Listing of Factors to Consider when... (as of October 2020)
How to Stay Safe & Where to Live A New Microscope Shield & Choosing a Dental School/Practice Location
This episode opens with a discussion of the recently concluded IFEA meeting and what Ruddle presented. Next, the new Shieldont is introduced and we Zoom with its creator, Dr. Micah Nuzum, about this timely invention. Afterwards, Ruddle talks about various issues to consider when choosing a dental school and/or practice location. The show closes with Ruddle addressing the misrepresentation of one of his cases at the recently concluded IFEA meeting.
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INTRO: IFEA Meeting
Welcome to The Ruddle Show. I’m Lisette, and this is my dad, Cliff Ruddle. We have a great show for you today, including a special guest, an endodontist named Dr. Micah Nuzum, who we Zoomed with yesterday. And you will see that momentarily, following our opening. But first, I know you did something pretty special this weekend, and it’s concerning this graphic we had behind us. What – why don’t you tell us what you did?
Well, yeah. First of all, I had to get up, like really early, because in India, Chennai – Chennai is in the south. It’s 12 ½ hours different time zones. So to do my part of my presentation and my close, I was up very early. So, yeah. I was excited this weekend to be part of that. It was a great meeting.
It’s IFEA, right, the --
It’s IFEA, and for our friends who don’t know what that means, that’s the International Federation of Endodontic Associations, Associations. It’s all the member countries around the world, all come together, usually every two years, and there’s a big Congress. We were supposed to be there physically, live, during this exact period. But because of COVID and the increasing outbreaks, the whole meeting was canceled. And so, it became an online Congress, and most people said it was impossible to do it.
So, I want to acknowledge the Indian Endodontic Society. They had – they threw an army of people behind it, and in conjunction with IFEA, and their organization, those two organizations put together this technical event that was very, very difficult to do. But it came off flawlessly. It was fabulous!
I understand that even besides the speakers, I think you told me that they – you can even go to the vendor booths as well, virtually.
Yeah. You walked in on the virtual set, you know, you were looking at your monitor, so just imagine this. I’ll try to paint a picture. And you’re way up high in a massive hotel, granite and stone everywhere, and you have the information desk, and you have big escalators going up at the Schilder Room, the Hithersay [sounds like] Room, the Exhibit Hall, that you mention. And you can go into that Exhibit Hall, and you can go to the various booths. You can click on a booth and talk to people. You go to the information thing.
I mean, it's all hot buttons. So, I mean, this wasn’t just like, blah, blah, blah, blah, and give your lecture. I mean, you felt like you were in India. I actually got excited about it! And they had music and dancing, and they had flyovers of massive waterfalls and huge tributaries and rivers, dumping into the Indian Ocean. Whoa! [laughs] And birds and leopards, tigers, elephants, so, I kinda thought I was there.
It sounds like the – they kind of gave you a feel of India, like they sort of celebrated certain of their historic sites and stuff like that?
They wanted us that couldn’t physically go there, they wanted to get each of us this special experience. And by showing us a glimpse of their country -- well, I’ll just say it now. There were 24 total speakers, in over 4 days. And each speaker had something to offer. Each speaker gave their presentation in their own style, their own knowledge, their own experience. And each speaker’s presentation, I guess, was intended to move our profession forward. So, that’s what was thrilling about it.
But I wanted to say to you, before each speaker, three people introduced that speaker. The first person made a very nice comment and made everybody feel excited to be online and – I mean, it was just – you know, there weren’t jokes. But I mean you just felt great. Good energy! Second speaker, maybe for five minutes, spoke about India, the land of enlightenment. And they showed famous temples, and they told us its history, and – you know, in 450 A.D. or B.C., we did this, and we did that.’ And so, you’re starting to realize, you feel really small when you think about the incredible things that have happened over the eons of time and how civilizations grew, and humankind evolved. It was really impressive.
Kinda sounds a little bit like the Olympics, like you watch the sports, but they also really tell you about the country that’s holding the Olympics. And you end up, at the end of the Olympics, knowing a lot about the country, too.
Yeah. In fact, speaking of that, I had Phyllis grab her camera, because, to open up the Congress, starting with the alphabet A, you know, we see Australia going in, and Austria going in. And you finally get down to Z, but all of the countries and the flags are coming by, and it really does fell kind of like an Olympics, maybe.
What was your lecture on?
On the management of removing broken instrument segments, both surgically and non-surgically.
And so, all of the lectures were prerecorded, and then, you had the live Q and A?
Well, Isaac, I affectionally call him “the shooter”, but I’m supposed to say “the photographer” --
Or “cameraman”. [laughs]
-- your – cameraman, your son, the genius one, we shot it right here. I mean, they don’t know this, but there’s three sets. This is just one set that you see quite a bit. There’s another teaching set, where I usually give a little educational clip. And then, we have another set. So Isaac shot my IFEA lecture right here. It was prerecorded, like you said. It was sent over to them, and then, at the end of every presentation, though, every speaker was in real time, live, and they got Q and A’s for 30 minutes.
Very cool. Well, it sounds like it was a lot of fun. I know that there was one thing that happened, that was a little more serious and controversial. But we’ll talk about that at the close of our show. So stay tuned for that. But is there anything else you wanted to say about it?
Well, I would say that to the colleagues, since the shows are taken down, I don’t know, maybe today or tomorrow – maybe it was the end of September. This is – Happy October!
Oh, yeah [laughs].
Yeah. We’re in the month of Halloween. You’re surprised I didn’t wear a pumpkin or something, right? Anyway, all the shows, I think, are gonna be libraritized, and I think for a small fee, you can go back and watch these shows. But you have a chance to watch 24 internationally renowned, respected people give their slant on everything from minimally invasive endodontics to growing pulps.
And all the lectures were in English? All of them?
