Everyday Oral Surgery

Writing patient notes is a simple (albeit boring) task that can have major implications if not done correctly. There are certain things that should always be included in patient notes, and others that should never be, and in today’s episode Scott, Jake, and I share some examples of what’s on each of those lists. Scott also gives us a rundown of the electronic medical records system that he uses, and with pharmacies heading towards a total ban on paper prescriptions, everyone will benefit from hearing his advice. Although writing notes is certainly not the most exciting part of being an oral surgeon, we recommend putting an episode of Seinfeld on in the background to make it a whole lot more manageable! Key Points From This Episode:A description of DSN, the electronic medical record system that Scott uses. How Scott and his assistant collaborate to be most efficient in capturing a patient's information. The phrase that Scott never allows in his notes. How DSN manages the sending of prescriptions.  A downside of DSN, which is in the process of being addressed.Why it’s important to make it clear in your notes if your patient has refused non-surgical treatment to restore a tooth.Other examples of what you should be putting into your notes. Issues that can arise if you haven’t written down reasons for undertaking a procedure. How pharmacies are driving the switch from paper prescriptions to electronic records.The TV show that helps me get through the note-writing part of my day. Links Mentioned in Today’s Episode:DSN Software Inc. — https://www.dsn.com/ Todoist — https://todoist.com/ Dr. Grant Stucki Email — grantstucki@gmail.comDr. Grant Stucki Phone — 720-441-6059

When looking for ways to finance his dental degree, Dan Hammer came across the Health Professional Scholarship offered by the Navy. His receipt of this scholarship formulated the trajectory of his career as an oral surgeon. Dan’s journey has involved treating war warriors as a GPR, completing a head and neck fellowship, and helping to develop the digital adaptation of the “jaw in a day” surgery. Following in the footsteps of many OMS pioneers, he has done all of this with a single degree, and he explains why he does not believe he is not disadvantaged by this fact. Although there are some tradeoffs to working in the military, there are also numerous benefits, and Dan openly discusses the pros and cons of his chosen career path in today’s episode. Dan also offers some valuable advice around getting as much exposure as possible to your fields of interest (no matter how trivial an activity may seem), listening to the opinions of other professionals (even if you don’t agree with them), and a key to optimal parenting! Key Points From This Episode:Why Dan joined the Navy.Dan’s experience as a GPR in Bethesda, Maryland in 2011. What inspired Dan to do a head and neck fellowship. Where Dan is currently working. Some of the pioneers in the OMS field who had a single degree. Legal and political elements of practicing surgery with a single degree.Benefits of working in the armed forces. Dan’s first flap out of fellowship. The collaborative multidisciplinary environment that Dan works in. Compensation that Dan receives through working in the military. A tradeoff that you need to accept when you become an active-duty oral surgeon. The variety of procedures on which Dan spends his time. Dan explains the “jaw in a day” surgery in more detail, as well as the “digital jaw in a day” adaptation that he and his team came up with.The value that lies in listening, and getting as much exposure as you can in your fields of interest.The correlation between Dan’s work and home life. Advice from Dan around raising children. Dan’s favorite quote: Comparison is the thief of joy. Links Mentioned in Today’s Episode:Dr. Dan Hammer on Instagram — https://www.instagram.com/drdanhammer/?hl=en Leaders Eat Last by Simon Sinek — https://simonsinek.com/product/leaders-eat-last-book/ Extreme Ownership by Jocko Willink — https://www.amazon.com/Extreme-Ownership-U-S-Navy-SEALs/dp/1250067057 Can’t Hurt Me by David Goggins — https://www.amazon.com/Cant-Hurt-Me-Master-Your/dp/1544512287 Dr. Grant Stucki Email — grantstucki@gmail.comDr. Grant Stucki Phone — 720-441-6059

