, and completed deployments to Guam, Spain and Bosnia. He completed his active duty obligation in 1997. Upon leaving active duty, Dr. Kirk was selected as one of two dentists for advanced training in anesthesia at The Johns Hopkins Hospital in Baltimore, Maryland. Dr. Kirk completed his Fellowship in Anesthesia and Critical Care Medicine from Johns Hopkins Hospital in 1998. Advanced postgraduate training in Oral and Maxillofacial Surgery was obtained at the University of Tennessee Memphis and Regional Medical Center in Memphis, Tennessee. Dr. Kirk received his certificate in Oral and Maxillofacial Surgery in June of 2002. Dr. Kirk began practicing in Lebanon, Tennessee, July 2002. In 2005, Dr. Kirk was mobilized to active duty. He closed his private practice to serve as the staff Oral and Maxillofacial Surgeon at the United States Military Hospital Kuwait in conjunction with Expeditionary Medical Facility Dallas. He returned home and re-opened his practice in March of 2006. He opened a second office in Mount Juliet in 2007. Plans for renovations to this facility are underway. While maintaining his schedule at the office, Dr. Kirk remains very active in the United States Navy Reserve. Dr. Kirk was promoted to the rank of Captain in June 2013. He is currently the Senior Executive for Expeditionary Medical Facility Great Lakes One. Dr. Kirk also remains active in hospital, dental and civic activities in the surrounding community. He is an active member of the American Dental Association, Tennessee Dental Association, Nashville Dental Society, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgery, Tennessee Society of Oral and Maxillofacial Surgeons, and Diplomate of American Dental Society of Anesthesiology. Dr. Kirk is married to Dr. Ann-Marie Sutherland. They have two daughters, Presley-Kate and Harper-Grace, and one son, Brennan James. His hobbies include training in Krav Maga and Brazilian Jiu Jistsu.

Howard: It is a huge honor for me today to be podcast interviewing Dr. Russell Kirk who was born in Union City Tennessee and lived in West Tennessee throughout his childhood after graduating from Obion County High School in 85 he completed his undergraduate training at the University of Tennessee Martin in 1990. He attended the University of Tennessee College of Dentistry and graduated with honors at 94. Immediately upon completion in dental school dr. Kirk accepted a commission as a dental officer in the United States Navy, he became interested in the naval services after being awarded a Health Professions scholarship his last year dental school. During a senior he was also selected by the Navy to participate in a one-year postgraduate residency in general dentistry. Dr. Kirk received a certificate for general practice rusty from Naval Hospital Great Lakes at 95. After completing his Navy residency Dr. Kirk served as a dental officer and department head for naval mobile Construction Battalion 4-0 during his tour with the Seabees he was based out of Port Hidden California and completed deployments to Guam, Spain, Bosnia. He complete his active duty obligation in 97, upon leaving active duty dr. Kirk was selected as one of two dentists for advanced training in anesthesia at the John Hopkins Hospital in Baltimore Maryland. Dr. Kirk applied his fellowship and anesthesia and critical care medicine from John Hopkins in 88. After advanced postgraduate training in oral maxillofacial surgery was obtained at the University of Tennessee Memphis and Regional Medical Center in Memphis Tennessee. He received a certificate in oral maxillofacial surgery in June of 2002. Dr. Kirk began practicing in Lebanon Tennessee 2002 in 2005 he was mobilized active duty he closed his private practice to serve as a staff oral maxillofacial surgeon at the United States military hospital in Kuwait, in conjunction with Expeditionary Medical Facilities Dallas. He returned home and reopened his practice in 2006 he opened a second office in Mountain Juliet in 2007 plans for renovation of this facility are underway while maintaining is sketch the office Dr. Kirk remains very active in the United States they've reserved he was promoted to the rank of captain in 2013 that means we actually call you officially doctor captain.

Russell: Yes

Howard: He is currently the senior executive for  Expeditionary Medical Facility Great Lakes One. Dr. Kirk also remains active in hospital dental and civic activities in the surrounding community he is an active member of the ADA, Tennessee Dental Association, Nashville, American Association of Oral Maxillofacial Surgeons, American Board of Oral Maxillofacial Surgery it goes on and on and on. He's married to Dr. Ann Marie Sutherland they have two daughters Presley Kate and Harper grace oh my god you must be a big Elvis fan to have a Presley and grace

Russell: We are

Howard: and one son Brennan James. His hobbies include training in Krav Maga and Brazilian Jiu Jitsu . Well I'm glad we're doing this over Skype so you don't hear in person to kick my butt but I actually call I actually contacted you, you did not contact me I was on I'm a big fan of your website, you have a podcast you're the only oral surgeon that I'm aware of that has the podcast and my gosh thanks for coming on the show how are you doing?

Russell: Oh man it's an honor to finally be on here and talking with you virtually face to face Howard.

Howard: So my gosh it seems like there's two kinds of kids out there they either just want to do soft and pretty sub bleaching, bonding, veneers, Invisalign or there's the blood and guts guys that want to pull teeth and do dentures and partials and you know place implants and all that what will percent of dentists you think are really cut out for oral surgery blood and guts versus I just want to do soft and pretty stuff?

Russell: Well that's it that's a tough one I don't have a number I know that locally here we're in a rural more rural community outside of Metro Nashville and a lot of the guys around here excellent surgeon. So they all play in that realm and both of them actually, so I couldn't tell you an actual number who who just does that for primary purpose in their practice...

Howard: Well first of all I want to thank you for your service and and when that

Russell: You're welcome

Howard: and that kuwait thing popped up and you had to close your practice down go serve your country. I've read I've read that in America only less than 1% of Americans ever serve is that true

Russell: I think that's a pretty accurate number yes Howard

Howard: and I don't think I've ever had a guest on my show that had to close down their office and go serve the United States military and thank you so much for that was that a was that a huge burden economically and on your family and three kids?