The official language was English.
Okay. All right! Well, we have a great show for you today. So, we’re going to get started on it right now.
Though I gave my show in Hindi.
SEGMENT 1: Shieldont & Zoom with Micah Nuzum
Welcome to The Ruddle Show. I’m Lisette, and you can see my dad, Cliff Ruddle. And then, also, a special guest that’s joining us today, Dr. Micah Nuzum, which we will – who we’ll meet in just a moment. But first, I just want to say that you might remember from our last show that we discussed the World Health Organization, the WHO, extending its recommendation to postpone routine dental appointments, citing a risk of aerosol transmission. And then, we talked about several dental organizations that are opposed to this, and they say they’re totally committed to safety and have the appropriate PPE.
On that note, we have a guest, Dr. Micah Nuzum, who is an endodontist and an inventor of the Shieldont, and we’ll discuss that in a moment. But first, I just want to say, welcome to The Ruddle Show, and thank you for joining us today.
Absolutely! I appreciate the welcome and looking forward to it.
Dad, you actually found out – how did you find out about Dr. Micah Nuzum and the Shieldont?
Well, I was talking to one of the shortest endodontists in the world – that’s a joke, for all the viewers out there.
A dear friend that I’ve known for about 35 years, Julian Webber, and Julian Webber’s an endodontist in London, on Harley Street. And he contacted me and said, “You know, you’re doin’ these shows, and I’m really enjoying watching them. And we’re getting a pretty good UK audience.” And he said, “I think you need to have a guy on named Micah Nuzum.” And I said, ‘Well, tell me a little bit about him. I should know him. He’s an endodontist in the United States.’ And he said, “Yeah. He’s in Ohio.”
So, he told me a little bit more about it, and I contacted Micah, and we had a really – he’s a really great guy. And that was our first introduction that I’m aware of. And we’re just delighted to have you here. And you’ve done some really neat things and really, something that is a gamechanger. And it’s going to give people a lot of confidence. It’s going to help ‘em feel better. I think we’re going to flesh some of those things out during this discussion. But thanks for coming here.
Hey, thank you so much for having me.
So, we want to hear all about the Shieldont. But first, can you just tell us a little bit about yourself, like where you practice? I think my dad just said Ohio, but just tell us a little bit about what you do.
Well, everybody knows Ohio, because it’s cow country, right? That’s what everybody thinks. I [laughs] – it’s what I always hear. I am actually born and raised, I was – in Columbus, Ohio. So right in the backyard of Ohio State University, or THE [with emphasis] Ohio State University, as they like to refer to it [laughs]. So, yep. Grew up right there. Son of a NFL lineman and – who ended up turning to – in probably ’74 through ’80 was in the League, and then, jumped into the mid-80s, he went into the pastorship.
So, he’s been changing his game from beating up people on Sunday to saving ‘em on Sunday. And my [laughs] – my mom was a registered nurse, and she ended up staying home, once kids came around, and practiced a little bit before that. But great family. Now, I’m married. Just hit my 20th year anniversary. Was supposed to be over visiting Dr. Webber in London, but that got shut down.
So [laughs], COVID happened, and I couldn’t make the flight anymore. So, big plans for 20 years, but my wife and I are happily safe at home, I guess, if that’s the way we wanna look like it. We didn’t do much except have Taco Bell. I don’t know. [laughs]
So, five kids, crazy. Life is crazy. And even speaking of today, I was getting ready for this at my house, and unpredictable things happen. And I had the house set up, and the power went out. You know? It’s just 2020, all around. So –
Well, Micah, they don’t measure --
Well, we have a lot of power outages here.
-- they don’t measure people by what they do when things go well. We measure people by –
-- how they do when things go poorly. So, way to recover. Nice recovery!
So, why don’t you tell us about the Shieldont. Like what is it, exactly? How – and how did you even think of it?
Hey, great question! For what it is, it is a microscope shield that essentially is taking the protection that a face shield would provide but designed to place it on the microscope, without disassembly. It can slide directly onto all major brands. We’re working with a lot of the companies and their engineering departments and users to individualize it or customize it for that microscope and adapters. But essentially, it ends up protecting me, the operator, as an endodontist, as well as – or practicing, as well as just the patients out there that are underneath the microscope. We’re protecting each other, in part.
But it’s – it blocks operative splatter or that splash-back from the [laughs] – if you wanna look at it from an irreversible pulpitis, lower molar that’s gonna come up and change your life real quick, when you – when your assistant sprays it with the air-water syringe. So, this – the shield essentially blocks us from that, enjoying a little bit more freedom and peace of mind behind the microscope, that I never had before.
So, when you’re using it – I’m sorry, Dad. Go ahead.
No, that’s just interesting, because I think you were telling me, before we went on live, that you were trying the goggles and different things. And I hear from all over the country, people are just talking about the distortion and how clumsy that was. So, you’ve really –
-- give people not only the ergonomics, but you’ve given ‘em the benefit of the microscope vision.
Yeah. I mean, what it took – what it stole from me, with COVID, was trying to add glass in front of the glass in front of the glass of the binocular. My eyes were getting strained. Proper eye relief is huge for both eye health and function, behind the microscope. That was distorted so greatly that – let alone fogging [laughs]. So, you start wearing double masks, and all of a sudden, wow! There you got – you can’t breathe. You’re starting to sweat, with those goggles on. And then they fog up. And now, you’ve lost all the purpose of why you have a microscope, in the first place, to be able to see. So --
What – what is – so, when you’re behind the shield, do you – so, you’re not wearing goggles now. But I assume you’re still wearing masks?
-- yeah. I’d love to --
-- not wear the N-95, but it’s still a protocol. Again, I don’t – I don’t feel that anything less than the N-95 is really protecting us from aerosols. We’re still trying to figure out the science on COVID. But I know I have protection from what’s being splattered out of the mouth now.
