Laura is a registered dental hygienist with fourteen years of experience in a periodontal practice providing non-surgical periodontal therapy and periodontal maintenance. Laura believes in using the latest technologies to achieve the most predictable outcomes for her patients, and has used a periodontal endoscope from the start of her career in dentistry. A master trainer for OraVu’s DeVa dental endoscope, Laura also delivers educational presentations on the topic of visual scaling and root planing. Laura serves on the Arizona Dental Hygienists’ Association board as Treasurer and is a past president. She earned her hygiene degree from Phoenix College and has a BFA from Arizona State University.
VIDEO - DUwHF #1466 - Laura Corbin
AUDIO - DUwHF #1466 - Laura Corbin
Subscribe to Dentistry Uncensored on Apple Podcasts:
Subscribe to Dentistry Uncensored on Google Podcasts:
It's just a huge honor for me today to be podcast interviewing one of my neighbors right here in phoenix Laura Corbin RDH that stands for registered dental hygienist with an associate of applied science and a bachelor of fine arts she is a registered dental hygienist with 14 years experience in a periodontal practice providing non-surgical periodontal therapy and periodontal maintenance Laura believes in using the latest technology to achieve the most predictable outcomes for her patients and has used a periodontal endoscope for the start of her career in dentistry a master trainer of orvu's davao dental endoscope Laura also delivers educational presentations on the topics of visually scanning and root planning Laura serves on the Arizona dental hygienist association board as treasurer and as a past president she earned her hygiene degree from phoenix college and has a bfa from Arizona state university um thank you so much for coming on the show today how are you doing I’m doing great thank you so much for having me Howard I really appreciate well you know I really want to get you on here because um you know the whole show's aimed at you know um I think the only value of knowledge is if you can transfer it you know who cares what you know if you don't tell anyone else and now that I’m 58 just had my six grandkid um I’m um focusing on dentistry for my grandchildren when I’m gone and so I’m trying to focus this on the um the a quarter of our listeners are still in dental kindergarten and it's neat to kind of impart these lessons and the lesson I wanted to bring you on for is that when I was in dental school it was all the things that you were talking about of doing everything to save the tooth and then titanium implants came along and everybody thought you know the best way to treat this tooth is just throw the thing away and put in titanium and that was the miracle for 10 years and then after 10 years everybody's looking at these implants and saying oh they still got peri-implantitis and this wasn't exactly the miracle thing we were looking at so now the last 10 years I’m seeing a shift back to conservative stuff where people are realizing um we need to just save the natural tooth and um just replacing everything with uh artificial six million dollar man parts um isn't necessarily the biggest have you seen that transition in your own practice well I think that it's kind of like you say the pendulum swing on the one hand we swing all the way to one side and everybody's all about the implants and then we kind of realize that oh but people can still have problems with implants you can still have failing implants you can get peri-implantitis and if you have a failing tooth next to an implant that can affect the implant too so the best option is really to figure out what's best for the patient if the tooth really can't be saved then an implant sooner rather than later is probably the best option but then again if you can if you have a problem with that implant you're going to have to be able to treat that peri-implantitis because you don't want to have to replace that implant and then you know add additional uh investment on the patient's part not to mention pain and suffering so I think that we're swinging back a little bit more toward the middle I doubt that we'll go completely toward old-time dentistry where periodontists used to try to do anything to save a tooth and now like I still have some patients who come in and they have roots of three triple rooted teeth hanging on by the skin of their little roots but they're still there and if the patient has excellent home care you know it's actually sometimes still an option for them so I guess what I may answer is the short answer is um yes we are more conservative but we still keeping our implants yeah and um and that's all true so for these little kids that did on kindergarten school where the rubber hits the road and um I got an MBA from um asu and uh is you know i've already lived 58 years and we you have to warranty it five years I mean if it only lasts five years in my 58 years I would have had to have it replaced 11 times and when you come out of school some of these young kids will see a an incisor snapped at the gun line and they're like oh I can save this and they do a root canal and a post build up and this big old crown and they charge out you know thousands of dollars and then you know one year later the patient comes back and it's in their hand well they you know you did great but they like I couldn't afford to do this 58 times for one tooth so I draw the line at five years we warranty everything we do for five years so if some young kid is coming to my office and he was associated he did that I would take the root canal buildup and post crown and I would apply it to either an implant a crown or a three unit bridge and I know this sounds crazy but I still think um an anterior three unit bridge is uh more predictable aesthetic pleasing uh than an implant and a single crown because that you know that that I mean when you replace a central incisor with a single root form implant and a crown and you nail it uh I honor you know just come by here ill all nail down and kiss your feet that's tough and um but um it's got to last five years or it just doesn't make economic sense I mean these kids are in dental school that was four years um could you imagine getting this done um a root canal bill and crown and didn't make it to the end of dental school I mean so five so you have to diagnose aggressive enough to last five years and that's I think that's a really good checks and balance and I used to get really upset um and stop using some um endodontics because they would do everything and then it ended up being pulled and I said well it didn't work man are you going to give the money back no man I did everything I could I tried my best and it's like well your best wasn't good enough in diagnosing and treatment planning because it didn't work and that's why I kind of was hoping that endodontists would start placing implants because if I got an hour here and I can make the same money either way then I know you're probably going to do what's right if you um can't if you can only make money doing treatment a and 0 on treatment b you're going to be really busy and successful and you know to always make the right decision if that's not internal um but I just think five years is a great cut off do you um have you seen a lot of people warranting their stuff five years here in town um you know it seems to vary a lot I think that there's usually a minimum of three years because that's usually if something's going to go wrong three years is like the minimum at the maximum time but then sometimes it takes up to seven years for an implant to um to have problems if especially if it's related to the cement that they use so I think that they're going back toward things like um screw retained implants being more prevalent screw what screw retained versus oh screw retain cemented implants I thought you said screw it you train and I’m like yeah I have not heard you're thinking of a chain on an implant so one of the things that you bring up is um like anterior teeth uh people want to save their anterior teeth obviously they want to save all their teeth uh i've done a lot of cases using the dental endoscope where i've we've been able to save like nine millimeter pockets on an anterior tooth and have that tooth be vital many years later so this is where that more conservative approach of treating versus automatically um uh extract and replace can come into play if the tooth is not due for a root canal necessarily um one of the things that that I really love doing is trying to find out um if there is some retained calculus which we're able to use done along the scope and see we can remove that calculus and have a chance for healing and it's a lot less of um an investment on the patient's part than immediately pulling the tooth or even doing um even doing gum surgery is um you know there's a difference between boys and girls that's just uh obvious and lecturing 50 countries around the world when you get to poor countries the men just don't care and they'll lose all their teeth and they don't seem to have a problem eating and I saw this in my own family I went to one of my grandma's funerals in dental school and some of my uncles were like 80 years old and were edentulous and threw their dentures away years ago and they would sit there and eat almonds but like when you go to more poor countries more developing countries the men just let them go and usually fall out but the women only do um canine to canines so and I you go to so many cities and the women you know they do their hair and they got a little flower in there and they got six pfms upper and lower and zero back teeth so um and then in the united states in a wealthy country like this