Russell: So we didn't have kids at the time and I had only been in practice a couple years so I did a startup and it was very near economically devastating to me but I had I'd played it well I'd saved enough money and so the practice loan I was able to distort my equipment come back to to open another day it was at the time of course a lot of the things in life you go through those rough patches they're pretty depressing but now I look back and it was a it was a good experience for me it was a way to come back and restart fresh and I had made it several mistakes in my business and I was able to up write that and come back with a little different opinion and a little different attitude toward how I would open my practice the second time around.

Howard: and you know the best foundations are built on rock bottom I know

Russell: Amen

Howard: I mean I know so many dentists have hit rock bottom weathers for divorce or criminal judge something to do something or having to close down your bride go serve the military whatever and it really gets you thinking more holistically than it allows you to see the big picture.

Russell: Yeah a big picture I think that's where our growth happens I really do I mean when you get into those tough spots and that's why I'm a fan of Brazilian jiu-jitsu has taught me a lot too.

Howard: Yeah and you know another thing is what when you go back and you listen to podcasts on like a world war one or war two, it's funny how in my lifetime nobody saw the prediction of the falling of the Berlin Wall the Arab uprising 9:11 nobody nobody really saw the outbreak of World War one around the corner or World War two. So when I start seeing these events like the other day when Venezuela and Russia was saying don't you know don't mess with Venezuela and they were sending bill and you look at all these things and it's just like you need to be prepared for the worst because I don't think in all of history anybody can see around the corner. I mean nobody was telling everybody in Europe hey there's a world war about to break out so you know settle down and get that free and build a bomb shelter. Do you agree with that perspective that you never know when these hostile events are gonna break out?

Russell: I think so I I think we have a better finger on our pulse and I think really I had an opportunity to go through the Navy War College and I have a little better understanding of that than what I did prior to going through that program and it's its diplomacy it's pushing your flower power forward and I think it's all politically based and I think they probably understand that a little bit more. We read history but sometimes we don't learn from it but I think the more recent stuff that's happened I think that's a little bit more unpredictable.

Howard: So tell us about your journey first of all most of our viewers are 25% in dental school the rest are under 30 there's only a very few old and senile people at my age that are listening to podcasts I still read textbooks and newspapers. What do you what advice would you give these these young kids, one thing I wouldn't get asked about is I'm out here in Arizona and there's there's a death out here I mean it seems like every couple of years there's an anesthesia death by a general dentist. One was the hygienist numbed up a kid four four quadrants of pediatric dentistry and then when the dentist walked in the room he didn't know the hygienist had numbed, so here re-numbed four quadrants and the kid died of an anesthesia overdose and of course those kids you know so that was just but other ones are pediatric dentistry where they're doing IV sedation I mean you you see these on Facebook calls I'm and what do you think of kids that their whole life when they go to the hospital, the hospital would not allow the cardiovascular surgeon to do the IV and the bypass they split those jobs up. What do you think about these kids learning IV sedation and do you think that's kind of over their head or should be a specialty or what what do you think about that?

Russell: So I come from an anesthesia background with my time at Johns Hopkins and I the thing that I see that the most that was drilled upon us up there all the time was it's not if you have a complication it's when you have a complication so I think what you have to focus on is if you're going to do that is you really need to be comfortable with how you're going to bail yourself out should you get into a problem situation. I think if you're properly trained and we all have different skill sets and we all have different reps and different procedures that we do and the more you can do and the more mentorship and the more education you can get I think it's okay I don't have a problem with it, where I see some bumps in the road is when we don't know what we don't know when it comes to these things and we get a little overconfident I'm guilty of it as well and then you know the dental guides will humble as quickly and so I give that I give that piece of advice just be sure that you're comfortable with the complications if you're going to go down that path and there you go.

Howard: Well you've had three kids I had four my gosh my wife my ex could deliver them in the middle of the night and they just paid an anesthesiologist in there they're right there for an epidural to me of course I'm spoiled I'm in Phoenix and a metro of four million people I just don't know why you would put yourself through all that training and risk if you could just have a board-certified anesthesiologist show up in your practice literally 24 hours a day seven days a week.

Russell: So there are guys that do that I know oral surgeons that employ a dental anesthesiologist is it is it recognized specialty yet, no is it coming it's likely I know it's been closed a few times and the ADA forum I understand. So you know I think it's just a matter of time before that happens where I think in a lot of respects we probably mirror our at least parallel medicine our parallel medicine not mirror it, but I think at some point this is all gonna break out and we're gonna end up like medicine for the better or for the worse of it

Howard: Yeah so you went to Memphis do you think the kids are learning oral surgery properly when they come out of dental school do you think when they come out $400,000 of student loans they're good in oral surgery or do you think they need more advanced training or what would you recommend on their journey out of dental school?

So here's my take on that and I speak of this after going through those programs because I'm on the other side of those now. I don't think that we should be any different than medicine and we should have residency programs to get those clinical skills honed and give us a little bit more understanding and I'm okay with that now I know there's probably people that are counter that that's fine everyone's subject to their own opinion but I think it works pretty well for the medical field and and to do that have an extra GPR AGD or maybe a surgical externship and I don't think that's a problem. I think that's probably a good thing for clinical and business Howard.

Howard: I want to ask you something else, their's kids who extract teeth and don't place implants do you think  do you think that it would be harder for you to place an implant a single implant on replacing a Mac you know a first six year molar or an upper secondary bicuspid or removing a semi impacted wisdom teeth. What do what do you think takes more advanced surgical skills?

Russell: I think probably the wisdom tooth removal, probably more.

