Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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724 Excellence in Dentistry with Dr. Kianor Shah : Dentistry Uncensored with Howard Farran

724 Excellence in Dentistry with Dr. Kianor Shah : Dentistry Uncensored with Howard Farran

5/30/2017 1:51:39 PM   |   Comments: 0   |   Views: 309

724 Excellence in Dentistry with Dr. Kianor Shah : Dentistry Uncensored with Howard Farran

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724 Excellence in Dentistry with Dr. Kianor Shah : Dentistry Uncensored with Howard Farran

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VIDEO - DUwHF #724 - Kianor Shah


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AUDIO - DUwHF #724 - Kianor Shah


Dr. Kianor Shah is a 36-year-old practicing Dentist and an Entrepreneur from Palm Springs, CA. As a traveling and temporary healthcare provider, Dr. Shah has practiced in more than 300 offices. As a businessman, Dr. Shah has built numerous co-brand, private label, and Peer-to-Peer partnerships in the Healthcare Industry. Dr. Shah is a seasoned educator in clinical topics of Head and Neck Anatomy, Biophysics, Surgical Extractions, and Oral Implantology. Dr. Shah addresses domestic and international financial executives annually with Healthcare Industry forecasts and advises Financial Technology companies. Dr. Shah completed his undergraduate studies at Western Illinois University, where he earned a Bachelor of Science in 2000. Dr. Shah graduated in 2006 with a Doctorate in Dental Medicine from Southern Illinois University. He has finished an M.B.A. at Brandman University in International Business in 2016. His participation as a Fellow of the International Congress of Oral Implantologists, Fellow of the California Implant Institute, and Fellow of the International Academy of Dental-Facial Esthetics has culminated in his Mastership and Diplomate status of the International Congress of Oral Implantologists. Dr. Shah has been in various roles as an Inventor, founder, owner, Chairperson, CEO, President, Managing Director, Partner, Associate, and Consultant for a variety of domestic and international related business matters. In addition to his expertise practicing General Dentistry, Dr. Shah practices in the fields Prosthodontics, Periodontics, Endodontics, Pedodontics, Orthodontics, and Oral Surgery. Dr. Shah reads, writes, and speaks English, German, and the Farsi languages. Says Dr. Shah, “A dentist is a lifetime professional commitment. Part artist, part architect, part entrepreneur, part physicist, part surgeon, part businessman, part therapist, and part community friend.” Dr. Shah enjoys world travel, public speaking, studying and researching historical events, and participating in sports including soccer, table tennis, and fitness.

www.KianorShah.com 


Howard Farran: It is just a huge honor for me today to be podcasting a mentor of mine, Kianor Shah, DMD, MBA, DICOI, we both have the same initials, I'm a DDS, MBA, Diplomate, International Congress Oral Implantology. Dr. Kianor Shah is a 37-year-old practicing Dentist and an Entrepreneur from Southern California. As a traveling and temporary healthcare provider, Dr. Shah has practiced in more than 300 offices. As a businessman, Dr. Shah has built numerous co-brand, private label, and Peer-to-Peer partnerships in the Healthcare Industry.

Dr. Shah is a seasoned educator in clinical topics of Head, Neck Anatomy, Biophysics, Surgical Extractions, and Oral Implantology. Dr. Shah addresses domestic and international financial executives annually with Healthcare Industry forecasts and advises Financial Technology companies.

Dr. Shah completed his undergraduate studies at Western Illinois University, where he earned a Bachelor of Science in the year 2000. Dr. Shah graduated in 2006 with a Doctorate in Dental Medicine from Southern Illinois University. He has finished an MBA at Brandman University in International Business in 2016.

His participation as a Fellow of the International Congress of Oral Implantologists, Fellow of the California Implant Institute, and Fellow of the International Academy of Dental-Facial Esthetics has culminated in his Mastership and Diplomate status of the International Congress of Oral Implantologists.

Dr. Shah has been in various roles as an Inventor, founder, owner, Chairperson, CEO, President, Managing Director, Partner, Associate and Consultant for a variety of domestic and international related business matters. In addition to his expertise practicing General Dentistry, Dr. Shah practices in the fields Prosthodontics, Periodontics, Endodontics, Pedodontics, Orthodontics, and Oral Surgery. Dr. Shah reads, writes, and speaks English, German, and Farsi. Says Dr. Shah, “A dentist is a lifetime professional commitment. Part artist, part architect, part entrepreneur, part physicist, part surgeon, part businessman, part therapist, and part community friend.” 

Dr. Shah enjoys world travel, public speaking, studying, researching historical events, and participating in sports including soccer, table tennis, and fitness. So, table tennis is ping pong?

Dr. Kianor Shah: That's right.

Howard Farran: My gosh. I was lucky, my dad bought us a ping pong table, and then we had this thing we put over it, it turned it into a ping pong table, so I love that sport. My gosh, you have more amazing websites, I think, than anybody in dentistry, I mean, there's so many. You have Kianor Shah, K-I-A-N-O-R Shaw, S-H-A-W, KianorShah.com, he's got Extract Exact, E-X-T-A E-X-T Academy, so Extraction Academy, ExtAcademy.com, Surgical Sedation Partners, Fulcrum Implant, SynergySmileDesigns.com, LendHealth.com, my gosh. I don't even know where to start with you. Where would you want to start? 

I never been a fan of dentists who, well, I'm not saying I'm not a fan of dentists. For myself personally, I always saw my dental office in my zip code in Ahwatukee, which is Phoenix, is that I have to treat anybody who walks through the door, and so I never target a market to via cosmetic dentist, or an implant dentist, or any of those things like that. A lot of times, people go to their dentists and they are in pain, and the doctor can't do the extraction. They say, "Well, I don't like the blood and cut thing, I just like the soft and pretty bleaching, bonding veneers, CEREC CAD/CAM." 

You're talking to a lot of kids right now. It's May 24, so we're going to have another 6,000 kids graduate in a few hours. Probably half of them don't like extract teeth. What advice would you give these young kids coming out who say, "Well, I don't like the bloody stuff"?

Dr. Kianor Shah: First and foremast, the mast majority of patients coming in have a problem of some kind and sometimes it's pain related. Extractions being the most common dental procedure around the world, not counting the United States and the biggest healthcare market, it's a very important procedure to know. I started with extraction, that interested me into implantology and other fields, but with time, as demand comes into the office, these younger students are going to realize how prudent it is to learn and perform extractions and not to have to refer them out. I had a practice in southern Illinois. For 60 miles, we didn't have an oral surgeon or periodontist, so if you are going to be part of the community, to be able to do simple extractions is very, very important. 

I'm not saying that you should do all extractions. You should be very discreet about the case selection process, but at the same time, your patients need the service, and it would be great if can provide it. You don't learn it in dental school unless you spend a lot of time in the oral surgery department, clock in and clock out, you really need some training and continuing education classes from your colleagues that have been doing it for a long time.

Howard Farran: What would my homies find at ExtAcademy.com?

