Everyday Oral Surgery

Anesthesia is critical to surgical procedures, ensuring patients are comfortable and pain-free during operations. However, administering anesthesia is not without risks, especially for patients with underlying health conditions like aortic stenosis. In this episode, we are joined by Dr. Paul Rollins, Oral Surgeon at Falls Oral Surgery & Dental Implant Center, to explore some of his anesthesia near misses with patients. Learn about the basics of aortic stenosis, what the symptoms are, and how to identify it before administering anesthesia. Discover how to differentiate between aortic stenosis and Still’s murmur, why you need a high-quality stethoscope, and how to identify a diastolic murmur. We also delve into the process that follows after reliably identifying aortic stenosis, the pitfalls of relying completely on advisors for clearance, and the importance of maintaining a patient’s blood pressure while avoiding hypertension during anesthesia. Gain insight into other issues to consider before administering general anesthesia, the importance of asking questions, and more. Join us as we learn about some of the ways anesthesia can go wrong and how to avoid them with Dr. Paul Rollins!Key Points From This Episode:Why case reviews are so valuable for preventing problems.First case: an older male who exhibited aortic stenosis before general anesthesia.Second case: an older male with hypertension who exhibited a clear aortic stenosis.Third case: an older male diagnosed with aortic stenosis but cleared for general anesthesia.Fourth case: an anxious older female who had an obvious red flag.Fifth case: an older female who misrepresented her medical history. Dr. Rollins’ final takeaways and valuable advice for listeners!Quotes:“One the most frightening things about healthcare, what we do on a daily basis, and healthcare in general is we base so much of what we do on what the patient tells us about their history.” — Dr. Paul Rollins [0:04:00]“Once a patient becomes symptomatic with aortic stenosis, the mortality rate approaches 50% within two years without any intervention.” — Dr. Paul Rollins [0:07:14]“Sometimes [aortic stenosis] murmurs are so loud that you will hear it almost anywhere on the chest.” — Dr. Paul Rollins [0:18:51]“If you hear a diastolic murmur, don’t move forward with the case. Get it diagnosed and figured out first.” — Dr. Paul Rollins [0:29:00]“Never do something that you are uncomfortable doing because a patient is trying to pressure you into doing it.” — Dr. Paul Rollins [0:32:18]Links Mentioned in Today’s Episode:Dr. Paul Rollins — linkedin.com/in/paul-rollins-25248848Falls Oral Surgery & Dental Implant Center — fallsoralsurgery.comShōgun — imdb.com/title/tt2788316Narcos — imdb.com/title/tt2707408The Gentlemen — imdb.com/title/tt13210838The Little Book of Common Sense Investing — amazon.com/dp/1119404509Man's Search for Meaning — amazon.com/dp/1846042844/Everyday Oral Surgery Website — everydayoralsurgery.com Dr. Grant Stucki Email — grantstucki@gmail.comDr. Grant Stucki Phone — 720-441-6059

We often underestimate the importance of sleep and how “horror sleep” can negatively affect all aspects of our lives. One of the major hindrances to good sleep is airway complications, but maxillomandibular advancement surgical interventions may be the answer. To help us in our exploration of the impact of airway deficiency on temporomandibular disorders (TMD), we are joined today by the jaw and airway expert, Dr. Christian Andy Loetscher, DDS, MS. In this episode, Dr. Andy explains how a compromised airway leads to TMD complications, with technical examples of the exact causes of TMD. He also describes how regular deep sleep can eradicate most problems, how premolar removal is detrimental and the best practices for TMD treatments. You’ll learn about assessing and preparing patients for maxillomandibular advancement surgery, Dr. Andy’s process for these surgeries, and receive some helpful resources on the value and power of good sleep, plus a whole lot more! Tune in today.Key Points From This Episode:The relationship between airways and TMD. How a compromised airway causes TMD issues. The importance of deep sleep.  Best practices for TMD treatments. Getting technical about the exact causes of TMD. How premolar removal works as an effective treatment. His maxillomandibular advancement surgery process post-diagnosis. Examples of some of his more complicated cases. The relapses he sees in his patients and his outcomes regarding nerve issues. Some helpful resources on sleeping.   Links Mentioned in Today’s Episode:Dr. Christian Andy Loetscher on LinkedIn — linkedin.com/in/atlantaoralsurgery  Dr. Christian Andy Loetscher on X — twitter.com/OralSurgeryATL Dr. Christian Andy Loetscher Email —  jawimplant@aol.com  Atlanta Oral & Maxillofacial Surgery & Dental Implant Center — jawimplant.com ‘Sleep Prosthodontics: A New Vision for Dentistry’ — id.cdeworld.com/courses/4684-sleep-prosthodontics-a-new-vision-for-dentistry ‘The Sleeping Brain: Harnessing the Power of the Glymphatic System through Lifestyle Choices’ — mdpi.com/2076-3425/10/11/868  Why We Sleep — amazon.com/Why-We-Sleep-Unlocking-Dreams/dp/1501144316 The Matt Walker Podcast — sleepdiplomat.com/podcast  ‘Dr. Matt Walker: The Science & Practice of Perfecting Your Sleep’ — youtu.be/gbQFSMayJxk   Dr. Jeffrey S. Rouse — https://www.rousedds.com/jeffrey-rouse/ Everyday Oral Surgery Website — everydayoralsurgery.com/ Everyday Oral Surgery on Instagram — instagram.com/everydayoralsurgery/ Everyday Oral Surgery on Facebook — facebook.com/EverydayOralSurgery/Dr. Grant Stucki Email — grantstucki@gmail.comDr. Grant Stucki Phone — 720-441-6059

