Stem Cells and Growth Factors in Dentistry with Dr. Kianor Shah, DMD, FCII, FIADFE, DICOI, MBA

Host: Ladies and gentlemen, this is The Dental Up Podcast, brought to you by Keating Dental Lab, a full-service, award-winning dental laboratory. Each week, you’ll learn tips and techniques from real-world dentists, bringing you in-depth interviews, motivating stories, current events, and sports. Host: Here’s your special host, the General Manager of Keating Dental Lab, Bob Brandon. Bob Brandon: Hey every one, Bob Brandon here and welcome to another episode of the Dental Up Podcast. Our guest this week earned his DMD degree from Southern Illinois University and completed an MBA at Brandman University in International Business in 2016. He’s a seasoned educator in clinical topics such as head and neck anatomy, biophysics, surgical extractions, and oral implantology. Currently practicing in Palm Desert California. Please help me welcome to the show today, Dr. Kianor Shah. Bob Brandon: How’s it going Dr. Shah? Dr. Kianor Shah: Thank you for having me on the show Bob. Bob Brandon: Thank you. Well, I know you are a busy man and you have a full day of patients today so let’s get right down to it. I want to begin by asking you how you first became interested in dentistry and at what point in your life did you think, okay, I want to be a dentist? Dr. Kianor Shah: Back in undergraduate I was studying to become a cardiac surgeon, but I volunteered in the local hospital, at the local hospital where I accrued some community service hours and saw how the cardiac surgeons were operating and coming in late at night and also having the interactions with the patient, things of that sort. They were telling stories about hardship at home with their families, which is not for me. I’m not saying every cardiac surgeon has these problems, but I wanted to help people but at the same time I wanted to be able to set my own hours to attend to the patients on my own schedule and one thing lead to another and one of my best friends got accepted into dental school and I decided to go the dental route. Bob Brandon: Excellent. And that’s what I enjoy most about my job here is getting to interact with our customers and our dentists and you know hearing the story about their families and how their kids are growing up and I truly believe, even in my own personal experience with my father whose a dentist, having him around, having him be able to participate in my life and my siblings life has been just so beneficial and you’re still able to help a tremendous amount of people at the end of the day. So, thank you for that. Dr. Kianor Shah: Yeah, you have to be good at multiple things. When you’re a professional in our industry your not really regulated like the hospital doctors are and you have to be multitask. It’s just not enough to be good at one thing, even in your clinical practice so diversification is very important. You have to be good at home. You have to have time to spend with your family. You have to be able … All those things sum up to a happy life. Bob Brandon: Absolutely. And you epitomize that truly in all of your many talents and we’ll get to that as we get through this podcast, but I was on your website last night. I must admit I was cheating a little bit, but I was so impressed with how many different facets and areas of dentistry you have, become not only proficient in but mastered and you’ve obtained fellowship status in so many different organizations. Why don’t you tell me a little bit about your dental school experience and then how those experiences sort of guided and shaped you into the dentist that you have become today. Dr. Kianor Shah: So dental school is the basics, the 101. When we went to school, I was very interested in surgery, about third year of dental school, towards the end, I almost had all my requirements done, and I would go in a lot into the oral surgery department and clock in and we had a really nice doctor there that taught me a lot. But still when I got out of dental school, I was sitting there reading off probing numbers and it was all too new to me and the doctor walked up to me and it’s like, the doctor I associated with, you’re not in dental school any more. When I was doing the endo I would be very, very conservative in opening up an access. And you know the same thing, he would come over and say, hey if you really want to work on that tooth you’ve got to open it up more. So when you get into the learning with dental school, they didn’t teach us anything about business and they don’t in many of the dental schools. Dr. Kianor Shah: And you have to get out and get your feet wet. So, with everything rapidly changing in dentistry, every five, 10 years there’s so many new technologies, procedures are changing. You walk through laboratories they don’t have burn out ovens anymore, they have scanners and printers and so the dental schools can’t keep up so you’re only going to get your basics in dental school and certainly business acumen or business training of any kind is not really taught at the dental schools. So dental school experience was good, but I did one smart move when I got out is I found a senior colleague to take me under his wing and