And what about fogging? Do you fog up behind the shield? Because we all saw the Kansas City Chiefs Coach, the first week, just completely fogged, behind his shield [laughs].
Yeah. Well, that’s part – part of the issue is keeping it far enough away from you, the user, that – or the operator, so that it doesn’t get in the way. So, I don’t – no. No fogging at all. So that’s a benefit.
So, Micah --
So, how did you think of this? Oh, go ahead, Dad.
-- well, that was [laughs] – you and I are exactly [with emphasis] on the same page!
I’m going – I’ve invented a couple things in my life, and they’ve come to me in different ways.
A few! [laughs]
Well, you know, just – but one of ‘em I was fishing. But I was – so, I was very curious when Lisa and I got you scheduled, because you’re so busy, because I want the audience to know, he’s not just practicing and inventing. But he’s also at schools, and he’s installing and helping grad programs. But as an inventor, how did you think about this, and what were the circumstances that might’ve encouraged this? I think we’d find that interesting to hear.
Sure. Well, I mean, COVID happened. March 20th, my wife – I had planned a 40th birthday surprise party for her, and that got canceled, along with so many other plans. But I went – that was about – I remember that’s when all the kids came home. It was – that was when we were starting to change things. So, all of the AAE guidelines, ADA guidelines, man, it was email after email after email, tiresome, wearing. And so, from that side of things, I was asking the question, “Do – can I even stay open, first of all, as an endodontist?” And so, we did, though. We stayed open.
I have an associate that was – we both were willing to say, “Hey, we’ll take the time. We’ll be one of those few offices that are willing to staying open during COVID”, not exactly knowing what that would entail. Give it a few weeks, working hard, using an N-95, I bought my staff face shields. I bought all the regulatory gowns to throw away. We were just using our inventory, because you couldn’t get much, anymore. So, start using it, try to reuse stuff that was applicable to be used.
And I got sick, to be honest. Yeah. I got the high fever, you know, we were already scanning ourselves to make sure we were healthy. But I was actually – it was a – I think it was a Wednesday. I was working at the house, because all the kids were home, now. Everybody’s bored. But I was working on – let it be a chicken coop. I know – there, I just – I just made it seem like we’re back in Ohio, right? I bought my kids chickens [laughs], because they were going nuts for my wife, homeschooling all five of ‘em at that point. So [laughs] – so, I’m workin’ on the chicken coop that morning, and I just like, “I don’t feel good. I can’t hardly breathe, and I’ve got this – I’ve got” – and I was like, “Ooh!”
And it wasn’t – it was pretty cool out. This was March, April, so it was pretty cool, normally, in Ohio, at that time. And I knew I had the fever, and so, next step was quarantine. I had to quarantine myself, because I had all the classic signs and symptoms of COVID. I remember my wife saying, “Do you wanna walk with me?” I’m like, “No, I can’t even walk!” So [laughs], I was worn out. That is when I really had to double back and look at, “What are my – What am I doin’ different?” What’s – I’m an endodontist. I use a microscope. I’ve been tryin’ all these things.’
But I knew I couldn’t always be protected behind the microscope, because I tend to sit back or relax a little bit, from the binoculars. And that’s when it was like, “Hey! My staff have face shields. None of them have gotten sick.” And by God’s grace, none of them have, throughout this whole thing, which has been awesome. So, we haven’t had anybody else get sick. I was the lucky one. But [laughs] – I’m giving – when I – I’m giving credit to the Lord, because I just thought, I went home and I was – I was thinkin’gabout, “Well, how can I wear a face shield?” And I said, “I don’t wanna wear a face shield.” [laughs]
And that’s where the idea of putting it on the microscope came from. It was kinda like God saying, “Take the burden off of you, put it on the microscope. It’s already there. It’s already functioning in that space for you. Just add it.” So, that was the – that’s where the Shieldont came from. Worked out of my garage for a long time. You probably understand that. You’ve said like, “Fishing”. You know, that’s – I was doin’ chickens. You were fishing, you know? [laughs] So –
It’s interesting that somehow, when you step outside the office, and you just step away, then you can kind of – like my dad has talked – last show, on – about – or maybe two shows ago about documentation when he’s out of the office, looking back at his cases and stuff. He’s come up with some great ideas of how he could do things differently. So, like, once you’re out of the office, it seems to be, you kinda get a little more open to ideas coming in.
-- yeah! Yeah. It was a beautiful thing. I mean, I literally – I literally took tar paper, which is used underneath shingles. And I’m like, “I’m gonna cut a pattern out of this and see if this can form around me.” And cut a hole in it, make it work, and then, I – then, the next thing was, “You know what? That’s – that doesn’t work, because you can’t see through it.” I knew that.
But it was just, I needed a rough pattern, which is what you do in any kind of engineering. You make that – you make that first – that first pattern, and then, you go from there. Then, went to the local glass company, said, “Cut me some – cut me some plastic. I don’t care.” They found a scrap, sent me home with it. Stuck it on the microscope, started taking a Sharpie and designing it, how it would fit. Tried a bunch of different ways, and that’s where it came from.
And this is where the bioengineering guy, maybe a family member, but he was good in ergonomics and bioengineering?
Yes. Brilliant – brilliant prof, up at University of Michigan, twin brother of my brother-in-law, great friend, great family guy. He’s worked with Google X and some of the other big companies in designing prosthetics for amputees from the military; really cool stuff. But I thought, “You know, I know – I know Elliott’s gone through this design phase. I’m not – I’m not an engineer, and I know I need to get this in a CAD DXF file of some form, so that we can actually make it – make it for more than just myself.” So, he really jumped in.
Is this Dr. Elliott Rouse? Dr. Elliott Rouse?
