Author Bryan McLelland

S2EP3: Create Passive Income with Real Estate—featuring Chris Salazar


As dentists and oral surgeons, we’re dependent on our hands to make money. And if something prevents us from working, we lose that income—and the security that goes with it.

That’s why I’m working with Chris Salazar to invest in real estate and create an additional income stream separate from my oral surgery practice.

Chris is the Founder and CEO of Archstone Capital Partners, a vertically integrated real estate investment firm headquartered in Dallas. Chris and his team focus on value-add multifamily properties in the Midwest and Texas, and Archstone currently operates a portfolio of 500 doors.

On this episode of Dentist Brain Candy, Chris joins me to discuss the advantages of investing in multifamily over single family properties and describe how his value-add deals make a positive impact on the community.

Chris walks us through the tax benefits of investing in multifamily and explains why he likes deals in a tertiary market like the Quad Cities.

Listen in to understand how Chris’ conservative underwriting protects investors and learn how real estate can help dentists and oral surgeons achieve our financial goals!

Key Takeaways

What Chris likes about investing in the Quad Cities market

The advantages of investing in multifamily over single family homes

Chris’ goal to build a 1,000-door portfolio in 2022

How returns differ in primary vs. secondary or tertiary markets

How real estate can help a dentist or oral surgeon achieve their financial goals

The tax benefits of investing in multifamily real estate

How Chris’ value-add deals make a positive impact on the community

What investors should ask about the sponsor, the market and the deal itself

Why Chris’ buy-improve-hold approach generates healthy returns

How Chris’ conservative underwriting protects investors

Connect with Chris Salazar

Archstone Capital Partners

Arsenal Capital Partners

Email: csalazar@arsenalcp.com

Connect with Dr. Bryan McLelland

Dentist Brain Candy

Dentist Brain Candy Podcast

Dentist Brain Candy App

Dentist Brain Candy Continuing Education

About Dr. Bryan McLelland

Dr. Jawbreaker on YouTube

Email bryanmclelland@hotmail.com

Resources

Limitless: Upgrade Your Brain, Learn Anything Faster and Unlock Your Exceptional Life by Jim Kwik

Liberty Oral Surgery February Event

Archstone Before Photos

Archstone After Photos

S2EP3 Transcript

Intro:

You’re tuned into Dentist Brain Candy, where we bring relevant, meaningful, value-filled knowledge bombs straight to your brain, featuring your host and oral surgeon, Dr. Bryan McLelland. Now, sit back and enjoy the sweet treat of Dentist Brain Candy.

Dr. Bryan McLelland:

Well, welcome DBC peeps for this week’s episode of Dentist Brain Candy. Today, I have a special guest for you. He’s a friend of mine and someone that I’ve been working with over the last, what year, year plus, and his name is Chris [Salazar 00:00:30]. Now Chris is the founder and CEO of Archstone Capital Partners, which is a vertically integrated real estate investment company headquartered in Dallas, Texas. Chris, we’re going to have to dig into this vertically integrated real estate company and really figure out what that means, okay?

Chris Salazar:

Yes.

Dr. Bryan McLelland:

Archstone focuses on value add and opportunistic family acquisitions through the Midwest and through Texas. Chris is responsible for all investment, due diligence, and acquisition, along with the business plan execution and asset management. Chris resides in Dallas with his family and enjoys reading and playing golf when not working on real estate deals. So Chris, just out of curiosity, how much time does that leave you for hobbies when you’re not working on real estate?

Chris Salazar:

It’s been pretty hectic recently, but hectic is good. So a lot of activity last year and hopefully more this year. Yeah. Doesn’t leave me too much extra time, but I make time where I can.

Dr. Bryan McLelland:

So do you have a favorite book that you’re reading or just a favorite book in general?

Chris Salazar:

Just general, I mean right now, especially as we’re growing the team, I’m very focused on just leadership books in general and just reading different just business biographies regarding business leadership. In the beginning of my career, I was just more of a solo entrepreneur, so just really trying to learn more about, yeah, just managing people, being around people, and all that kind of stuff.

Dr. Bryan McLelland:

I think that’s fantastic, Chris. I think I also prefer to read, well and end up reading non-fiction. I would have to say, I probably would enjoy fiction books, but nonfiction books, it sounds to me you’re like me where you’re looking for different pearls, different things to sharpen your game, to get better, to constantly improve and strive to just be better and better at our crafts, what we do. Does that sound about right?

Chris Salazar:

Yeah, absolutely.

Dr. Bryan McLelland:

I have a book right now that I’m reading by Jim Kwik called Limitless. I’m only into the second chapter, but so far so good, man. I’m really, it’s been a while since I’ve had a book that’s captured my attention so far like this that’s non-fiction so actually part of my plan is with this podcast is to systematically go through it as I pull up different pearls and stuff as well too. So for all you listening out there, that’s maybe a little carrot to tune in future episodes as well. Well, Chris, tell me about you and about your company and just what’s going on outside of the whole introduction that I did.

Chris Salazar:

Yeah. So you summed it up pretty well, but I’ve been doing real estate deals for several years now. I started my career in the Quad Cities, which is Davenport, Iowa in the metro area there. I went to undergrad at Augustana College. So started in that market just naturally and cut my teeth there, learned quite a bit pretty quick, had the opportunity to acquire about 60 single families in my first year. So that was a headache and a half, but a great experience, learned a ton about the operations, but just overall quickly realized that multi-family was the way to go. Quite a bit more scalable just from an operational standpoint, less sites to manage, and a lot of opportunity to create value. Whereas a lot of residential real estate, people buying single families or duplexes or even fourplexes. Those are all controlled a lot by the sales comps, whereas commercial real estate’s controlled by the value that you’re essentially creating and adding to the bottom line there.

Chris Salazar:

So it’s just quite a bit more attractive being able to have that control and being able to help values where you can just by being a better operator. So that was really attractive to me. That’s what continues to attract me to multi-family specifically. So since then, we’ve done about close to 500 doors now in the market. We currently are only focused on the Quad City market. We’re adding a second market, which I imagine we’re deciding right now, but that should be probably, I would imagine DFW is going to be the next market, but we are right now…

Dr. Bryan McLelland:

That’s Dallas/Fort Worth, right?

Chris Salazar:

Dallas/Fort Worth. Just makes sense geographically and with the track record we built, we are able to compete somewhat on some of these sweet deals on here in a very high varied market.

Dr. Bryan McLelland:

Dallas/Fort Worth is a much different market than say the Quad Cities. I’m going to ask you a question about that here, coming up here too, just the difference between the… I think you would term a primary market would be like the Dallas/Fort Worth area and maybe Quad Cities is maybe more of a secondary market?

