1473 Dr. Ronni Brown, DDS, MPH, on Public Health Dentistry and Treating Meth Mouth : Dentistry Uncensored with Howard Farran
Dr. Ronni Brown is a dentist, researcher, speaker and author who bridges the gap between dentistry, public health and substance abuse. She is a leader in dental public health, experienced in identifying emerging issues in the care and delivery of dental services to underserved populations, and competent in developing strategic action plans to achieve measurable results. She is a triple “Bruin” earning her bachelors, dental, and master’s degree in public health from the University of California, Los Angeles. She completed a post-graduate dental practice residency at the Veteran’s Administration Medical Center, San Francisco and a dental public health residency at the University of California, San Francisco.
VIDEO - DUwHF #1473 - Ronni Brown
AUDIO - DUwHF #1473 - Ronni Brown
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***Please excuse any typos as this was digitally transcribed. It is just a huge honor for me today to be podcast interviewing Dr Ronnie Brown DDS MPH dentist researcher speaker and author who bridges the gap between dentistry public health and substance abuse she is a leader in dental public health experience in identifying emergent issues in care and delivery of dental services to underserved populations and competent in developing strategic action plans to achieve measurable results she is a triple bruin earning her bachelor's dental and master's degree in public health from the university of California Angeles she completed a postgraduate dental practice residency at the veterans administration medical center san Francisco and a dental public health resident at the university of California san Francisco as a dental public health specialist Dr brown's career has focused on providing care to underserved patient population whose oral health impacts not just their systemic health but their employment and housing opportunities and overall self-esteem for the past 23 years Dr brown has worked at a medium security correctional gel facility that's how we met I was the inmate and providing much needed dental care to inmates the majority of whom have significant substance abuse disorders her research in collaboration with the ucla and ucsf on the impact of drug use patterns on methmous severity published in the journal of the California dental association has garnered national and international interests with more than 700 reads and 10 citations and has positioned her as a leading expert in the oral effects of substance abuse Dr brown realizes that the patients she serves aren't isolated incidents of misfortune but reflective of the growing use of methamphetamine and other illegal drugs used by patients in all walks of life she states that these drugs cause irreversible damage not just to their oral cavity but also to their lives robbing them of their family friends physical and mental well-being and even their freedom her courses at the world's top dental conferences help the dental team learn the rcts and that's not root canal therapy that's for recognition communication and treatment of treating the addicted dental patient so it will no longer be the silent epidemic in their practice she's the author of the recently released number one bestseller a state of decay your dental guide to understanding and treating meth mouth available on amazon we're not treating speaking or writing Ronnie can be found hiking baking and visiting zoos across the world um my gosh um and and I I you know it's so sad because I I think the government has been a bigger problem in all the substance abuse in my lifetime um then the help I mean you would think the hoa the head rancher in charge looking over 330 million cattle uh would be there you know finding the coyotes getting the wolves out of the den it seems like they're a bigger problem than all of this um than the poor guy that um starts using I mean he starts using he makes a bad decision usually because he's a little kid he's trying something he's bored he's whatever you know something happens next thing you know he's addicted and when the government shows up they're ready to handcuff him throw him in a cage throw him away leave a big internet paper trail so he can never find a job it's like wow thanks for the help I mean I’m sure glad I give you you know half my paycheck every time I get paid I mean I mean it seems like if if you're in trouble I’d almost rather be found by the mob uh than than the u.s government I mean they have more people in prison than mao and stalin did I mean how do you have three million people in prison and a millionaire is for a medical disease where you know they're using and I had another podcaster on a long time ago um Wendy and she's been in substance abuse for her whole life and she thinks 85 of the people have other mental issues going and they were probably self-treating so if someone has a mental issue and they start treating themselves how does arresting them and handcuffing them and throwing them in a cage and ruining their whole life future I mean it's just uh so I’m glad you're tackling I mean I mean what you're tackling is a hell of a lot more important than an mod cavity on number three I mean you're going right you're going right to the brain their life their whole life is going to be determined on how society treats this mental disorder and I think the government is doing the worst job and I think you're doing the best out there that I’m aware of trying to to right the wrongs well I thank you you touched on so many things Howard um you know substance abuse is a mental health disorder and as you know in this country we are now starting to finally address some of the stigma around kind of mental health issues as well as substance use issues and you know it is tragic and the lives that are impacted by addiction it's not just the user it's the family it's the friends and unfortunately I’m very downstream in the process in that the patients that I serve are you know at a correctional facility recently arrested and I’m really seeing um missed opportunities along the way missed opportunities that could have redirected or made a difference in their lives I think you know as dentists you know my mission is that we no longer let this be the silent epidemic in our practices you know it's not just patients I serve but we all have patients in our practices that have substance use disorders and we start having these conversations making appropriate referrals we might change the impact and the tragedy of our patients lives