His name is Dr. Elliott Rouse? Okay.
And he’s at the University of Michigan?
Yeah. We don’t – we don’t like to say that – “The school up north”, is what we call it down here in Ohio.
[laughs] It sounds like we’re in --
So, how --
-- football country.
Yeah [laughs]. A little bit.
For our international guests, in the United States, maybe like your football, soccer, is in Latin America, in Italy, and across the world, it’s maybe a – kind of like a religion. So, there’s a lot of rivalries in some of those – like – he’s like Pittsburgh, he’s got Cleveland, and he’s in this little town of Wooten?
Wooster! And you’re kind of –
-- in between Cleveland and Pittsburgh. So anyway, think football country.
Yep. Yep. About 20 --
-- so, you --
-- about a half hour from here is the Football Hall of Fame. So, Canton, Ohio.
Yep. Yep. So, it’s where it all started, back in the early days. So, yep.
-- okay. Well, so, back to the Shieldont [laughs].
So, you’re actually doing everything yourself, right? You don’t have a distributor as this point? You’re actually like – are – you’re shipping them? You’re doing everything, right?
Yes. Yes. It’s a fun process.
And how is that?
I thought, you know, it was simple to be a – an ideas guy. I’ve always kept a little journal beside my bed, and my wife is – I don’t know how many times I’ve woken up with – at night, say, “Hey – hey, honey! I got it!” She [laughs] – “I got an idea!” So, I – instead of just forgetting about it, I write ‘em down. But it was – you know, the idea side of things is maybe simple. To go from an idea where it just works for me, maybe a step further, maybe not simple, but prototyping is unique in itself.
But to go from prototyping to production is a whole, long [with emphasis] and grueling process, really. But when – when I got the opportunity, I was just – I was just excited. And that’s what – from – like you said, Lisa, the starting point, sourcing, manufacturing, distributing, it’s happening in-house, yes [laughs]. So – so, it’s –
I won’t even ask you about regulatory.
-- yeah. Don’t ask me about regulatory. All the fun –
[crosstalk[ very painful! [laughs].
-- yes. Yeah. Just getting it right, making sure your products of choice, what you’re recommending, how it’s designed is safe and useful and following guidelines.
And you have five employees there, that are handling it? Your wife, and then, four --
-- five kids and your wife? Six employees? [laughs]
Yeah. Six – six, full-time. Yeah. Six, full-time. I mean, we’re not worried about – we’re not too worried about those – those child – I think there’s some – like, if they’re your own children, they can work for you. So, I’m pretty sure that [laughs] – I should ask – I should ask you, Cliff. How’s that work, when you start out?
What kind of – what kind of feedback have you gotten from the marketplace about it?
Oh, great. You know, I just got back from Detroit Mercy Residency Program, and I – literally about 1:00. I was just – I was gonna pick – grab the email. But the Department Chair, Dr. P., up there, was so grateful for us to come in and provide those shields for their residents. When I got there, they had taken some sort of – I mean, sheet of paper like this, that’s plastic, clear, and had popped a couple holes and put it on the binoculars, just something to protect their residents. So, I was just – the – they were so, so thankful. And I guess I – I didn’t anticipate the thanks of something like this. I was hoping that it would bless other people and starting to see that that is a happening is fulfilling.
So – but yeah. One of my first users out of California, he was in his later stages of practice, and he said, “I – I was gonna just – I was gonna throw in the towel, quit. I did not want to go back.” And then, he saw my shield design on the “AAE Connection” forum back in May. I think it was the first week in May, when I just shared that design prototype. And he reached out to me, and he was like, “If there’s any way you can help me, I’m all in.” So, just exciting to keep people in practice, you know, that, hey! This is – this is something that could change somebody from closing their doors, to staying open.
Micah, you’re so right, because I talk to a lot of people on a daily basis that practice endodontics around the world, and you won’t believe how many people younger than me that are deciding risk versus benefit, where they are in their careers, and a lot of ‘em are just saying, “Bye-bye.”
So, one reason you’re on the show is because we know some of the best years of practice can be even at my age. So, if you have your health, and you can practice comfortably and breathe well and see well, it’s still fun. And there’s a lot of great –
-- dentists and endodontists out there, that can continue to serve the patients. So, I want everybody to know about that, and I want them to also know that when I’m in Europe it’s Leica. We see a lot of Leica scopes in the demos, and over in the United States, it’s Global and Zeiss. And you’re in Germany, it’s Zeiss. So, I want the audience –
-- to know that you have a shield that goes on various scopes. And I think we’ll be able to see those. And when you go to clean those, between visits, I’m wondering, do we have to worry about scratches or some degradation of the surface?
Well, any plastic will break down with time. We know that using different material properties – we’re using – there’s – we’re basically choosing to use a certain type of plastic that will clean well, but – yes. You can’t use – I mean, a strong bleach on this will cloud this and fog this, just like any acrylic or plastic. So, what we start with is just the appropriate dental disinfectant, whether it’s like a wipe or – or if you – a lot of people use different – I mean, it’s different per state and different per country.
But at – the appropriate disinfectant is okay to use. But at – they will leave a residue. So, we use – we recommend using it with a soft 2-by-2 or 4-by-4 cotton, as you then – once you spray it on, and then, you wipe it down. And then, you let it dry, doing your spray, wipe, spray. Your last thing you wanna use is like the 70 percent alcohol, which will clean that off nicely, and defog the glass, essentially.
So, if someone is interested in purchasing one of these, what – how do they go about it?
Pretty simple. Just get on our website, www.shieldont.com, shield, O-N-T, dot com. And you can – right now, there’s definitely some savings and discounts. We’ve had a code up there for AAE members, but we’re also gonna extend that to The Ruddle Show viewers. So, yeah.