Howard: So basically if you're listening to this right now and you're driving to work on your hour commute and you pull someone's impacted wisdom teeth but don't place implants you just heard it from an oral surgeon that you have more than skill necessary to place a replace a first molar or a maxillary second bicuspid.

Russell: I think they each have their own you know their their own set of complications again their own things that you have to be aware of and solid skills and foundational surgical skills are gonna get you there.

Howard: So talk about your journey to your website owner I love the name owner its ownr for owner, mag for you have another website talk about your journey and how I mean there's five thousand oral surgeons in the United States and you're the only one I know that migrated to the the podcast world, talk about your journey and how did that happen?

Russell: I started listening to podcast and as I started listening to all my I was listening to a one called six-figure side gig with Mark Costas you know Mark and I didn't even know he was a dentist I was listening to him for entrepreneur advice and then one day I'm like wait a minute this guy's a dentist, then I started looking for he didn't know podcast and as I listen to these I'm like you know I wonder what it would be like so I start about with curiosity in the tech side of things and as I started looking I've done a course I'm like oh I'll try to do this course and see if I can at least put a couple episodes together just to see if I can do it to take the challenge and here we are later. I use a lot of my first episodes and even some today to just that I can own and these riffs you know about what happens during the week what happens you know some positive some negatives and then I try to play off that say hey this is where I used to think this is what I did this is what I would recommend not doing I've made that mistake just to give people. What i found most howard is people go I'll get emails from them or I'll get facebook messages and they'll say you know I've got the only one in that in the same situation. I'm glad there are other people and I think that's the beauty of podcasting is we get off of that island of isolation if we're solo practice guys and gals and I just found it fun and I get to meet people like you and I've had an opportunity to talk to people that I otherwise wouldn't have because of the podcast. So it's been a real good networking thing as well.

Howard: It was so funny because when I'm when Jobs came out with the iPhone which really started that the apps and all that in 2007 in podcasting it was funny how Wall Street was saying that um the day of the hundred million dollar blockbuster movie is gonna get slaughtered by user-generated content and now you look at the fact that a google youtube uploads enough content every day that you'd have to take you 2,000 years at 24 hours a day seven days a week to listen to what's upload every day. So it's neat that you know it used to be media had to go through these gates you know like digital magazines or whatever movies had to go through you you could film a movie and put it up on Hulu and in fact there's a new movie up there on Netscape, I don't know it's causing an uproar on Dentaltown root cause have you heard about that that movie on Netflix?

Russell: Oh no what happened I think I know what it might be about but go ahead and tell me.

Howard: Well I mean its root cause and these guys are saying their holistic dentist saying that root canals have there's no other surgeon in the world that leaves a dead tissue in your body and when they do a root canals the tooth is dead they're leaving a dead tooth in there and that's 97% of all women who have breast cancer have a root canal tooth and they're making all these statements and it's really driving the Townies insane on Dentaltown but anyway so I those buddies I asked some of my non dentist friends here in Phoenix and every one of them that watch I told him to watch it and tell me what they thought about it and thought and every single one of them came back to me like Oh god those root canals are terrible should I have mine pulled and it's like wow I wonder I so yeah I wish you would you usually watch a show and do a podcast on your owner mag or or or I wonder if I could if we could get those people on the if your listen to this and you know the dentist that were on Root Cause they want to come on and talk about their show that that would be an amazing podcast. So what do you think about all this holistic thoughts I mean their's anti-vaxxers, anti root canal, their's  anti-metal I mean there's patients like you know what is this all coming to?

Russell: So I think I go back I fall back on my training it what what's the science say you show me the research show me the science let me read that look and then I think you can give me that I can compare it to what I have learned and then I'll make my decision but you've got to show me you've got to show me the science because that's what we all are how are we're scientists. I mean I know we're more than that but at the end of the day we're scientists and so you've got it you got to bring that to the table and it's got to be more substantial than just some anecdotal stuff and I and I say that because I haven't seen this show, I want to watch it though.

Howard: Talking about science so I podcast interviewed an oral surgeon from Germany and he was telling me that they're more quote evidence-based dental research and that oral surgeons in Germany pull out significantly less third molars than their American counterparts and he feels that a lot of Americans removed the four wisdom teeth simply because they exist and the Germans like to think do we have any data that shows this is gonna cause a long-term problem do you how do you explain the discrepancy between a higher percentage of wisdom teeth removed in America versus Germany?

Russell: I think goes back on our training what's really interesting is I have had an evolution and my private practice in my personal approach to that I started out I was you come out of training I was much more aggressive, I talk more people out of having wisdom teeth removed and sometimes I risk upsetting my referral base because I disagree with them on certain cases but I moved toward the more conservative side. So I can see their point answer me I'm not saying that it's you leave them all in but there's got to be some good valid reasons that we do these surgical procedures.

Howard: and what percent of your practice would you say is exodontia versus dental implants?

Russell: So I roll out about 60% exodontia with the anesthesia I'm playing about 30% implant bone graft and then about 10% pathology, that's the mix-up.

Howard: Wow and and what did what did you want to talk about now did you want to talk about what do you think it'd be a good subject I'm placing implants extracting teeth what do you think it'd be good.

Russell: You know what I'd most often get questions about is extractions so we can go down that path if you like, Im happy to answer any questions.

Howard: I felt very lucky I went to the University of Missouri Kansas City and there's two oral surgeons there Dr. Brett Ferguson and Dr. Charlie white and I believe Brett was the past president of the Oral Maxillofacial factories in Tennessee do you know Brett Ferguson?

Russell: I do not

Howard: Yeah I think I think he's in a I think he's in Nashville or but anyway there were so many good lessons and then do you remember Mathias Horgan?