Chris Salazar:

Yeah, I would say [crosstalk 00:05:21]. Yeah, it’s a tertiary market.

Dr. Bryan McLelland:

Tertiary, okay.

Chris Salazar:

In the [inaudible 00:05:26] there, there’s about 400,000 people, whereas Dallas is obviously quite a bit bigger and you have just tremendous growth in general. So it really drives pricing up, it really drives cap rates very much down, and a lot different analyzing those deals for sure. Whereas in DFW or in any growth market, similar Atlanta, Jacksonville, those returns for the investors are typically just really made from the appreciation. That’s potentially where we have historically invested in deals where the majority of the returns aren’t made on appreciation, they’re just made on the cash flow, which is, in our minds, a bit easier to navigate and what we think is less risk there.

Chris Salazar:

It’s not as speculative. But as far as the Quad City market, like I said, we’ve got about 500 doors there that we bought, renovated, managed, and have sold the majority. So we’re looking to continue to build out our operations there. We want to acquire 1000 doors this year in Iowa. So the Quad Cities and Cedar Rapids area, we’ve been looking at deals in Des Moines. It just of makes sense, geographically. We’ve got about 15 employees in the Quad Cities and we’ve got scalable operations in place now and some systems. Yeah, really looking to expand. We really feel like you have the right people in the management seats and are excited about it.

Dr. Bryan McLelland:

Yeah. This is fun. When I first started talking to you about the Quad Cities, at one point you mentioned Cedar Rapids. My wife is from Cedar Rapids. So I used to live in Galesburg, Illinois, which is just south of the Quad Cities between Quad Cities and Peoria, Illinois lies Galesburg, Illinois. So I was actually fairly familiar with that. I think you told me this before, but overall, Iowa side preferred a little bit more towards more than the Illinois side. Is that true?

Chris Salazar:

Yeah, definitely. Just the state of the economy in Illinois is obviously not great. I think Chicago… I mean, I love Chicago. I lived there for several years, but it’s just unfortunately run very poorly and it’s having a huge effect on the state. So yeah, we focus on the Iowa side, a lot more landlord-friendly.

Dr. Bryan McLelland:

Yeah. That’s what I was thinking too. It’s a lot more landlord-friendly on the Iowa side.

Chris Salazar:

Yeah, definitely.

Dr. Bryan McLelland:

Not that a good deal isn’t a good deal. I mean, it’s not like I would think you’re not going to say no to a screaming deal, even if it’s on the Illinois, but it has to be a little bit more enticing than say the equivalent deal on the Iowa side.

Chris Salazar:

Definitely. A big thing is just the tax. The taxes are quite a bit more on the Illinois side. That really [crosstalk 00:08:14].

Dr. Bryan McLelland:

I also lived in Chicago for four years.

Chris Salazar:

Oh, wow.

Dr. Bryan McLelland:

Did you know that?

Chris Salazar:

I don’t think so.

Dr. Bryan McLelland:

Yeah.

Chris Salazar:

I don’t think you told me.

Dr. Bryan McLelland:

I went to Cook County Hospital. I did my residency there.

Chris Salazar:

Yeah. I really love it. I never thought I’d leave, but it was getting a little too crazy. I had a young family and moved down to Dallas just about a year-and-a-half ago. So it was a very sad day, but definitely excited about all the growth happening down here and just being in a very vibrant environment that’s business-friendly.

Dr. Bryan McLelland:

Yeah, such a stark contrast between the two environments. One thing I wanted to circle back to, you mentioned multi-family versus single family homes. Correct me if I’m wrong here, but it seems to me like if you’ve got multiple doors under one roof, multiple doors that you’re renting that are under one heating and cooling system, et cetera, et cetera allows for that cost per door, if you will, and rental income for that given roof, and if maintenance needs to be done, you’re replacing one roof, not five roofs or 15 roofs or 50 roofs. So is that part of the economy of scale that you’re talking about in the scalability of multi-family versus single family?

Chris Salazar:

Yeah, definitely. I mean, it’s a lot less headache to manage on that end from a capital expenditure perspective. We’ve got, like you said, 1, 2, 3 roofs on properties versus just having a lot more singular major systems to really oversee. A lot of that stuff and those reserves are baked in. I mean, similar to how you would look at analyzing a single family deal, but just from a management perspective on a multi-family, you’re looking at maybe five or 10% in those CapEx reserves. So it’s just over time, a lot of cases, we really never have to tap into those reserves. So it’s just easier to manage really just for overall from our end.

Dr. Bryan McLelland:

Yeah. Another thing I wanted to circle back around and maybe help clarify for myself is I want to make sure this is right. The difference between… This is a gross generalization, but a tertiary or maybe even a secondary market versus a primary market, is that one big difference is cashflow versus appreciation. I think you alluded to this or even maybe said it, but maybe I just need to clarify, the Quad Cities, a couple of the things that we have done together, which we’ll talk about in probably in a future episode, are more cashflow-oriented where perhaps an investment in say Dallas/Fort worth area, ideally you would have some cash flow, but appreciation is where your real gains are. I mean, am I oversimplifying, or am I close with that?

Chris Salazar:

Yeah, no, I think that definitely explains it well. So in a market similar to the Quad Cities or the Quad Cities, you’ve got a lot of… You can typically… So on a typical deal, you’re saying 8% preferred return in cashflow markets. You’re usually easily able to hit that threshold, whether investors are paid out monthly or quarterly. That’s typically not an issue that would be run into where the general sponsor wouldn’t be able to cover that press, that preferred monthly payment. On the other hand, in a larger market where there’s maybe a lot more things going on with the deals where there’s a, bigger CapEx side, there’s larger debt service, those returns are typically made from appreciation, which historically has shown… I mean, those returns are actually quite more rewarding than cash flow returns. Although it’s just based on the investor. I mean, those are a lot more speculative.

Chris Salazar:

So in a down market, you have a lot more volatility there in cash flow markets that have a diverse job base, have strong employment in general and just not stagnant and not a bunch of people leaving, but just even if it’s plus or minus, if it’s one or 2% positive, that’s consistent with inflation. I mean, you’re going to have a very conservative monthly cash flow, a nice investment there. Whereas if you are in a bigger market, you might have to wait until that deal is termed out. So say it’s a five-year hold for that deal or if it’s a 10-year hold that the sponsor is electing to do there, most of those returns are not going to be paid out until that deal is sold off.

Dr. Bryan McLelland:

So if I distill this down, if I understand things right, the way I would summarize what you just said would be going into a Quad Cities type market is going to be better for cash flow, but because there isn’t a big surge of population coming or going, and that the market isn’t nearly as volatile as say coastal regions or large urban centers, that you’ll have this steady cash flow, that you’ll get some rent appreciation over time, which does add to the net value and the overall valuation of the project, but the capital appreciation, which means when you sell the building or refinance the building and take cash out, will not be as great. But your cashflow is likely to be stronger through that hold where if I’m going to use it, and maybe an extreme example, you buy something in California, you get absolutely no cash flow, hopefully not negative cash flow, but you get no cash flow.