women are getting like 85 percent of all the plastic surgeries and things like that and uh so um yeah there is a difference um in what they'll do to save a tooth but I mean unless you're the stud of all studs avoid women's anterior teeth placing implants until you've got at least a hundred under your belt I mean uh like I like uh I can't even imagine how many Ralph’s placed by now how many do you think he's placed oh gosh I couldn't even begin to guess um he does a lot and he does very successful ones so um I’m I don't even know how many years he's been practicing so plus the implant's gonna stay in there because they come out they know he's a black belt and he's just gonna kick his kick their butt uh they're probably and they're just uh scared to come out um but uh so um we're talk about your journey of orvu um am I pronouncing right or a voo or a view it's it looks like yeah yes nice that is nice I really like that um so or of you um i've seen that before I mean you know you wouldn't go to your dentist if it was Stevie wonder you'd prefer someone could see and you can't see underneath those gums and so talk about your journey how did you decide you wanted overview well um I had been using the what people know of as the perio in periscope which most people know that name which is a the dental endoscope that was made originally by dental view and now it's marketed by zest and that was um perioscope was made by orr view and then sold okay now we're viewing periscope was made by dental view dental view back in like 25 years ago and um so eventually through a series of different things it eventually ended up being owned by zest who now owns perioscope who owns the periscope company sold a zest which owns periscope yes so I had been using a perioscope for 10 years when I was working for Dr komarnicki here in phoenix and um we were approached by Michael Austin with the company that became aura view and they wanted to know what was working and what wasn't working for us with the periscope and so Dr k and I conferred with them and he conferred they conferred with others as well but they decided that what they really wanted to do was get an endoscope a periodontal micro endoscope that was easier to use easier to train on more predictable in terms of the lifespan of the product and easier to move around so that it could be used say for traveling hygienists who want to go to different offices and provide services or whatever whoever wants to train people so they created this new diva endoscope and I got to use the very first one that they had which was their pre-production model and it was really an awesome process of getting to give feedback on what was working with that one and how much easier it was to use with the interface that they had um just a touch screen tablet versus a big heavy unit um so now uh eventually I i became able to train others on using the diva endoscope which I do both here at azpiro I train other hygienists how to use the periodontal endoscope and also speak um and train other offices that that purchase the scope so i've just been kind of really excited to see the whole process evolve how forward-thinking this company is because they took a product that was pretty good but kind of kind of a little bit stagnant because they had you know the company had gone through different hands and the people who were really passionate about using the product really were devoted to keeping the technology but um but it really took another visionary like Michael Austin to take it to the next step and create the new diva scope which is direct viewing assistant I think diva is what that's all about is that what that stands for yeah direct no I don't know um actually when oris um periodontist uh orist uh kobaninsky uh he when he came on the show that was episode 898 uh that was a few years ago um he actually was talking about um not ready he came by my house December uh 2017 and he said it's not ready for prime time but he was talking about this going on right and it's ready for prime time now which is the awesome thing because we have um well the overview company I work for them as a master trainer I’m not I’m not like on the board or anything but you know we sell we sell all around the world and train hygienists and dentists all around the world so uh it's really taking off uh people are starting to really get the benefit of it um all over it's uh they have a new system which is called the diva generation two or second gen I guess it is uh where instead of having um this fragile fiber optic line which if you kick it too much it breaks and then after 50 uses you need to replace it well now they have a line that has a tiny camera at the very tip of the fiber so it's much more durable and it has the ability to focus to infinity so you don't have to bother focusing it it's called just part of automatic so they're definitely charging ahead their technology is really state-of-the-art that is amazing and I’m so dumb the thing I’m excited about the most is I learned uh um the what the vue was I just kept saying and then explain it to or view and dental view um so what are what are your um challenges of getting that out and uh what is uh what is Michael Austin and um now he's a consultant to ropar uh which uh do you remember the um the founder of uh ropar pharmaceuticals yes uh so he michael used to be on the night his name is escaping me uh is it was it perry harry there he is and he was the coolest guy he was the coolest guy um perry Radcliffe and now his son James l Radcliff runs that but perry I couldn't believe it I it was in the 87 and I called him up and I had this perio question he goes um he goes you know what he goes that's a long answer and I’m on my way to dinner and it was at some fancy restaurant in paradise valley he goes and I was like in you know 24 years old in 1987 he goes you know if you come by why don't I just buy you dinner and I went there and I think we drank from like seven o'clock until they closed the restaurant down at one and I think he single-handedly doubled my period knowledge he what a great guy man just an incredible guy but anyway sorry to interrupt with that no there that's a great company ever um all the hygienists that I know love the closest product so uh that's all so you know how he invented that uh no he will probably uh shoot me if I uh say this but it's dentistry uncensored and I’m pretty sure you and I are the only ones that are gonna hear this show um he was sitting by a swimming pool right here in phoenix Arizona where it's you know it's 110 degrees for half the year and he started realizing if I didn't put chlorine and acid in my swimming pool it'd be a green swamp of mold and algae just like the lakes in Kansas or whatever and um and they start studying that and obviously if you put in chlorine uh that that kills but um when you lower every time you lower the ph. by one it doubles the amount of hydrogen uh released and um if you next time you switch with um closest it's uh it kind of tastes like swimming pool water this is true and then and then an endo um the guy for the apicoectomy uh retro field material whatever uh it's a hard name to say uh saranabad or whatever it was um mta um same thing he was sitting by a swimming pool and they were repairing it and the guy patched it and he said so you patch that and it'll work under water and the guy said yeah so immediately the light bulbs went off on mta and the next thing you know he had mta which costs more than any drug you could find I mean like a gram of it was over a hundred bucks and uh so swimming pools have been good to dentistry maybe uh maybe dentists should swim more and get the uh third product uh but um so what's the challenges with uh I’m getting um hygienist to see what they're doing well they just don't have the access to the technology I mean I think all hygienists um we're all doing our best with the scaling and root planning that we do and it's really disheartening when you realize that um up to forty percent of calculus can be missed on surfaces on the on the distal uh well closer your teeth so once you realize that and that we can do better if we have this technology it's really it's really important to kind of move ahead with technology just as hygienists have embraced ultrasonic scaling because it's more efficient and more effective I think more and more hygienists are going to be using the endoscope as it becomes more available availability to training availability to the system it is a challenge to learn to use it the first time it probably takes about 10 cases to get really under your belt and then another 20 to really become completely proficient but uh we're all about removing that calculus that's kind of what we do as hygienists we're really sad when we miss calculus and if we can get something in our hands that will help us to do better for our patients that's really what we want to do um but dentists can do it can use it too i've trained dentists to use this equipment and um they're also kind of amazed that um that this exists and that they didn't know about it it's been around for like I say like 20 years now maybe in in terms of different kinds of equipment and we both live in the same town and we've seen uh the big oral uh cancer company um I i've been through this many times I mean um just because something's logical doesn't mean it works like I remember the oral cancer technology where they were taking uh um basically ob gyn technology and they were doing the Italian blue smear looking for the deals and they just took all that technology for women and applied it to the mouth and you started looking at the number of people that died from oral cancer and this and that but the first thing that happened is the insurance