Russell: I know the name yes

Howard: Yeah he was an oral surgeon and what was neat about him is he was shipped off to Korea for several years and back then the oral surgery kit was a small large elevator at a 150 to 151 and in dental school you know you're always trying to look for this Altima four Seth and he had this old military general gruff Mathias saying I spent four years in Korea I could but anyway what he did and I kid you know when I tell people this they don't believe it but I mean we pulled almost all the teeth just with a periosteal and a small elevator. I mean it was you basically had to beg to get a force up out of that guy and then his other lesson was on whenever you couldn't get it out and you call for help he'd always say well hell I couldn't pull it out with that flat I can't see it he goes you know a two-inch flap will heal the same as a one-inch flap he goes spend your time I want to see the damn thing then he'd go in there double the size your flap peel it open like a banana and then like just you know. So talk about tips on oral surgery that these young kids need to think about when they're trying to remove teeth.

Russell: You go you got me smiling because one of my one of my mentors back in dental school would talk about flaps he said those things don't heal end to end they heal side to side. So he's like make up wide make a wide flat make a long flap and I always remembered that and it's true visualization is key. I think case selection is of utmost importance and you know as you go through your practice you learn the things that you want to do and the things that you would prefer not to do and you get yourself into a bind a few times and and that's and that's expected. I mean you do this long enough again I say the demo gods oh they'll they'll humble you quickly about the time you think you've got to figure it out you'll catch something that surprises you so I think flap design is good and I know there's all kinds of fancy names but I learned it as an envelope flap, a three-cornered flap, four corner flap and now I've seen one a variation of that that you could sit I could call a six corner flap and that's basically all you have.

Howard: That's four flaps?

Russell: Envelope yeah envelope, three corner, four corner and then a six corner. So you really only have about four different variations on that

Howard: Three-cornered four-cornered and six cornered

Russell: Yeah that's the way the six corner when I saw about five years ago Tony Sklar down in Miami, I went to one of his courses and he would tuck back at the base of the flap heap he'd cut them back in a little bit so you can hit you would have six corners on that to get some better advancement to give you better primary closure with with no tension. So that's that's a newer one that I've seen I didn't do that one in my education or in my back by training but that's one that's pretty cool.

Howard: Well I've never I've never heard that the four flaps envelope three-cornered four quarter and six cornered you want to go into more detail about that?

Russell: Yeah I mean the envelope is the one that we classically use. So you take a third molar case you got it you go in you make your incision along but the crest of the third molar retromolar pad area you may extend that up to say mesial of the second molar and then you just dissect back you've got that envelope flap. I use that one primarily for all of my third molar cases, occasionally you get to a point where you need a little more visualization I'll do a little dogleg off of the distal and that's a three corner flap. Occasionally you need to release the papilla and do a vertical incision at the Meisel of the first motor reflect that way back you can even score your periosteum that's a four corner flap and you can put that pretty much anywhere in the mouth upside down sideways or right lifted they're all the same. I'd have to think simply and they all have these different names if you look back at the history they all got their names attached to them but I just do it I just do it that way to make must make it easier for myself.

Howard: and are you a novocaine man except the King talking about anesthetic anesthesia...

Russell: So I am a I'm a lidocaine, marcaine guy I will do bilateral marcaine block on my lower thirds for the most part I am a fan of septocaine for soft tissue I've had an incidence twice in my career where I used septocaine early on and I had some paresthesia and I less controversial but I had a couple paresthesia cases with septicanie on a mandibular block and and I don't go that route anymore just from my own personal experience. So I'll use a lidocaine marcaine primarily.

Howard: I don't do you think I don't think marcaine is very very popular so they all know do 2% lidocaine is that without 1-100 epi or 1-50?

Russell: Yeah I use 1-100 and I use a half percent marcaine with 1-100. Those are my go to's and I do have some barticanie or septocaine

Howard: Yeah but talk about marcaine cuz a lot I would guess 90% of the dentist under 30 listening this podcast do not use maricanie do you agree with that or disagree?

Russell: I don't know I don't know what they're teaching them or what their training

Howard: Talk about the difference between lidocaine and marcaine.

Russell: So the big difference is the onset slower for marcanie but the longevity is longer. So what I'll do because typically we're removing more bone to the upper thirds come out a little easier the lower thirds are most challenging for us and the bones a little more dense so if you're taking bone to get those thirds out on the bottom, I'll get marcaine you can get four six sometimes a little longer on your anesthesia after surgery so they're a little more comfortable and they could get home they can get rested and get settled and they're not hurting as quickly and that seems to play. The one thing that I do find is I get phone calls after hours sometimes and they're saying I'm still numb is this normal and it is for the use of marcaine. So that's the reason I use it

Howard: How long do you think they stay numb from in your practice from lidocaine versus how many hours?

Russell: I would say closer to a couple hours hour hour and a half two hours probably it's not that long.

Howard: For lido?

Russell: Yeah for my experience yeah

Howard: and then how long for marcaine?

Russell: I'm saying but I'm saying about six hours

Howard: Six hours, I'm well I got out of school in 87 in the 80s for you I can t I don't even know what there's other people that say show weren't even born then. We were the medical was the bad guy because grandmas over here died in a cancer and she's in pain and everybody was like you know you've got to technology give her morphine what are you worried about she's gonna get addicted she's dying. Dr. Kevorkian was out there saying you know we need euthanasia look how uncomfortable she is you know we should put her down and we were the bad guy because we weren't prescribing opioids. So that one swung and everybody started switching I mean when I got a school I mean that was that was just a rare deal and then everybody started prescribing opiates now we're the bad guy again because now they're saying the you know last year seventy-two thousand Americans died opioid addiction that's more than the attend year Vietnam war that's more than last year's combined accidents thirty thousand car accidents thirty thousand and now the pendulum swing back. I have friends in town who will not give a vicodin or a percocet for any reason whatsoever and then there's a bunch of doctors who you know some still do so what do you give for pain med and what's your thoughts on our role in opioid addiction you've obviously seen some of the articles that some say that seventeen percent of kids their first experience was an opioid was at the dental office. So talk about opioids.

