Dentistry Uncensored with Howard Farran
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713 Periodontics and a Drug-Free World with Dr. Bernard Fialkoff, DDS : Dentistry Uncensored with Howard Farran

713 Periodontics and a Drug-Free World with Dr. Bernard Fialkoff, DDS : Dentistry Uncensored with Howard Farran

5/19/2017 12:27:09 PM   |   Comments: 0   |   Views: 241

713 Periodontics and a Drug-Free World with Dr. Bernard Fialkoff, DDS : Dentistry Uncensored with Howard Farran

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Born in Havana, Cuba and bi-lingual in English and Spanish, Dr. Bernard Fialkoff graduated with a DDS Degree at the State University of New York at Stony Brook in 1980. He received the Alpha Omega Award as class valedictorian and was elected to OKU Academic Honor Society. Dr. Fialkoff received his Periodontal and Dental Implant post-graduate board eligibility at the combined Memphis Veterans Administration Hospital and University of Tennessee Dental School Post Graduate Specialty Program in 1982. He established his Bayside, New York practice in 1982, delivers Periodontics, Dental Implantology, Laser Therapy, Dental Cosmetic Plastic Surgery and runs a monthly study group for local dentists. His office offers state of the art computerized digital low-radiation dental x-rays, intra-oral camera and Cone Beam 3D Cat Scanning. Dr. Fialkoff and staff have worked closely with local dentists to help achieve patient dental goals for over 33 years. 

Dr. Fialkoff is the Founder and Executive Director of the Fialkoff Dental Study Club and the Implant Certainty Training Program, both continuing education programs that have been the premiere dental groups since the early ‘90’s. Dr. Fialkoff has lectured around the world including at the CONAOD International Dental Congress in Santo Domingo, and nationally including at the Greater NY Dental Meeting. He was inducted into the Pierre Fauchard Honorary Society and Academy in 2015 as well as into the Academy of Odontology in 2011, and has received such honors as the “Leadership in Dental Education Award” by Interfaith Medical Center, and the National Coalition of Latino Officers Humanitarian Award, as well as Honorary Memberships with the High Intensity Drug Trafficking Area Program, Fraternal Order of Police, National Latino Officers Association, and Rockland County Hispanic Police Association, Community in Action. 

Dr. Fialkoff is the Founding Sponsor and President of the Foundation for a Drug Free World The Americas Chapter, and has produced or presented at more than 1200 drug education events around the globe including on the Eastern Seaboard of the USA, as well as in Haiti, the Dominican Republic, El Salvador and Guatemala. He has forged national agreements with the National Council of Drugs of the Dominican Republic and Haiti, as well as with the militaries of El Salvador and Guatemala. His chapter has received accolades and proclamations from Senator Chuck Schumer, Senator Kirsten Gillibrand, Congresswoman Grace Meng, NYC Public Advocate Letitia James, among 20 other notable government leaders. He is also the Founder and Director of the US-Cuba Humanitarian Trip program, being one of the primary medical professionals to bring dentists into that country for the first time in half a century. 

Dr. Fialkoff and his wife Maria have four children, Jason, Meghan, Oswaldo and Scott.

BernardFialkoffDDS@gmail.com 

www.baysidedentist.com

www.drugfreeworldamericas.org


Howard Farran: It is just a huge honor today to be podcast-interviewing Dr. Bernard Fialkoff, all the way from Bayside, New York. Where's Bayside? Is that a suburb of Manhattan?

Bernard F.: Thank you, Howard. Bayside is in the borough of Queens. New York City has five boroughs. Queens is one of those boroughs. Bayside is right next to the Throgs Neck Bridge, which goes over into Connecticut. That's where it's located.

Howard Farran: Bernard was born in Havana, Cuba and bilingual in English and Spanish. Dr. Bernard Fialkoff graduated with a DDS degree at the State University of New York at Stony Brook in 1980. He received the Alpha Omega Award as class valedictorian and was elected to OKU Academic Honor Society. He received his periodontal and dental implant postgraduate board eligibility at the combined Memphis Veterans Administration Hospital and University of Tennessee Dental School postgraduate specialty program in 1982.

He established his Bayside, New York practice in 1982, delivers periodontics, dental implantology, laser therapy, dental cosmetic plastic surgery and runs a monthly study group for local dentists. His office offers state of the art computerized digital low-radiation dental x-rays, intra-oral camera, cone beam, 3D CAT scanning.

Dr. Fialkoff and staff have worked closely with local dentists to help achieve patient dental goals for over 33 years. He is the founder and executive director of the Fialkoff Dental Study Club and the Implant Certainty Training Program, both continuing education programs that have been the premiere dental groups since the early 90s.

Dr. Fialkoff has lectured around the world, including at the CONAOD International Dental Congress in Santo Domingo and nationally, including at the Greater New York Dental Meeting. He was inducted in the Pierre Fauchard Honorary Society & Academy in 2015, as well as into the Academy of Odontology in 2011, and has received such honors as the Leadership in Dental Education Award by Interfaith Medical Center and the National Coalition of Latino Officers Humanitarian Award, as well as honorary memberships with the High Intensity Drug Trafficking Area Program, Fraternal Order of Police, National Latino Officers Association, and Rockland County Hispanic Police Association, Community in Action.

Dr. Fialkoff is the founding sponsor and president of the Foundation for a Drug-Free World, The Americas Chapter, and has produced or presented at more than 1,200 drug education events around the globe, including the Eastern seaboard of the USA, as well as in Haiti, the Dominican Republic, El Salvador and Guatemala.

He has forged national agreements with the National Council of Drugs of the Dominican Republic in Haiti, as well as with the militaries of El Salvador and Guatemala. His chapter has received accolades and proclamations from Senator Chuck Schumer, Senator Kirsten Gillibrand, Congresswoman Grace Meng, New York City Public Advocate Letitia James, among 20 other notable government leaders.

He is also the founder and director of the US/Cuban Humanitarian Trip Program, being one of the medical professionals to bring dentists into that country for the first time in half a century. Dr. Fialkoff and his wife Maria have four children, Jason, Megan, Oswaldo, and Scott. That's the part of your bio that hurts, because when I got married, I only wanted one little girl named Megan and all I got was an Eric, Greg, Ryan, and Zack. Congratulations on getting your Megan. I hope you enjoy her for the both of us.

Bernard F.: All right.

Howard Farran: Man, that is so interesting that you're born in Cuba, your father was a physician. I was watching on the news the other day, VICE News on HBO was talking to me how the Cubans have a 25% five-year survival rate with lung cancer. It's a vaccine and they're trying to get it into America and start testing on it ASAP. The Cubans, they said that since they were a poor country, they couldn't do all the expensive treatment that they needed a medication, a vaccine for. It looks like they're really on to something. Did you see that on Vice?

Bernard F.: No, Howard, but I visit in Cuba and I went to the facilities. Coming from Cuba back in 1962, one of the things I always wanted to do was go back to my homeland, which I did, very interesting, 50 years later on the same month that I left. It was very, very deja vu-like, a very, very interesting experience.

We got toured by Ministry of Health, very nice man, one of the in-charge, Jorge Portilla. We brought down with Bob Schwartz, who was this former CBS, 60 Minutes producer. We went down and we visited. We met with a lot of different dentists, very nice experience.