didn't pay for an oral cancer screening exam and that means it's usually dead on arrival I mean you know um when renkin came out with the x-ray machine uh dennis played with it uh but it wasn't until in the end of world war ii when the um when the longshoremen's unions started a dental insurance company what would become delta dental and they covered x-rays at a hundred percent and then like a domino effect all across America all the dentists had x-ray machines the next day and so um I think the oral cancer screening is simply dead um because there's not an insurance mechanism to pay for do you agree with that or well I think that we are definitely very insurance based as consumers and so maybe um it can be difficult to get to get our patients to accept things that they have to pay for out of pocket it doesn't mean that we should stop trying because clearly insurance led dentistry is not always the best for the patient just because the patient will pay for a pfm doesn't mean I’m sorry an amalgam restoration if that's all they pay for that doesn't mean that that's all that the patient will agree to so like working in a periodontal practice we do have that conversation a lot with our patients they'll have we'll have patients that only want to agree to oh my insurance only allows me two cleanings a year so that's all I really want to do and you have to have that conversation where well the insurance company doesn't really care about your parental disease all they care about is what they've agreed to provide for you so being a consumer you have to understand that insurance is not dental insurance is not the same thing as medical insurance it's not going to cover everything you need so patient education part of it we do get patients to pay out of pocket for a lot of things that they wouldn't ordinarily do if they were just relying on their insurance so patient education is a huge part of that um I think that if the patient sees a direct benefit from it they'll do it like patients with fluoride varnish we'll have um many of our patients using fluoride and for egg products because we know we can convince our patients the truth of the fact that they're having dry mouth and they're putting all their expensive restorations at risk if they don't get their carries under control so I think that there is definitely a bandwagon effect if insurance covers things will definitely the floodgates are open and everyone jumps on that but that doesn't mean that um that the patients won't accept something that insurance doesn't provide but you're it's a cultural thing it's a hard sell because I mean um when people just believe things like I mean like um luckily the only thing they all believe in is uh money um you know they'll always you can pay them in this money and then they believe that it's a store of value and they go use the money even though all through history it's just one currency collapse after another I mean uh my older sister is a nun she really believes it I couldn't give her a four hour presentation and make her hindu um you know she'll always be a catholic nun in fact you should see the picture my mama sent me a say my mom made her a new outfit my mom always sewed all seven of her kids all over their clothes and uniforms all through catholic school and she's still making um the uh clothes for my uh 60 year old nun sister uh but if they if they believe that they should buy their house and car and take care of it but they believe when it comes to health care they should be a ward of the state and the state takes care of them or their employer's insurance it's a hard belief to change I mean it's not logical but most beliefs are irrational you know they just believe them and gosh that's hard um so do you um are you very successful about getting people to upsell people to pay out of pocket for things that aren't covered by the their belief model insurance yes um I would say we are because people who come to the dental office already have a belief that they want to save their teeth if they're not if they're not invested in their mouth then they're not coming to office so you already have a belief system that you're working the only thing is that now you have to kind of unpack what they um what their perceptions are in terms of what um what they're able to pay for and what they're already expecting I mean it's kind of like you're saying here in the united states we have an expectation that you can smile and you'll have teeth you can talk and you can be understood because you have teeth and a tongue and a healthy mouth and reasonable breath that's not going to scare off people around you so all these kinds of things that are built into health are built into our societal expectations so um when a person comes into the office and they've invested um many thousands of dollars in bridges and crowns and implants and they're not flossing and they're not brushing that's to me it's harder to get them to floss and brush than it is to get them to accept fluoride varnish sometimes i'll give them a choice between a couple of fluorides i'll say well you can have the take-home fluoride that you have to use every night after you brush your teeth or I can and it costs um half of what it costs you if I put the varnish on now and you can walk home and you can be done for two to three months so convenience is a big part of it you have to just talk to each person and know your patient and know what their own values are um like I say if they come to the next office it's because they're trying to save their mouth their teeth their health all these things that kind of come play into that so I don't I don't really see that as being an issue it's more um let me tell you how big convenience is um I just read a study um two days ago where a school um just made the coke machines you know they're in the cafeteria but they kind of pushed them over towards the corner and then towards where everybody's coming in and all that they put um big deals of ice bottled water and just by making one the bad choice slightly more inconvenient and the water chores slightly more con convenient 20 of the students switched to water and then when they would ask us dude the student didn't even know what's going on in their mind they said well why did you pick water and then oh I love water you know I’m thirsty I love water it's right there it's like wow one in five people that would have drank the soda and I saw the same thing with milk um when they were like why is coke and pepsi beating us up well you can't go into 7-eleven and buy milk that you can put in your cup holder in the 80s and the 90s and when the milk farmers finally said well it's not convenient it's the package and they got a whole bunch of milk cells so conveniences everything um distance um it's one of the primary drivers of which dental office they pick they always google dentists near me and the second one is I’m the type in their insurance so um dentists that takes you know blue cross and blue shield near me so you know uh you know how they're thinking but convenience is just huge um does this um on dental town um people are asking um about um orvu perio endoscope this guy has a really good question he says uh um is this would you um think it would be um even more helpful to add um monox monocycline uh arrestin um if you don't do minocycline or rustin you consider to be like that amount of value or do you not ever use an adjunct antibiotic and you're just mechanically scaling and do you think it's is even better than a rest or something well um arresting is really helpful in cases where there's active action separation bleeding um but it's not going to be effective if you don't remove the calculus and the biofilm uh if you can't expect arrests and to solve the problem if you haven't removed the you know the cause of the infection so um if we use in my working with az perio we do use arrest in but we don't use it as our first response after during scaling and root planing or laser we use it more of more as to treat isolated areas we find that you can once you've removed the source of the infection it should heal up on its own if there are other factors that are preventing it from healing up on its own then arresting can come into play now there are a lot of other kind of host modulation therapies that some offices use like periostat and things like that and we do use those sometimes as well for people but primarily the basics are we use scaling root planing we use the yag laser we sometimes use both scaling root planing with the periodontal endoscope and the yacht laser and all those things are to give the root surfaces the cleanest possible outcome so that those areas can resolve but as far as one of the problems like talking about insurance is if you want to use the menocycline in a lot of areas it gets to be really expensive for the patient so you not using it as a first line of uh treatment is probably it's probably better to do a larger overview of the mouth first with Scandinavian planing or laser that kind of thing definitely using the diva endoscope will help enhance any scaling root planing and it I use it um when called on to use with the in conjunction with our laser um of course the doctor uses a laser and then we can we can kind of go from there and see how well the patient resolves it takes about nine months after the laser so to really check anything so you know we're not we're not going to be placing anything under the gum line during that nine months but afterward we would check and see and what did you uh blow my mind telling me that diva stands for again dental visual assistant my gosh you never know when these Ackerman’s actually mean something uh because when you said diva I always think of you know the