eventually he wanted to sell his practice and I wanted to buy. Dr. Kianor Shah: So I didn’t go the corporate route and I started learning from that doctor. And then another doctor came around a couple of times a week and he would do everything, the root canals, the implants, the sinus lifts and just hanging around him I probably learned more from him in the year and a half that he was with me than I did in dental school. So, yeah, Southern Illinois University School of Dental Medicine is a small school down on the border of Missouri in Alton and I spent some time there and it was a very good experience. You had a lot of interactions with the faculty. The smaller school is it tends to happen that way, but certainly not enough to be able to go out and know it all at that time. Bob Brandon: Yeah. It provides a basis and I think you’ve touched on another theme of many of our customers where after they graduate dental school then it’s like what’s next. Well, you hit the perfect scenario by joining up with an older experienced dentist that was looking for an exit strategy and was a multi-tasker and did everything. And was this first practice after dental school, was it in a smaller town? Were there other specialists available or was the practice do everything practice more out of necessity? Dr. Kianor Shah: It was a very small town of 14,000 people and I believe you had seven dentists in town. Bob Brandon: Oh wow. Dr. Kianor Shah: That was probably the most lucrative environment I was in. So my opinion, small town America you can do very, very well in if that’s where you want to settle. For us there was probably a 60 mile radius where we didn’t have an oral surgeon. We had an endodontist about 30 miles away, but you had to drive all the way to the Fairview Heights area from where I was. So, patient’s don’t like to travel that far so you have two options, you can start leaning those tasks and taking continuing education and doing them yourself or you’re going to have to inconvenience your patients to go to get that kind of treatment done. Oh, there was also a periodontist in town where the periodontist was and I was working with those guys at first but then I started doing more endo myself and I got the skills I picked up in dental school allowed me to do it myself. The doctor that used to come in, he was doing some orthodontics and Invisalign and one thing lead to another where I started just about doing everything myself. Bob Brandon: That’s great. Is there one area that you particularly enjoy more? And I know you’ve touched on surgery a couple of times, is that still a focus or have you maintained everything equally at your current practice? Dr. Kianor Shah: I like surgery. In 2006 I got out and 2007 there was a company by the name of CAMLOG out of Germany that had a weekend course up in Chicago … Bob Brandon: We know them well. Dr. Kianor Shah: … pertaining, yeah, pertaining implant placement so they invited us. They said, hey this is a course so you can get the basics a little bit and introduction. And I loved doing extractions, I always have and so I’m like okay, let’s go up there and see what they’re talking about. And that weekend course lead to a career now of 12 years, 13 years of placing implants and doing sinus lifts and all kinds of all in fours and all in eights where after awhile there’s only so many MODs you’re going to do where you don’t get excited about it anymore or so many denture adjustments. If you’re not improving yourself you’re dying. And that’s basically the philosophy I took. If you’re not innovating and improving yourself, you’re essentially slowly or quickly dying. Bob Brandon: Definitely. So, when you came out to California how long did it take you to establish your own practice? Dr. Kianor Shah: The first thing I had to do was up my dental skills. I mean not dental skills, but also qualifications. So, more fellowships and then the mastership and [inaudible 00:10:11], but I saw an arbitrage opportunity. The market was saturated, every corner in LA another dentist and these guys weren’t skilled or qualified to do their own endo, they were referring it out. They were sending their extractions out and they were sending their implants out, so I started advertising in the Dental Trader and other venues like Dental Shopper, started saying, “hey, I’ll come to your office. I’ll bring my own equipment.” I still had some equipment from Illinois, my implant mortar and all that. My extraction instruments and I started going from office to office and I got so busy. You know I go in, we do an implant. We split the fees essentially equally after overhead. I started doing endo implants and oral surgery in all of these offices for a few years while I was doing the fellowships and while I was doing the MBA. Dr. Kianor Shah: And there’s a particular reason I did that MBA and there’s a particular reason I started setting up the International Extraction Academy and the Global Summit is because I wanted to see if I can create a bridge for younger doctors that are coming out of school and are in the same situation, to get more excited about surgery and be able to go to this bridge of first extractions and then the easy implants and then the more