The thing is, what I wanted to say, Howard, is with all of that, they have accomplished a lot. They have a very preventatively-oriented program. One of the things that I've seen, because I've traveled the world as I've done this drug education program, is that there's no place like United States of America.

One of the things that I've seen is the amount of technology we have in this country and the ability to obtain different modalities of treatment, it's astounding to me. Some of the things that we take for granted in this country, when you come back, after I've come from other countries, Europe, Latin America and whatever, we can talk about more later, is astounding, so really-

Howard Farran: What-

Bernard F.: Yeah, mm-hmm (affirmative).

Howard Farran: What is the population in Cuba, about three million?

Bernard F.: It's very small, yeah. What happened after the exodus, it got cut down maybe by half. They've got maybe about four million, five million. In fact, they have a population crisis, where they actually want people to have kids, because the population continues to shrink and has been a problem for them.

They have a number of engineering problems in the city of Havana with the water supplies and whatever. I think the fact that the relations have opened up is going to be a good thing. I think it's going to lead to an ability to help each other and to break down some of these walls that have happened over the years, which would be to the benefit of my previous country and my present country.

Howard Farran: How many dentists are in Cuba?

Bernard F.: That's a very good question, Howard. I don't have an answer for you. I would love to have an answer for you, but I don't.

Howard Farran: Did you visit many dental office? What was the dental office like in Havana these days?

Bernard F.: Yes. What I did, is I visited the University of Havana, the dental school. I was taken aback, because some of the things that they were teaching in perio or preventative, very rudimentary, even though, through technology that we dispose of in the United States, they would benefit by in Cuba.

I actually spoke to the head surgeon of the country, a oral maxillofacial surgeon, very well-renowned in Latin America. At the end of the presentation I gave, he said to me, "Our Stryker unit just broke and it's the one we have to use surgeries on. I have no idea what I'm going to do without the Stryker unit."

What happened is I went down there with 18 dentists and one of the dentists, this great guy, Dr. Marzouk, went online, he found the Stryker unit, and we got it down there for them to actually utilize. What I can tell you is, really, they have a scarcity of equipment and their treatments are very rudimentary, which is why they have to go very preventative. The preventative approach is very good, but they're very much lacking in the other technology, armamentarium they need to follow-up with, yeah.

Howard Farran: Of the nine specialties recognized by the American Dental Association, your specialty, periodontics, has changed the most in the 30 years since I graduated. My God, your profession. It looks like the pendulum, it was all root planing, curettage, periodontal surgery, all these fixing defects, but then as implants emerged, a lot of people starting saying, "Oh, forget all that stuff. Let's just rip the tooth out and place an implant."

I think it swang all the way to the right, but I now see the pendulum coming back down. I think a lot of dentists have a problem with it, because they'll see a three-rooted molar and it might have bone loss and this and that, but then they're starting to think, "Would I want to pull my own maxillary first molar? Would I want to sign the slip?" I see a lot of people ... Where do you think that pendulum is? Do you think it's still swinging? Do you just forget everything we learned in periodontal surgery and extract and go with titanium or do you think the pendulum is starting to come back?

Bernard F.: It's a excellent question. I have to go back to when I graduated dental school, because, really, the reason I went into my training was not to become a periodontist. I actually wanted to practice all forms of dentistry back then, when I graduated in 1980.

I wanted to get the surgical training. I decided to go the perio route, rather than the oral maxillofacial route. I was more intuned to restoring and doing this. What happened is, once I took that training, the myriad of treatments that I had no idea existed became obvious to me, so I came out, I never practiced dentistry again. I actually, after a few years, went and limited my practice.

Your question is very well-taken, because, really, one of the points is very important when we're delivering treatment to our patients nowadays is to take a look at them, and you brought up an excellent point, is what would you and I want to do to ourselves?

In fact, one of the things, and I know that one of the things you had asked me before the presentation today, this interview we're having, is what advice we could give new dentists today. One of the advice that I would give them is to look at the person as if they were there in the chair or if it was their mother or their father. What would they do for their mother and their father?

The reason I say that is so many now are taking different courses in marketing, which is all fine, but really what it boils down to is a matter of trust. When you have that viewpoint, like you and I were discussing, where you're really looking at what would we want done for ourselves, that actually relays to the patient.

Many of the young dentists nowadays are coming out and they're concerned about repaying their loans. Obviously so, but one of the things that they need to take a look at, and I would definitely encourage them to really make number one priority, is to each patient that they have, regardless of plan, coverage is to take a look and to see what is the way that they would want to be treated.

What they're going to find is they're going to get a tremendous amount of case acceptance by approaching it that way. They're not going to need to have a lot of the paraphernalia. It's all great to have all the digital x-rays, photography, CAT scans, and we need that, and laser diagnosis, we need all that, but the thing is is that all that has to come behind the banner of trust and actually doing what we would want to do for ourselves.

In terms of the pendulum with surgery, I think perio and dentistry itself has come tremendous distance. It's unbelievable what we can do now, regenerating bone in doing sinus grafting that we do and rehabilitating and actually keeping certain teeth. Really, with the implants, if you restore the posterior occlusion, now you can maintain teeth anteriorly that normally you wouldn't be able to because of the trauma from the occlusion.

I think it's actually reached an equilibrium, where people actually realize that there's a tremendous amount we can do, but we can also do routine perio. I see what's been happening is that the panacea that implants were going to be 100% is gone. I kind of tease sometimes and I say, "As a periodontist, I treated a lot of failing dentistry. Now, as a periodontist, I want to treat a lot of implant problems," which I have been doing.

Howard Farran: These young kids see so many ads and so many lecture courses that say that dental implants have a 98-and-a-half percent success rate. What do you think the real success rate is? There's two successes. One is right out of the gate. They open the gates and the horse or the dog doesn't fall down, whatever. Then, when you start seeing these, quote, "successes," I see so many implants that been in the mouth 10 years, but they have peri-implantitis. Then, the peri-implantitis concerns everyone, because they start talking about the oral-systemic link.

I read that book last weekend, "Beating the Heart Attack Gene." This guy has a whole chapter on ... He thinks five pathogens in gum disease are significantly, research-wise, correlate to heart disease. The problem with the patient is, that implant's solid as a rock. He can go to McDonald's and eat a cheeseburger, but it's got five, six millimeters of peri-implantitis around it. If a patient walked in to you today and said, "Doc, what's the success rate of this dental implant?"

Bernard F.: Excellent question. This is where I base all my dentistry, is that everything needs to be planned. Everything needs to be done properly. I think implants have a tremendous success rate and I've seen them now since I first started back in 1988, when I first started doing with the Core-Vent, then I had switched over to the Branemark, and then to Biomet 3i, because of with the fit. I've done different systems over the years.

What I've actually found is crucial to the implant from the practitioner's standpoint is the passivity of the fit of the prosthesis, the occlusion, the number of visits, of the competence of the dentist who is actually restoring the implants. One of the things that needs to be brought up that maybe is not brought up enough, the number of times to remove and place abutments or prosthetic pieces or impression copings during that initial phase actually affects the long-term result of the implants.