Russell: Oral surgeons in particular have been have it been implicated in this problem but a cause of that fact a lot of the a lot of the teenagers that come in haven't had a medical procedure or surgical procedure and we're the first introduction. So that's that's some of the concept about how this is taking place that we're the gateway into that potential addiction and abuse. I still do prescribe narcotics for acute pain post-surgical pain. I limit it and we counsel them what's really interesting is now we are even down to a lower dose, we structured everything in Tennessee we had a change in the law and they've really tightened up on us with the DEA of course also being a part of that when they stopped allowing us to call it in over the phone. So I think we're headed in the right direction but as far as us primarily being the they the offender in this I can't say that I believe that and of course I'm biased but we have you know we have our orthopedic colleagues that you get something done you know with a long bone and they'll give you 30 and then they'll give you two refills for percocet of 30, so you got 90 then we've got our chronic pain clinics that we see out there that have 120 140 a month that they're prescribing patients, that that has to be a role to and has to be included in the conversation but I still prescribe narcotics.

Howard: You know I did a podcast with a Wendy guessing and she's been in substance abuse rehab her whole career as long as I have we're about the same age and she was telling me and I've read it before that a lot of the addiction overlaps with mental illness said about you know like say then I say it's like 14 15 percent of people have some substance abuse problem and she said those people probably have some they're self-medicating that that's her deal she's she doesn't believe you give a healthy mind a beer and the next morning they're drinking it for breakfast that people who you know some people drink a beer before they go to bed but the ones that have for breakfast they're self-medicating. So she  actually thinks that if you have an addiction problem you probably have a mental issue problem you should stop treating yourself with you know drugs and you should talk to a mental health expert. Do you agree with that or disagree with that?

Russell: Well it's really interesting you I've been doing some recent study and on that spectrum and I found this in a physician's study they were studying professional burnout or workplace burnout and so you start on the left of the spectrum and go right you first have workplace stress the normal stress that we deal with day to day and we can adapt my design be people that would be on the left side yeah so as we move from the stress in our workplace that we can adapt to we start getting overworked we start having problems where we can't adapt to everything that's being thrown at us and then we move into what's a burnout what we all i've used the term i've heard other dental colleagues use the burn term burnout then burnout is upstream of clinical depression and then eventually you can get into suicidal ideation and suicide. So this spectrum is is where we're living at any given point and the healthy of the healthy people we can adapt i think once you get into the burnout that can push us into these addictive behaviors whatever that addiction may be and that's the way i have understood in my own reading about the topic.

Howard: Yeah I'm sure it's a very complex issue I think a lot of people when they're young thing binomial up-down left-right on/off and a little late Lake Prison like the United States is the largest prison population in the world and I think eighty percent of them have three things in common they didn't finish the 12th grade they have a substance abuse issue and they grew up below the poverty line and you got countries like in Scandinavia screaming at the Americans saying putting him in a cage isn't helping him. I mean he didn't finish 12th grade why don't you do that for him as a substance abuse issue why don't you put him in and in rehab and all that and he lives below the poverty line once you give him work training and it seems like it's really changing because seems like when I was young everybody was right-wing you know throw them away throw them you know you can't put them in jail long enough and now the science is kind of saying maybe there's more to being in jail than meets the eye and a lot of it might be treatable.

Russell: So it that's more from a mental health state maybe how people think and I mean I had the deck stacked against them has a couple things they're, you know low or no education and then living up living in a pretty austere environment and then how do you start to think about things, you start negatively thinking and then that triggers you into these other behaviors and so I could I could I can support that.

Howard: I've only had two surgeries my tonsils taken out and a vasectomy and then after my vasectomy I asked for a vicodin and he said the job was so small that I should be fine. I'm not hearing a podcast to be someone's friend I like to punch my homies where it hurt so that's what's needed but my gosh it seems like to me half the dentists in America every time they pull the tooth it's just an automatic pen PK 500 milligram 28 tabs and vicodin 16 tabs and a lot of scientists are saying that you know there's superbugs generating which I don't know if I really believe that because 90% of all the antibiotics made and sold in the United States our going into cattle sheep pigs and chickens because it makes them fat but but what do you think about my homie listen to you on the way to work that ever and then he says to me the lawyer thing there's 1 million attorneys in the United States he goes you know just cya I'm just covering my ass I mean uh you know so address that do you think everybody that gets an extraction she have the pen VK 500 milligram?

Russell: I think my personal practice on third molars I typically give I don't get pen PK I give clindamycin I get clindamycin 150 short course three to five days depending on how long the surgery is but I also am a big proponent of chlorhexidine and I know there's controversy about that but the antimicrobial and when you shift over and you look at somebody that has maybe Crohn's disease or some some gastrointestinal stuff I won't put them on clindamycin but I'll put them on the the oral rinse I'm still in the antibiotic camp I still I still prescribe antibiotics.

Howard: but you like clindamycin what dose is that?

Russell: I usually give clindamycin 150 tid and I'll do a three-day course or a five-day course if I do IV sedation on implants I'll hang up I'll hang 300 in the in the IV bag and that seems to help.

Howard: So let's do I'm from any other exodontia to attempt some I think a lot of its fear I see just fear.

Russell: So when I had the opportunity and residency to be in the dental school I think one of the biggest thing is just people are timid and maybe that's not the right word but you're timid when they go into surgery. So that I agree with that second I think it's if you think at any point when you're working on extractions and you runs through your mind I wonder if I'm gonna need a handpiece pick the damn thing up just use the handpiece it'll make your life so much easier if you've got a profoundly anesthetize just pick the handpiece up and get and use the thing. I think we worked so damn hard don't getting them out manually and sometimes it's just the decision to pick up a handpiece and go.