Dr. Bryan McLelland:

But if everything goes the way we hope, it appreciates like wildfire, because you’re in, let’s just say San Francisco, and when you actually sell the building in five years, your real gains are being appreciated at that point through the sale and the cash acquired through the sale, but you didn’t have a check coming into your mailbox every month in the same way. I mean, I oversimplified, but does that maybe summarize?

Chris Salazar:

Yeah, absolutely.

Dr. Bryan McLelland:

How can real estate help a dentist or an oral surgeon achieve their goals? I have some personal reasons and I can tell you what my reasons were, but I’m just wondering if you can just give me some insight, how can you help?

Chris Salazar:

Yeah. So I think mainly we can help, and it all depends on personal goals. But I think the majority of dentists…

Dr. Bryan McLelland:

I want to be rich, Chris. I want a lot of money and I want to be rich.

Chris Salazar:

Yeah. So we can do that, but we do [inaudible 00:15:01] calculated fashion. I think that a big reason why people choose to invest with us is the fact that yeah, we can take an investment and pay out those monthly or quarterly returns consistently. So it provides very consistent cash flow that investors can count on.

Dr. Bryan McLelland:

Yeah. Okay, so for me, I’ve said this on a previous podcast here recently. Oh Chris, just so you know, this is season two of Dentist Brain Candy and you’re one of the first episodes on season two. But what I said is just to let you know, in the last couple weeks here is that one of my personal goals is to not be dependent on my hands to create income. What I mean by that is right now, if I want to get paid, if I want to make any money, I have to show up, I have to get in front of a patient. I need to do some actual procedures, build those out, collect the money, pay the overhead, and hopefully there’s something left at the end of the day. Heaven forbid I go skiing this weekend, which I’m not by the way, I break my hand. Guess what? Until my hand heals, there could be limited to no income or even worse, overhead continues.

Dr. Bryan McLelland:

So something that I’ve been acutely aware of when I go on vacation is not only do I not get any income, but I actually have this overhead with my practice that continually requires me, not physically writing a check, but really I am actually, quote unquote, spending money every month. So I want to have a source of income that’s separate and distinct from my oral surgery practice. So that’s one of the goals for me over the next three to five years is let’s see if I can replace my surgical income, my dentistry income with investments that cash flow. So for me, when I hear about cash flowing markets, and by the way, when I get those checks in the mail from you quarterly, it makes me smile because it gets me that much closer to that goal for me. My suspicion is that the people listening to this podcast that are dentists and orthodontists, oral surgeons, periodontists, whatever, they all really understand what I mean by if you’re not in the trenches, elbow deep in saliva, you’re not making any money, which there’s a level of insecurity that goes with that.

Dr. Bryan McLelland:

So this is a way of creating a stability or source of income or security that is distinct from the practice of dentistry that can allow me to do more, be more secure for my family, create a legacy, and give more away too. So that’s where I’m coming from and why I was so excited to meet you and your company and what you do.

Chris Salazar:

Yeah. Yeah. I think that’s great. We definitely are grateful to have you on board here with us. I think another key point, I think everybody’s situation is different as well, but for people with high incomes, I mean, they look for tax write-offs, or hopefully they do. I think real estate can definitely provide an attractive avenue there. It could look different for different people, depending on situations. I’m not a tax professional, but I know that there are those opportunities. I think, especially with, for example, we’re doing cost segregations on a lot of our properties where we can accelerate appreciate, and there’s write-offs that would take effect in the first two, three years of ownership versus doing straight line appreciation across the life of the deal.

Dr. Bryan McLelland:

I’m going to interpret that into dental talk for our dentist listeners out there. So what I understand from this, and I actually had such perfect timing. I talked to my accountant yesterday about this. There are two different designations that we can have as far as depreciation is concerned. Now, the first thing is the cost segregation study, which a lot of dentists are going to be familiar with with their buildings. If they own a building, they can do… I mean, yeah, a cost segregation where they can look at the property, figure out what they can depreciate faster versus not accelerated depreciation, which gives you write-offs. Then if you are… Those write-offs can be passive or active. If you’re an active real estate investor, and I think if people work with you long enough, they’re going to cross that threshold of being an active real estate investor. Now, there is a litmus test that you have to pass and you have to go through your accountant and figure out what the IRS needs.

Dr. Bryan McLelland:

You can actually offset your normal wages, your normal income with that. So that although you have a building that maybe it’s worth a couple million bucks, it’s depreciating, losing value on paper. You’re still getting a check in the mail that’s coming to you. So you’re getting paid out cash. It’s depreciating. Even if you can take the income that you get from that building, offset it completely, and if there’s leftover, you might even be able to offset your W2 wages as well and create a tax break for yourself on the wage side. Now, just like you said, I’m not an accountant and certainly not a financial planner or anything like that. You’ve got to check with your own personal situation, but that is good to know because that can to really make a huge difference. Because from my perspective, what I’m thinking is whatever I save on that tax-wise is going back into more investments with you to continue to get that snowball rolling and to get that momentum.

Chris Salazar:

Yeah, definitely. We do some projects as well where we 1031 our proceeds and defer tax down the line as well. But I mean, there are so many benefits outside of just as a vertically integrated company, we’re building, we get an opportunity to take these very poorly run, dumpy properties and make them very nice places for people to live. So you get to participate in that side as well for the…

Dr. Bryan McLelland:

Yeah, it feels good, right?

Chris Salazar:

Yeah. No, it feels great. Being able to see people smile when they see our units, I mean, stuff like that, just making a bigger impact on the community for us is extremely gratifying outside of the return.

Dr. Bryan McLelland:

Well, it’s a fairly well-known fact, the more value that you can give to other people, the more you bring to other people and improve their lives, the more you’re going to get a financial reimbursement for that. So by taking a 55-unit rundown property and making that into a really nice place to live, just improved the lives of 55 families. Potentially, I mean, if they’re families are four on average, I mean, that’s 200 plus people. So it’s a really positive thing for that neighborhood and that city and those folks.

Chris Salazar:

Yeah, absolutely. We actually have an opportunity that we’re buying later this month, that’s a 96-unit complex. It was condemned by the city and now we’re getting a chance to renovate that whole thing and turn it from a class D property that was still extremely rundown property. Now, we’re going to make this thing brand new property, but bring a nice, refreshing property to the community. So those opportunities are really great.