The implant has an adhesion. What happens is that, on, off, on, off too many times from a lack of competence actually affects that initial adhesion, that initial integration. The other thing that's important is there's a lot of needed implants nowadays. As you said, yes, they integrate, but one of the points I always bring out to patients is that they integrate, but you're going to be left with bone loss and this is going to lead to problems.

The point you came out with relating to disease, to cardiac disease, medical disease is very well-taken, you're right. Here, we have this titanium rod in the bone, integrated with a pocket that's actually infected. It's a very well-taken point. I do think they're very successful, but I think that they have to be done properly, restored properly.

I think if they're restored properly, I've found unbelievable success rates. I think that when they're not placed properly and there's too many too close or not enough for the occlusion or not restored, then they are the problem that you're talking about, absolutely. I think there's no all or none. Again, it goes back to really getting quality treatment, planning it out, and working together. As a periodontist, I work together with my restoring dentists. It's a team. It really is a team activity.

Howard Farran: You started out with Core-Vent. Was that Gerry Niznick's?

Bernard F.: Yes. Yeah, that was ... Uh-huh (affirmative).

Howard Farran: We did a podcast with Gerry. Then, you went to Branemark, [inaudible 00:15:57], which is [inaudible 00:15:59], then 3i. Did that get swallowed up by Biomet Zimmer?

Bernard F.: That's right. Now Zimmer has it. The reason I went to Biomet is because a study a long time ago, this binding study, was a very interesting result, because the 3i pieces actually fit better on all the other companies' implants than those company's implants fit on their own implants. At that point, I realized the quality of 3i, which is the point you'll see goes over and over with me, is I just believe in doing things as quality as I can, as a hundred percent as close as I can. That's why I used 3i all those years.

Howard Farran: Are you still using 3i Zimmer Biomet now?

Bernard F.: Yeah. I use 3i still now, but there are other systems also out there that are very good that you can utilize. I think, again, the main thing has to do with the number of implants placed, the positioning, to make sure that they're not too close, to make sure that we have enough for the occlusion and that then we restore it passively, that the occlusion is actually correct. Then, at that point, it just becomes a matter of routine maintenance. I think they're very successful at that point.

Howard Farran: The dentists, they always want me to pin you down for exactly what you use. Exactly, you're placing 3i Zimmer Biomet?

Bernard F.: Biomet 3i.

Howard Farran: Biomet 3i, owned by Zimmer?

Bernard F.: Yeah.

Howard Farran: Any particular one of their implants?

Bernard F.: Yes, I like the Natural Tapered. The reason I like the Natural Tapered is because they go in very firm, very solid. They have a good initial seating and they work out really, really well, very, very high success rate with them.

Howard Farran: I wonder what percent of Zimmer's business is dental, because they do hips, knees, spine.

Bernard F.: Yeah, they're mostly orthopedics. Uh-huh (affirmative).

Howard Farran: Yeah. What percent are they dental?

Bernard F.: It's a good question. I don't know. I would say maybe they do 15%. I think mostly that it's a small portion of it. [crosstalk 00:18:06]-

Howard Farran: I was really excited. I was reading on the internet that the biggest problem with a hip implant is, if they get a staph infection, it's horrible. The mortality rate of a staph infection on a artificial hip is huge. They've got some new surface on their hips that is stopping staph infections.

Bernard F.: Yes.

Howard Farran: Did you see that?

Bernard F.: Yeah, it's all new surfaces. Basically, you're coming into a point that I think is well to take up, that surgical technique, and also the patient's medical status before the surgery. I think the first thing is it's important, again, for the dentists who are going to be watching this, is to really make sure the patient is medically sound, that there's no uncontrolled diabetes.

There have been so many patients that come into my office that tell me, "Oh, I'm under control, Doc." I look at them and I say, "I'd like you to get a test." "Oh, Doc, I just had my recent test and everything is fine. I'm under control." Over the years, invariably, I find that six months later, three months later, a year later they tell me, "Oh, you know what, Doc? I really did have a problem. It's interesting, but I'm on this medication now," or, "I'm taking insulin now."

I think it's important, number one, is to really make sure the patient is medically stable before you place the implants, number two is that they're actually cleaned up. There's a tremendous correlation between periodontal disease existing in the mouth and just placing implants. It's important to do our routine dentistry that we were taught in dental school, clean out the periodontal disease, get an area that's going to be free of infection. Then, at that point, then it depends on the surgical technique.

I think that some of these things that I see push the envelope and trying to put in immediate implants or immediate full-mouth restorations. In those cases, in those kinds of situations, you can develop early bone loss. They may integrate because you place a number of implants in a sufficient number, but like you said before, now you have a problem where they're going to be infected. To me, really, it's important to follow a good surgical procedure because that, to me, is what's really, I would say, probably 85% if not higher of the problem.

Howard Farran: What do you like to see when you have their diabetes under control? Some people think that fasting glucose is the real gold standard. Other people have no problem using the A1C. Some like to see the C-reactive protein. What do you like to see when someone's fighting ...

Bernard F.: I like to see the A1C.

Howard Farran: The A1C's good enough for you?

Bernard F.: Over a period of time. One of the things that I do is I really do a lot clinically. I look clinically. I see what my estimation is. I don't necessarily go by just a number. If I see that I don't feel that they're under control, I'll have them retake the test.

As I said, sometimes the test doesn't show it. Then, a few months later, it comes up on the test and nothing really has happened, other than for some reason it didn't show up the first time. To me, I think as a clinician, I think it's important for us to use our clinical exam and use our laboratory findings. I think the clinical exam really goes a long, long way in how the patient looks.

Recently, I treated a patient who had a heart transplant and he's done very well. It's amazing now. He's about 10 years now, he's alive. His skin color is different. He has implants. We had to extract some teeth that we had to do, but he's a totally different person. When I look at him now, he's got normal pink color. Years ago, he was yellow.

I was very concerned, I didn't really want to touch him, but he kept getting better and better because we did routine dentistry. We got him under control. We controlled the bacteria. His physician got him under control medically. To me, again, you'll see a lot of this with me, Howard, I really believe that a doctor has to use their acumen, their diagnostic abilities and use the other test, more or less, as a correlation to what they're already getting.

Howard Farran: Carl Misch would place implants on smokers, but his brother, Craig, said no. Where do you weigh in on smoking?

Bernard F.: That's a great question. I don't have an all or none answer. Some heal very well and others, the tissue retracts, heals slowly and it varies. It really varies. All smokers are not the same, but they don't heal the same as a non-smoker. What I tend to do with a smoker, which is probably one of the things you'd want the dentists to know, is I tend to go a little deeper placement with the implant, anticipating that they're going to lose a little bit of crestal height, which smokers tend to do.

I want to get the tissue very healthy before I do the surgery. If they have periodontal inflammation on a smoker, it would be really important to get it under control before you do the surgery. With a smoker, anything like that is going to be prone to not healing properly, to receding, maybe to exposing a screw.

If you do that initially, you're already behind the eightball. Those are the things that I would emphasize that they should watch out for in the smokers. Other than that, at that point, they integrate. The restoration would be very important and it would be important to do it in as few visits as possible for the reasons I mentioned before, especially more so in a smoker, but to just place it and do the impression, place the prosthesis as quickly as possible, as well-fitting as possible, in as few visits as possible.