It is so important to be able to find humor in every situation, even difficult ones and as an oral surgeon, you may encounter difficult situations often! Today’s topic of discussion is a bit of a lighter one, as we are joined by Ben Hechler to break down all the different oral surgery stereotypes and our experiences of them. Maybe you are the grump surgeon who has worked way past your retirement or you’re the bro surgeon who wants to make friends with everyone! Perhaps you are the assistant who likes to give medical advice or even the storyteller front desk worker. You could even be the nervous nelly oral surgery patient. Whatever stereotype you fall under, this episode is a hilarious anecdote that is not to be missed so be sure to tune in now! Key Points From This Episode:Welcoming Ben Hechler back to the podcast. Why it’s often appropriate and beneficial to find humor in stressful situations as oral surgeons. A breakdown of stereotypes of different types of oral surgeons and our experiences of them: 1. The God-Complex Surgeon.2. The Bro Surgeon. 3. The Grump Surgeon. 4. The Canceler Surgeon. 5. The Veteran Surgeon. 6. The Almost Viral Surgeon. 7. The Resident. What these different kinds of surgeons generally wear. Observations of some stereotypical front desk workers: 1. The Bullsh*tter. 2. The Blocker.3. The Storyteller. Dissecting some stereotypical assistant types:1. The Old Hands. 2. The Doctor. 3. The Absent-Minded Professor. A few archetypical oral surgery patients and how to handle them as oral surgeons:1. The Nervous Nelly. 2. The Big Chill. 3. The Loud Laugher. 4. The Cellphone Junkie. 5. The Raging Bull. Links Mentioned in Today’s Episode:Ben Hechler on LinkedIn — https://www.linkedin.com/in/ben-hechler/Dude Perfect — https://dudeperfect.com/Everyday Oral Surgery Website — https://www.everydayoralsurgery.com/ Everyday Oral Surgery on Instagram — https://www.instagram.com/everydayoralsurgery/ Everyday Oral Surgery on Facebook — https://www.facebook.com/EverydayOralSurgery/Dr. Grant Stucki Email — grantstucki@gmail.comDr. Grant Stucki Phone — 720-441-6059