Dr. Bryan McLelland:

Sometimes I joke and I call those a class J property. A lot of jail time that comes out of those properties. We’re going to supply some photos, I think, here. Maybe you could send those to me and we could put those as a resource that people could get an idea of maybe some before and afters, just come to general finishes that you do. But I have to tell you guys that it’s solid work and it’s durable and it’s neat, it’s clean, it’s current, and topical, but not over the top either. So it’s very respectful for the investment and the investor as well. So I could keep going on and we are going to start to draw this to a close for today. We are going to do this again soon. I’m thinking we should maybe get into the first investment that you and I did together [inaudible 00:22:56] the future. For today, I’d like to ask and get your insight on just what a potential investor should ask you and what they should expect if they’re investing with you and your group.

Chris Salazar:

Yeah. I think in general, it’s great for investors. I mean, they must understand the risk, first and foremost, with our business plan, how we operate as a company. We are very calculated on the risk. We do a ton of due diligence. We are extremely confident in the investments that we’re providing and the opportunities we’re providing, but it’s always good to ask questions about the sponsor, about the sponsor’s track record, about specific questions about the deal and the market. Those three, sponsor, deal, and market, really just understanding those key aspects. Pretty much all you need, I guess, understanding the different business plans and risk associated with each, whether it be we typically buy class C properties and help to make them class C plus or B properties. We’re not buying class A properties and making a 5% return. We’re looking to make a 20% return for our investors.

Dr. Bryan McLelland:

Yeah, the term forced appreciation comes to mind.

Chris Salazar:

Yeah, a little bit of that. So we definitely, we’re value add investors. We don’t just look to buy and hold something. We like to buy and improve and hold something. With that comes some very, very healthy returns typically. Those are risks that other people may see as pretty extensive, but we are confident in the fact that we can address those risks and they’re all calculated in how we underwrite deals and how we evaluate different acquisitions.

Dr. Bryan McLelland:

Yeah, when I’ve gone through the [proformis 00:24:48] on different projects and evaluating things, one thing that always struck me is that they’re very conservative. What that does is it protects the investment and the investor, and it protects me so that I can take a look and say, “Okay, what are you using as projected rent?” Well, that’s a pretty low, reasonable rent for area. Those are easy enough things for me to just go on the internet and research and look at. I’m like, “Oh.” I mean, that’s very reasonable and likely to be higher, which adds some… It’s on the right side of the curve for me where I’m like, “Okay, this is conservative. This is a reasonable expectation. There may be even extra gravy on this that shows up that I can even be happier about.” So I do appreciate your style on that.

Chris Salazar:

I think a lot of operators say they try to be conservative. It is difficult now with just all the competition in the multi-family space.

Dr. Bryan McLelland:

Whoa, a lot.

Chris Salazar:

With the relationships that we have and the people that we have in place and the way we can execute on the construction end, I think that provides a lot of opportunity for us to be able to go in and still achieve those returns and make deals make sense. We can still go in with a conservative mindset, whereas a lot of people are now fluctuating and maybe adjusting their terms based on specific deals just to get the deal done. So that’s not how we operate. We’re not looking to just buy anything and everything. We’re looking to buy what fits our box. We want to protect the downside risk, always.

Dr. Bryan McLelland:

Yeah, how about this? Give me the three-minute elevator speech on this 96-unit property. Let me know if there’s any room for investment in that and if you’re looking for investors, and then how someone can get ahold of you to find out more information and to talk to you more about this stuff.

Chris Salazar:

Yes, definitely. So the 96-unit project is a class C minus, class B property that we’re going to take to a class B. We are pushing rent about $250 on average per door. Right now, it is a fully vacant property condemned by the city. We are taking out a bridge loan to fund about three-and-a-half million dollars of construction. The property cost itself is only 2.8 million. For you guys, we already have the deal fully subscribed. So there’s no room in it. We’re closing it this month.

Dr. Bryan McLelland:

Fantastic. Do you have anything that’s open?

Chris Salazar:

We don’t have anything that’s open currently. I imagine, based on our pipeline, we will in the coming weeks. I’d say in the next two to three weeks, we’ll have probably our next opportunity.

Dr. Bryan McLelland:

Well, this sounds… Although it’d be nice if you had something going and open right now, what that tells me is that there’s demand for your product, what you’re offering. If anybody’s interested in doing something like this, starting the conversation now, getting to know Chris and his group, getting to know your own tolerances, what you want to do, et cetera, et cetera, and starting that conversation now without the pressure of a deal looming, may be a good place to be. So how would someone get in touch with you?

Chris Salazar:

Yeah. My email is probably the best, which we can link to I believe, right?

Dr. Bryan McLelland:

Yeah, we’ll provide your email address in the show notes.

Chris Salazar:

Our website’s actually under construction. Like I mentioned prior, we formally merged with our construction and property management team. So we’re Archstone Capital Partners. Our website should be up in the next couple of weeks, I’d imagine. That URL would be Archstonecp.com.

Dr. Bryan McLelland:

I think by the time this podcast goes live, that website is likely to be there. Is [inaudible 00:28:27] Capital still up in the meantime?

Chris Salazar:

Yeah. It is.

Dr. Bryan McLelland:

Yeah. So if someone wanted to get a sneak peek at least, they could go there. Vertically or integrated company just means that you’ve got not only the acquisition of the investment, but also management of the investment and the construction project, et cetera, et cetera, all the way through all the verticals of the investments from beginning to end, which means that Chris and his company’s got money and skin in this game in every single property as the sponsor, and has every financial incentive aligned with you as the investor to make these things rock and mull. That’s really important. It’s not someone’s that’s just building it, handing it over to you or someone else, and then walking away. So it’s that willingness to see it through to the very end. So I find that to be a very good thing and changing from just the capital acquisition and the acquisition of property and integrating just requires some rebranding. That’s basically what you’re telling you’re doing now.

Chris Salazar:

Yeah. Yeah. We’re really just combining under one brand. We’ve got a great marketing partner that’s involved and should be rolling that out here in the next few weeks, which is very exciting. It’s a lot of moving pieces, more than I had imagined and anticipated, but it’s really exciting for us. So we have now about 15 employees. I imagine if we get to 1000 doors by the end of this year, we’ll have probably close to 50. So a lot of growth and a lot of good things are happening.

Dr. Bryan McLelland:

Nice. Well, Chris, thank you so much just personally for the investment that we’ve done so far, super excited for 2022 and moving forward with even more with you. Thank you for doing this podcast, man. I know you’re busy and you’ve got lots of stuff to do, but I really do appreciate you taking your time out to do this tonight. Let’s do this again soon. We’ll maybe go specifically into property, maybe tell people about how you can use 401k and IRA money to do this, and the stuff that you and I have done together, just a couple of them, just to give them an idea of what they could expect from a deal.