Howard Farran: What if they're only smoking high-class Cuban cigars?

Bernard F.: Well, then it's no problem, Howard.

Howard Farran: How many did you sneak in your suitcase when you flew back from Havana?

Bernard F.: That is no problem. Yeah, when we were in Cuba, we visited a tobacco factory. We went through. [foreign language 00:24:22]. I want to just throw that in, because they're probably saying, "Howard, give us a break. Fialkoff is not a Cuban guy." Yeah, it was very nice to be there, because I spoke to them at the tobacco factory. I saw them actually putting the cigars together. Then, afterwards, we went down to their shop, we bought. One thing I have to tell you about, I'm very prejudiced, but Cuban people are wonderful people. Very, very nice people, very warm, and it was a nice experience.

Howard Farran: At Dentaltown, we have a seminar division. We got a couple people that work, because we have that annual meeting every year, the Townie Meeting. We've had it 15 years in a row. If you ever want to put a Townie Meeting in Havana, I think that might be really, really fun.

We could down there and have some great speakers and market it to everyone on Dentaltown. A lot of the Americans would probably want to go there, because they'd want to see it, probably. Then, a lot of the local dentists, we could let in free and edumacate them.

Bernard F.: Actually, Howard, it's very interesting, you came up with something that I was thinking about before our broadcast, is I've always admired that you are really out there and you're really getting dentistry to change, [inaudible 00:25:42] dentistry. I've always admired that. I would definitely take you up on that.

What I would tell you, and we could lead into this afterwards, is doing this drug education program that I've been doing, I've actually been in many Caribbean, Latin American countries and abroad. There's definitely a need. We could do a Townie in Salvador. In fact, one of the things that you should know is I have accords with a lot of universities. I have an accord, actually, with a Salvador dental school and they would welcome this, so absolutely. 

What we can do is we can see and mention it during your broadcast, because maybe your Townies would love to come. We could have something in Salvador. It's call Usam, in the city of Salvador. We could do one in Guatemala. We could do one definitely in Dominican Republic, where my friend is the general, who is the director of the Council on Drugs. There's a tremendous need for our type of dentistry.

What we have in America ... I feel, Howard, this is a motto that I go by, and that's never desert a group to which you owe your support. I really feel and I say I feel the camaraderie with you and I've seen what you've done over the years is that, I think as a doctor, we have more than just a title. It's not a title. Being a doctor, there's a word in the Jewish religion, it's called a "mensch." You're a mensch. A mensch is a nice word that says you're a real human being. You're a regular guy.

To me, as a doctor, our role, and I think dentists in general, because if you look at dentistry and how difficult it is to do and you look at the tiny aperture that we're working in and you look at the fact that we're handling fear, anxiety and all these emotions that we handle, really, by and large, just by communicating, to me, the dentist is really a tremendous clinician, is a certain type of human being, is a human being that knows how to deal with people, who cares about people, because he's doing this procedure that's impossible to do. Then, he's arguing about millimeters, which is what's so great about dentistry.

I want to let everyone, again, to the students out there to realize, is think a lot of yourselves, not so that you get overconfident and cocky, but think a lot of yourselves so when your patient is there, they feel it, that you're going to take them, you're going to help them. You're going to guide them.

Getting back to your proposition, absolutely. Let's do one in Salvador. Let's do one in Dominican Republic. Let's do one in Cuba. You're interesting, you've actually hit to my passion. Let's take dentistry and let's put it on the map. Let's do something for dentistry.

I wanted to bring this out, and you actually got me to bring it out at this point, we don't have to lose dentistry to corporations. It doesn't have to happen. When you're a father, and you're a father of four, you know this, you are responsible for how your kids grew up. You could blame it on some corporation that came and took your kid away, but the reality is is what we do with our kids is what ends up happening.

Why do I say that? I say that, because as a perspective with dentistry, we have the ability in dentistry, because we have a good living. Supposedly now, we're one of the most lucrative professions in the United States, a very well thought of profession, even when we walk out with all this debt.

Why am I saying this? Since we're in this position, we can take our position and we can actually help our community. If we help our community, what ends up happening? All these mothers and fathers are going to be very happy with us. If they're happy with us, we're going to be in a very good position politically, because those people are voters. Since they vote, politicians will pay more attention to us, so that we can work together as a group with all our societies, all our groups, and make sure that dentistry stays a profession the way it's always been.

I don't think there's any problem with dentists wanting to have specialists in their office, but it should be dentists. I don't think that we should lose dentistry to corporations. I think it's important for it to be maintained as a health profession. We've done tremendous amount of good for people, so I would definitely welcome your idea. It's a beautiful idea.

Howard Farran: The corporations can't keep their dentists. Some of these very large dental corporations, their average dentist doesn't even stay with them one year. When you go into the private sector, it's the same problem with associates. If you surveyed a thousand 50, 60-year-old dentists and say, "What do you think about associates?" They say, "They only stay two or three years and then they go get their own place."

If you look at the data, the dentists don't go to school eight years to be your servant. Dentists, physicians and lawyers, it's like herding cats. These people that say, in 10 years, half the dentists will be working at corporate, they must be living in Colorado, smoking that legal marijuana, because there's just no evidence of that.

Then, on top of that, forget the dentists, quit making it about us, the patients, they don't keep their dentist. You look at a dentist who's 60-years-old and they still need new patients. It's like, "What happened to the 10,000 new patients you had in the last 40 years and you live in a town that only has 5,000 people?"

The dentists can't keep their patients. The dentists can't keep their associates in private and corporate. Humans are complicated. It's hard to keep a human happy for a long time. Look at marriage, half of those end in divorce. We're in the people business and that's the one thing I see.

If I had to pick one common denominator between all the successful dentists, that they really were well at the people skills. They were good communicators with their patients, their staff. I want to pin you down on a couple more of the implant things, though, because they get a lot of questions. Do you believe the-

Bernard F.: Howard, before we get to the implants, there's something you brought out, it's very important, that I want to bring out. We should mention this and you let me know when we can get a little more into it, but I know all the viewers who are going to be viewing this are going to know that I did this drug program.

One thing that I want them to know, is I view this program that we're doing and I want dentistry to know, it's our program. It's not my program, it's our program. There's many dentists who I've gotten involved in the program. I want dentistry as a whole to take a look at it. I'm more than willing with you, with your meetings, too, also, that I want you to know, is to come to your next meeting and I'd be more than happy to present to all of them how they can do it in their practices. I want to show them a different marketing technique.

I want to actually just show you something, Howard. Back in 1980, in Dental Student magazine, when I graduated, I wrote an article, because we were getting hit by ... Remember Xylan? Xylan, it was the enzyme that was going to eliminate dentistry. Remember this? [crosstalk 00:32:48]-

Howard Farran: Wow, that's a flash from the past.

Bernard F.: Yes, Xylan. What happens is, you can see down here, I was graduating in 1980. There's my name. I'm going to read you something from this and then segue into something. "To assume the title of doctor means more than restoring teeth for monetary and personal gain. We have other responsibilities to the patient, which will continue to grow as science and research expand the body of knowledge."