Dr. Kianor Shah: They would start with an online portion where we train and teach in the most basic concept, from anatomy to biophysics, to what we generally do in anesthesia settings, the dentists are aware of, they bring an anesthesiologist to their office to alleviate pain for patients. Then we move into workshops where we do an extraction workshop, where we see a greater amount of participants, where we work on pig jaws, general concepts. I got a doctor from New York University, works in oral surgery department, he comes out for these workshops and brings us the latest updates, and what is acceptable in coronectomies and other procedures, and what the opinion leaders are saying. We, essentially, are a conduit for the information out there about new extraction techniques and how we can do things better. 

Things have changed from your time, a little bit, when you started, with hand pieces advancing and other techniques coming about. We think differently about extractions now than we do 30 years ago. You look at this as the foundation of the next step in the prosthetic treatment, be it an implant or any other prosthesis. You want to maintain bone, and when you do extractions now, you want to think about what and where you're going to end up because if you don't, and you don't do things, such as socket grafting, or you don't attempt to do those type of things, the patient ends up having to do extensive additional ancillary procedures down the road in order to be able to get that implant. 

It's very, very, very important that if you don't even want to perform extraction, which is your right as a dentist, you choose the areas that you want to practice in, that you know the general concepts, so you can refer properly, and you can also have a long-term plan for your patient.

Howard Farran: You know, I'm so old. When I started extractions, we just tie a rope around the tooth to a big boulder and walk them to a cliff and throw it over. Where are these courses at? Are they all in Palm Springs where you practice?

Dr. Kianor Shah: No, we've done some close to the CDA, we do some in San Diego, we are now expanding to other areas. We have 12 faculty members, that have recently joined, that do believe it's important to teach more extractions. Being an implantologist, and so are you, you're very familiar, everybody that I run into is trying to teach how to place implants better. We already know that 98%, plus, of the time, if you do proper implant placement, you get initial stability, you're going to get integration, but if you're teaching extractions and then you're not teaching extractions, because that's, in my opinion, probably 80% of the work, if you were going to be doing an immediate implant and maintaining a buckled bone, and knowing all the tips and tricks on recovering root tips, and then it become very handy for you. 

If you want to show that on pig jaws and tougher tissue type scenarios where we can suture and train the doctor, especially the younger generations. Some of them continue to module three, where we teach immediate implants, and module four, where we do live surgical courses, but I think the module two is very prudent for all of my colleagues.

Howard Farran: How many modules do you have?

Dr. Kianor Shah: Four modules.

Howard Farran: Four modules, one, two, three and four. Tell me, are all four of these modules, are these on KianorShah.com, Extacadamy, or Surgical Sedation Partners? Which website explains all four?

Dr. Kianor Shah: ExtAcadamy is specifically focused on advanced extraction techniques and immediate implantology.

Howard Farran: Okay. Is that one of those modules, one, two, three or four?

Dr. Kianor Shah: That has the entire many residency, which is composed of module one, which is the online portion, module two, the extraction workshop, module three, the immediate implant workshop, and module four being the life surgical training with us where we do shoulder-to-shoulder training with the doctors, and then they, essentially, graduate from this many residency. We route them towards our colleagues in the implant industry to get training, if they're interested in that, after that.

Howard Farran: How much does each module cost, or is it a package deal for all four? This is dentistry uncensored, they want to know the brutal details. How much does this cost?

Dr. Kianor Shah: I believe the online series, with 12 continuing education credits, $900. The module one workshop, which is an eight-hour course and various conference settings, that's $1,000. The immediate implant workshop is $1500, and life surgical is $3800, that's a two-day course. 16 credit hours combined, you get some 30 something-

Howard Farran: You kids, when you see these prices, I see people sit there and say, "Well, I don't want to learn orthodontics." Brock Rondeau, his whole series, or Richard Lit.

Dr. Kianor Shah: Oh, sure.

Howard Farran: Well, I want to learn ortho, but Richard Lit's continuum is five grand and Brock Rondeau's is five grand, I'm like, "Dude, one ortho case is five grand. You go pay a thousand dollars to an extraction course and come home and remove one set of wisdom teeth, you just got your money back instantly." I want to go back to some of the things. I just want to say one thing that I picked up big time over 30 years, and all my oral surgeon friends agree with me. 

I've never had an oral surgeon friend disagree with me, but when they look at complications from removing the wisdom teeth, a lot of them start with you snapped off this little two, three, four millimeter root tip and you go digging after it, and then you do some damage, and they just said, "My God." You just have to be humble and have an ego big enough to leave a little root tip in there. Don't go in there. I mean, you've already pulled out 95% of the tooth. 

The wisdom tooth's probably pericoronitis, a minor [inaudible 00:11:25], but they say the only problem they have with root tips is a year later, when it's being exfoliated through the gum tissue like a splinter and you take it out with Tweezers. Do you agree with that or do you disagree with that?

Dr. Kianor Shah: We have this debate all the time at the extraction academy. It depends on your philosophy. My philosophy is if I am getting ready to infringe up on anatomical non-Mark VITA, a nerve, or an artery, or a vein that I know is there, if I'm close to the submental fossa or sublingual fossa, you have to consider your situation. Sometimes it's wiser to just leave the two millimeter or three millimeter through it so you don't cause more damage, or permanent damage, at that. Who cares if you have to exfoliate in a year or six months? A coronectomy, that's what it's all about, is that you take the crown off, prevent the root from pushing or causing cavity underneath the second molar, and then come back. 

If the body rejects it, there's two things that can happen. Even the body is going to deposit bone over it and you'll never know it's there, or it's going to eject it, or it's going to make it looser on a periodontal ligaments, so next time you come around, you can lift it out a lot easier. You have to watch the patient because if you leave too much root now the body can say, "Hey, this is a foreign object, I'm going to start an infection here," then you got to go in there. Maybe it's a good time to refer to an oral surgeon and say, "Hey, I'm not comfortable with draining this thing and popping just this root tip out, will you please do that for me?" There's a lot at play. 

I have doctor Greenwood, for example, in our academy, he doesn't leave anything. He goes after, he's like, "What? Leave a root tip? I'm the surgeon, I'm going to get it out," so they go in and get it out. It depends on your philosophy.

Actually, at this course next, on the 9th in San Diego, at the San Diego Dental Convention, we're going to be focusing specifically on this debate of is it wiser to leave even more than four or five millimeters of roots, especially in the wisdom tooth area, versus trying to take it out? If you have a premolar root or a functional tooth that you need to restore with an implant, then you obviously got to get the root tip out and then you have to look at it. Am I close to the sinus? Am I close to the mental nerve? 

There's a lot of different variables that a clinician will have decide on when they are in the surgical field.

Howard Farran: You know, I don't know what I have more of. Root tips left in or skeletons in the closet. I don't know. I think it's very profound that you have your extraction course module two and then implants number three because I've always been amazed at how many of my friends have the skillset to extract a tooth, but then they cringe and say, "Well, I don't think I could place implants." 

It's like, what do you think needs more skill? To remove a tooth or to replace it with an implant? Are those equal skills or is one greater than the other?

Dr. Kianor Shah: No, implants are a lot easier, they're a lot less painful, also, for the patients. I always compare it to having a filling or a crown because you have bone, for lack of better term, much similar to a solid structure like wood. You're going in, it's guided, it's very easy. The hardest part is extraction. 

