Dr. Kim is a specialist in the fields of periodontics (gum disease) and dental implants. Dr. Kim's practice works closely with your family dentist (general dentist) to maintain the health of your teeth and to replace them immaculately, once they are lost. Trained at University of Sydney (down under!) and at UCLA Medical Center, he is a dual board-certified specialist. He maintains a teaching position at UCLA School of dentistry as a lecturer. When not seeing patients, he lectures and writes on cutting edge (no pun intended) surgical techniques. To date, he has lectured in over 16 countries internationally, at various conferences, and at universities. He is a father to 3 adorable boys, and they enjoy boy scout activities in Fullerton.
You don't want to miss this!
Video transcription:
Liz Lundry, RDH - “Hi. Welcome to the StellaLife Innovator Series. I'm Liz Lundry, the clinical education manager for StellaLife and today we're going to be presenting Dr. Jin Kim. Dr. Kim is a true innovator with periodontal practice in Diamond Bar, California. He's been a lecturer and clinical professor at various universities such as UCLA and the University of Sydney, and he's active in many organizations including the North American Society of Periodontist, or NASP. And Dr. Kim is the founder of the Global Dental Implant Academy, or GDIA. They provide live surgical courses, including implant placement, soft tissue surgery, restorative courses, and more. He's going to be offering the GDIA Life Surgery Continuum in Southern California starting this November and today he is going to be talking to us about guided post surgical healing. We're so happy to present Dr. Jin Kim.”
Dr. Jin Kim - “I'm Doctor Jin Kim. I'm a periodontist practicing in Southern California. The most important thing of all the list up there is the fact that I am one of the directors for the Seattle Study Club in Southern California. We are called the West Coast Study Club. I'm going to spend a few minutes with you talking about guided post surgical healing, what we can do to do better to our patients so we can avoid these kinds of disasters that we see from time to time. I'm not going to pinpoint chlorhexidine as one source, but this is, I believe, very closely linked to issues like this. See, if we do not use chlorhexidine, for instance, we are under the fear that we may be getting a post surgical infection of some sort. Here's a patient who presents two weeks after surgery. Did not take the denture out, did not brush his teeth, did all the normal activities, but did not use chlorhexidine, but there's no infection per se. In fact, that white material in the roof of the mouth is actually dead skin, basically. Epithelium that shreds and piles on top as a result of not brushing. But we don't see a sign of post surgical infection. In fact, would you like to pour some strong chemicals on a very delicate surgical wound like this immediately after surgery, in the first week or two and the cells really need to do their job to heal? So let's really think about that. chlorhexidine is a very popular chemical that we use for many different things. Unfortunately, chlorhexidine is a very effective chemical. It actually kills bugs very well. Unfortunately, it's a very effective chemical in that it kills everything that it comes into contact with, including the oral epithelial tissue that we want. So these are some of the uses for chlorhexidine. It's been used very widely in clinical dentistry for the past couple of decades. Chlorhexidine has this mechanism of use. Basically when it comes into contact with the cells, and it doesn't matter whether it's bacteria or your whole cell, they seem to attack the cell membrane to the point where the cell membrane bursts and that's a very simple mechanism as to how it works. Pucher and his group back in 93 did a very simple study where they looked at the effect of chlorhexidine in different concentrations and try to see what it did on human fibroblast. To cut to the chase, when we dilute chlorhexidine even about 60 fold from what is the normal therapy to use that we use from the bottle, it still killed a lot of fibroblast and this slide is very disturbing. Our main target is this, the bacterial pole that we tried to kill. And one must convince each other that there's so much bacteria that all of our surgery is going down the drain. But the truth of the matter is not that much of an issue. In modern day post surgical healing is quite uneventful. So why are we throwing very strong chemicals? So let's look at some of the other effects, like the cytotoxicity. And it's very clear when chlorhexidine is used, especially immediately post surgical, it tends to affect the fibroblasts and this particular paper shows that because fibroblasts are selectively killed off, the tensile strength of the wound, namely, when the incision line is pulled, it rips open much easier in the early phase of the healing. So these kinds of studies have been available, and this is actually my mentor, by Barry Kenney from UCLA. Their studies going back have shown time and time again that it affects other white