Today’s guest is an oral and maxillofacial surgeon who specializes in alveolar cleft grafting, cleft orthognathic surgery, and distraction. Through these life-changing procedures, Dr. Chris Viozzi is doing his part to give back, and he does this not only through treating patients within the US, but also those outside of it during 10-day mission trips he was doing twice a year prior to the pandemic. In today’s episode, Chris explains the variation that exists amongst the patients he treats, as well as amongst the techniques that can be used for the procedures he does. We also discuss donor sites, follow-ups, and common concerns relating to cleft surgeries. Chris is not fellowship-trained, and his OMS basic training was more than enough to get him to his current position on the Mayo Clinic’s Cleft and Craniofacial Clinic team. Key Points From This Episode:The craniofacial team that Chris is a part of, and his niche within the team.Other medical professionals who make up the craniofacial team.Diversity amongst the patients that Chris and his team treat at the clinic.  Vital understandings that anyone doing alveolar cleft grafting must have. Elements of alveolar cleft grafting that have evolved over time. Examples of the variety of techniques for alveolar cleft grafting that exist. Why the iliac crest is usually the best donor site. Common concerns around allografts.  Chris shares why Infuse was black-boxed by the FDA, and his opinion on using it for alveolar cleft grafting.Timing of follow-ups post alveolar cleft grafting.Why Chris avoids corticocancellous blocks whenever possible. The approximate percentage of alveolar cleft grafting patients that need cleft orthognathic surgery later in life. Differences between Asian and Caucasian children in terms of the likelihood of requiring orthognathic surgery.Where Chris acquired the majority of his cleft surgery skills. Chris’s experience doing mission trips, and the perspective he gained as a result. The lack of continuity of care in many countries outside of the US.Challenges to OMS involvement in cleft surgery. Book recommendations from Chris.Chris’s favorite OMS tool.  Links Mentioned in Today’s Episode:Dr. Chris Viozzi — The Immortal Life of Henrietta Lacks — http://rebeccaskloot.com/the-immortal-life/ Quiet — https://www.quietrev.com/quiet-the-book-2/ Medical Missions for Children — https://www.mmfc.org/ Dr. Grant Stucki Email — grantstucki@gmail.comDr. Grant Stucki Phone — 720-441-6059

In this episode, I’m joined by two repeat guests, Drs. Jake Stucki and Scott Weiskopf, who are here for a discussion around every oral surgeon’s indispensable tool: forceps. In today’s episode, we take a virtual trip around the mouth and share which of the large variety of forceps we think are preferable for taking out each type of tooth, although it’s important to note that there are many different ways of doing things and what works for us might not work for you. We also have some valuable advice to share around how to avoid a root tip breaking, and even how you can prevent your patient from swallowing a tooth (speaking from experience!). Key Points From This Episode:What forceps are used for, and when to use them.Scott’s favorite forcep.Each of us shares what we think the best forcep is for removing maxillary molars.Common problem that Scott sees occurring when students start out with the more aggressive forceps. Forceps that we generally use for upper and lower premolars. A comparison between some of the many ashes that exist. Circumstances under which you should be removing tissue. Why the concept of “apical pressure” can be confusing. The tool that Scott starts every tooth removal procedure with. What Jake and I like to use the cow horn for. Scott’s approach to removing mandibular molars. Our thoughts on using a hand piece.How the root shape determines which tools we use. Benefits of using rongeurs. Scott and I share how we like to hold forceps. When you should swap one forcep out with another during a procedure. Advice to avoid breaking the root tip off. Experiences we have had of patients swallowing a tooth, and how to avoid this!Tips for using throat packs.Links Mentioned in Today’s Episode:A.Titan — https://www.atitan.com/ KLS Martin Group — https://www.klsmartin.com/en/disciplines/dental-and-oral-surgery/ Dr. Grant Stucki Email — grantstucki@gmail.comDr. Grant Stucki Phone — 720-441-6059