If you mess up on the extraction, you can have aesthetic problems, you can have all sorts of different problems. The vast majority of the work is done after the extraction. If you like extractions, you will like implants, you just need to take a couple of courses and get all the tips and tricks. If you know your anatomy, you're good to go. Extractions are the hardest part, by far.

Howard Farran: You have module one as an online series for you. You have 12 online courses, right, for 900 bucks, right?

Dr. Kianor Shah: Correct.

Howard Farran: You know what I think would be the best marketing for you to do is put the first course on Dental Town.

Dr. Kianor Shah: I'd love to do it.

Howard Farran: We've put up, I think, 411 courses and they're coming up on a million views. A lot of people, you say they have a three-day course for three to six grand, or whatever, and it's a big jump to go for them. I'm seeing this ad in a dental magazine to pay in three to four grand and flying across the country, so to disintermediate the sales, putting an hour online C-course and say, "This is the greatest hits," I would do a greatest hits online C-course for each module because then they'll fall in love. They'll meet their instructors, they'll fall in love with you, they'll also get information. 

It's kind of like when they do those reverse annuity commercials. You can't get Grandma to sell her house and take an annuity in a 60-second commercial, so they disintermediate it. The whole commercial's just to try to get them to get the CD-ROM, and then the whole CD-ROM is just focused on, "Well, just make the phone call," so they can tell you how much your house is worth and what your monthly annuity would be. I think the best marketing would be to do a one-hour course on each one of your four curriculums.

Dr. Kianor Shah: You used to do seminars, and I would love to talk to you about that a little bit because like you said, for younger kids coming out of school now with three, four, $500,000 in debt, it's really a tough one to swallow. When I got out from Illinois, it was 110, 120 some 11 years ago, now these guys are coming out, they're buried with debt. They're being hammered with bills and they want to start their life. They want to get married, they want to buy a house, it's not on top of their mind to spend five, six grand on an ortho course, but $900 is very reasonable. 

When they can do it from the convenience of their home and get all of the insight, at least then they can decide if they want to go to another symposium, or a course, or a participate in one of the workshops. To be able to collect 12 credit units from the convenience of your home, or where ever you are, for a reasonable price, which is going to give you a lot of insight into the most common procedure in dentistry. I think it's a valuable proposition.

Howard Farran: Well, they say think outside the box. I'm going to say this to you, and you're going to think I'm crazy, but it's true, if you look at American's worth, $100 million or more, most of the people think, oh, it's some 65-year-old man that owns a big factory. No, it's always an 80-year-old female widow and they're all living out where you are at Palm Springs, so they should go to this course and you should have a dating site with 80-year-old, 100 million year-old women dating these young, hot little students walking out, If they marry right, who cares if they're $500,000 in debt?

Dr. Kianor Shah: That's right.

Howard Farran: She's got $100 million and she's 80, you need to marry that woman. Hey, there's a big controversial thrown on Dental Town about bone grafting apposed to extraction site. The naysayer's say, "Okay, dude, you're just doing that because you're billing the patient an extra three or 400," then other people say, "No, this is necessary," and then it gets into all these details. Well, is it necessary only if the patient is going to have an implant later? 

What if they don't get the implant for two, or three, or four years? Did the bone graft even matter? Where do you weigh in on bone grafting and extraction site?

Dr. Kianor Shah: I have a philosophy that goes both ways. As you mentioned, back in dental school, the oral surgeon, that I attribute a lot of things that I've learned from, was keen on allowing the extraction socket to heal from bottom up. His contention was that if something gets lodged in there, the body will push it out and these bone grafting materials are not going to be staying there. Then there's the contention that, hey, all of these bone grafting materials, they're not going to be part of our own body, they get resorbed, they're only there to attract osteoclast and osteoblast, and whatever cytokines we need, and growth factors that we need to make the bone, so it's going to turn over into your own bone. 

Where would I recommend bone grafting? If you're planning to do an implant in a site and you're taking the tooth out, it's just the fight for you to do bone grafting there. You keep the volume, the thickness, the height, and as you know, vertical bone grafting is extremely tough. If you're in a maxillary wisdom tooth and you put bone up there, it's a little bit unethical because you're not going to do an implant up there, you know it's going to heal. You barely sometimes need to even suture it. 

On the lowers, okay, now you have a reason. You're going to put the bone in there, there's less chance of dry socket, you know that food is a lot harder to go up versus down so they lodge in the lower wisdom's. Sometimes I break off the bone graft and then I put some bone in the lower wisdom teeth and I get no phone calls afterwards, and the patient is happy, comfortable. In essence, both of these forces have a great point.

If you go in and every time you take a tooth out, you put bone in there with the wrong intention, then you're overcharging the patient because the patient might not need it. If you know you're going to do an implant in there and you know you're going to come back, or you know that the sinus is dropping everywhere else, it would help the patient if you put a little bit of bone up there to keep it up there, then it's justified. There's a yes and no answer to both scenarios. Again, it comes down to clinician's expertise and the clinician's intent, 

That's what's most important. What is your intent?

Howard Farran: Okay. You said that it's very different for maxillary versus mandibular. You're saying that. Go over that again, that might've flown over a lot of people's heads. Yeah.

Dr. Kianor Shah: If you're going to take a maxillary tooth and you don't have the sinus [explorer 00:21:13], put the mirror in there and you hold the patients nose, and you have them breathe a little bit and you don't see any kind of fogging on your mirror, or any kind of sprain of little droplets of blood, then you know you don't have a sinus explorer. Food is not going to go up there, so you know, if you do your standard post-operative regimen, of telling the patient, "Hey, you're not supposed to suck through anything and spit," and so you don't lose that blood clot, you're not going to have problems on the uppers. Sometimes on the lower, if you have a very apprehensive patient, that you go in and you start cutting and you have to section the tooth in three, four pieces and you got a big, big hole there, and you got to get primary closure, and you want to, you can't pull your tissue around. It's not a bad idea to put some bone down in the membrane and close it up and get your primary closure. 

You're going to be rest assured, you're going to have much less of a possibly for a dry socket in that scenario. Not that I do that on every case, but in occasions where I have removed bone and I know this patient's going to be undergoing some pain, especially during the first 72 hours, I purpose it and then I do it, but routinely I don't recommend every patient getting a bone graft on every site for no reason. There has to be intention and there has to be a reason of why you're doing what you're doing, and you have to document it so you can justify why you did it.

Howard Farran: There's all kinds of grafts. When you do a bone graft, what are you using?

Dr. Kianor Shah: I use demoralized autogamous bone graft and I explain to the patient, they always wonder where it comes from. In California, you have to really explain to the patients where you got it and what it is that you're putting into their body. Once I explain to them that it's demoralized and it's been cleaned, and it's been part of a bank, they always have the same concerns about STD, any kind of diseases that might be transferred to this grafting. Once you settle them and you explain to them that this is happening in just about all the surgical practices across America, and they start being a little bit more apt to accept your proposal to putting autogamous bone graft in. 

There is also xenografts, and bovine, and this and that. Like you said, the list is extremely long. Once you get more involved and you get into some of our other adventures of your own, we'll be able to teach you how to do PRP, PRF, which Dr. Hocamin is big on, someone that you actually recently podcasted, that he works with us on the academy on that. We'll teach you other methods where you can accelerate healing for the patient, if that's indicated.