cells and helpful cells that we really need in the healing process. Now here is a classification of how our implants tend to open up. It is a category of different types of exposure and many times when we encounter these kinds of unfortunate situations, most of the key opinion leaders tends to say, well, you either have to open it up earlier on, or you may have to just use something like chlorhexidine to quell down the possible infection. But what are we really doing? Are we really helping the cells, or are we really disturbing the wound and making things worse? I think we really need to relook at this particular topic. I think chlorhexidine can be used in the following four categories. So post surgical, as you realize by my bias here, I can say it's probably not the best thing. So do we have some alternative? And that is once you have an acute injury, we want the injured site to have as minimal amount of inflammation as possible, go through a lot of active fibroblast activity on other cells that come into the area and do their job, and together with good blood supply and nutrition supply that makes the wound heal well. Here's a good example. This is a typical type of surgery that I do on a daily basis that, frankly, is one of the most uncomfortable situations for the patient. It's what we call the Phrygians bone graft, what we normally also call expensive graft. It's where epithelial tissue is taken away from the roof of the mouth and in today's world, we use platelet rich fiber and a concentrated growth factor to serve as a wound dressing. Here, lots of things have been done in this patient. Implant was placed immediately. Gingival graft is done in the vestibule area, the facial surface. But let me show you. Here is some gel that we're putting on. It's actually a natural source. It is a commercially available gel called StellaLife. We tend to liberally put that on before the surgery and after the surgery, as a matter of fact. It comes in a gel form and liquid rinse form and this is a patient that we saw recently at an implant training program that I run in Tijuana, Mexico. So Maria Angelica just had the surgery finished. You can see the wound in the roof of the mouth as well as on the buckle surface of her lower right side. This natural medication was applied. It contains Anika and all kinds of goodies. And honestly, I'm not smart enough to even know what those ingredients are. All I know is that it actually helps the healing process as opposed to killing the cells that inadvertently we've been doing with chlorhexidine. This is a 24 hours post surgical image. To look at it side by side, you might say, "what's the big deal? It doesn't look any different" but here's the fact, many of these surgeries do become quite uncomfortable. Swelling edema is very naturally associated with injuries like this. And this is the roof of the mouth at 24 hours also. And here she is, the patient, Maria Angelica. Actually, I cut the audio down for this purpose, but she's actually telling us that the first 24 hours, which we expected to be quite rough, this was not only a brutal surgery, it was actually done by a trainee dentist who's not very proficient on this procedure. So you can imagine that surgery is a little more rougher than average. But despite that, at 24 hours, she is describing to me, to us that it was not a big deal. It didn't hurt very much and the gel truly did help. So I think there are alternatives like this on the market. I'm not going to go into the details of how to use it and so forth. I think you can visit the websites of these friendly people and get more information. But the three steps that they advocate is a systemic spray under the tongue that actually causes an environment of anti inflammation. We use it immediately before the surgery and immediately post-surgical. It is a natural ingredient so people can swallow it and it does not tend to interfere with healing. Here's my good friend Jason Stoner. Everybody knows Jason Stoner. He actually did a split mouth design study in his own patient, in his own office. One side was StellaLife, the other side was chlorhexidine. Exact same procedure, aloederm type of gingival graft, the outcome was pretty much the same in terms of clinical variability. However, in terms of patients pain, redeem, redness, you can be the judge as to what the differences can be. This is a slide from Dr. Thatch, an oral surgeon in the Chicago area, and he's done a pretty gross, significantly traumatic surgery, a cyst removal. And this is the one week post up and I can vouch for this because what I'm seeing since I've started to use this type of approach is that we're seeing like a three, four week healing in a typical one week, which is a much more accelerated response that people tend to see. This is a very common thing that we unfortunately do see from time and time again, exposure of graph material, exposure of thermal matrix material, which can very quickly turn into a disaster. And in this case, just simply using this product tends to rapidly quell down the inflammation and somehow get you out of trouble, namely secondary