complex procedures. But yeah, for the longest time I was essentially traveling, I believe it was 300 offices I’ve done something in, surgery of some kind. Bob Brandon: Wow. Dr. Kianor Shah: Or full mouth restoration or what have you. But for the longest time I was just traveling, all over, San Diego, North LA, Inland Empire and it was quite lucrative. It was certainly better than $500 a day … Bob Brandon: Yep. Dr. Kianor Shah: … and eventually we got an associate situation here in Palm Springs and then I set up my practice in Palm Desert in October of 2017. Bob Brandon: And do you have associates that work for you while you’re out in all of your teaching endeavors? Dr. Kianor Shah: No. I’m doing something very unique in Palm Desert. When I had all the six offices, the most challenging thing was in the dentistry, was all the employees and the benefits and the vacations and the raises and the HR was what was making me old and lose my hair, so I decided it’s best to just have a small operation, two chairs, very, very high class. So I came in and I picked up about 1000 square feet on El Paseo, which is like a road like Rodeo Drive, but out here in the desert and I’m the only dentist on this strip and it’s a different situation. There’s two chairs. I see eight, 10 patients maximum a day, give them full attention and I spend time with them. I’m not running from room to room numbing people, having some office manager tell me go in this room, do crowns, go in here and do fillings, and all that stuff is gone for me. Bob Brandon: Yeah. Very smart. Dr. Kianor Shah: I’ll never be interested in that again. But then these patients become friends. If you for example go on line and look at our reviews, it’s one after another. They bring us things and we do fun events with them. You just sit down with them for half an hour or 45 minutes at the initial appointment and just listen to what they want. Just because they told you to do it a certain way in dental school, doesn’t mean this is what your patient wants. You might actually upset the patient if you’re trying to do what the status quo. So just listen to what the patient really wants and then put yourself in their shoes and see how you would like to be treated. So, it’s a completely different environment. Your bigger cases, like for example today this morning I went in at eight and I did bilateral sinus lifts, put in four implants, did six fillings, did scaling and root planing on this patient was under sedation and he’s happy as can be. He just left and I came here to get on the show. Dr. Kianor Shah: But work smarter, work better, and do it with quality care and everything falls into place for you. Bob Brandon: Absolutely. Dr. Kianor Shah: Even out of two chairs … I’m making more money out of two chairs than I was in the same day scenario in the other practice, outside of my first practice. That was very lucrative. Bob Brandon: Yeah. You touched on a number of important points there on listening to your patients and providing a higher level of care and I think a lot of our clients and probably a lot of dentists in general in the United States and around the world, they feel so rushed to produce and to hit a number because they’ve got the overhead, they’ve got the staff, wages, and everything to meet. But I applaud you for taking the opposite stance and really putting the patient first and allowing that patient to really benefit from your skills and your additional training and it sounds like, really it sounds like you’ve got a great life because of that too. I mean, it’s … Dr. Kianor Shah: Bob you’ve got to look at the facts of the matter. The golden age of dentistry is over. The corporations have come in. Their profit driven no matter what they say. Bob Brandon: Yeah. Dr. Kianor Shah: Their profit driven and no matter how they structure their systems, at the end of the day they want to see numbers. There is somebody sitting in some management company that’s running the show that wants to see numbers. And that environment you know you end up with dentists in the marketplace that are 65. They can’t pay their student loans and are still working, but there is also arbitrage opportunity. You can do something they can’t, which means if you just focus your time and effort on one practice, get involved with the community, get involved with the Chamber, start marketing, do quality care. And I don’t care about all the different venues of marketing dollars out there and what works and what doesn’t work versus print and social media outlet nonsense, most powerful remains the word of mouth. Bob Brandon: Absolutely. Dr. Kianor Shah: And you can beat the corporations and you can compete with them and you can do better than them, but you have to carve out, environments where these standard type of transitions happen, the corporations come in and take over there is also an opportunity for the individual doctors to flourish if they do it properly. Bob Brandon: Yeah, that’s actually been our philosophy of this business, of Keating Dental Lab, we’ve undertaken that from the onset where we put the customer and the patient first. Our motto is creating smiles every day. I mean we don’t want to be the biggest. Shaun might kill me for