The Ruddle Show viewers are big-bucks people. They have lots of money. So, I think they get twice --
-- they get twice the fee.
Yeah. Double it. Double or nothin’, you know?
Well, thank you for joining us.
What’s the – I wanted to ask one last question, from my side --
-- that I’m interested in. How many microscope users – don’t answer. But we gotta think of how many CBCT users do we have? How many microscope users? So, Ruddle to Micah, my newfound friend, there’s a huge [with emphasis] market called general dentistry. And I don’t know how you do this, but maybe be thinkin’ at night, sweating and everything [laughs] --
-- maybe think how you could bring an idea like this to the big market, because they would be – they would oh, so benefit from it. I hear stories about the general dentists, just like the endodontists. You’re giving the endodontists some freedom. Maybe think about if you could give that same kind of an idea, how you would bring it in there. I don’t know how it’d be suspended, blah, blah, blah. But you would.
Yeah. Yeah. Well, thank you for that. I – I’m – I enjoy thinking through the care and protection of my colleagues, and I do feel like it’s an opportunity to really reach them individually plus reach the – whether it’d be the residents or students. Yeah. So, thank you.
Well, thank you so much for joining us. And definitely, there is a need for this right now. So we’re grateful to you for thinking about it, thinking of the idea. But then, going all – taking all those other steps to actually make it available to everyone. So, thank you very much for joining us.
Oh, it’s been my pleasure. Great to have this time with you both. Thanks.
SEGMENT 2: Choosing a Dental School/Practice Location
[Music playing] So, we often get email requests for your opinion on what are the best graduate programs to do a residency? Or what are the best dental schools? And then, additionally, we also get people wanting your opinion, graduating residents, of where they should set up a practice, once they graduate. So, people want your opinion on where to live, learn, and work. So, how did you choose – you went to the Harvard School of Dental Medicine. How did you choose that?
When I was at my last year at the University of the Pacific in San Francisco, I was really very passionate and enthusiastic about endodontics, so I was very interested in pursuing it as a specialty area. And of course, I talked to some faculty people there. The guy that stands out the most is Ron Borer, and he said, “Cliff, go east. Go east. You’ll get a different philosophy, you’ll get exposed to different people, you’ll be thinking different, and you’ll put it into the UOP experience. And put it all together”, he said, “You’ll be a more enriched person.”
So I assume that he was a trusted individual for you and that you respected him, because you did take his recommendation. And also, Harvard is pretty a prestigious school. You applied to four schools?
I did apply to four schools.
And you got into all four of them?
So then what made you choose Harvard versus the other three?
Well, having interviewed at all four schools, when I got to Harvard, what seemed different is not – it wasn’t so much dogma. It was kinda like, “You’re gonna learn the Schilder technique, because everybody on our staff basically is BU trained. So, if that’s a concern, check! You’ll be able to down-pack and back-pack and move that warm gutta-percha around and develop hydraulics and fill in the root canal systems. But you gotta learn to shape, too!” So, I felt, at the end of the day, I was going to learn everything that I would’ve otherwise learned.
As an example, Boston University loved Schilder. Didn’t know him really then, but knew he was a big name. But I chose Harvard, because it was family. There was a lot of opportunities in research, and I just liked the whole feel of it.
And when you say “family”, you don’t literally mean family. You mean that it made – you felt like you were part of a big family, there?
Yeah. It was a really international family. Paul Gron was from Scandinavia. He ran all the research. Z. Skobe, you know, he was a big SEM guy in the United States, outside of dentistry. And these names were people we could work with, we could learn from, when we did our research. So, I just thought it was a great opportunity. Phyllis liked it. So we usually make our decisions together, and it seemed better than Temple or Penn or Boston University. Seemed like Harvard.
Okay. Then once you graduated, I know a lot of graduating residents actually stay in the same city that they did their program at and set up a practice there. What made you decide to go back across the United States, to Santa Barbara, California?
Well, the simple answer is, I thought I was going home [laughs]. I was from California. I wasn’t born in California, but I’ve lived in California for, I don’t know, 25 years. And so, we just thought, naturally, we’ll be going back to where we came from, and we came from the Bay Area. And when I say the “Bay Area” to you, you know what it means, but it means San Francisco on the peninsula, Oakland. It means San Jose on the south, Berkeley, and then, Marin County, over the Golden Gate Bridge. So, I just thought, “In that area, there’s a lot of people, there’s a lot of general practitioners. And of course, we have a referral-driven practice, so I need to be where there’s lots of general dentists.”
Okay. Now, why didn’t you go back to the San Francisco area?
Well, this is sounding like the Spanish Inquisition, but anyway.
No, it’s fun. I hope it’s fun.
Well, I know the answer to the question is important, so that’s why I’m asking you [laughs].
You know, when you’re young, you don’t have as much confidence, and you do what people tell you. At least I was doing more of what I was told or advised. So, it seemed like everybody I called to get on as an associateship, that would lead to a partnership, I called, I don’t know, 15 to 20 offices in the greater Bay Area. And everybody said, “You know, if you would’ve called us a couple years ago, we were lookin’ for somebody just like you. But today, we have associates, and we’re not as busy as we’d like to be”, because, you know, the economy’s always going through its cycles.
So, they said, “You’d have to come on your own, and we wouldn’t recommend that, because, you know, it might take you 5 to 10 years to actually make it.” So, I listened to that. I believed everything I heard. And I thought, “Well, I like ocean. I like coast. I like California, the weather. What else do we have? Where would it be?” And that led us to Santa Barbara.
And also, I’ve heard you say that in the time you went to Harvard, when you got back, that the number of endodontists in the general area had like doubled.
It had almost tripled. Yeah.
Okay. So, there’s obviously maybe not as many opportunities, if there’s a lot of --
-- endodontists. So then you chose Santa Barbara. And I know that you kind of just came across an opportunity. And explain how that worked out.