I'm going to just kind of go into the next thing, "The time for change is now. We must begin to educate ourselves, our community, and our governing bodies. The course must be planned, not haphazard occurrences created by the whims of politicians or corporations. It's a bright future if we allow for it and continue our development, however, it can be as bleak and pessimistic as those within our profession would profess, 'Dentistry only was and always will be.' The choice is ours, to nurture or to neglect, to deteriorate as close-minded technicians or to arise as true doctors of the oral cavity and truly deserve and not just desire the title of "Doctor of Dental Surgery."

Why do I say that? The reason I say that is that most dentists are looking to get more new patients. Imagine if, instead of teaching brushing and flossing, which we need to, we went into schools when there's an epidemic in the country of synthetic drugs, heroin everywhere, really, all the country kids are dying everywhere. 50,000 Americans died of opioid abuse last year, which is why our societies have come out with all these courses we have to do.

What does this have to do with dentistry? Imagine a dentist in his area having his hygienist or staff or himself go and educate on drugs, educate the kids why they should avoid drugs. What's going to happen, he's going to make that kid safer. His mother's going to want to know, "Why did Dr. Farran do that?" "That's interesting. Did you hear, Dr. Farran was in our school the other day talking about educating kids about drugs so they don't take them?" "Wow, I should see Dr. Farran."

What happens is the mothers and the fathers will all be on that the dentist's actually doing something that's caring for the community. By caring for the community, they will then, in turn, it's karma. It will come back to them in their practice. It'll be the best marketing that they've ever done.

What I would love to do with you, Howard, and all our leaders, is put dentistry in a position where dentistry will be known as the profession that saved kids in America from going on drugs. I want to tell you one fast story. I had a dentist, who's a friend of mine. His neighbor couldn't come to one of the educational events I gave, but he said, "You need to do this event."

His name is Danny. Danny said to me, "Ben, he wanted to let you know his son was in two rehabs. He's 22. The other day, he walked into the Long Island Sound and committed suicide." He said he was distraught and when he heard about this program, the Foundation for a Drug-Free World Education Program, he said, "Keep doing it, Dr. Fialkoff."

What I say, Howard, is let's not make it "Dr. Fialkoff." Let's make it the dental profession of the United States where we educate kids so no more people have their sons or their daughters going into the Sound or into an accident and die. I think it's an important time for us to go forward. It'll definitely come back to us, that's not the reason to do it. I wanted just to mention that, since I know you talked a lot about the drug program at the beginning.

Howard Farran: I think before they went into the school, they really want to see you, the master, here. How many of these have you given, 1,200? 1,200 courses. We put those online CE courses on Dentaltown. We put up about 400 courses. They're coming up on a million views. Do you have any taping of your program, where you're actually in the room, giving the program?

Bernard F.: Yeah. Here's what I can do and I can offer your viewers is, number one, what I can let you do, Howard, there's some excellent one-minute public service announcements that I'm going to send to you, so you can put them online. It'll help the dentists in their area to safeguard. They may have somebody in their own family. They may have someone in their own family who's maybe doing something with marijuana, with cocaine, with prescription drugs.

There are very short 45-second public service announcements that you could put on your website. I'll see how we can get them to you. We could definitely put some courses online with you. Definitely, I would welcome being with you in your courses so we can teach nationally, for sure.

Like I said, it's a passion of mine. One thing I want to let you know as a Cuban-born American, I lost my country as a Cuban-born American. I'm Jewish descent, so my grandparents lost Poland earlier. There was no place after United States, so one of the missions I have and passions I have is, to me, I want to preserve United States of America. I don't want us to have a drug problem. I don't want anymore kids to die. I see we're going to end up doing it. Let's do it. It makes a lot of sense. You talked about your Irish background. I loved it. We're all immigrants in this country and we need to help each other.

Howard Farran: On Dentaltown, if they're Jewish from Cuba, they call themselves "Jubans."

Bernard F.: That's right.

Howard Farran: Have you heard that?

Bernard F.: Yeah. I'm a Juban.

Howard Farran: As far as going into Havana, when I thought of this, when they normalized plane flights, I called my two favorite Jubans from Dentaltown and I was really surprised at how they wanted nothing to do with it. They were still mad as hell at Fidel Castro and his brother, Raul. They were violently opposed to my idea and they said it was a horrible idea.

I like your philosophy. It's like, look, I don't like to talk politics, religion, all that stuff like that. We're dentists. I see the Cubans as people and patients who need better dental health. I don't want to get caught up in all their politics. I bet if we did that deal in Havana, Cuba, you'd be surprised, even though it's a quick plane flight from Miami, that a lot of the Cuban dentists in Miami wouldn't have anything to do with it.

Bernard F.: There's a lot of emotions into what happened back there. There's a lot of emotions that have never moved. This would be a whole talk we could give some other time. You're hitting on a topic that's very hot. You're right about that. To me, Howard, I think what you and I have in common is that we have to have a human side in everything.

The only way something can resolve is by actually having some rapport, some honest communication. Whenever I have a problem with one of my staff members ... Let's give something more to the young dentists. You're going to have problems with your staff. We're talking about Cuba, but let's talk about the staff. We're talking about people, like you said, Howard. You're going to have problems with your staff.

When you have problems with your staff, even though they may do something that you told them four times not to do it the same way, you have to try and come back the next day and realize how difficult that is to get staff to approach and say, "Why did you do that yesterday?" Not when the patients are it, before patient treatment or at the end of patient treatment, "Why'd you do that yesterday? I went over it with you four times. Was there something that you didn't really understand, but you kind of felt uncomfortable telling me because you think that I'd think you were stupid or that I wouldn't want to keep you in the office?" You let them talk. Let them voice.

The best thing I can tell young dentists out there with staff, there's no panacea. When you encounter that, I'm sure you're going to get emotional. We're very high-powered people dentists. Just realize afterwards, try to go back to them at a point where it's quiet and speak to them.

Getting back to a nationwide level, absolutely, Howard. I think that by helping, somebody once said that the basic reason we're all here is to help each other. If we weren't helping each other, there'd be no reason for anything. It's kind of an interesting view point.

Howard Farran: You're the president of the Foundation for a Drug-Free World, The Americas Chapter. What do you think of states like Colorado legalizing marijuana? Do you think that's a good thing or do you think 10, 20 years from now they're going to realize that was a really bad idea?

Bernard F.: I'm a periodontist. I'm a dentist, so I'm a doctor. I deal in scientific facts. Let me give you some facts actually from the government from, it's called "High Intensity Drug Trafficking Agency," which is a federal agency in charge with actually getting the truth about what's happening with statistics.

In Colorado, since the legalization, traffic accidents related to marijuana have gone up about 40%. Hospitalizations have gone up about 32%. Emergency room visits have gone up about 49%. The director in Colorado, Gorman, of High Intensity Drug Trafficking Agency, he said that the school resource officers, which are the officers in charge of safeguarding the kids in the schools, what they noticed is, since it was legalized, the kids go out at lunch time and they get high. They come back to class high.

He said, "Are those the students that we want doing surgery on us in the future? Are those the students we want to leave in charge of the government? Are those the students we want as policemen who think it's okay to be high when you're on the job with a gun?"

