Today, I want to dive into a topic that affects us all: fatigue in our dental practices, particularly in oral surgery. We all experience tiredness from the daily grind of dentistry, and I want to share some insights on the different types of fatigue we face and how to manage them. Physical fatigue is often the most obvious. It can stem from poor sleep habits, lack of exercise, or simply working long hours. While I've improved in this area, it's still a challenge for many. Mental fatigue, or deci...
Jun 04, 2024•12 min
Oral Surgery Is Hard Hey everyone, it's Russell. Today, I want to talk about something a bit different – our profession itself and the challenges we face. The main thing I want to emphasize is that oral surgery is hard. We all struggle sometimes, and that's okay. As we progress in our careers, more experience leads to better outcomes and techniques. You'll find the instruments and approaches that work best for you, and case selection improves with time. Early in our careers, we often face pitfal...
May 28, 2024•11 min
I want to share a story that highlights the importance of comprehensive evaluation and patient education when it comes to third molar pain. Imagine this scenario A 17-year-old female presents with bilateral jaw pain. Exam reveals Impacted third molars, no obvious pathology No intraoral signs of infection or pericoronitis Teeth are removed without complication But at post-op visits, the patient reports Pain persists or worsens No response to anti-inflammatories Headaches develop What's going on? ...
May 21, 2024•16 min
Case Selection Versus Case Complexity Hey ya'll. In a recent post on X (formerly Twitter), I proposed that case selection is one of the most critical factors in achieving good surgical outcomes. Today, I want to dive deeper into that idea and explore some common pitfalls that can lead us astray. Why do we sometimes struggle with case selection? 1. Ego and overconfidence: We overestimate our abilities and take on cases that exceed our skills and experience. 2. Inability to admit limitations: We'r...
May 14, 2024•14 min
TLDR. Course link: PRFBasics.com Today we're diving into the world of platelet-rich fibrin (PRF). I learned about this technique from Dr. Anthony Sclar out of Miami, and I've found it to be a game-changer in my oral surgery practice. Let's break it down into my "P3 Approach": 1. Phlebotomy (Drawing the Blood)-Check local regulations on who can perform phlebotomy; - Draw directly from IV (if sedating patient) or vein-Equipment: Tourniquet, alcohol swab, gauze, Vacutainer with glass tubes (no pres...
May 07, 2024•14 min
Here are the show notes for this episode, where I tackle a few more great listener questions related to previous topics. As always, I'm sharing my personal opinions and experiences, not definitive clinical advice. Bone Wax, Bisphosphonates, and Type 1 Diabetes: Listener Q&A Hey everyone, it's Russell again. I really appreciate you sending in these fantastic questions! This week, I'm diving deeper into a few topics we've covered before, based on your queries. Question 1: How do you use bone w...
Apr 30, 2024•13 min
Link to Youtube video AI Differential Diagnosis Smackdown: ChatGPT vs. Claude vs. Meta AI Hey everyone, it's Russell, your resident tech nerd and oral surgery geek. This week, I wanted to put some of the big AI language models to the test with a fun little experiment. The contenders: OpenAI's ChatGPT. Anthropic's Claude3 Opus. Meta AI's LLaMA-3. The challenge: Given the same photo of a lip lesion and identical prompts, how well can each AI generate a differential diagnosis list? The lip lesion: ...
Apr 23, 2024•18 min
Here are the podcast show notes for this episode, where I answer some common questions from referring dentists and online dental communities. As always, I'm sharing my personal approach and opinions. ---------- Hey everyone, Russell here. This week I'm switching things up and answering a few questions that have come my way recently. Remember, these are just my thoughts - if you do things differently and get good results, that's great too! Let's dive in. Sinus Perforation Repair: - 5mm perforatio...
Apr 09, 2024•15 min
MRONJ Review: What You Need to Know Today I want to dive into the important topic of medication-related osteonecrosis of the jaw, or MRONJ. We used to call this "BRONJ" for bisphosphonate-related osteonecrosis of the jaw, but now we know other medications can also cause this serious complication. Common culprits I see in my practice: - Bisphosphonates: Fosamax, Boniva, Actonel, Reclast, Zometa (IV forms like Reclast and Zometa carry higher risk than oral) - RANKL inhibitors: Prolia, Xgeva When p...
Apr 02, 2024•14 min
Risk Factors for Post-Op Infection in Third Molar Extractions Hey everyone, it's your host, Russell, here. In this episode, I want to share with you an interesting article I came across in the Journal of Stomatology Oral Maxillofacial Surgery, published just a few days ago on March 21, 2024. The article is titled "Risk factors for post-extraction infection of mandibular third molar: a retrospective clinical study" by Muka Naka et al., out of Japan. Key takeaways: - This large-scale retrospective...