that, but we want to be the best and we really take a lot of the same philosophies that I believe you have in your practice into treating our 750 customers across the US on a monthly basis. Bob Brandon: And yeah, I do know that corporate structure, we have a very large California entity that’s located less than a mile from here and some times I’m on Red Hill Avenue and I drive by their nice shiny, huge building and I’m like, yep, there’s a lot of bean counters and accountants and MBA types in there that are making a lot of money, but I often wonder what kind of dentistry is being done there. Any way enough of that. Dr. Kianor Shah: Dentistry, I’ve been in those environments and I’ve learned a lot on how they operate and dentistry is just not a standard invasion, cookie cutter, customize everything, put a bunch of robots in there and its just not sustainable. But they will find that out in the long run. Bob Brandon: So, being at the forefront on the educational side and by providing so much continuing education, I want to ask you a little bit about technology and some of these newer devices and pieces of equipment, what’s the latest that’s in your practice? Where do you find your one or two new purchases, you know this can even go back two or three years, but some pieces of equipment or some technologies that you just can’t live without? Dr. Kianor Shah: Certainly can’t live without my CT now. We just purchased a very nice imaging system and you’ve got to protect yourself and you’ve got to protect your patients. If you’re even doing wisdom teeth or if you’re doing implants, you really want to be able to image better and it establishes a great, great patient rapport. When patient’s see me manipulate the slides on a CT scan and place an implant in there and explain to them where they have little bone where they might need additional bone, where the sinus is, where inferior alveolar nerve is and then all of the other anatomical landmarks and then just talk it through with them as I am studying the CT pretty much solves the treatment plan. So I picked up a PACS I-3D Green from VATECH and the software that I’m working with is very easy to use, the Ez3D-i. And we have digital x-rays in the office. We’re just starting to work with a scanner, which I can’t discuss that much because it’s getting ready to go public for this company, but I act as a key opinion leader for this entity. Dr. Kianor Shah: And the world is changing. I’m thinking myself if I don’t use any more impression material, I don’t have to buy any more and this is going to be cleaner and I can go ahead and pick up the SDL file on the scanner, email it over to a lab that accepts it, like yourself, and have it turned around in the mail, one way mail is only necessary. I’m not a big [inaudible 00:20:38] guy because patients come in with [inaudible 00:20:40]. You have to send them out or they’re going to be sitting there in your office bored for four or five hours by the time everything is baked, cooked, done. It’s just not efficient I believe. That’s my opinion. Dr. Kianor Shah: But being able to take the scan, mail it over to the lab, have the lab mail it out, and send it to you, that seems like a pretty good ordeal. Not only from the logistics perspective and cost, but also patients don’t like … they always talk about this goo thing you know … Bob Brandon: Yep. Dr. Kianor Shah: … and they don’t want the goo in their mouth and [inaudible 00:21:14] so yeah. Digitalization of the practice is going to save you a lot of money and time and create a tremendous convenience. You are always going to have the people that are still using flip phones that are probably developing x-rays out there and … Bob Brandon: You’re right. Dr. Kianor Shah: … these people are hard to change. So the newer generation shouldn’t even consider it as a plausible option. Although you can probably find very cheap equipment to get started. So digitalization has been my favorite of the last couple of years and I can’t keep up with the printers that are coming on with the different material, but there’s a lot of technologies happening. Every conference that I go to annually, next year there are so many new people there with new things it’s just mind boggling at the speed that we are developing. Bob Brandon: It is. The manufacturers, the vendors, the technology, what’s available to us as a dental laboratory and to you as a clinician, it is that we’re in a very explosive growth phase in the industry. It’s very exciting. As we wrap up here, I have one more question and then I want to give you some time to talk about your upcoming course that’s going to be out here in Orange County in about a month and a half. So, the last question I’d like to ask is because you’ve been out of school about 15 years and transitioned through so many different areas of the country and phases of practice, if you could give some advice to some dental school graduates that have may be graduated in the last week or in this coming few weeks, what type of advice would you give them? Dr. Kianor Shah: If they want to be their own boss and they want to set their own schedule and a very comfortable life, the best recommendation I can make is up your business