During this episode, Dr. Dallen Mill joins us to share a few technologies that have been so beneficial to him that he would almost describe them as magic. We kick off our conversation with a brief overview of the history of anesthesia before we unpack how to address respiratory compromise and airway emergencies. Dr. Mill shares four studies on two options for laryngoscopies, discusses tips for negotiating the tube through the vocal cords, and offers some tech suggestions to support the process. We also talk about IV placement, the power of having a longer IV catheter, how to optimize the process with the use of an ultrasound device, and much more! For an informative review of some of the most helpful technology available in anesthesia today, don’t miss this conversation with Dr. Dallen Mill. Key Points From This Episode:An overview of the history of anaesthesia. Respiratory compromise concerns and how airway emergencies can be managed.The appropriate time to apply direct laryngoscopy versus video laryngoscopy.Four studies on the relevance of these two approaches.Tips for negotiating the tube through the vocal cords.Different options for purchasing a video laryngoscope.Learning how to get the necessary view and practicing insertion.Other scenarios where video laryngoscopy can be useful.The role of an ultrasound in the process. IV placement and alleviating patient anxiety. Why a longer IV catheter can be beneficial for the ultrasound process.Linking the ultrasound device to your iPad. Using the BIS Monitor where relevant.Fine-tuning the wake-up process.A guide to practicing IV placement. Links Mentioned in Today’s Episode:Dr. Dallen Mill on LinkedIn — https://www.linkedin.com/in/dallen-mill-055338/‘Video versus Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults’ — https://pubmed.ncbi.nlm.nih.gov/37326325/‘First-attempt success rate of video laryngoscopy in small infants (VISI): A multicentre, randomised controlled trial’ — https://pubmed.ncbi.nlm.nih.gov/33308472/King Vision Video Laryngoscope — https://www.ambu.com/airway-management-and-anaesthesia/clinical-evidence/king-vision-video-laryngoscopeGlideScope Video Laryngoscope — https://www.verathon.com/video-laryngoscopes/BESDATA Video Laryngoscope — https://besdatatech.com/video-laryngoscope/Sonoque — https://www.sonoque.com/Butterfly Network — https://www.butterflynetwork.com/ Dr. Sono — https://drsono.com/ Everyday Oral Surgery Website — https://www.everydayoralsurgery.com/ Everyday Oral Surgery on Instagram — https://www.instagram.com/everydayoralsurgery/ Everyday Oral Surgery on Facebook — https://www.facebook.com/EverydayOralSurgery/ Dr. Grant Stucki Email — grantstucki@gmail.com Dr. Grant Stucki Phone — 720-441-6059

Neurological and psychiatric expert, Dr. Andrew Jenzer, discusses common neurological terms, mood disorders, perioperative considerations for anti-depressants, headaches, serotonin syndrome, and more. Insightful conversations cover seizures, epilepsy, and the importance of asking questions as an oral surgeon. Banter about sci-fi books and Harry Potter houses adds a fun touch to the episode.

Allergic reactions are as nuanced as they are subjective – there are no blanket treatments for anaphylaxis, and each case needs to be observed in isolation. Today we are joined by the Dental Anesthesiologist, Jonathan Bacon, DDS, to walk us through everything we need to know about anaphylaxis diagnoses and treatments when under anesthesia. After learning more about Dr. Jon, we discover what anaphylaxis is (with a more accurate definition from the World Allergy Organization), what causes it, how to identify it, and how to treat it. We discuss the right dosages for anaphylactic treatments, the factors that affect the severity of attacks, comorbidities and triggers to be aware of, and the relationship between hypertension and anaphylaxis. We end with a deeper examination of anaphylaxis treatment options, how to administer them, and the importance of educating patients to ensure that they know how to deal with anaphylactic attacks at home.Key Points From This Episode:Dr. Jon Bacon’s professional history and current practice setup. What anaphylaxis is and how we deal with it as healthcare providers. The main causes, signs, and symptoms of anaphylaxis. Assessing the right dosage for anaphylactic treatments.  Age and other factors that affect the severity of an anaphylactic attack.A more accurate definition of anaphylaxis, as proposed by the World Allergy Organization. How Dr. Jon handles patients who develop hypertension while under anesthesia. Comorbidities and triggers to be aware of during anaphylactic episodes.   How the type of allergy influences the anaphylactic attack and the required treatment. What we’re looking for from a clinical presentation. How to decipher between isolated hypertension and anaphylactic-induced hypertension. Exploring what happens after an anaphylaxis diagnosis; how to treat it. Mountains Beyond Mountains, Unbroken, painting, Severance, and Top Gun.Links Mentioned in Today’s Episode:Dr. Jon Bacon Email — jpbacondds@gmail.com Just Wisdom Teeth — justwisdomteethdc.com/  World Allergy Organization — worldallergy.org/  ‘Perioperative anaphylaxis – management and outcomes in NAP6’ — bjanaesthesia.org.uk/article/S0007-0912(18)30401-X/fulltext Severance — tv.apple.com/us/show/severance/umc.cmc.1srk2goyh2q2zdxcx605w8vtx  Top Gun: Maverick — https://www.imdb.com/title/tt1745960/ KLS Martin — klsmartin.com/en/   KLS Martin 35% Discount Code — StuckiFavs Dr. Stucki’s KLS Martin Instrument List & Instruction Video — klsmartin.com/dr-stucki-instruments Everyday Oral Surgery Website — everydayoralsurgery.com/ Everyday Oral Surgery on Instagram — instagram.com/everydayoralsurgery/ Everyday Oral Surgery on Facebook — facebook.com/EverydayOralSurgery/Dr. Grant Stucki Email — grantstucki@gmail.comDr. Grant Stucki Phone — 720-441-6059