Chris Salazar:

Yeah, absolutely, Bryan. Thanks for having me on. I certainly enjoy our partnership and friendship. So thanks again.

Dr. Bryan McLelland:

Same here, brother. Thanks again, everybody for tuning in to this week’s episode of Dentist Brain Candy. Just as a reminder, we do have a CE event coming up February 18th at [inaudible 00:30:50]. If you want more [inaudible 00:30:52], if you want more information about that, just email me at BryanMcLelland@hotmail.com, or you can always call the office too at 509-922-2273. In May, we have an implant symposium that you’re all invited to too. It’s a full day, all about implants, and then we’re going to do the CPR and OSHA renewal again in the fall. So thanks for tuning in and we’ll catch you on the flip side.

Outro:

Thanks for tuning in on another episode of Dentist Brain Candy. Don’t forget to check out our website for sweet upcoming events and remember to sign up for our newsletter at www.dentistbraincandy.com. There is no guarantee as to the accuracy of this information and no treatment decision should be based on this information presented. Although every attempt is made to be accurate and factual, some items discussed are the opinion of the author and no liability will be assumed for the content presented.

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S2EP2: Trigeminal Neuralgia & the World’s First Successful Face & Hand Transplant

In 2018, Joe DiMeo fell asleep at the wheel. In the resulting accident, he suffered third-degree burns over 80% of his body. He was left without eyelids, ears and fingertips.

But in August of 2021, a team at NYU Langone Health performed a face and double hand transplant on Joe. Was the procedure successful? How has his life changed since the surgery?

On this episode of Dentist Brain Candy, I share two journal articles that piqued my interest this week, beginning with the recent Journal of Oral and Maxillofacial Surgery feature on trigeminal neuralgia that describes the symptoms of this long-term facial pain disorder as well as its treatment options.

I go on to discuss the world’s first successful face and double hand transplant surgery, explaining what’s involved in the patient selection process, why 22-year-old Joe DiMeo was a good candidate for the procedure and how he’s doing now.

Listen in for insight into what was involved in the 23-hour face and hand transplant and learn about Dr. Eduardo Rodriguez, the pioneering oral and maxillofacial surgeon who led the surgical team.

Key Takeaways

The symptoms of long-lasting facial pain disorder trigeminal neuralgia

What causes trigeminal neuralgia and how it’s triggered

The surgical and non-surgical treatment options for trigeminal neuralgia

How Dr. Eduardo Rodriguez led the world’s first successful face and double hand transplant

The team of 140 healthcare professionals who conducted the 23-hour surgery

What made Joe DiMeo a good candidate for the procedure and how he’s doing now

A brief history of human face transplants

The patient selection process for face transplant surgery

Connect with Dr. Bryan McLelland

Dentist Brain Candy

Dentist Brain Candy Podcast

Dentist Brain Candy App

Dentist Brain Candy Continuing Education

About Dr. Bryan McLelland

Dr. Jawbreaker on YouTube

Email bryanmclelland@hotmail.com

Resources

Liberty Oral Surgery February Event

Email info@libertysurgerycenter.com

Nobel Biocare

Ken Parish at Nobel Biocare

Ian McNickle of WEO Media

Jet Virtual Consults

‘Trigeminal Neuralgia’ in the Journal of Oral and Maxillofacial Surgery

NYU’s Press Release on the World’s First Successful Face and Double Hand Transplant

Photos of Joe DiMeo

 

S2EP2 Transcript

Speaker: Dr. Bryan McLelland

You’re tuned into Dentist Brain Candy, where we bring relevant, meaningful, value filled knowledge bombs straight to your brain. Featuring your host and oral surgeon. Dr. Bryan McLelland. Now sit back and enjoy the sweet treat of Dentist Brain Candy.

Hello, DBC peeps, and welcome to this week’s episode of Dentist Brain Candy. I am your host, Dr. Bryan McLelland, and thank you so much for tuning in. You’ve probably noticed here in season two that we’ve added to our repertoire to include a YouTube channel titled Dr. Jawbreaker. Now Dr. Jawbreaker is going to be a combination of episodes like this, on that generally geared more towards a dental professional, and then the videos of surgical procedures, which are geared towards the dental professional and just anybody that’s interested. There will also be just the audio version of this available on any podcast player that’s out there, stitch your radio iTunes. Remember if you can go and leave reviews that, really does help bring more people to this program and helps them find us, and is greatly appreciated. Of course, on YouTube, I believe thumbs up leaving a comment down below and subscribing, is also very helpful to get the word out about this program.

And if you enjoy this or want more of this, this is your way of letting me know that you’re out there. So, pause this right now go get that done. Thank you. Couple of announcements here before we get moving. COVID has been quite the nuisance over the last couple of years, although I believe we’re getting near the end of all of this nonsense, and I say that [time cheek 00:01:39]. But we have some live events coming. We had a little hiatus, we’re starting again. So February 18th, that’s right. Coming up February 18th, 2022, we’re going to have an OSHA update, a CPR renewal, HIPAA lunch and learn. And then two afternoon speakers. One of them is myself. I’m going to be speaking about wisdom teeth, maybe 30 to 45 minutes. Indications for referral, timing of referral, reason for extraction, update on the science behind wisdom teeth removal or not removal.

In October 21st, for those of you that can’t make it in February is going to be exact same program. Again, these are all going to be held in Post Falls at the Red Lion Templin’s. It’s a pretty cool venue, it sits right on the Spokane River in Post Falls, Idaho. You guys probably already know this, but I have two practices with Dr. Olson and I, one in the valley and one in Post Falls. So this would be a nice way to get people back together again and get some CE credits. Now, we are going to be streaming this on Facebook live. If you’re in person you can get CE credits, you’re welcome to attend the live if you wish, but there’s no CE credits available for those attending live. So February 18th and October 21st are the dates of those two events. May 13th, Noble Biocare is sponsoring an event. And this event will also be at Red Lion Templin’s in Post Falls.

And we’re going to have Ken Parrish, being one of our two speakers on that day. And his talk is titled Unlocking The Power of Innovation. Understanding the benefits of Thai ultra in the zeal surface technologies. Discover how the new implant topography promotes early oseointegration, learn the rule of DTX studio, which is a software for treatment planning and its ease of use. In the afternoon, we’re going to have Ian McNichols from WEO Media, probably pronounced weo media, I don’t know. Best practice for driving new patient growth and how to get new patients for all this new implant technology that you just learned. Hope to see you guys there. Also want to let you guys know about Jet Virtual Consults. Jet Virtual Consults is an app that I had developed for my practice, and it has been phenomenal. And the whole idea of this app is more than just the video consults.