Howard Farran: Where are you buying your demineralized bone grafts?

Dr. Kianor Shah: I would have to get back to you on that. From our supplier, I think [Pierston 00:23:56] is supplying us.

Howard Farran: It's so expensive, though, isn't it?

Dr. Kianor Shah: 120, 130 bucks, maybe one CC's, two CC's.

Howard Farran: Why does that stuff cost more than my heroin and cocaine? I never figured that out.

Dr. Kianor Shah: This is certainly uncensored, huh? They do really well.

Howard Farran: How come my bone grafting material costs more than my Oxycontin, and heroin, and cocaine, and whatever else they're selling on the streets today? Let's go to your next website. SurgicalSedationPartners.com. What do my homies find at SurgicalSedationPartners.com?

Dr. Kianor Shah: This is actually a recent project we launched with Dr. Jahroumi from Loma Linda. She recently worked with me in another practice. Things developed and we started thinking, everywhere we go, because she's a traveling dentist and anesthesiologist and I'm a traveling dental surgeon, I'm still a GP, but what we noticed in all of these practices that I've gone in and out of, and talking to my colleagues, hundreds of them, and then understanding what their needs and desires are, patients that come in and their apprehensive right in the waiting room, for example, I had an Italian patient two days ago that would jump out of the chair, would cry, just haven't even picked up the needle and she would get worried about her toe being numb. You have a tremendous amount of patients that have dental anxiety. How do we solve that? 

Yes, I've seen some of the videos of some things you have done in training and teaching, treatment presentation and working with the apprehensive patient, but all of those things don't always cut it for the most extreme side. Anxiolysis, conscious sedation, deep sedation, a general anesthesia, if you can offer that service in these practices, to all of my colleagues in Southern California, and later nation-wide, it's a phone call away for the office to pick it up and say, "Hey, guys, we need help with this patient. Can you come down?" We come down, we put the patient at ease, they sleep and dream all of their anxieties away. 

We get to a quiet sense. I do a lot of full-mod rehabs, a lot of All-On-8's, All-On-4's, full-mod extractions, and it's really convenient when the patient is not gagging and is not regurgitating. You can do your work in a clean environment and knock it out in a speedy, and the patient is comfortable. They wake up, which is my biggest thing in dentistry, what I love is when they wake up with this newfound confidence. It's amazing. 

We thought that it would be a good idea to provide this service, like a double pack, to every practice in Southern California. When they call us, we bring our own carts, we go in, they have a room for us, we set up 15 minutes, we have already done all our homework on the patient's medical history and have given them all the instructions and the consents, and we get to work. The patients are happy and they spread the word, and it's a good situation. I think it's very important to offer this type of service to all patients. 

As you know, not everybody likes us. We're doing something really good for society. If they like this, there would be a big line out the door, but people are afraid of us. They're afraid of root canals, they're afraid of extractions, they're afraid of all of it.

Howard Farran: I don't think they are afraid of dentists, I think they're afraid of the dental assistant.

Dr. Kianor Shah: Okay, they're afraid of the needle, if you want to get down to the-

Howard Farran: Yeah, no. It's that scary dental assistant, it's not the dentist, we're the nice guy. I have a lot. When you lecture around the world, and man, if anybody's lectured around the world, it's been you. Hell, you've lived in, what, three countries? 

You know, other countries do not allow the surgeon to do the anesthesia. They say no. In American hospitals, the cardiovascular surgeon can't do the anesthesia, in any hospital in America. They say, "No, these are two separate skills. We want one person completely focused on the anesthetic," and it's only in this cottage industry dentistry where oral surgeons, and periodontists, and general dentists are running IV's and doing the surgery. 

I think it's a really bad idea. 

Dr. Kianor Shah: Really?

Howard Farran: The other reason I think it's bad is because when someone loses a patient, think of the tragedy of that. Think of going home after work, most nights you're tired and you just a beer and watch ESPN, but imagine going home and someone else went to the morgue. I just think it's a really bad idea. Do you agree with that or disagree?

Dr. Kianor Shah: I absolutely agree with you. I have never touched a patient without an anesthesiologist in the room, and you don't do two patients at the same time, ever. I've never had a fatality. I have had colleagues that have fatal fatalities. 

I've been in this business for 11 years working with countless anesthesiologists. I hate to tell, there's also been incidents with children and it's devastating for a clinician. I think it would break me if I had such an incident, but at the same time, there is a demand for it, and if you do it safely, you do it with professional, these are graduates from Loma Linda, the anesthesiologists have been doing it for a long time, that I work with, and if you do it in a safe environment, you do all your homework with everything else, you will come out safe. That's just it. 

You should never do it yourself, never. That's a horrible idea. As a dentist, don't do it yourself, have someone there. You want to spread the liabilities, and you want to, also, be prepared for the patient. I'm not saying any dentist should do it. 

I have 11 years experience, she has 10 years of experience, we've been doing it quite a while. We just picked up another anesthesiologist that has 20 years because the demand is going up. There will be more surgeons and specialists that are going to join us, but don't do it yourself. Reach out to people. With like anything else, reach out to people that are experts in this.

Howard Farran: I'll tell you what, when you go to your little course and you think you're all that and a bag of chips, when they get you on the witness stand and they bring in a Board Certified Anesthesiologist to start cross-examining you, the jury finds out in about 11 seconds that you don't know your ass from second base.

Dr. Kianor Shah: You're done.

Howard Farran: Then there's a dead person. It'd be one thing if the dead guy was an 80-year-old man with a liver spot, but oh, my God, imagine killing a child. I mean, it's just crazy. I also predict this, the lawyers, everybody hates lawyers until they get a good one to defend them, and I'll tell you what, the lawyers are the check and balance. I predict that in ten, 20, 30 years, there'll be some landmark case where they ban anybody, any doctor in America doing the surgery and the anesthesia because that was the issue in the United Kingdom, what, five years ago? 

Do you remember when it popped up in the United Kingdom?

Dr. Kianor Shah: Yeah.

Howard Farran: The NHS started looking at the number of deaths per million by anesthesiologists versus the only people doing the anesthesia and the surgery, which was oral surgeons. Don't quote me on this, but I think they had a three to one mortality rate over the anesthesiology. There's both incredibly rare events, but I wouldn't want to be put down with a three times greater chance than a one. You know what I mean? I don't want a three times greater chance. 

By the way, tell Dr. Duromi, her name's Margon B. Duromi, if she wants to come on and podcast, in fact, if she can do it quick, we could release her's after yours, if she's interested in that. Yeah.

Dr. Kianor Shah: She's an amazing doctor. She went to Michigan, as one of the better schools, then she did Loma Linda residency, now she's a dieretic at the Children's Anesthesiology Unit in LA, and she's a director at Loma Linda, so she impresses me of what she has done. I trust her because the Dental Board of California gets their advice from her. They consult her about anesthesia cases, so it's very prudent. 

I agree with you 100%. Don't do it yourself, no matter what course you took, no matter how good you think you are, get somebody that's an expert, or it's going to be your butt, like you said, when you stand on that stand.

Howard Farran: Loma Linda, that's in Redlands, right?