The purpose of a dental elevator is to break the fibers of the periodontal ligament, and if you know how to use it properly, it is a very powerful tool which can do a lot more than you think! In today’s episode, Dr. Jake Stucki, my brother, is back on the podcast. Our discussion covers how an elevator works, which elevators will likely be most effective in which circumstances, and the times when we wouldn't recommend using an elevator. A lot of my time is spent doing elevations, and as Jake advances on his journey as an oral surgeon he is realizing more and more the value that lies in these procedures. Although there are numerous elevator instruments, some of which we talk about today, we also feel that there’s something missing, which is why we are currently working on the “Stucki Elevator!” Key Points From This Episode:Some of our favorite Everyday Oral Surgery episodes. A story about car trouble which relates to the struggles we can face when taking out teeth.The purpose of a dental elevator, and an explanation of how it works. How the process of elevating can differ between patients. Some of the most difficult teeth, and how to deal with them. When a back action isn’t the way to go.Comparing the Cogswell B and the Crane as elevation tools. Examples of times when you shouldn’t elevate. How to sustain pressure when doing a dental elevation. Why some people don’t think it’s a good idea to elevate against another tooth.How to ensure you have control of the dental elevator.Power that comes with knowing how to use an elevator properly. Coming soon: The Stucki Elevator.Jake’s book recommendation for today!Links Mentioned in Today’s Episode:Dr. Jake Stucki —Lost Connections by Johann Hari — https://thelostconnections.com/ The Second Mountain by David Brooks — https://www.penguinrandomhouse.com/books/217649/the-second-mountain-by-david-brooks/ Dr. Grant Stucki Email — grantstucki@gmail.comDr. Grant Stucki Phone — 720-441-6059

In the United States, aggressive pain management practices have led to an opioid crisis which is responsible for thousands of deaths every year. Among those who have lost their lives in this untimely and avoidable way was Dr. Omar Abubaker’s son. The unspeakable pain of losing a child led Omar down a path of discovery around the dangers of opioids, which are the common go-to pain management drugs for doctors of all specializations, despite their highly addictive properties. Equipped with knowledge and compassion, Omar is on a mission to educate as many people as he can on the subject of opioid addiction, and alternative ways to deal with pain, so that other people don’t have to suffer the same fate as his son. It is our responsibility as medical professionals to do what is best for our patients, and we all need to think long and hard about pain management practices that we advocate for.Key Points From This Episode:Omar’s home country, and his journey to becoming chairman of the VCU OMFS program. How Omar’s weeks are structured.The life-shattering experience that led Omar to understand the dangers of opioids.  Steps that Omar has taken to educate others about opioid addiction. Why the US population is more susceptible to opioid addiction than most other countries.What pain management should entail.None: the safe amount of drugs and alcohol to consume before the age of 20. The joy and fulfillment that Omar experiences through the work that he does. How parents’ opinions on opioids being prescribed for their children have changed. The importance of weighing up the risks and the benefits of opioids for each patient.Omar’s approach to helping patients manage their opioid addiction. Substitutes for opioids that can be used during surgical procedures. Post-narcotic hyperalgesia: a condition that can come about after being subjected to intravenous opioids. The best book that Omar has read in the past year. How teaching helps Omar to be a better surgeon. Links Mentioned in Today’s Episode:Dr. Omar Abubaker on LinkedIn — https://www.linkedin.com/in/omar-abubaker-7a965295 The Second Mountain by David Brooks — https://www.penguinrandomhouse.com/books/217649/the-second-mountain-by-david-brooks/ When Breath Becomes Air by Paul Kalanithi and Abraham Verghese — https://www.amazon.com/When-Breath-Becomes-Paul-Kalanithi/dp/081298840X Dr. Grant Stucki Email — grantstucki@gmail.comDr. Grant Stucki Phone — 720-441-6059