This app will increase your productivity by 10 to 15% at a minimum. It will help you collect patient’s health history, their surgical history, their medical history, before even showing up at your office. They can take pictures of their cards, their insurance cards, before they come in or anything else you want them to take a picture of. They can review and sign your financial policy, they can review and sign your HIPAA policy, and that’s right. You can have your own forms within this app itself. If you’re doing a surgical procedure like extraction of wisdom teeth, dental implants, jaw surgery, et cetera, there are informed consent videos that are available as well. And then, it helps you collect reviews and increase the number of reviews that you have by doing a screening process, to make sure patients that are happy four or five stars are greater, are directed to the internet to leave an online review for you.

And then the grand finale of course, is the ability to do a video conference or video tele a dentistry/telemedicine consult that you can get paid for, so the patient can do this from the comfort of their own home or whoever they wish. Currently, I mandate five consults per day that are virtual. The average cost of a turnover of a room is somewhere in the 50 to $75 range. So if you do five consults a day at $50, that’s $250 that’s saved just right out the gate. Not to mention the increase in productivity. I was able to do the same number of consults in one hour less time, and do one hour’s worth of more surgery, which massively increases my productivity. So if you want to learn more about that, just go to Jeffer.consults.com or email me at bryanmclelland@hotmail.com. To go back to the CE events if you want to register for those, just email at info@Libertysurgerycenter.com or go to Eventbrite and search for Liberty oral surgery CE events. I do recommend emailing, it’s probably a little more predictable at this point.

Now, the first thing I’d like to talk about today is trigeminal neuralgia. Now trigeminal neuralgia, a really nice review article in the JOMS, that’s the Journal of Oral and Maxillofacial Surgery. Pages are 2378 to 2371 in 2021. The article is short and succinct, but quite useful. So, this article is by Ellie Farini. So trigeminal neuralgia is a long lasting facial pain disorder that affects the trigeminal nerve, clever name. Trigeminal neuralgia, trigeminal nerve. An even mild stimulation of the face can cause severe and excruciating pain. Initially it is experienced a short mild attacks, but this pain disorder can progress causing longer and more frequent bounces of pain and discomfort. Trigeminal neuralgia affects men more than women and is likely to occur in people who are more than 50 years of age. The symptoms include involving one of the three branches of the trigeminal nerve, which include the ophthalmic nerve or V1, the maxillary nerve or V2, and the manipul nerve V3. One, two, or all three of these can be affected individually or at the same time. However, trigeminal neuralgia commonly affects the men and maxillary branches only.

Symptoms include one of the more of the following patterns. Pain in the cheek, jaw, teeth, gum, or [teeth 00:07:24]. Pain usually affects one side of the face. The episodes of pain are severe in shooting that may feel like an electric shock. Pain can last a few seconds to several minutes, and the pain can be focused on one spot or spread to a wider area on the face. Sometimes there are trigger points associated with this. Some of the triggers which may set off pains include eating, drinking, smiling, brushing teeth, talking, touching your face or washing your face. Trigeminal neuralgia is caused by a disruption of the trigeminal nerve. Most commonly the problem is contact between a normal blood vessel and the trigeminal nerve at the base of your brain. The disorder can also be a result of just aging, and people with multiple sclerosis do you have an increased incidence of trigeminal neuralgia. So, if you have trigeminal neuralgia, oftentimes it includes seeing an oral and maxillofacial surgeon, and or a neurologist, and or a neurosurgeon.

The treatment includes nonsurgical and surgical approaches. Nonsurgical modalities include medications. And these medications can include things like Tegretol or Carbamazepine, Amitriptyline, Baclofen which is a muscle relaxant. And although it’s not in this article Neurotin or Gabapentin, is also used for the treatment of trigeminal neuralgia, particularly in my area. Surgical procedures are divided into two categories, either open procedures or lesional procedures, or lesioning procedures.

So, open surgery includes microvascular decompression, and it involves surgical exposure of the trigeminal nerve root by a neurosurgeon, decompressing the nerve and moving to the blood vessel away from the point of compression. This may result in relieving painful episodes and return to normal nerve function. Lesioning procedures. There are many minimally invasive procedures that can be used to treat trigeminal neurology of patients. Percutaneous, radiofrequency, rhizotomy is one. This minimally invasive technique uses heat to relieve pain by destroying the part of the nerve that causes pain. The surgeon passes small needle through the cheek, into the trigeminal nerve and use the heat current to destroy some of the nerve fibers.

Percutaneous balloon compression. This technique uses a needle that passes through the cheek to the trigeminal nerve. This surgeon places a tiny balloon then inflates it. The inflated balloon compresses the nerve and injures the fibers that cause pain. Percutaneous glycerol rhizotomy.This technique uses a liquid agent glycerol, to selectively damage the nerve. This interferes with the transmission of pain signals to the brain. Keep in mind that all of these will lead to some level or degree of paraesthesia and permanent numbness. And then there’s procedures that are stereotactic. Radiosurgery, such as gamma knife or cyber knife, this procedure delivers a single dose of ionizing radiation to a small precise target at the trigeminal nerve root. This ultimately interrupts transmission of pain and signals to the brain. The next thing that I’d like to discuss is really just a more an article, a contemporary article about a surgeon. An oral maxillofacial surgeon named Eduardo Rodriguez. And this individual is quite impressive, is quite accomplished, and is doing face transplant surgery. And actually was recently quarterback for a face transplant and a hand transplant surgery. Yes, you heard me right, face and hands at the same time.

So this was out of AMuS today in the most recent January release in 2022, the article goes like this. Dr. Rodriguez starts off by just saying that the first time he saw in a small animal model that a facelift or at least a partial facelift could be done, he was thinking, wow, how do we get this to clinical trials? Roughly 17 years later as head surgeon, Dr. Rodriguez led more than 130, 140 healthcare professionals at New York’s University, NYU Langone Health, it conducted the roles first face and hand transplant. A 22 year old new burn victim received a donor’s hands and a full face during the 23 hour surgery in August of 2020.

In total, Dr. Rodriguez has led four face transplant procedures. The latest surgery, patient Joe Damil suffered third degree burns over 80% of his body in a 2018 car crash. After he fell asleep on his way home from a night shift as a product tester. After about 20 reconstructive surgeries, the 22 year old had severe facial scars, no lips or eyelids and amputated finger tips. With the goal of transplanting, the patient’s face in hands, the surgery posed the most complex operation dr. Rodriguez has ever performed. Two previous attempts by other surgeons to simultaneously transplant a face and hands were both unsuccessful.