infections. This is another case where a mucositis lichen planus type of lesion is healed simply by application of this type of medication. In fact, my sister has a very severe autoimmune situation. Diffused inflammation, redness, eridema and so forth associated with pain, and she's been using the gel and rinse consistently, and she seems to be quite free of that. And there are many remedies, but this one seems to be very effective. Is chlorhexidine still valuable today in clinical dentistry? So again, this back to the slide where these are the four predominant areas that chlorhexidine can be used, but I'm going to be saying that post surgical use is probably not the most effective way of doing things. Then how about therapeutic use? A recent article in the JADA has sort of put a final nail to the coffin for the so-called therapy to use. You see, if you use adjunctive to scaling and roof planning or other non surgical therapy, look at the vast literature out there that's been collected, the data that's been collected in various institutions over the past several decades, and the benefit is truly marginal if that. So it's quite debatable and the experts are now pointing to the fact that maybe this isn't that helpful, no benefits. So in my practice, I do not. The reason why I don't is we see treating periodontal disease is hard enough. It is a behavioral change that we're trying to provoke onto our patients. It's hard enough to motivate them, to get them to understand the ideology, the cause, and get them to be responsible and take care of their home care in a meticulous way. And we give them half a dozen things to do. Why do you want to add another thing, like a mouth rinse, for instance, and many people may overestimate the effect of the medication and that might take away from their home efforts. So there's some psychology in there. So I tried to keep things as simple as possible. Floss, use anti proximal brushes, do whatever is necessary but let's not get them to rely on this magical potion. Therapeutic. It's very, very effective in the prodromal syndromes for apthous ulcers, for instance, so I use it for that. Surface disinfectant. You see, this is something we do every day. We have things coming in and out of patients mouths, cross contamination might be an issue and what do we use to surface disinfect things like this? That big jar on the right of the screen, which is glutaraldehyde. I don't want to see glutaraldehyde in my mouth or my patient's mouth. I don't mind using glutaraldehyde to surface wipe the floors, the chairs, and all sorts of things you want to do. But if it's something that's going to return to the patient's mouth, say, retraction, retractors or other instruments that go in and out of the patient's mouth, dental mirrors that we don't want to autoclip, then I think the better thing to use is actually chlorhexidine, because chlorhexidine is potent. It does kill germs effectively enough, so why not use something that can be put into your mouth when there's no active wound? So why don't you use it for that? So we have little spray bottles of these in each and every room. So when somebody takes an impression, for instance, I want them to use that everywhere before they take it out of the room. So I would rather chlorhexidine over cavicide. Pre-surgical rinses and wipes? Absolutely. Here's an example of how I use it. Every surgery, we actually have surgical drapes to keep the area clean. But that skin. You don't want any bacteria sitting in the skin because that sort of breaks sterility chain. So we wipe down the face, especially around the nose, the lips and ears, and wherever you might have physical contact, and then put the drape on. So when the drape is on there, everything in our surgical site is truly sterile. Interesting paper from USC, the Perry Department did a study where they looked at the bacterial content of exposed PTFE membranes and Interestingly enough, some of those samples contained skin flora. Why would you expect to find them? Hopefully from the operator's hands? Because if you are touching other things, patient's ears, nose, and whatnot the chances are you might have taken those bacteria into the surgical wound. So that is very important. So guided healing. Let's really give this a new thought and your perspective and let's see how other things that we're doing, taking for granted that we've been doing habitually, is it very wise or is it not? So let's rethink that and let's see if we can use chlorhexidine or not. Thank you for your kind attention and this is how you can get a hold of me if you do want to contact me.”
Liz Lundry, RDH - “Thank you. Dr. Kim, I've had the pleasure of attending several GDIA courses, and as a clinical instructor myself, I'm impressed by Dr. Kim's skills and his approach to teaching, providing one on one instruction and making everybody feel encouraged. We at StellaLife want to help you who get the best clinical results. We'd like to invite you to contact us for a complimentary trial of our guaranteed Vega oral care products that Dr. Kim uses. Stay well, stay safe and join us next time."