Although the crazy hours and high pressure environment that characterize hospital-based practice will not be everybody’s preference, there is nowhere else that Dr. Gabriella Tehrany would rather be utilizing her OMS skills. For the past 12 years (other than during the COVID-19 lockdown) the longest time that Gabreilla has spent away from orthognathic surgery is two weeks, and as a result, she has acquired a wealth of wisdom relating to the field, much of which she shares with us in today’s insightful episode. Gabriella offers advice around looking after your patients’ wellbeing and, just as importantly, your own. Our conversation covers a range of topics, from the value of teamwork to the protocol which led to an 88% same day discharge rate post orthognathic surgery at Gabriella’s hospital. In order to choose the direction you want to take as an oral surgeon there are numerous factors to take into consideration, and, as is Gabriella’s mantra, this episode will inspire you to “figure it out!”Key Points From This Episode:An overview of what Gabriella’s journey to becoming the Southern California Regional Chief of OMS has looked like.Perks of working as part of a Kaizer practice in a hospital setting. Factors to take into consideration before choosing the setting you are going to work in. Experiences Gabriella had in different practices while she was a resident. The importance of listening to your patients’ desires as an orthognathic surgeon.Why Gabriella never shows her patients soft tissue renderings prior to their surgery.How Gabriella looks after her body, and advice she gives to all residents coming through her practice. Gabriella’s involvement with students at UCLA.People who make up the team that Gabriella is currently working with.Value that lies in doing surgery with assistants. The protocol that Gabriella and her anaesthesiology team implemented which led to an 88% same-day discharge rate after surgery. How patients’ perceptions of being in a hospital changed after the pandemic began.Gabriella’s experience of working in a COVID ward. A rapid fire round with Gabriella.Links Mentioned in Today’s Episode:Dr. Gabriella Tehrany Email— gabriella.m.tehrany@kp.org The Plant Paradox — https://www.amazon.com/Plant-Paradox-Dangers-Healthy-Disease/dp/006242713X How Not to Die — https://www.amazon.com/How-Not-Die-Discover-Scientifically/dp/1250066115 Dr. Grant Stucki Email — grantstucki@gmail.comDr. Grant Stucki Phone — 720-441-6059

American born, European trained, and now working as the Division Chief and Program Director of OMS and dental medicine at Loyola, Dr. Stephen MacLeod has a broad scope of knowledge and experience and he joins me on today’s show for a discussion which is brimming equally with inspirational nuggets and practical tips. Stephen did a full medical degree after he completed his oral surgery training, and found nothing in it that he enjoyed as much. So, for any prospective oral surgeons who are sitting on the fence, this is your sign to take the leap. We discuss the rewarding nature of working in trauma, why practice is essential as an oral surgeon, what Stephen looks for in residents’ applications, his thoughts on externships, and more. Stephen’s philosophy is one of passion, continuous learning, and a commitment to community, and there’s a lot to be learnt from him! Key Points From This Episode:Stephen shares what his educational and professional career paths have looked like. Variation that exists between programs. The three broad clinical categories that Stephen spends the majority of his time working in.Advice from Stephen for anyone interested in the trauma field.How oral surgeons differ from other medical specialists in terms of our ability to handle trauma.Stephen explains the importance of practice when it comes to the oral surgery profession.Principles which form the foundation of the oral surgery profession. Traits that Stephen looks for when hiring residents. What your personal statement should and shouldn’t include.Changes that Stephen’s department made to their application process since the COVID-19 pandemic began.The most valuable residents to speak to. Stephen shares his thoughts about externships.Factors that Stephen doesn’t see as important in a resident’s application. How the OMS educational model differs between the United States and Europe.The “meat and potatoes” approach to OMS at Loyola.  Elements which signal the family friendly nature of Loyola. A message to anyone considering oral surgery as a career.A rapid fire round with Stephen. Links Mentioned in Today’s Episode:Dr. Stephen MacLeod on LinkedIn — https://www.linkedin.com/in/stephen-macleod-5002249/ The House of God by Samuel Shem — https://www.amazon.com/House-God-Samuel-Shem/dp/0425238091 Dr. Grant Stucki Email — grantstucki@gmail.comDr. Grant Stucki Phone — 720-441-6059