The first patient in 2009 in Paris died a month later because of infection. In 2011, a transplant in Boston, Massachusetts treated a woman muled by a chimpanzee, but her hands were removed days later. Team rehearsed this surgery in 2019 until the COVID 19 pandemic hit, and at NYU Langone Health resources and attention turned towards treating for those emergency patients and Damil’s transplant was postponed. Can you imagine having yourself as the surgeon, as the doctor, and especially as the patient, all psychologically prepared and you’re ready to go new face, new hands, knowing that this has only been done a handful of times and that you could die being postponed, dang as something else. I’m going to try to show you some pictures here of what this guy’s face looks like in his pictures. But, the whole mantra of this was that failure is really not an option, failure’s equals death in this particular situation, or quite possibly death. Six surgical teams, including one for each hand and the other for the face simultaneously operated in the donor and recipient rooms. So if you think about that, you’ve got like a donor.

One team procuring one hand, one team procuring the other hand, another team procuring the face, that’s three teams. Now on the patient Joe Damil, you’ve got one team that’s going to work on one hand, one team that’s going to work on the other hand, and then Dr. Rodriguez working on the face. The 16 surgical team, 80 member OR team transplanted the hands to the mid forearm and the full face, including the ears, the nose, the eyelids, and the underlying skull.Dr. Rodriguez said the surgery went better than expected. Craziness, let me show you some pictures. So here’s a picture of our handsome Joe [pand 00:14:20] good looking fella. And then the injuries, check that out. What a change, what a difference. And if we go up here, there’s some 3d planning that was done, and some modeling. Sorry, my fingers are over that of what was going to happen. Now want to show you actually at the end here, I’m going to show you what he looks like.

The surgery for the face and transplanted hands lasted 23 hours. And then the patient looked at his face. Before and after the transplant photos are coming your way, I’m going to make you wait. So Damil is now doing well, he’s extremely motivated. They do a whole bunch of psychological and social testing ahead of time and counseling to make sure the patients are adequate and well chosen for these procedures. He’s now lifting weights. He’s petting a dog, he’s actually grasping objects. That means his hands have some level of movement. Crazy. And he grasps objects such as balls, and he moves them. As soon as we can get them off the pain medications, he wanted to be off to see Dr. Rodriguez. He still has that same spirit. He’s a fighter. He’ll always tell you that he doesn’t give up. He’s not a cliche, he’s got the right attitude. We’re very, very proud of him.

History of transplants. I’d like to give you just a little touch up above that, or a little information about that. Human face transplants pose a relatively new world. Yeah, no kidding. Huh. And new challenges with fewer than 50 operations performed across the globe. The first partial face transplant was done in 2005, by an OMS [Bernard De Varaivel 00:15:57], a plastic surgeon Benoit Lengele and a transplant specialist team John Michelle du Bernard in France, to treat a woman that was muled by her dog to replaced the patient’s nose, chin and lips. The patient died in 2016, and this was done in 2005 at the age of 49 after experiencing infections and developing cancer. A team at Cleveland clinic performed the first US face transplant and reportedly the fourth in the world in 2008. In a 2008 on a woman’s shot by her husband in a botched murder suicide, it was a 22 hour operation that involved the nose, the eyelid, the skin, the muscles, the teeth, and the nerves, and was at the time considered the most complex face transplant according to the Institute.

Patient died in 2020 that’s 12 years later, at 57 due to an infection unrelated to her transplant. In 2010, the first full place transplant was conducted in Barce Spain. The 24 hours surgery was conducted on a 31 year old man injured in a shooting accident. The first full face transplant in the United States in 2011, at Brigham and Women’s Hospital in Boston, treated a 25 year old man whose face was severely injured. And when as a cherry picker, he touched an electrical wire. I just imagine this guy in a cherry tree, picking cherries and his face touching some wire and electrocuting him. Man. A 30 member team conducted this 15 hour surgery that transplanted the skin, nose, lips, as well as the underlying muscle and nerve from an anonymous donor. Rodriguez performed his first human transplant in 2012 at the university. It was a 36 hour surgery. Compared to Rodriguez’s first face transplant, this procedure was definitely shorter. Let’s see, 36 to 24 hours. Yeah, that’s a lot. Still, 24 hour surgery, man, that’s something else. Compared to Dr. Rodriguez’s first face transplant. This surgery was more than 11 hours shorter.

The length of state was about 25 days in intensive care unit by 28, and rehabilitation for six days. Patients submit requests for transplant at NYU with careful evaluation by clinical psychologists, psychiatrist, and ethicist, a large team is involved in patient selection. And patients must understand the consent process very well. But the operation offers a patient at a new chance of living. So Dr. Rodriguez explaining, and that he’s unsure with how long they will live with the transplant due to potential complications and issues related to under going operations, including infections and the effects of long-term medications. The future of these face transplants. The first face transplant Dr. Rodriguez led was 36 hours. Well, the most recent one was 23 hours. Dr. Rodriguez said he does not become tired during the long surgery, he’s is running on adrenaline. He takes breaks to drink coffee and to use the restroom. It’s glad to know that at least he’s human.

As for the future, other opportunities are subunit face transplants, transplanting portions of the face or the jaws, including skin or bony tissue. I think the major limiting factor in these patients have been the lifelong medications that potentially compromise our lives. And what Dr. Rodriguez is talking about here, is that despite doing testing and making sure they’re an adequate match, and that would be a fascinating discussion all on its own. They still have to take things like immunosuppressants, like tacrolimus and progra, et cetera. So, I just thought that this was like an amazing article, and I’m so pleased that an oral and maxillofacial surgeon is kind of one of the leaders in this really in the world. This Dr. Rodriguez is fantastic for our specialty is doing courageous. Really just courageous work, only overshadowed by the courage of his patients that are moving forward and doing this.

Now I want to show you the before and after picture. And we know that this patient’s a rockstar because they’re clearly a Boston Bruins fan. So check this out. Forgive me for the difficulties in transferring this through video, but I think you at least get a good feel for where he was before, and where he was after the success of that. Check out those arms and hands, love the tattoos, love how healthy and normal those hands look, definitely some contracture there. I’d love to more about that, but anyways, check that out. Hope you love this article as much as I did. Well, guys, that concludes this week’s episode of Dentist Brain Candy. I want to remind you about something that is current and pressing. If you’re interested in a continued discussion about how to generate income outside of the practice of dentistry and oral maxillofacial surgery, contact Chris Salazar.

He is a friend of mine that currently has an investment. The name of his company is Archstone Capital. If you email me at bryanmclelland@hotmail.com, I’ll get you in touch with Chris. He currently has like a 57 unit apartment building that he is looking for an additional $300,000 worth of investment, which will generate significant cash flow on a monthly basis. I haven’t looked into this particular deal yet, but every deal Chris has sent to me has at least an eight to 10% preferred return for the investor. So, on that’s on an annualized basis. So if I do some quick math, 10 percent’s an easier number. 300,000 is $30,000 per year once stabilized. So that means roughly once the project is completed, which means it’s a value add. In other words, there’s stuff that needs to get done. It needs to be fully tented.