Dr. Aaron Liddell, an expert oral and maxillofacial surgeon at Colorado Oral Surgery and consultant for the Denver Nuggets, shares his insights on managing zygomatic fractures. He discusses how these common injuries occur, and the importance of thorough clinical assessments, including assessing for orbital compartment syndrome. Liddell also delves into surgical and non-surgical treatments, emphasizing patient communication about risks and outcomes. With a focus on timing, imaging techniques, and innovative surgical approaches, this conversation is a goldmine for understanding maxillofacial trauma management.

Even when a procedure is done perfectly, dentists can and do cause neuropathic pain. During this episode, we discuss how to diagnose the spectrum of trigeminal neuralgia, how to approach management, and how to mitigate damage during treatment. Expert Dr. Thomas Robbins joins us and shares insights from his vast experience in addressing this condition. From symptoms and the diagnostic process to approaching cases with little to no images, bloodwork, and more, this episode is a detailed crash course on proven strategies and identification techniques. Dr. Robbins touches on different reasons that trigeminal neuropathy may occur and explains why he chooses to focus on this and emphasize it. We also get into the brain’s role in amplifying pain. You’ll also hear about the screening process for temporomandibular disorders. Tune in for a highly informative conversation with today’s expert. Key Points From This Episode:A brief history of Dr. Robbins’ career history and current practice.The experience that led him to focus on facial pain, trigeminal neuralgia, and headaches.How trigeminal neuralgia is diagnosed. Symptoms to expect from different types of trigeminal neuralgia.Why thorough investigation is necessary.How to approach cases where there is little or no imaging.The appropriate time to do bloodwork.Different procedures to address trigeminal neuralgia.Mitigating damage during treatment.How Dr. Robbins differentiates between trigeminal neuralgia and post-procedure neuropathy.Understanding that dentists can and do cause neuropathic pain, even from the most perfectly well done procedure. How the brain can amplify pain.Different reasons that trigeminal neuropathy can occur and why Dr. Robbins emphasizes them.Pain management and medication.Flare ups that may occur and how to treat them.Screening for temporomandibular disorders.Quick-fire questions including Dr. Robbins’ relationship with reading and how he cares for his mental health. Links Mentioned in Today’s Episode:Dr. Thomas Robbins Email — trobbins@mycenters.comDr. Thomas Robbins on TikTok — https://www.tiktok.com/@dr_tjrobbinsThe International Classification of Headache Disorders — https://ichd-3.org/New International Classification of Orofacial Pain — https://orofacialpain.org.uk/wp-content/uploads/2021/10/Link-7-Pigg-et-al-2020-JOE.pdfEveryday Oral Surgery Website — https://www.everydayoralsurgery.com/ Everyday Oral Surgery on Instagram — https://www.instagram.com/everydayoralsurgery/ Everyday Oral Surgery on Facebook — https://www.facebook.com/EverydayOralSurgery/Dr. Grant Stucki Email — grantstucki@gmail.comDr. Grant Stucki Phone — 720-441-6059