Well, as I said, you know, when you’re a resident, you’re back in Boston, you’re doing research, you’re tryin’ to finish all your clinical activities. There’s all of these things you’re winding up. And then, you have to defend your thesis. But then, you know, you have to find a place to live. So I believe I called the only endodontist, Ed Hocks, and I said, “Would you be interested in a kid, and take me on as an associate?” And he – I’ll never forget. He said, “I work alone!”
I said, “Oh, okay.” But he said – but – he said, “I’ll support you. And if you come to the community”, he said, “I’ll help you, but I work alone.” So, we found this ad in the paper, this building was looking for a dentist. They had 20 multidisciplinary dentists, largely general dentists, but they had all of the specialties. They lacked an endodontist. So, they had an opportunity. So I would say it was serendipity, where good things happen by accident.
It wasn’t a plan. It wasn’t a big deal. I had never been to Santa Barbara. In fact, my high school roommate in Academy, we were ballplayers, and so, we really were good friends. And he hung out in Santa Barbara a lot. So, I have great memories through high school. “Cliff, there’s a beach town. It’s called Santa Barbara. You gotta get there! Sailing! Surfing! Cliff, you gotta get to Santa Barbara someday!” So, I went after all my education.
So, just – I just want the audience to be clear that it’s not like he was just sitting back after he graduated, and this opportunity fell in your lap. You were actually doing a lot of legwork and talking to people and getting as – gathering as much information as you could. So, let’s now look at – that was great, your experience. But if we’re now talking to just dentists and endodontists or who’s ever looking for a new place to live or going to a certain graduate program, suppose you don’t have the – really good grades. Say you’re a – just got out of dental school. Your grades aren’t that good, and you – so, you don’t think you’re gonna really get into the program you wanna get into. What do you suggest?
Well, you have several choices, of course. You could go into another dental office and be an associate. You can join a dental service organization that’s – if you can find one, it’s very respectful, like Heartland. What a lot of kids do, though, is, I wrote here, they go to these advanced endodontics and general dentistry programs, AEGD. And these are intense, one-year programs. And what’s so neat for a kid, you don’t have to buy in. You have your own operatory. You get an assistant. Somebody at the front does the insurance, all the business stuff, the mailings, and all that. And you basically just get to go practice multidisciplinary dentistry. That’s the AEGD’s model, is clinical dentistry.
The other one is a GPR. So, you can go to more like a university and continue post-dental school, your training, as you’re waiting to get into endo school. GPR is Graduate Program Residencies, and they’re more focused on medical management. So, you have compromised patients, old patients. The VA used to have wonderful programs, the Veteran Administration, and of course, the veterans from some of the wars now are pretty old. So, you have a lot of compromised people. So those are great problems to tie medicine and dentistry together.
But in doing this, you put your applications back out, and now, you’re showing some good work, and you have a body of work now, after dental school, to maybe mask or cover up or have them look a little past just your grades from the past.
Yeah. I would think that that would really bump you up – your application up, if you were trying to get into a school. Now, say that you don’t wanna do that, and you just want to go to a school that will accept you, even though your grades aren’t the greatest. Maybe it’s – you get into not the prestigious school. So, then, is that going to affect your career, after you graduate? Is it going to make – is it gonna cause difficulties for you, down the line, is what I’m saying, if you go to --
Not at all.
-- the – not the best school?
No. I mean, we have people all over the world, in all different kinds of sports, attorneys, physicians, who didn’t go to the Yales, the Harvards, the Oxfords, the – you know, these prestigious programs. Because as you know, yourself, you went to a great school, and you were Summa Cum Laude, but that was because of you [with emphasis]. Okay? It wasn’t because your professors came over at night and helped you get the exams right.
So, I always tell people, “If your passion is to go to post-grad endo school, just get in!” That is – nothing happens, unless you get in! If the door’s open, kick it down! And once you go there, and get in, you’ll know where your deficiencies are. You talk to other residents in other schools, with the way the world’s interconnected with Zoom and Facebook and all this. Residency programs are available that help get these kids excited. So, there’s lots of ways to get in, and if you get in, you’ll know your deficiencies. You’ll do those things you need to do, to overcome those, and you can go to a really mediocre school, and you can be a world-class endodontist. You can be a master clinician.
Yes, I imagine, too, with the world as it is now, with all of the online information and online learning you can do, that you’re not just restricted from getting all of your information from the university that you’re training at. Like, you can get lots of different perspectives and philosophies and choose what’s best for you, I think.
That’s probably one of the biggest points you’ve made, because when I went through, in the ‘70s, there was no online stuff. So, what you said is very powerful for the young dentists. I mean, you can take a class in London from Julian Webber, tonight. You can have David Landwehr. You can learn from him. You can go to John West. You can do all this stuff. You can go Google stuff. You can read articles online. So the opportunities to close the gap between what’s possible and where you are has never been better.
Okay. So, if we look at some of the factors, I think we’ve maybe briefly touched on looking for a desirable location for – maybe go to school in an area where you want to live. Maybe it’s a reputable program. Maybe there’s some staff there that you want to train that, that you’ve heard about. And like you, you didn’t go to BU, Boston University. Herb Schilder was there, but then, you found out that Al Krakow at Harvard had actually trained with him, right? So, you were still getting a very similar philosophy?
Al Krakow was Herb Schilder’s second student. So, that was in 1960, ’61. So, yeah. He was baptized Schilderian.
And then, I also heard you say that just the friendly environment. So, once you get into a school, and you go and visit there, you can see, right away, whether or not you might fit in.