Howard: but some of them are even more scared because they think well my handpiece is air driven and I don't want to cause an error embolism and they don't have a slow-speed can you use an air driven handpiece in oral surgery is that just an absolutely no no?

Russell: I'm an I'm out a fan I've seen  air emphysema and it's scary as hell when it happens to you I mean usually time will will cure that but I am NOT a big fan of that I've seen it happen in some of the clinics that I've been a part of so I own a Hall nitrogen driven handpiece is what I use.

Howard: driver you use what say that again

Russell: Nitrogen driven Hall handpiece

Howard: Nitrogen driven Hall handpiece

Russell: Yes the train don't I still use that I've used the electric ones but I don't see that they have as much torque but if you're gonna do a lot of extractions get you get you in the nicest electric one you don't necessarily have to go and plumb med gases into your clinic I mean you can if you want to and I'd do that but I think some of the more modern electric ham pieces work pretty well.

Howard: Well why did why did you go with a nitrogen driven haul handpiece as opposed to an electric ham piece and you are there any electric handpieces that do you think good substitute evenly for your nitrogen driven haul handpiece?

Russell: So I would say in my hands no I've used a couple of the the electric ones I just not a fan of them and I trained on the hall handpiece so it's one of those Oh ever I trained here and I'm comfortable with it so maybe a comfort zone for me and I've used a couple of demos I just don't like them I just I can move quicker and I can section a tooth quicker and I can remove bone quicker with a hall handpiece.

Howard: You know I always look for just you know mathematical variances in the two million dentists around the world to see what's going up so you can kind of see you know kind of draws your attention to what to look at and I'm amazed at how more dentists in Germany and Europe is electric than the Americans. I mean Americans I mean you you could go visit four dental offices a day for a year or not and and they're all air driven what and but the Germans are more electric and then Americans complain about the noise of the air it's you know it's yeah but it's just kind of what you're born and raised on I mean it's like if you're raised in India you like curry if you're in the United States you like sugar and and if you start with it that touch air driven, it's a totally different feeling to have an electric drill in your hand.

Russell: I agree I agree that's that's a very good reason that I probably do what I do and the nitrogen and it's noisy but like you most of my patients are sedated so they don't they don't tend to complain as much.

Howard: So let's let's talk her down from the ledge she's afraid that she's gonna start pulling this tooth and not be able to get it out she gets stuck she only got in half out I've done it that way.

Russell: Well let's back up here a second so she's up she starts out afraid that she's not gonna be able to get the tooth out

Howard: No well she's afraid I'm afraid she's afraid that this patient's coming in I'm gonna pull that tooth but what if I don't get out what with the crown breaks off what if I can't get it out and then she feels like well I just can't send him to I mean the oral surgeons gonna think I'm an idiot. I used to I mean I used to pull out in in 87 and 88 for the first couple of years at least once a month I'd only pull the top half of the wisdom tooth out and then I'd have to send him out and either my me or my sister receptionist would either drive him to Dawn Gass oral surgeon during the day and if his evening hours Orszag I have a street named Bob Sundberg and he's just thinking was so funny he goes yeah Howard pulls out the top half I pull out the bottom half but they both laughed and helped me and taught me and so that would stop but they're just afraid that's gonna happen. So what would you tell her to do if that happened to her what are you supposed to do what how bad is it?

Russell: I think that it happens to all of us just to begin with it happens to me every week probably, so I think you go back and you say alright if I think this is gonna happen what are my contingency plans. I know this thing's if it breaks the crown do I have the proper equipment do I have the proper instrumentation because I find that talking with some guys out there and gals out there they don't have enough the surgical hand equipment to be able to tackle something like this. So be make sure you just make sure you have the proper armor Terry armamentarium to do it, have a handpiece in case you need to section that thing say it's an upper first molar and you need to cut the roots and take them out independently. That's the first step knowing that you have all that you need on hand is helpful and then if you get to a point and you work on them and you're just like I just don't think I'm gonna achieve this it's ok that's what we do call your oral surgeon and explain to them that this has happened to me it happens in here all the time and I wanna I want to build a relationship with my referring offices that they feel comfortable calling me not gonna get beat over that brow for doing something like that and I used to not be that way Howard I used to be a little bit more a little bit more egotistical and judgmental but over a period of time you learn that it happens to the best us so don't don't don't be ashamed to pick up the phone and call for help. Have the plan proper instruments and if you get into the weeds and you need some help call somebody to help you.

Howard: So what do you think made you on your journey switched from you say being arrogant, egotistical, judgemental against she shouldn't have tried to pull that - she should have sent to me in the first place to where right now where you're more accepting and understanding and was that what do you what made you change your mind on that?

Russell: I wasn't getting very far with folks doing it the prior way, so I knew I had to change at some point and it was bothering me too. So personal growth I think just understanding that sometimes we think we know we know more than we really do and you get a good dose of humility with we talked about this in a little bit before we started recording about life can knock you around pretty damn hard sometimes and you can either you can either accept that as a learning experience and an opportunity or you can we can keep banging your head on the wall whichever way you choose to go and I liked it to try and soften up and understand more.

Howard: Yeah I mean I used to be against when I'm going to Phoenix I used to be so upset at the homeless people on the intersection always panhandling when you're trying to get on the interstate and then I got involved with a homeless shelter and it was right away where I realized from the doctor there had been there 30 years that he said almost the only people that are homeless that get returned back to work and private sector he said that's only about five to ten percent and then he told me the other 90% are schizophrenic and and you know he's been doing for thirty years and then when you just learned that a little bit that this person has a 90 percent chance of being schizophrenic and anything they do makes them feel better if it's sniffing glue heroin meth anything makes them feel better than their current state and if you put them in a homeless shelter that the four walls the windows makes them go insane they make it worse they'd rather be sleeping on the sidewalk than in some in four enclosed room and yeah so it's not what you know it's yeah well that's good that you're humble and all that stuff.