Joining Dr. Stucki once again is Dr. Benjamin Hechler, an OMS practicing in North Carolina. On this episode, we wanted to circle back and dive deeper into TMD and TMJ hyper and hypomobility. The conversation kicks off with Dr. Hechler unpacking some of the common causes behind TMJ hypomobility, the definition of a closed lock (CL) including an overview of acute CL and chronic CL, with a quick reference to the anchor-disc phenomenon. We also look at the different flavors of TMJ hypermobility and various types of dislocations. Dr. Hechler details his technique with awake patients, why imaging would be indicated for TMJ mobility, and then delves into a detailed explanation of his approach to TMJ mobility treatment. To hear more about our thoughts on TMJ mobility issues caused by being in the dental chair, our tips and tricks for avoiding them, and what could tip the scale toward a more permanent management solution for these types of issues, be sure to start listening now! Key Points From This Episode:Our goal for today’s episode: TMJ hyper and hypomobility with Dr. Ben Hechler.Dr. Hechler unpacks some of the causes behind TMJ hypomobility. He defines what is a closed lock (CL).The difference between acute CL and chronic CL.A quick look at the anchor-disc phenomenon.Dr. Hechler highlights some different flavors of TMJ hypermobility (and dislocations).He details his technique to get an awake patient back into the proper TMJ relationship.We dive into a discussion on when imaging is required for TMJ mobility.He explicitly details his approach to treatment for this demographic of TMJ patients.His thoughts on how often TMJ mobility issues are caused by being in the dental chair.Dr. Stucki shares some of his tips on avoiding dental chair TMJ mobility issues.TMJ mobility management: when does the scale tip toward a more permanent management/treatment?The multifactorial aspect of connecting patient characteristics and our capabilities as surgeons to formulate the best possible plan.Links Mentioned in Today’s Episode:Dr. Ben Hechler — https://www.linkedin.com/in/ben-hechler Episode 236: Perspectives on Management of TMJ Disease, with Dr. Michael Miloro —https://www.buzzsprout.com/1404670/14614031-perspectives-on-management-of-tmj-disease-with-dr-michael-miloro KLS Martin Promo Code: StuckiFavsKLS Martin Email — usa@klsmartin.com Everyday Oral Surgery Website — https://www.everydayoralsurgery.com/ Everyday Oral Surgery on Instagram — https://www.instagram.com/everydayoralsurgery/ Everyday Oral Surgery on Facebook — https://www.facebook.com/EverydayOralSurgery/Dr. Grant Stucki Email — grantstucki@gmail.comDr. Grant Stucki Phone — 720-441-6059

Balancing having a family and career as an oral surgeon can be quite difficult and today’s guest is no stranger to this struggle. Dr. Samuel Scroggins joins us today to share how he manages to find the highs in life while running his own private practice, raising eight children, and going on incredible highpointing adventures. Tuning in, you’ll hear all about our guest’s background and training, what made him interested in highpointing, why he loves it so much, and his plans for his next adventure. We then delve into how he got through residency with his large family before he explains why he chose to open a private practice in a small town and the benefits of doing so. We even discuss how having eight children has helped Dr. Scroggins be a better surgeon! Finally, our guest answers our rapid-fire questions and leaves us with some wonderful words of wisdom about making the most out of life. Thank you for listening in! Key Points From This Episode:Welcoming today’s guest, Dr. Samuel Scroggins. A brief history of Dr. Scroggins’ training and current practice setup. What highpointing is and how Dr. Scroggins got into it. Dr. Scroggins’ plans for his next highpointing adventure. How he got through residency while raising a large family of eight children. Dr. Scroggins shares some tips for building a practice in a small community. The benefits of working in a small town as an oral surgeon. Dr. Scroggins tells us about the best book he’s read in the last year. How having eight children helps him be a better surgeon. The kinds of tools Dr. Scroggins prefers for extractions. A movie Dr. Scroggins watched recently and loved and a standup comedian he likes. Dr. Scroggins shares his favorite quote with listeners. Links Mentioned in Today’s Episode:Dr. Samuel Scroggins on LinkedIn — https://www.linkedin.com/in/sam-scroggins-8063b220/Dr. Samuel Scroggins Email — scrogginsoms@gmail.comSouthwest Virginia Oral and Maxillofacial Surgery — https://swvirginiaoralsurgery.com/KLS Martin — https://www.klsmartin.com/KLS Martin Discount Code — StuckiFavsOutlive — https://www.amazon.com/Outlive-Longevity-Peter-Attia-MD/dp/0593236599Everyday Oral Surgery Website — https://www.everydayoralsurgery.com/ Everyday Oral Surgery on Instagram — https://www.instagram.com/everydayoralsurgery/ Everyday Oral Surgery on Facebook — https://www.facebook.com/EverydayOralSurgery/Dr. Grant Stucki Email — grantstucki@gmail.comDr. Grant Stucki Phone — 720-441-6059