Yeah. Because when I was there, I got to meet the Dean of Medicine. Phyllis and I had dinner with him. That was in dental school. We got to meet this guy I told you, Z. Skobe, the SEM guy. We got to meet Paul Gron. And I don’t mean just say, “Hi”. We went into their offices and visited for two or three hours, and you talk about all kinds of things. You didn’t even know why you were in there, and you were worried [laughs].
And you met the other residents as well, correct?
Well, then, they wanted me to go to the clinic floor, just kind of walk around. Put a smock on me and had me walk around, and they introduced me to all the residents, when they came out. And then, they all knew who Cliff Ruddle was. And so, I just kind of went around and watched all day. I didn’t say hardly anything. I just listened and watched.
And then, I imagine probably cost is a factor that --
-- [laughs] could affect some people, maybe.
Cost is a factor. I’ll come back and play off you. Talked about weather, but we even know kids that came from the Caribbean, okay? And they’d go to Nebraska or Minnesota [laughs] for graduate school [laughs], where it gets minus [laughs] – minus 20 degrees Fahrenheit. So, you got this guy in his shorts and his flip-flops, you know, and he’s freezing to death. So I mean, you do what you have to do.
Okay. So, there’s – and then, now, choosing – okay. So now you’ve graduated, and you’re choosing a place to practice. I think we said, some people just stay in the same city as their school. Some people move back to where their family is. Obviously, those are considerations. I – what are some other considerations?
Well, single people seem to have more choices. I knew a lot of single guys and a few ladies that took off, got on a plane and went to another country and practiced endodontics. I mean, one of my classmates at Harvard went to Saudi Arabia, and he did two or three years in the oil business. But he was the endodontist on the base. So I mean you can get a lot of experience and then have weekend junkets, where you’re traveling everywhere and seeing things.
So, I would say, that’s a big consideration. If you’re married, if you’re just you and your wife, then, you have quite a bit of flexibility. It’s when you start to have children that you have to start thinking about the things you mentioned, like schools and, you know, how are they gonna go --
Your wife’s family, your family.
-- maybe all those things, sure.
I do think that that’s a kind of an interesting thing. If you’re single and maybe you want to travel, you – there’s like – you could even be a clinician in the military. Like you could maybe --
-- set up your practice almost anywhere. Like you said, some of the other opportunities of going to other countries.
As an example, we have many, many department chairmans of post-doctoral endodontics who spent a whole career in the military. You know, they get out – I’m making this up. I’m not a military person. But maybe they’re 45 or 50, and they got a full retirement. They, a lot of times, become department chairmans. So, you know, they’ve traveled, they’ve seen the world. They’ve done a lot of interesting things. So, you learn a lot from people.
And then I think I’ve also heard you say that really, location – like, where you want to live is pretty important. Like – what do you want – what environment do you want around you? Do you want to be in a big city? Do you want to be more in the country? Do you want to be on the coast? I mean, I think that you’ll be happiest – or like if it was Mom, it has to have four seasons there. You know, like four separate seasons [laughs], just – so, I mean, I guess that that’s – weather, location --
-- family --
-- right. And like you said, you – maybe you don’t want to go set up a practice in a town that already has way too many endodontists, as it is. Like --
You know, another thing we should emphasize is, do you work to live, or do you live to work? That’s a pretty philosophical thing, but think about it. Guys that practice in Alaska, they live up there to fish and hunt. It’s all about fishing and hunting. That’s why you live there in the winter, when it’s two or three hours of daylight. In the summer, the sun never sets. But you’re living to be in that environment, see? So, all these are factors that – and you have so much choice. That’s what’s so cool. You have so much freedom to do all these different things. Isn’t it wonderful?
-- yeah. It is. I guess you’ve given us a lot of issues to consider. And I – I imagine probably it just depends on what your priorities are. Like for me, I just like to live by the coast, because I like to be able to see the ocean. I mean, you can tell, I probably don’t go to the beach a lot, but – but I like to be able to see the ocean, and I like to see that expansive sea.
Well, I know you were permanently on your paddleboard in Hawaii.
We had to use a whistle to get you in. Yeah. I mean, I think, for me, my closing comment could be, if it’s okay, just to say something from a famous U.S. President. He was the 26th President, Theodore Roosevelt. We called him “Teddy”. But Teddy said – Theodore Roosevelt, “Do what you can.” Think about that. “Do what you can, with what you got, where you are.”
Well, you know what? I like that quote, and I have one more that I --
What do you got?
-- I want to say. And this is an unknown person. “If you don’t like where you live, move. You’re not a tree.”
So [laughs], I mean, it’s not like it has to be a permanent decision forever. If you try something out, and it doesn’t work, there are options.
Yeah. Maybe I’ll say this, then, in closing, to play off of you. John Stropko, we called him a Gypsy. John Stropko has moved all over, everywhere, to practice, because he’s not a tree! [laughs]
[laughs] Okay. Well, thank you for that information. [Music playing]
CLOSE: IFEA Closeout - Case Misrepresentation
So I had mentioned in the opener that we would be returning to the IFEA meeting, because of something troubling that happened there. And it involves a misrepresentation of one of your cases by Dr. Ove Peters, and the title of his presentation was “Evolution of Root Canal Treatment: TruNatomy, a Restorative-Driven Path to Endodontic Excellence”. So, I will just step aside and let you explain the situation.
Thanks. Okay. Listen. I’m here to encourage everybody to be the best they can be. You don’t have to be on my side. You don’t even have to have the same philosophy as me. No problem! We want to be like a rising ship that raises all – rising tide that raises all ships. So, the thing that bothered me is, I watched a lot of the presentations, and they were joyful, and they were fun, and of course, you always learn something. But what I wanted to bring about is a case that had been taken from me and shown, and that’s fine. I guess people can do that without permission. But here’s the case that was actually shown.