Russell: Well  I want to say you make a very good point it reminds me of a story and I'll tell this story real quick if you don't mind. So in Memphis we had the general education boat and there right across the street from that was a park and several people that were homeless would sleep on those park benches and so you're walking through the park going to and from the clinic in the cafeteria and whatnot. Well three of my classmates decided they were gonna take one of these homeless folks in I was a young guy and so they take him in they set him up they get him an apartment a small like economy apartment they get him a job they get him give him some money to get his food and about three weeks later he's back out there he told him he's like I appreciate it guys but I just can't I just can't do that it's just too confining. So you you're you're spot on with that at least based on that story and he's like he was happier outside on that bench that he was with any responsibility whatsoever so interesting.

Howard: Yeah Mila say well I don't want to give that guy money he'll probably go buy booze well maybe if you were schizophrenic living on a sidewalk there's a reason booze makes you feel better. It's just sad but I am another thing is this true or false, when we look at paresthesias and I am a lot of oral a lot of dental malpractice comes from paresthesia some people mainly back to dental school Matt Horrigan he used to always say that's look if you bring off a root tip he says you know you get a paresthesias going down they're trying to dig it out and removing all this bone and hitting the nerve he says it's not a problem and he would even say a good-sized root tip like maybe you know you know four or five six millimeters he said the body's gonna work out later he says he said you leave that root tip down there a couple of years later it's gonna be coming through the soft tissue you can take out with a pair of tweezers but going down there and digging after for half an hour is what's gonna get you in a paresthesia true or false?

Russell: True

Howard: Nice so it's ego it's the young that's what I think it's just this young ego this doctor just can't leave a root tip I mean he's a doctor of everything there's a root tip by god I'm gonna get it out and that's when they start destroying stuff and so what rant about root tips.

Russell: Okay so let me back up on that I'm gonna go a little indirect on this. So you have a person who come is fully develop third molar say they're in their mid-20s their only reason we're gonna take them out is to have symptoms you look at the you look at your imaging and you can see that the inferior alveolar nerve is at very close proximity to the root tip. I had counseled the patient I said ideally we would take the entire tooth out but you have a significant risk if we do that we could damage this nerve we can cause you to have a numb lip and chin for the rest of your life they're like I don't want that I said well there's an alternative treatment call it a coronectomy we go in and we take off the top part of the tooth that's pressing on the adjacent tooth or maybe sue the soft tissue with an oral communication we leave the roots behind and most of the time we never have to touch him again if we do they have migrated away from the nerve because they've moved up like like you were talking about toward the soft tissue level and we mitigate some of the risk. Same thing with sinus I mean I typically if I get a root tip in the sauna so I want to fish it out because I have seen some pretty sad situations with people with this big chronic sinusitis problems but I don't have a problem with even root tip I think the key to that is you have a reasoning for it say it's you know the risk of removing or retrieving the root outweigh the benefit of doing so because of nerve potential nerve involvement and I documented such like that.

Howard: Now you're in Lebanon, Tennessee or in Mount Juliet, Tennessee you're you have two offices right Lebanon and Mount Juliet.

Russell: Right right

Howard: Do general dentists ever come by and say I want to observe and watch you do oral surgery is that does that happen much is that cool does that slow you down, does the thought of that make you cringe or is that fun for you what are your thoughts on all that?

Russell: No I have had multiple multiple folks come through my office and hang out and if it's their patient I don't care and they come over anytime and I find it fun I like I like it because I'm a solo practitioner and when they come in we can talk and we can socialize and I'm fine with that I have no issue with it and sometimes I get questions about why are you doing this why are you doing that and I'll give them my personal reasoning as in my hands and my training the way I do it and the reasoning behind it and sometimes it's in disagreement with what they do and that's fine we all have our own techniques in our own ways that work better in our hands no problem I love it.

Howard: So you're 60% Exodontia and 40% did you say 40% implants or what did you say?

Russell: 3030 yeah 60 Dental alveolar 30% implants and 10% pathology, so I get a fair amount a fair amount of pathology more of the geriatric population coming in for soft tissue stuff that's what we primarily see I get a little bit of hard tissue pathology the big stuff like if it's a real big thing I'll sit at the Vanderbilt which is up the road here.

Howard: and is the pathology mostly there it's a suspect lesion and they want you to biopsy it or look at it or

Russell: Yeah you get the discolored lesions and it's just I think people sleep easier if they know what it is definitively and we could send it to the pathologist and get a get a read on that

Howard: I want to switch over to implants I do want to tell you that I have podcasts interviewed a lot of practice management consultants and when they find an oral surgeon who only does Exodontia their overheads about 40% and by the time their practice is all implantology their overheads about 60%. So that tells you I'm plan so higher okay but let's talk about implantology these young kids are coming out of school and if they're in America they say it seems like all the continued education on implantology is manufacturer driven. So do I need to pick an implant system because seems like most of the courses are sponsored by the implant companies or how would you cuz I know what she's saying right now she's saying I graduated from dental school and $400,000 in debt I didn't place one damn implant. How does she learn how would you recommend her on her journey to learn implantology, what system would you recommend, where should she learn... talk about implantology.