The actual facts are that it hasn't turned out to be what it was. It's actually drained the health system. It's a public health problem and that there are different agencies we could go into some other time, but there's a group out there that actually says how wonderful it is and presents ... Basically, what Mr. Gorman, who's the director of the government agency, says they present editorials. They present not based on facts, but on how things, they're no problem.

The reality is, I always keep it very simple, the facts show that it's a big problem. Aside from that, let me ask you a question, Howard. If you came to New York and I was going to do your dental implant, would you want me to smoke marijuana before the implant?

Howard Farran: No. I would mostly not want the dang pilot to be stoned or eating an edible. We should log onto Dentaltown. I published an article yesterday on Dentaltown that's really been controversial. It's called "The Impact of Marijuana Use on Oral Health." It was an interesting article. They were showing a study that if you smoked marijuana at least once a week for 15 years or more, you were three times more likely to have gum disease than those who don't smoke marijuana.

What do you think that is? Some people say, "If you get high, it's not the getting high that makes you three times more likely to have gum disease. If you get high, maybe you don't brush and floss," a tagging behavior. Maybe they eat Twinkies instead of fruit. Do you think it's the marijuana or do you think the marijuana is just tagging a certain type of individual who is less likely to brush and floss and visit the dentist every three to six months?

Bernard F.: It's actually multi-factorial. Let me first address the-

Howard Farran: That's always the brilliant answer. It's never one thing.

Bernard F.: Yeah, thank you. Let me talk about first the marijuana chemically. Something that's very important for everyone to know out there, is that marijuana has many, many more toxins within it than even cigarettes do. Something that's important for them also to realize is that marijuana causes cancer much more than cigarette smoking, much more. People worried about smoking and cancer, but one thing that never comes out about is marijuana and cancer. Marijuana actually causes more cancer.

The other thing is that these toxins that are in the marijuana that people are smoking affects the body, the immune system. When you affect the immune system, you get the results that you've been actually observing, Howard. I don't think your article is controversial. I think it's very much on the point. From the point of a toxin in the marijuana itself, it is toxic to the body.

Number two, something very important for them to know, a friend of mine in high school, who had a scholarship to play football in Ohio State, I won't give you his name, got kicked out of Ohio State because he was smoking marijuana back in 1972. He was such a good football player, they said to him, "Look, go to [inaudible 00:45:52] Wallace Junior College. You stay clean and we'll bring you back again on full scholarship, full ride." He got thrown out again because he still couldn't stop the marijuana.

Now, why do I say that? The marijuana back then, if you label it one, today's marijuana now is 10 to 15 times more potent. It's a much more potent strain. In fact, all of the drugs nowadays, Howard, because being director of this program, I've done a lot of research, all of the drugs that we're talking about nowadays are much more potent, much more dangerous, more highly addictive.

People are arguing about whether it's a gateway drug or not and definitely. In fact, you see how in the health professions, we've now regulated about prescription opioid abuse and regulating it. Why? Prescription opioids have become one of the gateways, next to marijuana, to the other drugs. It absolutely affects health.

Now, second thing, behavior. It's very simple, if somebody's on marijuana, they're high. They really are not going to have any idea or responsibility for brushing, flossing, going to the dentist. It's definitely a problem. Another thing that I want to bring out, because we're dealing with dentists who have offices, a lot of the problem why people have problems now hiring staff is so much of the population is on marijuana.

One of the people who was a friend of mine out in the Midwest was teasing with me. He was teasingly saying, "I don't want to solve the illegal immigrant problem in the United States." He said, "Ben, you know why?" I said, "Why?" "Because they don't go on drugs. They don't have the money for it. When I try to hire Americans, there's so many of them on drugs, I can't get a good employee. I'm concerned what's going to happen."

Why do I mention that? I see, Howard, we're on the same page, is that, how could we have gross national production? How can we solve our economy? How are we going to solve inflation or ever pay back our deficit if our population increasingly is on drugs and high? They're not going to produce.

Howard Farran: We need to get Steven Spielberg to ... Did you ever read that book about when the British landed on Hong Kong? I forgot what year that was.

Bernard F.: You're talking about "The Opium Wars."

Howard Farran: Oh, yeah. I read a 800-page book. Then, I went and found that the guy who wrote the book had a 12-hour audio cassette program and I listened to that. It was just mind-blowing. When they got there, pretty much everybody's daily task was in the making, growing opium, smoking it. The country was just laying around stoned. It was crazy.

There was something insidious, when was it, 1841. Someone needs to do a hundred million dollar blockbuster movie of the whole 1841, when the British went to Hong Kong and all that stuff, because history's repeating itself. I thought it was very weird. A couple things I want you to weigh in on. I'm going to rant two things to you and I want you to comment on it.

When I got out of school 30 years ago, a lot of the newspapers were filled with doctors were mean and they didn't have empathy and sympathy because this lady's dying of cancer and they wouldn't give her any pain pills. You pulled their wisdom teeth and she hurt for four days. We were the bad guys, because we wouldn't give these opioids.

Then, everybody gradually started giving the opioids. Now, the pendulum's all the way the other side and now we're the bad guys because we gave so many. I question the pharmaceutical company, because a lot of people complained about Vicodin or Hydrocodone had five milligrams oxycodone and 500 milligrams acetaminophen and they wanted something that didn't have the acetaminophen. They didn't come out with a five milligram Oxycontin with acetaminophen. They came out 50 milligrams. That's 10 times more. Don't you think that was bizarre?

Bernard F.: You know, Howard, you're touching on a point that's very well-taken. I don't really know if I want to put it on the air, my views on this, because the-

Howard Farran: It's dentistry uncensored, baby. Let it rip. I've made a living out of making people upset.

Bernard F.: Okay. Let's put it this way, your point is excellent. Let's do some actual facts. United States right now is suffering from something called "synthetic fentanyl," which is an opioid from China. Since 2009, about three to 500 synthetic drugs have been brought into the United States from China, three to 500.

Fentanyl is many, many times stronger than morphine. I was actually watching a program where the ambassador to China, along with the DEA director and some governmental drug investigatory panel were talking, trying to do something about this problem with the Chinese synthetic fentanyl.

One of the things that the ambassador said, "The Chinese said that we don't have a problem with it, so we're just producing it," which, to me, was ludicrous and I consider off-the-mark at the very least. I won't say really what I think. Synthetic fentanyl is actually put in patches.

My 90-year-old mother, a few years ago, for back pain, was given this fentanyl patch. One night, I happened to be there. She was really almost psychotic. Thank goodness, because of my training, I was able to help her get her off of it. About three weeks later, she was fine. She was off of all of it. She didn't have the pain she had. I was really, really very upset that it was ever prescribed to her, because it was very dangerous, a very dangerous drug.

You hit a point very, very well. Pharmaceutical companies, I think you're probably aware, Howard, in the last four or five years, have had billion dollar lawsuits that they've lost because of the drugs that they've put out. Some of them are psychiatric drugs, some of them are narcotic opioid type drugs. They've lost billions of dollars.

Something that's important for the dentists to realize out there and why, as a profession, we need to do something about it, the drug industry in North America, the illicit drug industry, is worth $35 billion a year in North America, United States and Canada, 35 billion, just in illicit drugs. We're not talking about prescription drugs.