I showed you the pre-op so you could see the adjacent teeth and get a sense for the quadrant. But particularly, we’re looking at this maxillary bicuspid. You can see, the pulp chamber has receded below the crest of bone. You can see, there’s recurrent caries. It’s had a crown prep, and we have a lot of curvature. And when you look at that bayonet-shaped apical one-third, you’re already thinking, “That could be a little bit of a challenge.” What I really didn’t like is, when Ove presented the case, he says, “The case is done beautifully.” There’s no doubt about it. That’s a quote. I copied exactly his text.
But he goes into great detail about, “We really have to look up here, in the body of the canal. And when we look up in this body, it’s really over-prepared!” And he went on to say that he would have grave concern [with emphasis] as a restorative dentist. He would have grave concern, even putting a single-unit crown on this tooth. Well, I’ve done thousands and thousands of teeth like that, and they’ve gone on to service the patient over decades of their lives. So, I would’ve preferred, if he’s going to show this case, and express all this grave concern, when he’s lecturing about TruNatomy, okay?
That’s a competing file system. It seems like it’s a little heavy handed. And of course, he’s comparing eras. This was done in the early 1980s. He’s showing his thinking, 2020. That’s only separated by 40 years or four decades! So, what he should’ve done, I think, to be really professional, because I’ve him for decades! I met him when he was a resident, at the University of Zurich, many, many years ago! “Cliff! I’m gonna show your case at IFEA! You said it was really a nice root canal! But did you have a follow-up x-ray?” He didn’t ask that. But I do have a follow-up x-ray, and that’s why I’m here today is to show you that endodontics, when it’s properly performed, and the restorative effort emphasizes occlusion, gnathology, work balance, get the ferrule effect! We’ve talked about that on other shows!
Apparently, some of these clinicians at IFEA think you can put little composites and glue and use your gun, and you can bond stuff! I’m talking about shoe the cusp and get a ferrule effect, and here we can go right to a 25-year-old recall. 25 years. That’s what was disappointing, to show this at IFEA and tell the world of dentists listening that it wasn’t restorable. He would have grave concern. Okay. I was going overlook that, and then, he does this.
This is the very next case. This is Cliff Ruddle’s pre-op! Okay? I didn’t do the root canal. It’s my pre-op. The patient wanted to save the tooth. This tooth was done by another endodontist. It got referred to my office because the patient really wanted to save their tooth. Obviously, they’d just gone through a procedure. Ove goes on and crushes it. He says, “We’re really overprepared! Massive [with emphasis] overpreparation!” Totally agree. He goes on to say that the apical thirds don’t look very optimal.
You know, we’re underprepared, we’re filled short, only got to length in one canal. I’m reading this distal root as coming around like this. So, short again. Underfilled and vertically underextended! So, what I want to do is say that this fracture isn’t even from occlusal loading. Listen, when you bite, and you put masticatory forces on these tables, these occlusal tables, you are putting hundreds of pounds of pounds per square inch of load, pounds per square inch. If you have fractures that come from mastication, they start coronally, and they work their way down the root. This didn’t even probe, pre-surgery. Okay? It didn’t probe.
And if you look carefully, you’ll notice the fracture is much more overt, deep in the root, and then, it gets fainter and fainter, and you can’t even see it, once you get about there. And then, if you put the gum back, it’s gonna be coming around like this! So, when we’re probing, two to three millimeters, and we’re down to the sulcus probing, we never have a pocket to fall into and get that narrow defect that we worry about. So, in closing, I would just want to say, he – I mean, I listened. It sounded like this was my root canal. It wasn’t. I don’t do this kind of endodontics, and I’ve never subscribed to it.
In closing, I think it would’ve been kind, again, if he would’ve said, “Well, what happened? What about the rest of the procedure?” What we did is, Ruddle hemisected the tooth. We took out the mesial root, and we put a little bridge in. We’re still going to have to cut a crown over here, a full veneer crown, on the anterior abutment. But we can keep off the second molar. So, that is my final view, where you have the restorative done. And it’s not about the endodontic seal. It’s about the rest of the seal. And as my friend Denny Southard says, “That’s the restorative effort.” Let’s restore our teeth. Let’s talk about that and not just talk about our endodontics.
So, hi. I’m back. This is a recall, also, of how many years?
Oh, this is 20-some years later. When – after we hemisected it and then, there was some provisionals, and then, the bridge work. And then, finally, this is a long-term follow-up. And the – you can see how it used to look. And so, when we retreated the distal root, we were able to pick up more anatomy.
Well, is -- what I get from this is, it sounds like Dr. Peters really underestimated the amount of documentation you do. So – and we just talked about that on our last show, the importance of documentation. I guess, in this case, it helps if you even need to ever defend yourself. [laughs]
Well, I like to document, because I teach. And of course, I like to show recalls. It was fun 35, 40 years ago, to show 10-year recalls, 20-year recalls. But it’s fun now to start showing we’re even breaking into some of the 40-year recalls. So, yeah. You gotta follow these up. That’s how you learn. That’s how you decide how big to make your shapes, how small. This whole minimally invasive thing, that was his whole message, is minimally invasive is to maximize your main tooth structure. We both agree with that message.
Well, thank you for presenting that. See you next time on The Ruddle Show.
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The content presented in this show is made available in an effort to share opinions and information. Note the opinions expressed by Dr. Cliff Ruddle are his opinions only and are based on over 40 years of endodontic practice and product development, direct personal observation, fellow colleague reports, and/or information gathered from online sources. Any opinions expressed by the hosts and/or guests reflect their opinions and are not necessarily the views of The Ruddle Show. While we have taken every precaution to ensure that the content of this material is both current and accurate, errors can occur. The Ruddle Show, Advanced Endodontics, and its hosts/guests assume no responsibility or liability for any errors or omissions. Any reproduction of show content is strictly forbidden.