Russell: Well I've come down that journey because in honesty when we were doing a residency you didn't start doing implant placement until  your fourth year at distant my particular program we did so much so much trauma so much reconstruction and orthognathic that was our focus and then your third gear you've got to assist and then first assist on those implant cases and then your senior you got to place and we used every system they had at that time. We had seven or eight systems around there and it was just it was mind-boggling. So the way I look at implants in the way I have elected to go is trying to look from a restorative standpoint okay what's the easiest restorative for folks and I know there's controversy as to who that is and I have I've elected to go currently I use 3i and because they have the encode abutment and this is just an easier restorative process because we use scans for digital imaging and scan all the scan bodies. As far as courses to learn how to place implants it goes back to the mixture is based sound science and research and I also I talked to a young man this past weekend about continuing education. If you see all the pretty cases Howard you know in a course go up and ask hey do you have some complications you can show me and if they don't show you complications because we all have those damn things happen to us we all have unfavorable outcomes then you need to probably look for another course to take because they're having them is we have to share those too because that's where we all learn is the space in which I think we learned the most.

Howard: Now when use that make sense would you say 3i is that biomet 3i?

Russell: Zimerman bought them so it's Biomet 3 I and and some guys over at East Tennessee turned me on to that and we've been using that and they're very expensive in comparison comparison to some of those fixtures out there but that was the reason we did it because it was easy for us because we were doing some of the scanning and the scan bodies you don't have to take off their one in the same with a healing collar and I will tell you this you mentioned and we're gonna go back and a comment you made earlier. So with that mix 60 30 10 with implants involved in my practice I run about a forty four point seven percent overhead my goal was 38%. So it can be it can be done and that's with a higher priced implant.

Howard: Now does it concern you that Biomet 300 Zimmer, so when I was little 3I was its own company

Russell: Yeah

Howard: and they would M&A; activity they called on Wall Street mergers acquisitions well biomet Zimmer through their name in the Hat for a possible sell do you think they were just fishing and have your first of all did you hear that or do you even care?

Russel: I didn't even know what happened until basically right when it occurred my my rep came in and was saying hey there's gonna be a significant change possibly there's gonna be this happening and that's the only way we knew it I'm like you're still gonna make the same implants the same system because shouldn't change at least short term I'm like okay and that's all I need to know, I didn't worry.

Howard: and you know Straumann, Straumann sells the most dental implants in the world because of mergers or something about they bought me Neodent in Brazil, MMS Israel and when you and I just want to cast some brazilian dentists the other day and and they don't even know or care that a company is that Scandinavia bought neo dead it's still the same company so so if yeah so biomet obviously they're not gonna close it down if they sell it to people who buy a certain wouldn't want to do anything but they're it's an entry space and back to the holistic people that um you know they don't want vaccines they don't want metal do you ever think about placing zirconia dental implant for the holistic people or is the holistic people not really a common thing in Tennessee demanding metal that's not?

Russel: Their are some folks I've had some rare rare cases when I would have someone come in there's I think there's a I think there's a guy Nashville that does that that's just not my space and I don't I don't know enough about them so I would refer them out and they're just not my target market

Howard: Yeah it seems like I don't want to sound I don't act Kenny buddy out but it seems like that more holistic thing is more big in like San Francisco or Silicon Valley than Wichita Kansas. I know people who change your SEO marketing in San Francisco to be off-the-grid holistic you know some of these key buzzwords and now they have people driving an hour to their office of course burning gasoline and there are there car so they can be more green and but it's different. So I can't believe I got the only oral surgeon who does a podcast um you got to sites where some my homies go you got and you got and where should my homies listening to you right now go they can follow you on Instagram at ownrmag then go to your own website but where do you recommend him to go to hear more from you?

Russell: okay if you want to hear more if you want to listen more on the podcasts out of things the business of dentistry podcast that's my podcast. So I do that and if you want to see more of a multimedia approach then the ownr mag we have articles it's all digital so and it's responsive you can read on your phone you can read it on your iPad on your laptop. So that's multimedia so we have some video we have some audio and we have some text so we have two or three different ways that we can interact with you their both good platforms.

Howard: My podcast producer Rebecca and Buster they only want me to be on sound they don't like me being on video they say dude that they can't see your face you got to do only sound and print no more YouTube

Russell: No no no no disagree that here's the thing going back to going back to the media gateway and the media gatekeepers the thing that's I think so important for what we're doing here is it is real, it's not some type of photoshopped polished thing. It's authentic it's a couple guys talking about things that they think are important and they're interested in and that's the beauty of what we do man and hey I'm good with it, you know you can always turn that off and just listen to me.

Howard: I know that's why I love you user-generated content and that's why I called my podcast Dentistry Uncensored because you know the thing I notice in 30 years have going to CE courses is that the speaker almost bores you and puts you to sleep and then three hours later he's at the our drinkin beers and he's the greatest on earth and keeps you up to one o'clock. I'll never forget one day I was in a fishing boat catching redfish in off the Louisiana off the swamp and I'm just listen to the speaker and i said why the hell didn't you talk like this yesterday that was the most boring pathetic life but on the boat he's telling jokes and he's being uncensored

Russell: So engaging

Howard: It's like okay keep it real I'm yeah this point is oh yeah

Russell: You get so much further I think with with people and your interaction and your connection with them when you can just be yourself and roll with it and I agree with you.

Howard: A couple ways to explode your podcast number one 65,000 of the Townies download the app and we have a place you can upload your podcast it's for free we have an app section.

Russell: Oh roger

Howard: The dentist that uploaded their app saw their subscribes on iTunes and YouTube explode and when I look at those articles the ownr mag I wish you'd put one in Dentaltown magazine I wish you'd do an online CE course. I just want more homies to know the man Captain Kirk

Russell: This has been fun I've followed you and I to your podcast to see your videos I'm cool with the videos and I appreciate you inviting me on and it's been a real pleasure.

Howard: Well it was an honor to have you on it's Dr. Russell K. Kirk go to hope you have a rockin hot day buddy thanks a lot. 

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