Dr. Kianor Shah: Yeah. Six to eight graduates, six of these guys a year that are doing anesthesia. A dentist and anesthesiologist. Even if you're an anesthesiologist from the medical profession in California, you still have to register with the Dental Board, or you're operating against the act. Things are very, very regulated. 

Your malpractice is heavily involved, so you have to be very careful with sedation. Yes, if you kill a child, you are going to be national news. I remember a couple of years that happened in Illinois for a little child that had anesthesia and never woke up, and the dentist was doing it, and it's a disaster. 

Howard Farran: It's every year. I mean, last year was one in Hawaii. There's one article going around, there's been several in just Texas. It's every year. If you're on Facebook, you can't go a year without seeing one of these cases.

Dr. Kianor Shah: Yeah.

Howard Farran: They're just devastating. Crazy, crazy.

Dr. Kianor Shah: I think you're going to have a great podcast with Dr. Jahroumi, and maybe even Dr. Weidamen, who is now up there in the oral surgery department in New York University, about why it is important and what we are doing in the extraction field. I'll definitely contact them, contact our colleagues, and I am fairly sure they are going to want to get this with you done rapidly.

Howard Farran: Does Loma Linda still have the dentil assistant's mafia going strong? When I got there in 87 to take boards, if I took boards in Kansas City, it was only for the Midwest, but I wanted to practice in Phoenix, so I had to take Western regional boards, and at that time, it was in Loma Linda. I called the other, I talked to Loma Linda and they were telling me, this is a true story, you can't make this shit up, they go, "Well, you know, the dental assistants, they're the mafia that run this board program." I said, "What do you mean?" 

He said, "Well, if you bring your own dental assistant, 40% of the people fail your boards, but if you hire one of their dental assistants, you will always pass the boards." I'm like, "Damn, okay." I'm taking my boards at Loma Linda and here I am, this 24-year-old punk ass kid, doesn't know anything, and I have this 50-year-old lady and she keeps looking at my prep and she's going, "No, you need more of this, you need more of that." She basically coached me through every procedure. 

Then the line to check the boards, all these strange dental assistants that were brought in, they're all line, but all the mafiosa Loma Linda dental assistant, they just walk straight in, front of the line, walk in the deal, so that's my tip.

Dr. Kianor Shah: You went from Kansas, right? You went to Kansas and then you took your boards here or in Arizona?

Howard Farran: Yeah. I was born in Woodstown. I went to dental school in Kansas City, but I decided to practice in Phoenix, so I just went on my western regional boards. At the time, it was only in Loma Linda.

Dr. Kianor Shah: Would you agree that the Midwest is a lot more warmth? There's a lot more warmth in the Midwest than out here? The dentistry is quite a bit different out in the Midwest because when I moved from Illinois, from Chicago to orange county, I was just unbelievable. These dentists don't want to hire. It's very populated from Santa Monica down to San Diego. 

I didn't have all these credentials, so these five, six dental offices just pouring these dental students out. These poor guys don't have jobs, they run to Nevada, they run to Texas, they run to Phoenix with all this debt, and then it's the most populated little strip in the country with dentists. Some of the best. You've got the [Dorphamens 00:36:05], and these guys and those guys, so you're competing and trying to get a job. It's almost literally impossible unless you go out and get additional credentials so you're compatible. 

To tell you that when I went from my office, to the six offices that I had in Illinois, to selling those and moving to California, my life, I was mind boggled. These doctors, they set up these shops, they don't have hygienists, they don't see the value in hygienists, they do their own cleanings, they're fighting. Every corner has a dental office, it's a big zoo out here. I'm sure you know. 

What is your take on the Midwest dentistry versus the west coast dentistry?

Howard Farran: I'm not a fan of the term United States of America because it doesn't make any sense. No one calls Europe the EU because no one compares Germany to Greece, no one compares Italy to Denmark. The United States, even the central bankers call it nine different countries under one flag. If you're graduating next week from dental school, two-thirds of the dentists go to 147 metros that have half the United State's population, and only one-third of the dentists go to the rural, which has 19,000 towns, and as much as 11% don't have a dentist. 

Everybody that goes, anybody that walks out of dental school doesn't take Medicaid, Medicare, no PPO's, signs that fee-for-service, does $1 million the first year and takes 350,000 home. They all were about a two-hour drive away from an airport to go fly to Palm Springs or L.A. When I look at the demographics from San Diego all the way up to L.A., Monterey, San Fran, within a mile of the ocean, you got about a dentist for every 350 people. There are so many towns in America, hell, Iowa. 

Iowa has a list of towns that if you go there, the governor will give a check for $100,000. Delta Dental will match it with $100,000. Then you go downtown, there's six boarded up bankrupt buildings that the mayor will give you. In the end, you have 200,000 in cash, you have land, building, no mortgage, and then in those towns, a great job is $10 an hour, so you hire the cream of the crop. You don't have to lower your fee with a PPO. 

I mean, think of this bottle of water. Say you make it for $.90 and sell it for a dollar. What does the PPO do? Oh, well, sign up for our plan and you can sell it for $.90. Well, now you're just busy. You're just making noise.

Dr. Kianor Shah: Yeah.

Howard Farran: In a small town, you'll say, "Well, I make it for $.90 and I'm not going to sell it for a dollar, I'm going to sell it for $1.30." You got to go rural. These people who say demographics don't matter, imagine going back to Europe. 

Dr. Kianor Shah: You could become a millionaire as a dentist in small town America, I'll tell you that right now.

Howard Farran: Every time.

Dr. Kianor Shah: The best office I've ran was in small town, Midwest America. That's the most income I had, the most success I had. The most ball-buster offices that I ran were in small town America.

Howard Farran: You know, a lot of people don't study the lesson of the genius, Rick Workman, who owns more dental offices than anybody in the world. He owns 1500 offices. He started in Effingham and he was so smart. He went to the insurance companies and say, "Where are you selling dental insurance getting complaints that there's no dentists?" 

I think it was Connecticut General who said, "You're in Illinois? Here's ten towns that don't even have a dentist. We get complaints from them all the time, and here's how many people have insurance." Then he even got to the point, he says, "Well, I can't open up all ten because I don't have the money," and they're like, "Dude, we'll co-sign the loan." 

Walmart was in 32 states before it landed in its first major urban city, like Dallas, or Kansas City, or whatever. They were just crawling through the back hills of America where there were no Sears, there were no JC Penny's, nobody cared about Bentonville, Arkansas. There's 5,000 people there and the SMP 500 doesn't even think they exist.

Dr. Kianor Shah: It's funny you mention that. I worked with both Rick and Walmart. I actually spent some time with Rick in Effingham, and I also had an idea about building some offices in Walmart, but you're right, the model that they're doing came through the rural areas. That's how they became so big, that they have 6500 plus locations now, Walmart does, but corporate dentistry is growing at the same pace, or maybe faster even.

Howard Farran: Let's go to your next website. FulcrumImplant.com. What is FulcrumImplant.com?

Dr. Kianor Shah: That's the big project of my life, my friend. It's an implant that I've designed for the past year and-a-half. I patented it. Well, that is about a new design implant and a new way of delivering that implant. 

It came about from walking one day. I walk eight, nine miles, when I ever get a chance, as a means to clear my head and I was looking at all these structures, skyscrapers, buildings, signs, they all position in to the ground. It's a solid structure, and they're not around like we are doing. Conical implants came around the early ages with the missioners and the [misicks 00:41:29], and those guys, and they just designed several different conical implants. 