Mar 26, 2024•14 min
Hey everyone, I recently had a viewer ask me a great follow-up question to my video about performing coronectomies on lower third molars. They wanted to know how often patients need to come back to have the retained roots removed after a coronectomy, and how long they should wait before doing so. I initially misunderstood and thought they were asking about the timing of the post-op visit, which I'll quickly address. I like to see coronectomy patients back at one week post-op to check their heali...
Mar 12, 2024•9 min
In this episode, I want to discuss a very specific but important topic—how I use panorex X-rays to evaluate lower third molars and decide on the best treatment approach, whether that's deferral, coronectomy, or extraction. While CBCTs provide 3D imaging, I still find panorex to be a valuable screening tool that I use all the time in my oral surgery practice. When looking at a panorex in relation to lower third molars and the inferior alveolar nerve canal, there are several key things I assess to...
Mar 05, 2024•11 min
In my practice, I frequently deal with challenging root tip retrievals when teeth fracture during extraction. It's inevitable if you're taking out teeth. I want to share my approach to managing these painful cases. First, I recognize high risk extractions in advance based on the radiographs. Curved, dilacerated, or endodontically treated roots often break. Vertical fractures, decay to the bone level, missing PDL space, and apex shape can also foreshadow issues. Knowing the challenges ahead of ti...
Feb 27, 2024•21 min
In my oral surgery practice, I frequently use 10 things that help me on a daily basis. I'll share them rapidly, not in any particular order: 1. C sponges/throat screens: I use these constantly whenever I put instruments in a patient's mouth. They prevent dropped instruments from going down the throat. 2. Hemostatic gauze: I put this in most extraction sites. It helps stop bleeding and oozing, especially for patients who can't go off blood thinners pre-surgery. 3. Disposable #15 blade scalpels: s...
Feb 20, 2024•24 min
I revisit my belief that continual learning is key to better patient outcomes. I also maintain that having a coach accelerates growth. I introduce a new belief: dentists should eliminate the phrase “simple extraction.” I see it as my mission to end the use of this term. There is no such thing as a Simple Extraction The ADA code D7140 does not say “simple.” It just describes erupting a tooth with an elevator or forceps. I feel insurance companies have popularized the term pay less. But there are ...
Feb 13, 2024•13 min
In this episode, I explain the meaning behind the provocative title "Running Sutures are a Sign of Weakness." This mantra originates from my formative experience observing renowned plastic and reconstructive surgeons at Johns Hopkins Hospital during my anesthesia fellowship. I was intrigued to find the esteemed Dr. Paul Manson and his entire team used interrupted sutures exclusively when closing their incisions. Key Lessons from Johns Hopkins Surgeons Working in the OR with Dr. Manson, I heard h...
Feb 06, 2024•15 min
In Episode 7, Dr. Kirk discusses the critical topic of preventing wrong tooth extractions during oral surgery. He shares how implementing structured “time outs” has helped avoid these devastating errors in his own practice. The Wrong Tooth Experience Russell opens by admitting he has extracted the wrong tooth before, as have colleagues he’s spoken to. He describes the sinking feeling when you realize an error occurred despite best intentions. Russell explains how reconstructing the process after...
Jan 30, 2024•10 min
In Episode 4, Dr. Kirk covers the important topic of managing bleeding during and after oral surgery procedures. He provides an overview of key considerations and his techniques for controlling hemorrhage when it occurs in the office setting. Prevention Russell emphasizes that prevention is the first priority when it comes to bleeding. Steps include: Thorough health history and medication review - look for anticoagulant use, bleeding disorders, etc. For warfarin patients, check the INR close to ...
Jan 23, 2024•15 min
In Episode 3, Dr. Kirk answers a question he recently received from a dental colleague regarding removing impacted upper third molars. He provides a step-by-step walkthrough of his technique for these challenging extractions. Case Background Russell describes the specific scenario: The upper third molars #1 and #16 are mesially angulated with the occlusal surface touching the distal of the adjacent second molars. The roots are positioned just below the maxillary sinus floor. The teeth are fully ...
Jan 16, 2024•6 min
Dr. Kirk opens this episode by sharing that he frequently receives questions about soft tissue flap design, especially regarding impacted third molar removal. He will focus today's show on covering his approach to flap design fundamentals and specifics for accessing lower and upper third molars. Russell first explains his background in learning flap design during dental school under Dr. Charlie Shannon. A key concept Russell learned was that incisions heal side-to-side rather than end-to-end. Th...
Jan 09, 2024•13 min
The host, Dr. Russell Kirk, introduced himself as a Board Certified oral and maxillofacial surgeon with over 21 years of experience practicing oral surgery. He shares that he has a passion for podcasting, having previously hosted a podcast focused on the business of dentistry before putting it on hold during the COVID-19 pandemic. Russell explains that in preparing to start a new podcast, he reconsidered the topic based on the feedback and questions he regularly receives from dental professional...
Jan 02, 2024•13 min