skill, start looking for a senior colleague, transition in with them that wants to get out, transition into them, try to pick up as much as you can and make it your own and develop your practice based on your own. You’re going to have to work hard. You have to work smart. You don’t have to own 10 offices to succeed in dentistry. You can get the same results just by focusing on one. That’s a mistake probably I made, that I should have just focused on one and stayed with one rather than trying essentially take over the world. Because a lot of dentists are running around buying up practices and doing that whole spiel. Dr. Kianor Shah: You can do just fine out of one practice, four days a week, paying attention to your patients, but you’ve got to up your business acumen. Patients don’t care about six degree tapers. I mean, yeah we do as clinicians, but they want to come into a clean office. They want to be smiled at. They don’t want you to hurt them. They have a whole set of different priorities and if you once in awhile put your hand on their shoulder it goes a far, far way. So your personal skills … also work on your personal skills because they can see, hear, and hear everything that goes on in an office. But the winner is going to be the doctor that works for him or herself. Bob Brandon: Yeah. I know. Patients, and I’ve been in a couple of offices and people want to be treated like people. They don’t want to be treated as a number coming through, standing in line, waiting in the waiting room a long time, waiting to be seen by the doctor, they want to be treated like people. Now I want to give you the opportunity to tell our audience about this very exciting course you have here next month, in July, in Lake Forest. Can you please share with us about your course and I look forward to seeing you out there. Dr. Kianor Shah: So, in addition to the International Extraction Academy where we’ll be holding five workshops this year and also have an online component that is over 30 CE units that you can take at the convenience of your home which ranges from topics of anatomy all the way to complex implantology and everything in between from pharmacology to anesthesia to different techniques in surgery and pathology and the endodontic perspective and on and on it goes. Those were recorded at the Global Implantology Summit 2018 with the speakers that we brought in from some 40 countries and that are specific expert in that particular field. Dr. Kianor Shah: So that was pulled out of the classroom so doctors can watch that at home and gain a lot of insight and learn from again senior colleagues and after that they would be able to apply those didactic and clinical information in practice, but also hands on workshop would aid in getting in pig jaws, doing flaps, placing bone, suturing techniques, potentially the guided bone regeneration membranes and a little bit of lectures at those workshops that happened with Dr. Thomas Wiedemann from New York University. He’s in the Oral Surgery and Implantology Department there. So him and I have been doing this for several years. Before him Dr. Hakimi was with us and Dr. Greenwood when we originally started recording a couple of courses, a couple of the sessions and doing some workshops. But it has flourished into something nice where we do it now every year in different areas of the country. So the next one coming up in Charlotte in two weeks, you can also look at the EXTAcademy.com. Dr. Kianor Shah: So once you get the Extraction Academy sort of mastered we have the Global Implantology Institute where we like to take you to the next step with the different courses that are up there between Dr. Javid, myself, and other doctors that are posting their courses there. But particularly stem cells in dentistry. About a year ago I ran into a company out of Orange County by the name of Invitrx, basically explains what it means, prescription done in-vitro in a lab. So one thing lead to another, I was interested to see what they were talking about stem cells and neuropathic pain and all of these different procedures that were being used in medical environment, anti-aging and I thought to myself I wonder if there’s going to be any benefit to stem cell in dentistry and the stem cells they were taking were from the cord blood and amniotic fluid and the Wharton’s jelly. Dr. Kianor Shah: Cord blood is essentially the cord of the mom to the child during the birthing process and the cord blood, also known as the cord of life, secretes a tremendous amount of stem cells, particularly Mesenchymal stem cells that turn into tissues and also you can find hematopoietic stem cells that turn into blood phenotypes. And understanding that amniotic fluid has over a hundred growth factors that doesn’t include all the coenzymes and little kines and all of the different factors in it, I kind of figured there’s got to be a lot of medical applications and also some dental applications. Dr. Kianor Shah: So I started investigating and there was a doctor in Irvine that was putting this in for just about all sorts of treatment from TMJ problems it was resolving, endodontic problems, and on and on it goes. So I started experimenting with it about a year ago and