When they lose three billion, four billion, it's like, okay, if you're a dentist and you're making $5 million, all right, so they hit you up for 50,000. Okay, you still came back home with whatever. I'm being ludicrous, but I'm just giving you an example because of the level that the pharmaceutical companies are at. Yeah, you have to look at their responsibility.

Also, they have tremendous lobby. With the tremendous lobby that they have, they actually influence physicians and dentists. There's actually a study in West Virginia, I don't know if you're aware of it, Howard, where there's a tremendous influx of opioids that in-flowed into West Virginia. Again, the article was basically why that happened, why did the pharmaceutical companies have that go into West Virginia, what was the reason behind it, which was well beyond the need for pain relief or whatever. I definitely believe that somebody's in pain. Obviously, as a periodontist, I'd get them out of pain. Sometimes they may need a narcotic or whatever. Somebody has a major surgery in the hospital, they may need a morphine drug for a day or two, maybe more.

Absolutely, your point is well-taken, is that what would happen needs to be looked at. The physicians and the dentists definitely were lobbied and we have something that's called a "drug culture." We can go on and on with this. I think at one of your conferences, we'll go on. We can give a master's program on this. I would love, like I say, is for us to have dentistry be one of the solutions for the drug problem in the United States.

Howard Farran: I think you'd reach a hundred times more people making it also an online CE course. I want to pin your feet down to the actual problem. Okay, she's 25-years-old. These podcasts are replacing radio. It's her hour commute to work. She just pulled somebody's wisdom teeth. She just did a root canal. What should she prescribe? Is Vicodin okay? Do you, yourself, when you place implants and bone grafts and you do complicated stuff, do you just say "Tylenol and aspirin"? What do you prescribe?

Bernard F.: Great question.

Howard Farran: What should she think about when she pulls out her prescription pad and she's really beat someone up with a root canal and wisdom teeth and implant?

Bernard F.: Great question and I'm going to give you a few answers. First thing is ... 35 years. Don't underestimate, this is to the young dentists out there and, really, any dentist, our rapport with the patient is tremendously important. I've seen over and over again, when I have a great rapport with a patient, it's amazing how they heal. When the rapport is not as good and I do the exact same treatment, the results are just not the same.

I've seen that now after 35 years and I don't really change my technique. The first thing I would tell all the dentists out there is make your office environment as calm as it can be. Make the patient as relaxed, allay their apprehension. Have your staff go in with them if you're going to do a procedure ahead of time and just relax them so that they're relaxed.

I find, though, when people are relaxed, number one, they're easier to treat. If they're easier to treat, I treat more quickly. Most pain comes from soft tissue trauma and inflammation. We can minimize it when they're relaxed. Number two, in terms of pain relief, is try to really be competent at what you do. If you're competent at what you do, the amount of trauma you'll illicit is less. Some procedures, you could take a fractured tooth that's ankylosed, you're going to cause trauma. It doesn't matter who you are. In those cases, what I do is I give Motrin immediately. I give a long-acting local at the end of the procedure. I do-

Howard Farran: What brand of long-acting local?

Bernard F.: Marcaine, the type. I don't-

Howard Farran: Okay, do you give Marcaine for the procedure or do you use ...

Bernard F.: After.

Howard Farran: After. What do you-

Bernard F.: Only just so you know, I don't do this routinely. I only do it in certain cases if I think that they're going to need it or if they have a long drive home. What I find, if I start the Motrin, sometimes I'll start the Motrin ahead of time to start the anti-inflammatory ahead of time. Sometimes I do it at the time of surgery at the end. I don't have one way.

Then, I do alternate the Motrin with the Tylenol, absolutely, to enhance the effect if it's necessary. In all honesty, what I've found over the years is sometimes you need the codeine. By and large, I have found, and this is really my experience, is that some patients want codeine, not necessarily even that they would necessarily need it, but they just want the codeine. I think they're really, more or less, addicted to it, which is why I'm happy with what's happened in dentistry recently in the last year.

That's what I tend to do. Another thing that's very important I want to share, that I went to a recent course on opioid control here in New York. The doctor presenting actually spoke about Decadron and that you can get it from Southern Surgical. He said that at the end of the procedure, he was giving a little Decadron so that he would reduce inflammation. He was finding that that was reducing pain.

I wouldn't say for people to do that routinely, but what I would say then is be confident. Allay the person's fear. Try the Motrin. You may want to try, if you have a procedure you think is going to cause a lot of inflammation, Decadron. You could speak to your surgeons in your area. The surgeons in your area are using Decadron. What I would urge all dentists to do is get trained. Don't just do something off the top of your head. Speak to someone. Speak to your referring surgeon, get their opinion. That way, you can-

Howard Farran: For in the last year, how many times have you prescribed Vicodin, Percocet, Oxycontin, anything like that?

Bernard F.: Probably 10 times.

Howard Farran: 10 times? 10 out of how many?

Bernard F.: Very little.

Howard Farran: Is it 1%, 5%, 10% of your prescriptions?

Bernard F.: Oh, it's tiny. It's probably less than 1%. It's a very small amount. Really, everything I just told you, Howard, is exactly what I do in my practice.

Howard Farran: Also, my job is to guesstimate questions of all these kids driving around, commuting to work. She's asking, "Why do you alternate Motrin with Tylenol? Why not aspirin?" Especially nowadays, when so many grandpas are on that low-dose daily aspirin to reduce their inflammation for heart disease. Why do you like Motrin and the Tylenol alternating, which I've seen so many studies on double-blind that that's better pain relief than Vicodin, Hydrocodone, but why not aspirin?

Bernard F.: If you want, you could do aspirin if you want to. It's a similar drug. You could do that, if you want. You could find negatives about everything. The Motrin, if you look at it, actually, in some studies, are correlated with heart attack. You don't want to just give Motrin and [inaudible 01:00:29] also, as if it's just no problem. You really have to control how much Motrin they take also. Vioxx was taken off the market, right?

Howard Farran: Right.

Bernard F.: Vioxx was an NSAID that was taken off because of that problem with the cardiac problems. The Motrin actually also, in fact, it's very interesting, because the presenter at the course I was at had called up the office of the director at VA and he spoke to her. He said to her, "Listen, I want to know from you about Motrin. Does it cause a problem with cardiac heart attack?"

She said, "It seems to, but we don't have any statistics." He says, "How am I going to evaluate it?" He told us at the very end that there was no study. There was no statistics that she could give him at a federal level. What I would say is minimize whatever drug you give. I think if you want to give aspirin versus Motrin or Advil or whatever, as long as you alternate with an acetaminophen, I think that would be the basic thing.

Howard Farran: You promised me an hour of your life and you gave me an hour and two minutes. We're on overtime. I want to ask you one overtime question, because it's so important. I know so many dentists that, after every single extraction, every single root canal, they give a 500 milligram, 28 tabs of Pen VK, which is ludicrous. When I say "ludicrous," I do not mean to offend my rapper artist, Ludicrous, not the rap guy, but they do. They give an antibiotic after every extraction, every root canal. They just say things like, "Oh, CYA, cover my ass," blah, blah, and they give 16 tabs of Vicodin.