divas of dentistry I mean you're right the hygienist diva yeah I met many people that told me they were a diva of dentistry and they were always uh very fun to meet and uh um but um so that's what that meant huh dental vision assistant and is that um how much is that well right now they are special and it is I asked about that because I asked that question um because you knew I was gonna ask I knew you were gonna ask the money question and I never I never pay attention to the money let me pull it up here real quick okay um the diva system is retails at 28 200 and the current introductory offer is 40 off with sixteen nine twenty okay tell me those numbers again I’m slow sixteen thousand nine hundred twenty is the forty percent off current um offer that they're giving the great thing about that is they're throwing in the training which is substantial if you can get your training thrown in um you get someone like myself to come out and train you your hygienist on how to use the system and make sure that you're comfortable using it and understand how to use it because that's what's going to make it possible for you to start paying off your investment a lot of times people you know they'll buy a really expensive piece of equipment and then it sits in the corner so you really have to make sure that you're using this so that you get good at it and then it just becomes your go-to instrument and you're you know you're getting an extra what 320 each time that you use it um depending on your fee structures um and then that pays for that pays for your product your device um so you I take it you only use this during a route planing and curettage patients and then the next big question they're gonna say is well how much time do you block off for a procedure like that yeah you use it for any time that there's a periodontal issue and it could be around an implant you can look and see if there's any retained cement or somebody's got a bunch of faucets stuck down and around there I can res and you can use it um with traditional scaling and root planing only it's visual scaling and root planing usually your time is going to be more at the beginning when you're first learning so maybe an extra half hour for each procedure that you would normally expect and then it kind of kind of pairs down to where you use about the same amount of time as you would for traditional scaling planing after you know how to use it really well so when you're first training you might need an extra half hour or more um for like for example if you're doing a sing say you do an hour per quadrant if you're doing a full quadrant heavy duty perio you might even build in a full a full another 45 minutes to make sure that you're getting everything the advantage of using a digital visual assistant like the diva you can see whether you've missed anything or not so you're not kind of guesting and going back over areas you can see and if you've already removed all the deposits you just move on to the next area you don't feel like you have to keep rejecting areas so those areas can go a lot faster because you don't have to kind of you're not second guessing yourself so eventually you become to where you're doing about the same amount of time um with the diva as you would with your uh with your traditional just instruments so diva is the one just to be clear that that um orist was working on right yeah he used to be the um the medical officer for the auraview system and then when he retired and moved then he um they passed that on to michael redmond rethman who now say when he retired he moved dr kominsky is now in uh las vegas really oh for taxes right was it just taxes uh no I think it was because his wife who is an attorney her practice her law practices there so once the kids were off at college um they moved to she wouldn't have to commute i've known I i've lost patients my entire career that that moved to vegas just for the tax purposes just to have real estate income tax and is it's just a huge thing for a lot of people I mean joe rogan just moved his um podcast from uh california to texas uh just for that point I mean uh taxes um are huge so when you're in there um when you see a bleeding so you're saying it's for five millimeter pockets and greater is that what you're saying yes you kind of have to have something deep enough that you can actually insert the explorer that shows you what you're looking at uh if it's too shallow there's you just can't see it it's too it's too narrow although you can if you're trying obviously if it's above the gum line you don't need it because you can see it with your own eyes and when you're when you're down there under five millimeters like let's say you're six millimeters and more what percent of the time do you not see any calculus or anything and it's just an exam saying yeah I’m good I got it all uh I would say that's probably maybe 10 of the time so 90 percent of the time uh you find something that's unmissed yeah and I was blown away this year you know we all you know we um you know when I was in school they you know they told you to get the right answer that decay was caused by streptococcus mutans now they know four millimeters deep into the cavity that there's no sign of streptococcus mutants but what really blew my mind a couple years ago is that paper that came out you know you got a you got an a whole nother besides plant animal you got fungus you know mushroom that it was working with the funga and the fungi was making the protective barrier um around it and if the uh fungi wall it off you know none of your antibiotics or anything's gonna do anything it's a the biosphere is amazing um especially how they work together I mean how does a fungus and a eukaryote work together when neither of them even know they exist I mean it's just entropy is uh bizarre isn't it it's pretty amazing they do talk to one another who knows their little sis their little chemical some symbol signals chemical signals um so I was going to say one of the um really cool things about the endoscope is even if you have let's say one patient I had had a distal um like an eight millimeter on the distal of 30 and we thought oh well there's got to be some calculus down there it's not a root canal traded too so it's probably not a correct route but I got in there with a scope and oh sure enough there was the root crack going all the way down so sometimes you never know what you're going to find and it was clean it just it was cracked root so you know the um you know a quarter of our listeners are still in school and they do bizarre things with their iphone and um when they first saw an intro camera they're on dental town first question is how do I connect it up to my iphone so I already know what they're gonna say they're gonna say um can this camera hook up to my iphone where they you know take a picture record a video um they love that kind of uh connectivity well yes actually uh you know it can because um the system uses a surface pro which is the microsoft product so if your phone can connect to a surface pro you can connect to your iphone i don't believe you can connect it directly and use it as a screen but anything that you use you can take photos you can take video of what you're working on so for example in that last so what did you say if your phone connects to microsoft what surface pro any anything if your phone can connect to a microsoft surface pro which is like you know a tablet um you know a touch screen tablet yeah then you can connect your phone to that and use any images that you take using your diva you can add them to your phone so for example um when I was scoping that case with the root fracture immediately I just hit the button on the diva and it took a picture of it and I sent it to the doctor and said look you know this is what's going on in this pocket and dr midnight said sure enough oh there's that root fracture we'll have to have that one out so it's definitely great because you can use it almost like a sub-gingival intra-oral camera and you can save those images you can save video from what you're using from what you're doing and show the patients what you found in the pocket and show providers oh this is what's going on in this pocket that's why we're going to see if it heals before you put that expensive crown on that tooth you know there's a lot of options that that are opened up once you're able to see uh under the gum line and document what you see very easily using that surface pro yeah now are you doing that I mean do you is that what you do you take pictures home to your husband at night of uh subgingival uh calculus on your iphone and uh as the appetizer that would kind of be against hipaa but I definitely like to show it to the patients and to my colleagues at work ah yeah um well you walked into another um subject that we need to go to and that is you were talking about how um the special today and by the way this isn't a commercial I don't do commercials she didn't pay to did you pay me money to come on the show um no sadly I didn't know that you tell the worst then that that he owes me a beer uh and uh I know he'll pay up on that but you were talking about this uh diva endoscope is uh sixteen thousand nine hundred dollars right and um there's another thing you mentioned the word laser um there's a nap and um that's how what is that about 135 000 and so the question is I think so yeah our error is uh are you and ralph and uh I always say ralph because i've known him from five thousand posts on dental town but um is ralph using the um the um lenap believe that all the periodontists at easy period use the lenap um so yes the linap really works very well for majority of patients we just have to um we can use it in conjunction