and it's concerning um you know I I’m guilty of some jokes but hopefully I’m when I’m doing a joke I hope they they know it's a joke you're always worried if they think you're serious um but um it it concerns me that you're a health care provider and then they're all over social media oh yeah this druggie call and he was trying to get viking it's like okay first of all he's a human and even if he was this druggie why are you talking about him like that you wouldn't be talking about him like that if he was on the jerry lewis telethon and he couldn't get out of his chair I mean why are you wouldn't be talking about that if he had crippling depression so how come when he's calling and you think he's I’m just trying to get vicodin why do you get all self-righteous and mad and and do all this stuff and and say all these things why don't you try to uh get them help like i'll tell you something I figured out young in my career um I couldn't um I couldn't buy into the tmj theory and I know the guy teaching it was god and he's a legend I love him and I went to his course several times and um but you know I asked him I say well you know when she's sitting there grinding her teeth is there any chance it might be some mental issue no it's an interference on number three and I said well you know her daughter just got arrested the husband's sleeping with the secretary she's gonna go bankrupt she lost her house her cars just got towed really none of that has anything to do with her going and I started seeing this and I started realizing that um boys are different than girls and I would write the boys when they had the grinding I’d write them a slit why don't you go talk to my buddy john you know he's a psychologist and this might be some coping mechanism about some stress you're not even aware of and then another a lady for the lady I don't know I just thought that and um my gosh now it's 32 years later I’ve got 20 30 people that say you know the best thing you ever did for me is when you referred me to that psychologist john and that that changed my whole life and I’m the dentist thinking I know and guess what else you did you quit breaking teeth you know that maybe there was something wrong in the noodle and I I just think a lot of this substance abuse instead of being all judgmental maybe there's something wrong in the in the chemical soup of the brain and there and they don't feel good like like why do so many people do drugs well maybe that many people don't feel good why does that many people I know when I get stressed out my mind I eat an entire lemon meringue pie I mean I don't even I don't even cut a slice out I just take the pie to the chair and just eat the pie maybe they're just maybe it's a coping mechanism because they don't feel good and they're mentally stressed well you know addiction is a disease so you definitely did uh tap on that and there's a genetic component so there is a significant percentage of the population that actually has genes for addiction and the determination of whether or not those genes will be turned off or on is really in response to some environmental issues you know whether it's environmental issues of abuse environmental issues of loss which so many americans are facing right now the loss of the job the loss of a relationship um the loss of a loved one and it could be someone physically being an environment it might be a home environment or a work environment or social environment where drug use is kind of the culture and then you layer on top of that being exposed to an addictive drug that kind of sets everything in motion and starts changing the neurochemistry and starts priming things for feeling pleasure and feeling reward so although it might start with a decision to try something it easily cascades into a significant and permanent changes to the neurochemistry and I think you know when you had commented about sometimes our reaction to patients who might be drug seeking in our practice a lot of those reactions is is based upon the provider you know our own junk around addiction right whether we know someone who is addicted and we've got a degree of embarrassment or shame around that if our belief about addiction might result in our thoughts about denial that we don't have in our practice or you know even um a feeling of helplessness like this is a road I wanna go down because I don't possess the skill sets to know what to say or what to do or how to help my patients so I think some of the responses that we sometimes give to patients is really based upon our own misconceptions our own personal experiences that create a high degree of emotional response to addiction so tell me about your journey I mean how does how does Ronnie go lucky walking around san fran end up being the queen of meth mouth I mean uh were you looking for a new diet cure you know or like uh because I I’m pretty sure meth if there and there's got to be something good about it it's got to be weight loss I mean you never see a short fat bald meth addict I mean they're always uh they're always skinny but what was going on in your journey where you ended up chasing down meth well you know it definitely wasn't the game plan that's for sure it wasn't what I was thinking about when I was in dental school um you know it really started with me kind of saying yes to a very unusual opportunity I saw an ad at the jail for a dentist I had never thought that there were dentists at jails and I applied and I really got fascinated because as you read in the introduction I really am very passionate about dental public health and I’ve been been so really since being in dental school and I saw this as an opportunity to um really kind of have this public health practice um in a correctional facility and I always share when I’m speaking that what kind of got me on this footpath of understanding methamphetamine was really my very first patient on my very first day of work and when he opened his mouth he was about 20 years old he was you know very polite very quiet but when he opened his mouth it looked like a bomb had gone off I had never seen anything like it before I had never seen anything like it in dental school or even uh in years prior to working in private practice and it wasn't just that patient it was all the other patients I was seeing and initially I you know kind of was trying to apply what I learned in dental school about curies you know this must be too much candy this must be poor oral hygiene maybe poverty overlaid on top of it um and so I started I started to kind of apply what I learned to dental school to these scenarios