had some tremendous results for bone grafting procedure. I had a patient that was numb, we recovered about 75% with these cord blood stem cell injections and then I started a case on osteomyelitis where we started resolving sinus tracts that the oral surgeons weren’t able to resolve for some two years so I couldn’t do implants on this patient. And one thing lead to another and I dived deep into it to see what the story was and started doing more and more of these cases and kind of mastered the injection technique and created a protocol for it. Dr. Kianor Shah: And more and more dentists came around and asked a lot of questions and so we decided it’s time to bring or help pioneer the stem cell industry into dentistry where it’s applicable. There is a lot of things to consider when you’re working with stem cells. We have to do very thorough consent. You have to know the health history. You have to spend a lot of time with the patient, understanding what their problems are and the market had a bad taste from some bad players in this space who were trying to line their pockets with easy procedures and profiteering at the expense of desperate patients. Dr. Kianor Shah: But you know I didn’t ask the question, I didn’t ask myself if stem cells really work, the question I asked myself was what if these stem cells work and we’re not offering it to our patients. What if it could help patient’s? Especially those that have exhausted just about everything else that are options from the status quo. Patient’s with chronic pain. So if there was going to be a possibility to help those patients improve their quality of life and as a doctor I felt obligated to investigate it. And if indeed my clinical judgment told me that this is real and the possibility existed, yeah sign me up for it. Dr. Kianor Shah: So you have to understand that what are indications, you have to understand what those indications are, you have to completely understand what is in this stuff and amniotic fluid and cord blood cells and Wharton’s jelly is kind of a jelly material, viscous material in the cord, blood in the cord itself, so once you get a good grip of that you’d be surprised what you’d find. You’re talking amniotic fluid, which is very reasonable to purchase, and you can do a simple injection and besides the 100 growth factors I told about there’s probable a 150 plus other co-factors and cytokines and polypeptides, exosomes and on and on it goes that we can’t get anywhere else. You can’t get it from yourself. We do PRP and PRF and those type of things. We’re lucky if we are looking at 10 important growth factors. So I invite my colleagues to look into this. Dr. Kianor Shah: We decided to implement courses in the Global Implantology Summit, Institute, Global Implantology Institute because it is implantation, it is implantation of stem cell and we’re going to get on some of the techniques on how to inject them, where to inject them, what the indications are, what the contraindications are, what the proper flow from the time this thing is manufactured at the extraction facility all the way to the time it arrives at your office in the morning and you inject it into the patient, what needs to happen to be compliant with the rules and the laws and the regulations and informed consent and protocols and then etc. and etc. and documentation so we put together some workshops. Workshops are always good. People come out, we spend a lot of time with our colleagues, have a good time and all learn from each other. Dr. Kianor Shah: Actually the first one is in July 20th and then the next one is October 19th. We have limited for 15 students we can do per workshop and this will be done at the extraction facility by this FDA registered company in Lake Forest, which is in the outskirts of Irvine. Bob Brandon: Yeah. Well that’s fantastic. That is a lot of knowledge in a very short period of time. I’m going to make sure that we get this posted all on our website so any of our listeners can go to our website and they can get linked to you EXTAcademy and the Global Implant Institute so that they can lean more about your courses. Again, Dr. Shah I can’t thank you enough for spending the afternoon with us, taking time out of your busy practice and your schedule to really educate our listeners and it’s really been a pleasure speaking with you this past half hour and I look forward to seeing you again soon. Dr. Kianor Shah: Thank you for what you guys do for our community and spreading knowledge and information and thank you for having me on the show. It was great fun. Bob Brandon: Great. Thank you so much Dr. Shah. The best to you. Take care. Dr. Kianor Shah: Have a great day. Bye. Bob Brandon: Thank you. Bye-bye. Host: Thanks for joining us on the Dental Up Podcast show this week. Make sure to follow us on Facebook, Instagram, and Twitter or search the Dental Up Podcast on iTunes for our weekly feed. Don’t forget to visit keatingdentallab.com/promo for exclusive offers. Keating Dental Lab is a full service dental laboratory and we’re nation wide. We’d love for you to send us a case so we can show you the Keating difference. If you dig what you heard, please leave a review on iTunes and we’ll be back next week.