with the diva as well in the offices that we have the diva but lenap is a very valuable procedure for patients sometimes we don't need it for all patients but it's a little bit um easier to get predictable results on back teeth I think with the lenap but studies need to be done more to kind of nail down those figures so we can actually have um have a conversation say look this is actually you know instead of just saying anecdotally these patients did great you know and um where I was um really um pleased with the nap is uh let me uh is um which is owned by uh robert gregg and don greg and millennium they were on episode uh 973. uh but my favorite lenap was um done four years ago with our local periodontist alan honeman do you know alan I don't and he was I mean he came out first and whenever you're first and you climb up the pole first you know everybody's just gonna shoot an arrow and throw a rock at you and that guy was just eaten alive uh from endorsing this little nap and of course you know most uh species eat their own children they don't eat other species children and uh my gosh um the abuse he took and then one by one people just come on saying nope alan was right alan was right allen was right and I always teased him I said did that bother you um all the abuse you took by on and he said no because all the bald dentists uh in uh dentistry are just bulletproof and he has a gorgeous bald head so alan honingman was right on dentistry uncensored in may of 2016 that you say I’m calling out because ralph let me give you a little background ralph so on dental town when any someone would ask some question where you'd have it'd be like you'd have to find a minister who could quote the bible or something you know what I mean and I would always whenever I was stumped I would email um just two people uh trish o'hare the hygienist here uh who had perry reports and ralph and it was because I knew if I said to him both that one would answer within you know four or five seconds but ralph his comprehension of the literature and of course you know that's all trish does is read the literature but my gosh uh ralph is uh just incredibly that that guy would do nothing if he couldn't sort uh you know quote 50 pdfs on it so the fact that um ralph is into this um lenap and using uh the or view is all I would need to know yeah and then that's not a commercial from either then that that's just I mean you'd have to know ralph he's an intense guy he's a black belt um and uh you um you posted on dentaltown um you say I work in two offices uh blah blah blah blah but anyway says where I frequently recommend water pick for those who refuse to floss but the other office um they don't like the water pick um because they fear um the patients might damage the gingival attachment to an implant um so do you do you think um things we do for our teeth brushing flossing water picks um are kind of different for natural teeth versus implants and when what are your thoughts on water pick today uh well obviously I think that um any patient who's able to do their brushing and flossing alone are not going to be getting deep enough to damage an implant without really trying hard to hurt themselves so not that they couldn't if they really try hard enough but I actually really like water picks I promote them to most of my patients that have implants they have really good science behind the new water pigs I tend to use tend to encourage people to use the um the lowest settings around their implants just because I don't want them to be shooting water up and around too deeply and too aggressively around their implants but like I say I think that people have to try pretty hard most of the time people don't try hard enough to get underneath the gum line with their brushing and flossing and professionals we know how to be careful and not over instrument around implants and things I mean there's definitely um there's gonna be that one patient that that over does things but that's the far end of the builder do you remember the shower floss oh yeah and uh and it came with four utensils and uh it was really great but I shouldn't say this on a dentistry and sensor but nothing's ever saw me before but uh I was getting ready to go in the shower and I had four boys I think they're like one three five and six and if I when I got in the shower if you knew what one of the boys was doing with that water pick up I thought okay so uh this is not working but what I thought was so mind-boggling about the water pick is the reality is if you tell a kid in braces or you tell the husband or you tell someone that you start using a water pick it's on the win it's on the mirror it's on the counter it makes a mess and whoever is cleaning the house uh does not like it at all and so I was really excited when the uh the water pick came out with the shower flosser so you could take the water pick in the shower I do everything in the shower I shave brush my teeth floss go to the bathroom you know everything right there yeah well it's the same pipe if you follow down the shower drain in the toilet drain the plumber can uh give everyone a diagram but those pipes actually meet uh right up and uh so I thought the water pick or the shower floss was perfect um but not if you share your shower with someone who's uh two years old uh but um but I think the um taking it in the shower do you use the shower floss in the shower or do you use it at the bathroom sink and get it all over your mirror and then your husband cleans it up um I use the countertop model and he uses his own countertop model and he doesn't make a mess but it's a matter of practice and I know some we both use the countertop model which have our own and um I do know a lot of patients that don't like the mess and so they get the handheld battery-powered one which they can use either over the sink or in the shower and if they don't want to have one on their shower actually attached to the shower so you know there's a lot of different options out there for me I usually tell my patients go online and google how to use it and it'll be a lot less messy for you the first time and just get out a really big towel because expect to make a mess and have a towel ready but you know really it is messy but it works really well and you know the one the one thing trish um I have to credit trish for so many um periodontal concepts that she uh took the old wrong ones out of my head and put new ones in but um her concept of dry brushing that you know when you're talking about brushing you don't need toothpaste you don't need sodium lauryl sulfate you know you need to mechanically brush with a soft bristle and the bristles need to be straight for two full minutes and I don't think anybody brushes for two minutes and so I think the only options are if you're one of those people who uh get in the shower in the morning and want to wake up the first two minutes you just stand under the water and you know you got two minutes or what I tell my patients is uh you know when you start brushing that's the perfect time you got one hand free go lay out your clothes go do this go turn on the coffee pot do something but do a routine and keep measuring it until you know well if I go lay out my socks and underwear and shoes and dental uniform and turn on the coffee pot if I go do these four things I got my two minutes in but it's just time is uh it's everything and that that's the longest two minutes of the day is when you're brushing your tooth and there's something and have more sympathy for gaggers because there's seven kids in my family and me and my sister kayleen it's both an issue I’m gagging by brushing and uh the only thing that really helps me to do it is that um that red close-up toothpaste for some reason it just does again but the standard crest and colgates and all the all the stuff like that but um man um you know you trying to get the patient to change their behavior um blew my mind when I saw that one study where identical twins um needed to buy a quadruple bypass a cabbage a coronary artery bypass graft and one got it because you know he had the insurance or whatever it's about a hundred thousand dollar procedure and the other one didn't get it for whatever reason usually finance or whatever and then they come back um and you look at the life expectancy the one who changed the behavior quit drinking smoking and start exercising and got healthy lifestyle but didn't get the bypass live three and a half years longer than the person who got the hundred thousand dollar surgery but didn't change any of their behavior and at the time in my life when I read that I had already seen it with replaying curettage where you know some people you tell them to do four quadrants and they don't have the money don't have the insurance don't get it done but they change and then the other ones um get it done and they wouldn't change and I always said from day one i'd rather take the one who didn't get the four quadrants of surgery that changed their daily behavior uh than the one that you know you go in there like superman you think you're gonna do all this stuff and make the day but you have to change their behavior yeah you can't they have to change it themselves you can open that door but if they don't change it themselves there's only it's a fight you're fighting a losing battle you can do the best you can for them but if they're not going to do their work at home um until they get that light bulb that goes off in their heads they're not going to be motivated to do it themselves and that is definitely I think that's definitely true people will some people will pay the dental office to do everything that they won't do for themselves and that's not that's not going to be a recipe for health