Many oral surgeons are likely to have a type-A personality and are often inclined to want to control, rather than delegate tasks and responsibilities. While these traits are useful to the focus required during oral surgery, it’s not always conducive to instituting a well-run practice. In today’s episode, we are joined by Dr. Mykle Jacobs and Consultant Bob Spiel, to discuss the keys to running a successful private practice. When Dr. Jacobs purchased his practice in March last year he only had a week before the world was hit by the COVID 19 pandemic. In our conversation, we discuss the transformative effect that Bob’s approach had on Dr. Jacobs’ practice and what it was like instituting these changes during a pandemic. Bob explains key adjustments that can revolutionize a practice, like foregoing a stop-start schedule, in favor of blocking your time off with like-by-like procedures. We also hear about Bob’s Roles to Goals method to create a more meaningful and motivating environment for staff members, and Dr. Jacobs reflects on what he’s learned from Bob, especially when it comes to delegation and understanding his leadership style. This conversation is jam-packed with indispensable insights and excellent tips so make sure you tune in to hear it all!Key Points From This Episode:Introducing today’s guests Dr. Mykle Jacobs and consultant Bob Spiel.Dr. Jacobs’ experience of acquiring his new practice a week before COVID hit.How Bob assisted Dr. Jacobs during the height of the pandemic.Some of Bob’s methods for facilitating changes for his clients’ practices.The transformative impact that Bob had on the practice.How Bob structures schedules to avoid burn-out in a dental practice.The impact that restructuring their scheduling and consultation has had on the practice.The joy and efficiency of establishing a flow in your practice.The role of a flow manager.How to empower your team so that they can support the doctor.Bob’s Roles to Goals process and how he uses it to train staff.How Dr. Jacobs incentivizes his staff to reach their goals.The importance of an effective and proactive manager upfront.The value of morning meetings and regularly communicating with your staff.Having a system mindset and how it helps your team take ownership of their actions.Why hiring Bob as a consultant was the best decision Dr. Jacobs could have made.Links Mentioned in Today’s Episode:La Grange Oral Surgery and Implant Centre Website — https://www.lgoralsurgerycenter.com/La Grange Oral Surgery and Implant Centre Phone — (706) 884-2655Bob Spiel Email — bob@spielconsulting.comBob Spiel Phone — 2085 206900Flip Your Focus: Igniting People, Profits and Performance through Upside-Down — https://www.amazon.com/Flip-Your-FocusDr. Grant Stucki Email — grantstucki@gmail.comDr. Grant Stucki Phone — 720 441 6059

If you’ve made the (great) decision that you want to be an oral surgeon but you’re struggling to choose between the 4 year, 6 year, or the less common 5 year program, this episode is for you. My brother, Jake Stucki, and I chose different paths, and in today’s episode we talk you through the costs and benefits of the single versus dual degree options, and what these years of your life are likely to consist of. There is no one size fits all approach; don’t listen to anyone who tells you that one type of program is better than another! But it’s important to understand what you’re getting into, and there are a number of factors to take into consideration before you commit yourself to any program. After listening to today’s episode you’ll be well equipped with knowledge that will help you to make this decision, and if you’re still confused we’re just a phone call or an email away!Key Points From This Episode:Who this episode is aimed at. The amount of time that you will spend on oral surgery when doing a 6 year (i.e. dual degree) program. Off-service time that is a part of the 4 year (i.e. single degree) OMS programs. Jake explains what a six year program generally consists of. Misconceptions about the 5 year program. Benefits of doing an internship year before medical school.Differences between the costs of 4 and 6 year programs. The value of moonlighting during medical school. Money making potential of the 4 versus 6 year degrees. Reasons to do a 6 year program. Variety between 6 years programs in the amount of general surgery that forms part of the degree. Our experience of general surgery residency. Why you should take into consideration the certification that you are going to receive before choosing your program. We share our thoughts on patients’ opinions of a 6 years versus 4 year program.Circumstances where having a 6 year degree may make your life easier. The split between 4 year and 6 year programs within the 100 accredited OMFS programs in the United States. My struggle to decide between a 4 and 6 year program. Unfortunate mentalities that people hold towards one degree or the other. Why you should find out how much practical experience you are going to get during the course of your degree before you enroll. Links Mentioned in Today’s Episode:Dr. Grant Stucki Email — grantstucki@gmail.comDr. Grant Stucki Phone — 720-441-6059Dr. Jake Stucki Email — jakestucki@gmail.com