I don't think conical implants are the right way to go. In my opinion, thinking outside of the box, I thought about initial stability via one unit implant that's polygonal and cross-dimension and that wedges in to the bone from multiple different angles. Not only from the fulcrum part, the bottom part that's sharp, that's shaped like a chisel, that self-adjusts in occlusion when the patients would bite, in theory, but also would eliminate the need for drilling, causing osteonecrosis. Since it's diamond shape and cross-dimension, it has a less buckle angle width. 

What it does is during the driving, it has osteo integration, holds and it allows for autogenous bone grafting as you drive the implant in. You get, probably, three to four times the initial stability than any other implant. We have tested it in various settings, swine, human jaws, and industrial grade pliers will remove them. When we get to the stage, when we do in vivo studies on humans, I might have something here that accomplished oral surgeons and periodontists have looked at and thought it's pretty smart, where you can load the same day, you don't have to make the patient wait six months. You are going to be able to very easily place it. 

Not only in extraction sites, but [inaudible 00:43:06] spaces. You're going to get your profound strength from a one solid unit implant with no holes, no screws, no parts, no cement, and you'll be able to drive it. You'll be able to restore it, temporize it, and then later restore it, and you're going to have your strong substructure. You're going to have your strong prostetic that goes on top of it, which could be ceramic, so you get the best of both worlds. 

There's a lot going with this research. We're getting ready to publish a journal article in a few weeks with some [infactful 00:43:38] journals pertaining to in vitro studies that we have done, and I will be glad to share that with you. So far, it's going really good. We're about a year and-a-half into it. We did some FEM tests, fatigue and strength, and it came back as, perhaps, arguably the strongest implant in the world.

Howard Farran: Tell me if you agree or disagree with this. I see a lot of posts on Dental Town, I get a lot of emails at Howard@DentalTown.com where they say in America, the implant you use is so bundled with the continue education, they feel like they almost have to pick which implant they're going to place before they go get [edumacated 00:44:21] because it's all wrapped up into one. My job on this show is to get great guests on, like you, and then try to guesstimate what questions they're asking. I'm basing my questions on what the email, maybe what I see on Dental Town, but I know they're all driving to work right now thinking, "Howard, ask him, what implant do you use?" 

If I did your academy, and I went there and the immediate of the implant, continue number three, should I already have a system? Do you recommend a system? There were 170 implant companies that had a booth at the last IDS meeting in Cologne, Germany, and if you Google "implant companies" the list is now 400 people selling implants. How is a 25-year-old woman, who just walked out of dental school, supposed to make sense of 400 different implant systems?

Dr. Kianor Shah: I think it's ridiculous, I think it's absurd, I think it needs to be stopped, at some point. None of these. Number A, I don't recommend any dental implant company. I currently use Sweden Martina, but I worked with countless, probably 20 different systems, because when I go into a temporary setting, whatever system they have, I use because I can come familiar with it in a matter of 10 minutes.

Howard Farran: What did you say you use? Sweden Martini?

Dr. Kianor Shah: Sweden Martina. They're a European company out of Italy. I've been using them for general implants. I've used DENTIS, I've used MIS, BioHorizon, you go down the list, I've used them all, but I don't promote any particular implant system at the courses. 

If an implant company decides they want to get a table in the back, that's fine. We honor that from time to time, but bottom line is 250 or more FDA-approved implant system, vast majority of them are non-compatible with each other, which creates a scenario scarcity and forcing these dentists to come back to the company, even if they're dissatisfied with their service. The biggest problem being universal compatibility. In my implant practice, I don't know how many patients come in, Dr. X, Y, Z places implant 20, 30 years ago, nobody can find out on the X-rays what implant system it is. 

The best of the best, you can't get the parts, it becomes a big, big headache. What we need in implantology is compatibility, uniqueness, a simplicity because more GP's should be doing this. It's becoming a gold rush. If you listen to some of Dr. [Zifsem 00:46:52] and his lectures, there's a gold rush in implantology. 

If you get on that boat, you're going to be setting yourself up for great success in your private, in your clinic, and you're going to help a lot of people because, as you know, it's one of the most common diseases, missing teeth. Implants are readily becoming center of care versus bridges. You want to keep making the money. You do the bridges and then somebody sues you, and you should've done an implant, it's a bad scenario. Shaving down virgin teeth, and so forth. 

I do not agree with the way the implantology world is going. These companies have way too much influence. They set up these global academies, and it's all part of their speil. You think you're getting clean education while you're getting influence to buy into the system, those things, we are smarter than that as doctors. We see through that right away, and we should continue seeing through that and only seek out the continuing education that tells us how to do the procedure, not what system works best. 

We all know it's going to work. 98% of them take, they all take. If they pass the FDA regulations, they're going to take. Yes, hopefully we can cut those down with an implant that comes out that is universally compatible everywhere you go.

Howard Farran: Let's go on to your next one. LendHealth.com. A financial technology, what's all that about?

Dr. Kianor Shah: I frequently speak at big financial events, it's called Financial Technology, it's a boom that has happened in the last, maybe, five to ten years, where these companies have come out and they cut out the banks, they cut out the third parties and do direct peer-to-peer lending. I'm big on peer-to-peer. If you are a dentist and you tell me something, I'm going to listen to it. If you are an outsider and you come into my profession and you're trying to tell me something, I'm going to be very careful, and I'm going to be listening very carefully what you have to say. 

Peer-to-peer is a huge idea. Now they're getting their own charter with the Office of the Comptroller of Currency. It's getting big, to a point where the banks are getting nervous because billions and billions are now flowing through these bank accounts of these entities that come out, set up a financial technology and enable a borrower and a lender to connect directly, without all the fees and all the games and all of the monies they take off the top to marginalize you. It becomes a scenario where senior colleagues can help their junior colleagues invest in a profession they understand, versus these mutual funds and all these other things that are pushed in front of them by these financial advisors. 

Peer-to-peer and financial technology is a phenomenal innovation of our time. It started with things like Bitcoins, and then it went into patient financing, and then it went to real estate, and then it went to auto business. I go and I sit in front of executives of banks, executives of financial technology companies, the politicians, and all of the major people that come to these very unique events, and I speak about healthcare. I'm establishing myself as the person that does the annual healthcare forecast for these people, be it in China, Europe, in the United States, so a couple of times a year, I get out and I lecture.

A couple of times I get out and I lecture in other things. They need to know, all these other forces need to know that, although we don't get enough business education and training in dental school. There's some of us that have a business acumen, and we want to take that business acumen and we want to pass it on to our colleagues so they don't get taken advantage of by the same people. I go to these events and I lecture, and I'm the only doctor, or dentist, at those events, and it's very well received. 

I do my research with the Bureau of Labor Statistics, I do my research about new innovations and technologies, and I consult some of these companies under healthcare divisions in order to do better so they're not coercing the dentists to make more money, but emphasize more on case presentation and treatment plan presentation and educating the patient. The patients will at their own discretion, sign up for these financing plans, and doctors will benefit without having to give up ten, 5% off the top. If you're working on the infrastructure, there's a lot of regulations involved. There's also, not only the regulation from the financial sectors, but also the regulation with us as professionals that are governed by the acts, so if everybody keeps, essentially, their hands in their own sandbox, it works really smoothly. 