for themselves they have to do what they can of course ideally both imagine the patient who got the bypass and changed the behavior they're gonna they're gonna live the longest of all and have the healthiest and most rewarding life with that they can I always think dentists are the most funny because then you know the older ones my age it's a conservative bunch of old men and they didn't want to hear anything about holistic they didn't want to hear any anything about alternative you know they just you know the surgery the pharmaceutical and then you watch them get their first disease and I got one right now who's um just really got hit hard with uh rheumatism and it's funny how the first thing you know that one doctor told him to put him on methyltrexonate he's like oh my god that's like chemotherapy and another one said so what's he doing now changing all his diet changing his exercise going to a dietitian going to a naturopath and um it's funny how when it's you it really changes and uh so when someone if I bought this from you right now um is that something like I would uh pick it up and use it right away or is it something like an iphone where I remember when I got my first one it took me 40 days and 40 nights just to learn how to uh use it uh what's the learning curve on this uh well the learning curve is that like I say it takes um you have to start learning your equipment kind of like when you first started well hygienists and dentists when you first go to school you have to learn what the instruments are you have to learn how to do uh viewing with the mirror and that's a big challenge the first time you do it so if that help if you went adapted to that very quickly you're going to have a shorter learning curve um when you start to use the diva if you do it does help if you have training um to have training and to watch videos and see how other people do it and to do things that that challenge your mind to learn um to look at when you look at something on the screen it's kind of like learning to use a mouse now everyone knows how to use a mouse right for their computer um it's very much like that you're not looking at the mouse when you're using it you're looking at the screen when you're using it so it's like the mouse times 10. so maybe the first you get a couple days of training with a couple patients and then you have um after you've practiced practice on a type a knot practice um using uh you know tracing uh patterns on a page and looking just you can follow the patterns when you're looking at the screen and not looking at your hand and then practicing on the type of dot and then finally having an actual patient and doing a couple of patients and then after you after the trainer leaves you get some patients by yourself and they're isolated areas so i'd say a good 10 cases in pretty you're pretty good to go um but that doesn't all have to be with a trainer and the more patients that you have the faster you're going to learn if your patients are spaced out it's going to be a lot slower process for you so and once you're 20 patients in you're pretty good you're pretty good to go 20 and how are you um how does someone get trained do you do you have an uh anything online um like you're here in phoenix what if they're in uh beeville texas where four or six of all my grandchildren live we can do distance learning but you really have to have an in-person trainer go to that so we fly out we fly trainers out and we help them know how to set up the equipment and how to use the equipment safely and keep it safe keep it in good repair and uh and then make sure that they have time to set aside with patients so that we can um practice with real patients have them start training on real patients and then of course we have support so if they have questions they can email me or email the other trainers um and ask their questions so um a dennis on dentaltown asks he says um I have a question as doctors why are we calling an srp a deep cleaning when it's truly more involved than that sure it's easier to get the patient to not their head and you ask them if you make sense to them during the treatment presentation but I don't think the patients really understand the value or purpose behind the srp or what it can do for them by calling it a deep cleaning patients want their dental care delivered in simple term but aren't we devaluing by saying deep cleaning i've had patients say to me well why can't you just clean deeper when you do the normal cleaning are there any other phrases that you use for scaling and root planing and what do you call it well like you say patients understand scaling and they understand deep cleaning so you kind of have to know where your patient is coming from so if you have a patient that you can ex scaling and root planing is and how you're doing a root debridement and why you can't do that as part of their quote-unquote normal cleaning there's good words to use would be root debridement um other kind of things would be definitive scaling um periodontal debridement if you can kind of introduce those kinds of words um then the patients might start to appreciate more that you're doing more than just a quote-unquote cleaning because uh cleaning itself is kind of like a house cleaner or you know all these kinds of things we don't really get a very good um image of what someone who just cleans does but if we're performing debridement and other words I’m trying to think um would be uh antisepsis or um there's words I mean it's kind of off the top of my head but I know that full mouth disinfection is also a word that sometimes people use I like disinfection versus sterilization because obviously we're not really sterilizing the roots we're disinfecting the roots so full mouth debridement full mouth um root debridement um all those kinds of things do help to kind of make it sound more like we're actually doing something that takes great skill and is in the patient's best interest um it can be difficult to get patients to understand terminology dental terminology so we tend to dumb it down a little too much and I agree that that's that doesn't do us all any favor does it help the patient to understand the importance of what they're asking what we're asking them to do um I notice the periodontist um are acting very endodontistly where the endodontists don't like the term root canal and they're trying to get everyone to say endodontic therapy and of course the hi the periodontist um took three seconds to log on and say um it should be called periodontal therapy not a deep cleaning or scaling your plane did you do you like the um term periodontal therapy periodontal treatment or do you think that's more greek and latin or where do you come in on this paranormal therapy I believe could I mean I’m I don't know the exact um if you were to go in a glossary and find out how they break these things down in the periodontist glossary but uh I worked at the previous paranormal office we always called it supportive periodontal therapy versus periodontal maintenance we just called it supportive periodontal therapy and periodontal therapy is definitely a good way to consider scaling root cleaning because we don't really do root planing anymore root planing was whoa you have to have those smooth glassy roots you have to make sure that they you know there's you've all the cementum off the roots which of course we don't try to do that anymore so scaling and root planing is kind of a an insurance carryover I think that the codes have been written for quote scaling and root planing so that's what we call it even though what we're doing is more debridement and periodontal therapy periodontal debridement I do like the term periodontal therapy but for insurance purposes if the patient gets their bill and they see they've been charged for scaling and root cleaning then we kind of have to have told them that what we're going to do is scaling root planing so I want to um this is dentistry uncensored so let's um piss some people off and ask questions that gets everyone mad hygienist um are talking more and more about direct access and I I’m a big fan that a hygienist she's an american she has rights she should be able to open up her own business it's very embarrassing when my colleagues give money to political action committees at the american dental association where they hire lawyers and pass laws that says no you can only work for me I mean I it's economic violence um you went to school you have a four-year degree and quite frankly when I would go on places you know like resorts and stuff and they'd have you know you could get a facial and you could get your hair done and you could get all the stuff like that and I just wanted my teeth clean and they said you know a lot of people asked for that but we can't do that because it's against the law why are my american colleagues hiring lawyers to make it illegal for you to do what you did uh learn from four years of college I so wish that the hygienist could get some big law pass and all the dentists would have to work for the hygienist just for like 50 years so they can kind of remember that lesson but it's economic violence why um why is it an issue uh I it's very definitely um a protectionist kind of kind of approach uh protect uh it's there's a feeling that um if the hygienists are able to access the patients directly that somehow the patients won't want to get care from the dentist I personally don't believe that I believe that um while I personally would not want to be my own business owner I would love to have the option if I wanted to maybe work part-time in office and have a diva and run out and do therapy at a bunch of different offices and run my own business um I think that I should be able to