300,000 is going to translate into $30,000 per year. You do 30,000 divided by 12 and you are well it’s 36, be $3,000 a month. So you’re somewhere in the… Just going to spitball like 23 to $2,600 a month. Check in the mailbox by making this one investment. You can use IRAs, you can use 401ks. And I’m just telling you what I’m doing for investments. Of course, you got to know that I am not an investment advisor, talk to your accountant, but I’ve never heard anybody and any of my friends or colleagues come and present these kind of things that have been vetted by someone that I know and trust. So hopefully, and trust me, this is stuff that I’m investing in. So just email me@bryanmclelland.com or bryanmclelland@hotmail.com, and I will get you in touch with Chris. Keep in mind that this investment is time sent sensitive, although he has other investments coming and projects coming in the future. If you want this one, you got to jump on this thing fairly quickly to get the information.

So, thank you for tuning in. I hope you like this. Please leave the reviews, high star ratings, comment down below, all the good stuff to make this become seen and known out there and the big bad world. So, appreciate it. Catch you next time and see on the flip side.

Thanks for tuning in on another episode of Dentist Brain Candy. Don’t forget to check out our website for suite upcoming events and remember to sign up for our newsletter@www.dentistbraincandy.com. There is no guarantee as to the accuracy of this in information, and no treatment decision should be based on this information presented. Although every attempt is made to be accurate and factual, some items discussed are the opinion of the author and no liability will be assumed for the content presented.

 

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S2EP1: Cognitive Bias Hazards, Minimizing Frailty Preoperatively and Is Penicillin Allergy a Risk Factor for Infection?


With oral operations, negative outcomes are bound to arise from time to time.

Though, when we take the time to continue to stay informed of possible hazards and complications, we can better avoid these possible outcomes.

On this episode of Dentist Brain Candy, I share three interesting articles from the the Journal of Oral & Maxillofacial Surgery, including my experience and judgment regarding each topic.

I explain what cognitive and negative bias is and how to avoid it, my experience with frailty and oral surgeries, and my personal insight on penicillin and allergy evaluations.

Listen in for insight on cognitive bias hazards after operative complications, how to minimize frailty preoperatively through prehabilitation and whether or not penicillin allergy is a risk factor for surgical site infection.

Key Takeaways

What cognitive and negative cognitive bias is

Positive responses that a surgeon can take regarding a cognitive bias hazard

Cognitive bias tendencies that can occur

Complications to avoid after a complication or an adverse event

Minimizing frailty preoperatively through prehabilitation and improving surgical outcomes

Dr. Bryan’s oral surgery experience with a frail 90 year old patient

Important things to take into account when dealing with a frail patient

A study on penicillin allergy and if it is a risk factor for surgical site infection after oral and maxillofacial surgery

Dr. Bryan’s insight on penicillin allergy and allergy evaluations

Sneak peek of upcoming episode with Chris Salazar, all about using real estate to create other sources of income outside of dentistry and oral surgery

Connect with Dr. Bryan McLelland

Dentist Brain Candy

Dentist Brain Candy Podcast

Dentist Brain Candy App

Dentist Brain Candy Continuing Education

Dr. Bryan McLelland

Dr. Jaw Breaker on Youtube

Email Bryanmclelland@hotmail.com

Resources

Journal of Oral and Maxillofacial Surgery

Cognitive Bias Hazards After an Operative Complication

Minimizing Frailty Preoperatively Through Prehabilitation: Improving Surgical Outcomes

Is Penicillin Allergy a Risk Factor for Surgical Site Infection After Oral and Maxillofacial Surgery?

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EP177: What Nerve Block Technique is Easiest to Learn, Jaw Fractures and Impacted Wisdom Teeth, BMP for Alveolar Cleft Grafting and more

This week we discuss some pretty interesting articles from the Journal of Oral & Maxillofacial Surgery the first one discussing the Akinosi nerve block technique versus the inferior alveolar nerve block technique for beginners to see whether there’s an ease in learning and decrease complication rates for beginners.   I didn’t ask us the use of recombinant human bone morphogenetic protein for use in grafting of the  Alveolar cleft. I then proceeded on to discuss where there’s a correlation between an impacted mandibular third molar, the type of impaction and mandible fractures and then the type of mandible fractures and believe me when I tell you there is. You’re going to have to listen to this episode to find out what that correlation is.

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EP176: Dental News – Win Back Lost Patients, Xerostomia Cured, Post Op Dental Implant Care System


This week in Dental news to abuse will start off by discussing how  dental offices can win back lost patience as well we’ll talk about a new retraction paste that’s made out of a combination of 15% aluminum chloride and kaolin Clay will also discuss  a new product available called Moisyn they can help patients with xerostomia or dry mouth. I will also talk about an implant post-operative care system and a handheld intraoral x-ray system and a new water line filter guaranteed to keep your water lines clean and bacteria free.

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EP175: Weight Loss with Jaw Fractures, OSA with Mandibular Setback and More


This week we go over weight loss with jaw fractures and whether or not doing a closed reduction or an open reduction makes a difference in this weight loss. The average patient with a mandibular fracture loses approximately 5% of their body weight but if it made it to the ICU they lose up to 9% of their body weight. We also will discuss obstructive sleep apnea and whether there’s an increased incidence of obstructive sleep apnea with a mandibular setback surgery using a vertical ramus osteotomy. We will also discuss the use of dental implants to facilitate jaw surgery in a complex restorative case in an edentulous maxilla.

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EP173: Dental News to Abuse Part 2


This week we are going to talk about enhancing your dental team’s communication as well as using salivary diagnostics for your dental practice to assist in bacterial identification for Paragon it is as well as caries risk assessment and oral cancer screening. We’ll also talk about how you can borrow Ritz-Carlton and their famous Empire for outstanding customer service to up your game in serving your patience.

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EP172: Dental News to Abuse

This week in Dental news to Abuse I discuss changes with coding occlusal night guards and how to bill them and make sure you get reimbursed for these little critters. In addition, I discuss the ins and outs of emailing patient dental records and making sure you protect Patient Healthcare information or PHI. I also discuss six patient retention strategies and how to use social media to find your next hire.

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EP171: Does Topical Work? Spontaneous Face and Airway Swelling- Be AFRAID!


This week I discussed two interesting articles the first one is a discussion about the use of topical benzocaine and that’s 20% benzocaine gel in the maxilla and specific of the anterior maxilla to decrease pain of injection and entry of the needle and deposition of the fluid as well I discuss hereditary angioedema for oral surgery patients which is the spontaneous facial swelling data can occur because of this rare genetic disease.

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