There's no coercion with the patient, doctor relationship, and you're doing some very big things there. When it becomes available, I would love to bring you up to speed so our colleagues can benefit from it, can invest in something they understand, and can benefit from something they understand better than other financial products.

Howard Farran: Back to implants, you talk about things you're excited about is one unit dental implants. Why does that have you excited and what does that mean? 

Dr. Kianor Shah: Because for way too long, we have been exposing patients to flippers, and other items, and they don't like it. I understand my colleagues are all going to come out, the ones that are going to pose the question, "Oh, integration, we came up with the idea of putting these implants under the bone for six months and letting them heal, so osseointegration is complete." Yes, at those times in history, we were forced to do that because we didn't have a better system, we didn't have a better plan. Now there are ideas, other forms and shapes that are going to convenience the patients. 

First impressions are everything. I don't care how good of a prosthodontist, oral surgeon, implantologist one thinks they are. First impressions with patients are everything. If you spend more time with your temporaries, they love you for it. They'll make a lot of noise for it. 

They see their face for the first time, it's a big event for them. To make them wait for six months, have them run around the flipper where you have substantial pockets of bone, where you could be smarter and have not something that's round, that's rotating around an axis with every force you apply on it, and it's going to fail, you can be more creative. Creating different designs and forms where you lock into the bone, you get much more stability at the beginning, you can load it, you can temporize it. I'm sure you have interviewed people that area talking about same-day teeth and stuff, our times, it's a great time in dentistry. A lot of things are happening. 

If you look up Yomi, for example, with the FDA, they just got approval with a handheld robotic that's going to assist you in placing implants. You can do it more accurately, you can do it guided, we know where our bones is, and then it comes back to the very thing, extractions. If you do your extractions right, you can use a guide to place your implant anywhere you want, but you have to know your extraction technique because when you lose your buckle bone, things get a little bit tough. I want to change that for patients. 

I want to be there where I can create a product that is strong, that cannot break, that it cannot be rotated, due to a structure, that there can't be any rotational failure, there can't be any fatigue failure because there are no screws, there are no button parts, so it creates a whole new advantage for patients. We have solutions for the angulation problem, and they will also be revealed when the product is on the market.

Howard Farran: Earlier you said that you do All-On-8's and All-On-4's. What do you think? All-On-4's invented by the oral surgeon Paulo Malo, lives in Portugal. Some people say All-On-4, if you lose one implant, now you have none on three. What do you think of the All-On-4 versus six or eight?

Dr. Kianor Shah: You're going to have a lot of surgeons that are going to come out and say, "Oh, I've been doing All-On-4 for countless years and it works fine." I'm not an All-On-4 kind of guy. I'm all about a piece spread, anterior, posterior spread. Your best anterior, posterior spread you're going to get from an All-On-8 or more. If you place them properly in a format in All-On-8, it's best posterior. 

All-On-4, you're absolutely right. You lose one implant, it's game over for a little while. You got to replace it and come up with a new plan. If you lose one with All-On-8, fine, you lose two, fine, you have to take those items into consideration. I don't think hygiene is the best. 

If you know biophysics concept, you know that we always want to exert the force down the long axis of a tooth, or an implant to have the best force distribution. With an All-On-4, you simply don't. You're coming at an angle, you're putting stress on the screw, at the screw button level, and you're setting yourself up for failure. It might work for some oral surgeons and periodontists because they're so good at it and so accurate, and they've done it so many times and know how to change the angulation for the best distribution at that time in that place, but there's no doubt in my mind that All-On-8 is superior than All-On-4.

Howard Farran: What I don't understand is these guys, they'll be charging $25,000 for an arch. I'm like, "Dude, for 25 grand, you couldn't afford to put a spare tire in there somewhere?" You know what, Jan, my dental assistant's been with me since day one, 30 years, I graduated dental school 30 years ago this month, May 11, in Kansas City, and some of my biggest implant regrets was when a family member calls and says, "Can you go see my mom in the nursing home? She was your patient forever." I placed two implants in a three inner bridge, now she's in a nursing home, she's very, very sick, she's probably not going to live much longer, one of the implants fails and I'm thinking, "Why the hell did I save an implant? Why didn't I do three implants and three individual crowns?" 

Even if I wanted to connect the implants, for whatever reason, it's almost like Jan and I so many times, we joke about [inaudible 00:56:30], we should just place an implant under every crown because when you're a young dentist and you're looking at this patient, especially when you're 25, you just walk out of school, you don't realize this person could live to be 65, 75, 85, 95. I mean, I have a handful of patients that are over 100. Treatment planning for life, in implantology, it's nice to have some spare tires.

Dr. Kianor Shah: You're very correct. We are in no position to determine how long a patient lives. By our standards, that's not our position. We have to recommend the best treatment plan. The reason you probably did that bridge is because a lot of times patients cannot afford three implants, so you throw that in there and say, "You know, an alternative option for you is I do a two unit and I bridge it over, as long as it's on the same implants, not natural teeth, and you save the substantial amount of money." It's still better than doing a long span bridge, picking up a tooth behind it and a tooth on the other side, so you done the right thing. 

It would've been better, ideally, to have three implants, but still with those two implants and a bridge, you have done a better treatment plan for the patient in a flipper or a bridge of any other kind.

Howard Farran: You know, you just said something flippantly that might've flown over their head. You said, "As long as the implant bridge isn't attached to a natural tooth," go back and explain that. Why? Somebody just heard that and said, "What?"

Dr. Kianor Shah: Implants are not teeth, that's the most important message I can reveal here, which I constantly do on social media. Implants are not teeth. Implants don't work on the biomechanic features of teeth. Teeth have a periodontal ligament, and until, in stem research or other research, we can restore the periodontal ligament, where does the slide give, implants will never be teeth. 

If you start putting a bridge on a natural tooth and an implant, one of them is dynamic and one of them is static. You're going to have horrible tetter totter force distribution. It's going to fail, it's going to cause one or the other to fail. Now you got these Europeans coming out and they got all these cute teeth that look like natural teeth, which is, in my opinion, you're not really telling the consumer the truth. 

Yeah, you can do a 3D animation, and you can [inaudible 00:58:53] it out to look exactly like the tooth you're extracting, but the minute that tooth goes into that socket, with whatever impact method you're putting it, it's operating on a whole set of different biomechanical and biophysical concepts than a tooth. You have to be very careful. As rarely as it justified for you to put, somehow have a bridge involved with a tooth, if you want to maybe rest in on there, or preserve bone by keeping the root and pulling up the root on top, and having something, but you're asking for trouble if you're loading a natural tooth with an implant.

Howard Farran: They're driving to work. What I do on these podcasts is we always do a transcript, so when we post on Dental Town, we usually have transcripts because they can't take notes. Another thing I do with my guests, I retweet their last tweet. You want me to retweet, that way when they get to work, they can say, "Okay, who is this guy?" 