do that without having to be paid through a dentist uh I don't see that there's a conflict I think we can work together and we're better and stronger if we all work together as a team instead of um fighting one another over who gets to be the boss I know uh the hygiene who owns a mobile dentistry um company and uh is it carol is the name cara here in town or um it's actually um mobile dentistry of arizona and um she has to be paid through I mean she hires dentists um and she can't be paid she can't she has to be paid through their um through their licensure or whatever which is insane but there you go um and so to me that's really silly you know if you can own a practice but you can't be paid to actually be the provider I mean I think as soon as insurance provides direct reimbursement I think that's going to go away um and it should say that again when what once we go back to the whole insurance thing once insurance starts reimbursing um dental hygienists and whoever as direct providers then it will solve that that conflict um but you know I think that there are states where hygienists can do direct provision and that that's why it's necessary number one um I I’m always uh suspect that when someone has a idea that's so great that they have to kill you to convince you of it or go get a law that if you break they have the right to kidnap you and put you in a cage so it's all starts with violence and when um colorado did this I’m only aware of about seven independent practice hygienists they were all in very small towns of course they didn't have the lucrative money after a cleaning exam or x-rays or whatever um to go have their own place so they just took out um you go in their house and what used to be a dining room table is now you know they got an operatory and people come by and she cleans her teeth and if she sees something she writes up a referral and they drive 25 miles up to town and you go talk to that dentist and he's in love with her I mean he just thinks it's fantastic and with um humans um distance is everything and um you know if it's not available accessible you know there's I mean on every corner of america you can buy um liquid sugar liquid nicotine liquid caffeine I mean they sell caffeine nicotine and you know on and sugar on every corner and then the dentist their best idea is to limit the access of um of getting your teeth cleaned and do it with economic violence through a law it's just um so that poll on dental town it's um so 22 percent do you support hygienists opening up their own clinics 22 percent um said yes and 62 said no and 16 said no opinion I don't know and that's really cool maybe they're really young maybe they hadn't thought about it but I mean you know that that you know that that's a thousand people voting and um I just um I just cannot believe um it's just kind of sad that two and three americans think that um I mean look at religious converts you know change to my religion or i'll kill you I mean that that doesn't work um and uh my idea is so great I had to get laws passed individually in all 50 states just to implement my great idea and then say in the same thing with um dental therapists every dental therapist you know the people building the schools think well if we create a dental therapist when she graduates with a million dollars in debt she's gonna cut down a tree and carve out a canoe and canoe up the river to where a bunch of native people live and do free dentistry while living under a tree and of course they graduate just like everybody else I want to go to the richest part of scottsdale and get the nicest apartment and the beamer and all that kind of stuff so that um with that being said every dentist I know that has them they love it because you go in their office in the first two rooms they got two hygienists they the dentists don't want to do the cleanings they got two people to do that and then with these um dental therapists um all restorative they numb up and they put on the rubber dam they do the prep they do the whole filling and he didn't want to do that and then he's just sitting here at the end and he can just do root canals or crowns or emergency patients or whatever and i'll tell you what you go to any dentist who's had their own hygienist for 10 years it's hard to take the hygienist away and get them back in that mode and I don't know any dentist that has a dental therapist that would ever because I had to tell you 33 years in this I graduated 87. my worst hour is when you look at the chart and there it says you know patient uh mod composite on two three four and five and you just gotta sit down for an hour no shortcuts and knock this thing out and if you told me uh that oh arizona laura corbin's now can come in your office and do all that well I would never do another one I mean they're fun at first you take all these courses around you go see the bird lotties and everybody but man after 10 000 mod composites really do you do you sit there and think about it the night before about how excited you are to go do four mod composites in one hour I lost a lot of the only thing uh fun with it is a different patient it's not the same technique so um so what is your official stance on independent practice and dental therapy I’m all for it I think that we need to expand opportunities I think that um dentistry in general needs to be part of the medical field so we need to be able to have hygienists going into um into hospitals and providing therapy to like intubated patients to keep them from getting respiration ammonia and we need to be able to have dentistry like you say much more convenient we need to be able to have heck have the dentist office in the walmarts have them uh all over the place have the uh I think airports are a great place to have dental offices people on layovers can get their dental care um I really I really think that expanding access is going to help improve people's access to care uh it's really difficult for people to get care in rural areas because people don't want to practice in rural areas they can't afford to practice if they have great student debt so any time that we can improve access to care we're going to improve things for health and we're also going to make it better for people to have more opportunities to practice um so I’m all for it I’m all for expanding practices for and plus when they don't when it's not done and dennis just sit and sit around in kansas and saying well you know they couldn't afford to do it they could well that well you will never know doc because you wouldn't hired a thug lawyer to write your law for the mob um just let them do it and then when you see how it naturally takes place I mean I’m a libertarian i've been i've been a registered libertarian uh forever I mean I know we're never supposed to talk about religion sex politics violence but I don't believe in any I think it's a binary star system that's taken us down a road of uh from abraham lincoln to today I mean there's 150 years of just you know one drove the car one to rob the bank um it's just a binary star of corruption that's uh that's led to these deficits and all the crazy things so I’m a libertarian and I think the best way to find out if this works is leave me alone yeah leave me alone and every hygienist goes and drops dental insurance and goes to the nicest place in scottsdale and charges what what's the most money you've ever paid to get the bouffant thing in your hair oh boy I am a really bad person to ask that because you can see I have really long hair I don't get my hair cut very often holy moly hold that up again that's like that's like how long is that is that two feet three feet how long is that it's probably maybe two and a half feet how many how many wigs for bald dentists could you make with that hair how many uh ten I don't know depending on how long they wanted them so you have a um you're um providing a hands-on uh diva endoscope course on november 6th is that what I hear right yeah that's correct um we're for the people who are local or um down uh down at the sky song building uh at um scottsdale road and mcdowell we're having a um a 12th person sky song building yeah the skyscram sky song building is that two words or one I think it's one word sky sounds at the sky building in uh in scottsdale yeah and if you go on the oravvue website where they have their education under company I think they have education or of you dot u s dot I mean slash education they have the flyer for it for people if they want to sign up but yeah they were having limited space so that we can do it very safely and everyone in mass everyone getting their temperature taken so we can minimize any possible risk of you know everyone should be healthy when they come in but you know if anyone doesn't know they're not healthy we'll all be wearing masks and gloves but at any rate they can come and they can they can get their hands on an actual endoscope and practice it using a type it on and um ask me any questions that they might have I’m sure that people have questions that they're that they aren't able to ask today um and see what it's like to use it we'll even throw in a little bit of food for them so oh now you just got me yeah you should come i've never said no to a sandwich um so I just found it so if you go to or a view on uh so think oral view v I e w but it's aura view vu so ora o r a v u dot u s um slash events and then it says removing the blindfold non-surgical periodontal therapy using the dental endoscope november 6 at 8 a.m at 1475 north scottsdale road um second floor let's try something new in this new crazy upside down mix-up world we decided to try something new we are hosting three separate seminar sessions and allowing only 12 attendees per session