I don't want to get into the bacteria deal, because dentists, really, a lot of them overuse antibiotics and opioids. What would you say to this dentist listening to you right now that's driving to work in Shawnee, Missouri and he gives a prescription for Pen VK and Vicodin after every root canal and every extraction? What would you say to him?

Bernard F.: Okay, this is what I would say, I'd like you, on your next patient ... Actually, let's start at the beginning. I'd like them to actually take at least an hour with their staff before the next day they work and go over with them, if they haven't already, to make a calm environment in the office, so the patient is relaxed when they come in.

I would like them to make sure the patient is actually relaxed before they start and they're totally anesthetized, that the patient is really totally anesthetized before they start on them, because some people need more time, and that they do the procedure and that they feel confident about it so they get done in a reasonable amount of time. At the end, give them a local. It doesn't have to be a Marcaine long-lasting. It could just be a local, so the person is numb at the end. There's a lot of psychological placebo with pain.

Then, what I would say is you don't need to give codeine. I have a very large practice in New York after many, many years and I don't believe in patients having pain, but I find very, very little need for codeine. I think it's way over-prescribed. I think that you need to take a look as a practitioner when you're listening to me, is that we have an opioid crisis in the country, 50,000 Americans died last year, 2016, of opioid related drug deaths.

In Vietnam, in 10 years, we lost 50,000 and people were at arms, protesting. I would ask my colleagues, "If 50,000 American soldiers died in Vietnam, over all those years, and we lose 50,000 Americans to opioids in one year and, before that, it was 33,000, then we need to look at that one of those thousand could be your cousin. One of those thousand could be somebody that you know in your neighborhood that's a friend of yours. We don't want these people being addicted to drugs, so limit the amount of codeine that you give."

In terms of antibiotics, I went to Stony Brook and Dr. Galler was a big proponent of doxycycline, because of collagen synthesis and healing. Doxycycline has other properties besides the antibiotic properties. I have, over the years because of my training, given Doxycycline. You're totally right, one of the things I would tell dentists to do also is give acidophilus.

The patient can get some acidophilus. They could take it in-between doses of the antibiotic. Tell the patients to avoid dairy, use the acidophilus, and to repopulate the system and to minimize the antibiotic. I wouldn't tell them how to do it with the antibiotic, but I would tell them, "Use your judgment. Every case doesn't need the antibiotic, but use your judgment. Some cases, if you don't give it, it will be a problem, but use your clinical judgment." I think more important is really the narcotic, because that leads to severe death, so absolutely.

Howard Farran: These narcotics, they're hurting my music collection, Prince, Michael Jackson, propofol. It's a ... What's that?

Bernard F.: Whitney Houston.

Howard Farran: It killed Prince. That guy, he's been putting out albums since I was ...

Bernard F.: Yeah. Howard, I was going to say something. The other day, I was watching on YouTube, Elvis, at the end. I used to love when that guy sung the song Chicago, about the little boy and the other little boy is dead in Harlem in the slums of Chicago. It's called "In The Ghetto," it's called, by Elvis Presley.

At any case, at the end, if you look at him and you ever play those YouTube videos, you see how the drugs made him so heavy, he could hardly breathe. It was such a sad thing that this great human being, who was such an entertainer, who people loved, and this guy was destroyed. When you found out what they had done, what the doctors had done, and how they had overprescribed to him, no one ever told him, "No, you can't have anymore." Nobody tried to do anything. It's a shame, like you said, Howard, that we've lost so many good human beings, entertainers. The other thing to point out is, God knows how many young people who become the next President of the United States or the next inventor or the next person to discover a cure for cancer, and if we have them on drugs, that's never going to happen.

Howard Farran: Yeah. MJ, you'd think that physician, when he put him down with propofol, that it'd just been a perfect time for an interception and just have him moved to a facility. The people around him just didn't man up to the top. A lot of it's culture. Look at Dominican Republic, let's switch from opioid to alcohol, they have three times the rate. You're three times more likely to be killed by a drunk driver in Dominican Republic. Look what it's done to baseball. How many of the best baseball players in America were from the Dominican Republic and then killed in the off season in a DUI?

You can see, Dominican Republic, how they have a more laissez-faire culture about alcohol and it's ravaging the country. All this stuff that we've done in America, you might think, DUIs, that we don't have it under control or we're not making it better, but compared to Dominican Republic, we're three times safer in America.

Bernard F.: I was going to tell you, Howard, is I want to extend an invitation. We're having our annual gala, our Drug Free World Gala in Great Neck, New York on June 1st, at night. I want to invite you. I'd like you to come. I'd like for us to discuss how we could get this out to dentistry. At that gala, we're going to have some very high level people speaking. One of them is actually from Dominican Republic. He's actually the general I told you about, who's a friend of mine. He's a director of a council. There's various generals who are coming, there's different directors who are coming. Absolutely, it's a big problem. That's why he's coming. That's why he's doing this program.

The other thing I wanted to tell you, you should ask me this, dentists probably wonder, "Dr. Fialkoff, why'd you choose this program? There's a lot of programs out there. Why'd you choose this Foundation for a Drug-Free World program?" By the way, they can download, for free, at drugfreeworld.org. It's called drugfreeworld.org.

It's an international organization. It's in 123 countries. It's a really unbelievable program, which is why I chose it, because it's audio/visual. It's in phone applications. It's on the internet. It's also written. It has a full curriculum. It has 14 public service announcements on each drug. It has 18 booklets. They're little tiny booklets. Let me see if I have one here, Howard, so I can show you.

This is actually the folder that it comes in, you see? It's a campaign folder. Then, inside the campaign folder, they get a DVD. Then, this booklet come with this little booklet. This little booklet is actually something that the dentists can put their logo on the back of. They can put their logo on the back of this booklet. Let's say, Howard Farran, you could put, "From Howard Farran."

What happens is these booklets educate the person on drugs. It gives them the facts. This is something that I just wanted the viewers to know that they can get. I would be more than happy, like I said, to do what we can with you to get this out to dentistry so we save the kids so they can actually get the potential, so we fix the economy, and so America stays America. It stays free.

This problem is an international problem. There's no mother or father in the world out there watching who wants their kids on drugs. One thing I would want the dentists out there to look at, whether he'd be male or female dentist, would you want your son on drugs? Would you want your daughter on drugs? Would you want to hear that your daughter got raped because the guys were on drugs? Would you want your son to die because some other kid was on drugs and ran into him on a Saturday night, coming out of a party?

I'm sure they all say no. The reason I chose this program is because it's just the most complete educational program in the world. A fact that the dentists need to know is the United Nations, last year, and the White Houses, both consensus that we weren't going to regulate drugs, we were going to prevent it. We have to educate, which is why, at this point, this program is so important.

Howard Farran: I want to tell you, it was just a huge honor that you came on the show today to talk to my homies about periodontics and living in a drug-free world. I forward you that link to your email about that marijuana article. I wish you'd go in there and post your thoughts on these and give the links to this stuff, too. I hope to do many more exciting things with you in the future.

Bernard F.: Absolutely. It was my pleasure to be with you.

Howard Farran: All right. Thank you so much.

Category: dental, Podcast
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