He's @KianorShaw, K-I-A-N-O-R-S-H-A-W. I'm going to repeat his register here for CEAdental.com extraction, and another one, it's got a bunch of courses, so if you get to work just go to @HowardFarran, and then my last two retweets were @KianorShah.com. You promised me an hour of your amazingly busy life. We actually went over an hour, but I just have one final question. What would your commencement speech be to these 6,000 graduates walking out of school? 

They're scared, they got a lot of debt, and they all have the same complaint, everyone I talk to says, "Well, they didn't teach me how to do, I didn't place one implant, I didn't do one Invisalign, I didn't do one snore guard." They're just overwhelmed because they're getting bombarded with, "Well, you should learn ortho, or sleep apnea, or Invisalign, or place implants," they're just overwhelmed. I know you're too young, at age 36, to have a daughter graduating dental school because you're not Catholic. Only 36-year-old Catholics would have a child coming out of dental school. 

Talk to that kid. Give her a three, four-minute, I mean, I know we're in overtime, but give her a rant, give her some farther-son, father-daughter advice.

Dr. Kianor Shah: Experience is everything. I came out of dental school, I thought I knew everything and I could do everything. It started with one guy, Dr. Francis, which was actually very heavily involved in Dental Town, and he would come to the office. I bought the office, he agreed to associate with me for a long time, and he actually passed away. Was a very, very well-known person at Dental Town. 

I would get on the site and if I had questions, I would read what my colleagues were saying because experience is everything. You can spend millions of dollars leaning this stuff yourself by making mistakes, or you can spend five minutes asking a question to your colleague. There's a certain bond between us that I've never seen in any other profession, or any activity of mine. When you identify yourself as your dentist, and your colleague knows what they have gone through, you're going through, they're willing to help and they don't always ask for anything in return. 

Get on these websites. Start associating with a doctor. They do, most of the time, have your best interest in mind. Use that as a stepping stone to building your own dream practice, and building a career and life for yourself. You're going to make mistakes. 

The most successful people in this world are the ones that keep getting up. They keep getting beaten down and they keep getting up, and they keep coming back, and they keep coming back. Yeah, you mess up a root canal, that's not the end of the world. You don't have to start thinking, "Oh, they're going to sue me. I've got these student loans, I'm going to lose my wife, my house, and the cars." 

Pick up the phone, call an oral dentist, call an oral surgeon, say, "Hey, I'll take you out for golf or coffee next week, do me a favor, bail me out with this patient." There's always a solution, and the best solution will always come from your colleagues. That's my opinion. Feel free to reach out to us.

I continue to learn. Dr. Harfran is quite humble today, but he, himself, I wanted to ask him one question at the end of this, what has motivated him, of decades and decades, to do what he has done for our community, to bring us together to his venues, I've always wondered that. One solid, most important lesson, go to your colleagues. Reach out for help, reach out for advice, don't pay them money to learn it the hard way. Learn it from other people's experience and then make your own opinion about how it should be done.

Howard Farran: I think part of it, well, it's a long story, but I think part of it is my dad was always humble, hungry, and curious. If you're humble, you listen to your colleagues, you listen to your staff, you listen to your patients. If you're hungry and have a work ethic, I mean, and Patton said in war, if you're always moving, you're going to win the war. Just don't stop, trench digging, just keep moving. 

Intellectual curiosity. I wold say in my 30 years watching general dentists, the ones that were humble, hungry, and took at least 100 hours of CE a year, like you got all these initials after your name, everybody I know that got their FAGD, their MAGD, their diplomat, and anything, that's tagging their behavior that they're curious. Half of those courses I went to, I learned more from meeting friends at the break, who became friends, that I did from the lecture. 

Dr. Kianor Shah: Yep.

Howard Farran: I remember going to the Misch Institute, I made so many life-long friends. Carol's lecturing there, but it's later, a week later. You're calling your buddy at the course saying, "What about this? What about that? What about this?" Just stay humble and curious. 

Of all these websites, which one should my homies go to? Kianor, K-I-A-N-O-R-S-H-A-W, and I just retweeted two tweets, so you'll find them there, how can they contact you?

Dr. Kianor Shah: There's a contact on that site, or they can email me. One thing I will respond, especially to my colleagues, if you're a dentist and you're reaching out to me, there's always an open door, an open line there.

Howard Farran: What's your email?

Dr. Kianor Shah: K-A-I-N-O-R.S-H-A-H@gmail.com

Howard Farran: Hey, man, I'm a big fan of you. I love reading your posts on LinkedIn. When you write those big LinkedIn deals, you should repost some, a blog on Dental Town, or start a thread, because one thing that's really, really cool, I was telling everybody that these people in dentistry, they write these columns for free. We've never paid anybody to write an article for Dental Town. When you read that in a magazine, no one knows you read it or anything, but on Dental Town, when you read that magazine, there's a share button. 

If you read it an article or a blog and you think, "Well, that was really cool. Thanks for writing that for free and sharing it with me," then just reach up there and click "share on Facebook", "share on Twitter" or "share on LinkedIn." I want to thank my homies so much for this because the shares, if you look at the shares of all the blogs and magazine articles online, it just keeps going and going and going. Every time I'm on Facebook, or LinkedIn, or whatever, I see all these blogs and articles that someone posted on Dental Town. It is. 

I always tell my patients the greatest gift a patient can give me is a referral, friend, or loved one. The greatest gift you can give any of your dental colleagues, who are taking the lot of time to write these blogs, articles for Dental Town Magazine, if you liked it, but you don't want to comment, or maybe you're anonymous, just hit share. Just share it to your colleagues. My god, the number of shares from our blogs and Dental Town Magazine articles is literally doubling, like every four months. That is so much respect, so a big shout out, respect to all my homies out there, because when you wrote that last article, I just read it, your LinkedIn, I mean, seriously, how long did it take you to write that article?

Dr. Kianor Shah: It takes quite a while, but where I've been mostly involved with you is on Facebook and LinkedIn because you're active everywhere. I got to tell you, on behalf of all of my colleagues, I would like to thank you for what you do for us, because nobody else is doing what you're doing. Also, I've been sharing a lot of your stuff, especially the humor. It makes people's day when you post these humor things, and I repost them and everybody enjoys those. 

I will get with Ryan and a couple of other doctors that you took interest in and I will set everything up so we can collaborate. You certainly have another life-long friend here.

Howard Farran: Oh, thank you, buddy. By the way, you must be the youngest person in Palm Springs. Whenever I go there, the 80-year-old is the hot chick at the pool. I mean, how many people live in Palms Springs that are over 100?

Dr. Kianor Shah: A lot, but when you're in the implant and full-mod rehab business, then it's a very good environment to be in.

Howard Farran: Okay. Well, hey, if you ever drive through Phoenix, stop by the house and we'll have a beer, go to a restaurant, have dinner, whatever. Let me know. Any of your colleagues that you want to do a podcast, or put online CE, or write an article, just let me know.

Dr. Kianor Shah: Yeah. I think you're doing a podcast with [Johnus Stafano 01:08:37] from the Treatment Plant Academy soon, I think that's going to be exciting. He's coming to visit you, maybe I'll tag along.

Howard Farran: Okay. All right, buddy.

Dr. Kianor Shah: Thank you, sir.

Howard Farran: Thank you for an hour of your life. Thank you so much.

Category: dental, Podcast
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