we also will provide mass productive shields hand sanitizers and temperature checks will be taken with unlimited jamison whiskey on ice interesting I like that dr ferran is bringing the jameson that is uh that that's awesome so um how are you gonna get the word out for that uh well we are promoting it on social media and um through our hygiene circles also and um and from you just now you just told everyone so yeah there's no better forum so thank you I’m going to help my homie here uh removing I love that removing the blind filled um I think you should have a subtitle removing the blind filled subtitle how stevie wonder learned how to be a hygienist you know he could probably do it without having to worry because he was that awesome so it wasn't he though it wasn't he um okay so um yeah um well I’m going to try to make it so down do you think because of covid and so um I know you've gotten past an hour and I need to shut up and get off let you go but um how have you how are you doing through kovid what major changes did ralph have to make in your office or the office that you work I know I know ralph has um seven he's the managing partner periodontist of seven offices and I know you work at the downtown one and he's out there in scottsdale where all the rich people live but um what did you have to change um you know what do you have to change because what I’m really curious about is what I wonder is all the stuff that we're doing now will we be doing 10 years from now or how much of this is just hype through the pandemic because I i've lived this to hiv a lot of the hiv stuff you know I remember um telling the dentist back in kansas they had to wear gloves in the 80s I mean they were mad and they had shotguns uh they didn't want to wear masks they didn't want to get rid of custard ores they didn't want to have water coming from the street all the way to their handpiece and so they did a lot of things that lasted what did you guys do that you think we'll still be doing 10 20 years later when the next pandemic gets here well I think that you make a really good point that um the changes that came in after hiv came to stay and so I think most of the changes are also here to stay I think that with greater um use of hve high vacuum high volume evacuation devices we're able to continue to use things like our cavitron units and our um our air polishers those are things that a lot of offices have gone away from but we are using them because we have really good high vacuum evaluation systems so we've changed some of those up I think that we will not go back from that as a hygienist i've gotten really used to liking using those uh wearing face shields I wouldn't go back I know you couldn't you would have to pry it from my hands your dead cold hands yes um and the way that um that barrier wrapping our operatories is much more like they teach in the schools um so school the way the school's practiced and then you got out of school and nobody did it that way well we're all doing it like the schools did so what do you call it barrier practice barrier wrapping are operatories okay barrier explain what barrier wrapping you're all barrier wrapping you clean your operatory and then you cover everything with plastic that can be covered with plastic so um it takes a little bit longer to set up and to tear down but you're minimizing the overall anabec bacterial load and viral load that's getting left on surfaces because those barriers get thrown away and also of course we're wearing disposable gowns after with each patient that's uh they're all these things that we're doing that and what do you think that's about wearing a disposable gown I mean it's that was still the main hiv thing they made our office change in 87 that really hacked on staff because here we are in phoenix it's a you know it's 110 every day for six months of the summer and our office uniform was white shorts a t-shirt a little said today's dental and white tennis shoes and the staff just love coming to work and a t-shirt and shorts and because of aids they couldn't wear shorts I had to wear long pants and long sleeves and my and I’m trying to explain you know my assistants are asking me well how am I going to get catch aids by wearing shorts and I’m like I have no idea but our overlords I think that the hiv it kind of this pointed up the fact that other things that people were getting exposed to were we're going to be protected from as well but um wearing the disposable gown basically means that anything that the patient coughs up on you doesn't get transferred to you or the next patient because you take that off after the patient's gone and then you don't have anything it's a precaution for sure it just makes it that much easier to not worry about um somebody sneezing at you I know I know you're a girl and girls don't tell their age but um so it's hard to tell what you think but it seems like in arizona there's two groups of people there's you know there's 55 to 70 year olds like me that are taking this thing serious and kind of avoiding coming into the dentistry but it seems like everyone in arizona under 40 just thinks this is crazy I mean um so do you personally do you worry about catching coronavirus because there were a lot of hygienists all over the news that were scared and crying and upset but I want to talk about you laura are you for afraid of catching this and do you are you fearful of this um I think that we have to take it very seriously I think that working in a healthcare environment we have to make sure that we are doing everything that we can to minimize our exposure um but I do feel like you working in the healthcare system we are exposed to a lot of things so to me I’m no more afraid of catching coronavirus at work than I am afraid of catching other communicable diseases from my patients and co-workers so um I think this is a good thing that we're kind of tightening up our protocols and having everyone wear masks and these because we're spreading less things around in general I am not a fearful hygienist in the sense that I um I worry like every day that I’m going to catch something from my patients because I feel like because of the precautions that I’m taking I’m not going to catch them I’m minimizing the likelihood that I’m going to catch those things so I believe in um in the disease theory that if you can minimize your exposure and you stay as healthy as you can generally you're not going to come down sick for the most part so but do I understand why hygienists were afraid and not wanting to go back to work and things I totally understand that because I have subbed in offices that I would not have wanted to go back to they were not going to provide their staff with the kind of protections that they need so just because I happen to be very fortunate and I work in offices that are on the forefront of really good um care for their staff and for their patients doesn't mean that everyone's in that same boat so for me I’m not afraid I feel like I can do my job and stay healthy um if I do get sick it's probably you know i'll hopefully I won't I won't be very sick because I do a lot to try to stay healthy but you know we kind of just um we do our best and keep working and um do you worry um and I know I’m uh running over but are you worried that um I mean we had to close down between st patrick's day and cinco de mayo and um do you worry does ralph worry I mean with seven offices that do you think um do you think there's gonna be a fall um outbreak um that maybe we'll have to um close down again or do you think that since we all adjusted with the ppe and the temperature and the rat and the barrier wrap and everything that we've done that we've done that we're like hospitals will be essential we'll stay open and they'll close more like bars and gyms and think restaurants or do you think it might be us again um I think that this is just speaking for myself not speaking for the company because I can't speak for the company um but uh I would find it really unlikely that um dental offices be required to close unless something some event happens that you suddenly found out that a whole bunch of people were getting sick after having visited dental offices and that hasn't happened to my knowledge there hasn't been any chain of oh everyone's getting sick because they're going to the dentist I don't believe that has happened and I don't think that it will happen so the likelihood that um that it will is to me really low um I think people are more likely to get sick if they do um you know bar crazy bar at um activities where they get all jammed in together and go to concerts and nobody's paying attention to social distancing I mean we can be smart about this we can protect ourselves we don't have to do those things and we can if we do if we are smart about it then we can reopen most of our businesses without feeling like we're going to put ourselves at risk or our customers and our patients and things I mean why would we want to put them at risk let's just be smart about it well you're confusing me because you you're asking americans to be smart about something that's a uh that's a tall order there laura uh you must be uh very optimistic um so um laura corbin rdh aasbfa removing the blindfold master trainer at orovu uh this november 6th right here in scottsdale and uh anything I can do to help the cause let me know um thank you so much for coming on the show uh um it was an honor to podcast you and uh I hope to see you there I’m going to try to make one of those november 6 and uh and um you know laura i'll probably bring like listerine but i'll have the vodka thank you so much howard I really appreciated talking to you and it was a treat all right have a great day laura thanks