and what I was doing wasn't working and I was making a lot of assumptions about my patients without really asking questions and so after a month or two went by I started to ask my patients questions you know what are you putting in your mouth why do you think you have so many cavities and my patients told me they used methamphetamine and this was back in 1997 Howard and I had never heard this word before I had no idea what it was and I thought they were kind of talking about some you know weird nutritional supplement they got at the local gnc store and when I started asking more questions I realized it wasn't a nutritional supplement they're referring to they were talking about a drug so I started trying to find research about the drug and at that point in 1997 there weren't a lot of articles published about methamphetamine let alone meth mouth and if they were published they were very you know pilot studies or uh you know a dentist reporting on his experience in private practice so I started asking my patients and I learned a lot about methamphetamine from just conversations and that made me realize that you can have conversations with your patients about drug use and then fast forward 10 years later I went to get my master's degree and I wanted to do my master's thesis on the oral effects of methamphetamine looking at things that I had observed clinically with my patients and things I want to investigate and I think that process of actually doing research led to a better understanding not only of the oral effects of methamphetamine but some of the variables that contribute to the varying degrees of meth mouse severity that you see with patients this is um going to sound like a weird question but um my friends in California I’ve actually have classmates in California that graduated you know in 87 and they were saying you know everything was fine fine fine then all of a sudden it's like a bomb went off and meth mouth is everywhere and I have close friends that went from like doing like a denture a month you know or maybe a denture every month to doing a denture every day and and when we were talking about this on dental town I realized I had messed up because the first time I treated a meth mouth I didn't even know it was a meth mouth and I was so dumb I did root canal buildup and crowns on eight of his molars and all of his bicuspids and his dad paper and I told him you know I I feel really bad about this but he's like I know I know but I did the whole thing and of course he was still using I didn't talk to him and two years later it was in removable and then I was so then I I finally got smart to say um look if you know if you're doing this you know we should go removable you know that you should really stop but my question was and this sounds so bad to say but it sounds like um bakersfield was the center of it in California and out here in phoenix with 3.8 million seems like they're all out in apache junction and I drive out to apache junction and it's normal I mean maybe has a little more retirees or a little more trailer parks and trailer homes but is it like that is it like more of a regional thing where there's little hot spots of it where it's 10 times more common than other areas and why is that so all right so the answer is kind of a yes and a no um another thing I mean you know in terms of where it really started it was really actually more in the like plain states like oklahoma nebraska you know kansas arkansas it started moving out west I would say probably in the 1980s you know it was like associated with motorcycle gangs um and then as in 2005 the president bush signed into law the methamphetamine epidemic act which decreased consumers access to some of the key ingredients that were used to manufacture methamphetamine those key ingredients being found in like common cold medications and that switched the manufacturing of methamphetamine to Mexico so now with states that have a southern border with Mexico California Texas Arizona we're seeing a huge increase in the distribution and manufacturing and trafficking of methamphetamine into those states but also when you track it you know across the country it's starting to pop up in areas that typically weren't really hot spots for the drugs you're seeing an increase in use in areas like Miami Houston Philadelphia Atlanta Washington because what's happening as the opioid epidemic is kind of curtailing and users are you know having more difficulty obtaining methamphetamine excuse me opioids they're switching their opioid addiction for a methamphetamine addiction methamphetamine is a very inexpensive drug and it provides a bigger bang for its buck quite frankly than almost any other drug you know the high associated opioid lasts about four to five hours the high with methamphetamine lasts like 9 to 12 hours it's a very very inexpensive drug that is extremely powerful yeah and um I I don't want to get into right and wrong because as scientists should just be you know like engineering what is a trade-off I mean if you want your car to survive a crash it might be built very differently than a car that gets the most gas miles you know uh one's not right or wrong it just is what is but it seems like like when um here's another example where um the government you know um they they they crack down on sudafed so what does it do now instead of the active ingredient being made by a pharmaceutical company that knows what they're doing now it's made in some bathtub uh you know in somebody's uh garage or being shipped in from Mexico or whatever same thing with opioids they always say about the opioid addiction that they massively crack down on dennis prescribing vicodin and perkadan and all that kind of stuff so what are they doing they're buying it from people who make it in their bathtub and they're cutting it with fentanyl and all this stuff and then every time they talk about the opioid epidemic though um like when prince dies or um who's the rock star um who died in her bathtub whitney Houston well when you look at the toxicology report there's five or six other things in there and I’m always thinking well prince had a jet and he's flying around trying to get this stuff maybe if he just went to walgreens and got it there maybe it had been legal um he still would have had his addiction issues still would have had all those issues but maybe he wouldn't be dead so I always wonder um when the government does this and makes everything illegal if the cure is worse than the problem did bush um making sudafed illegal and and now you know you need to you know you almost need to sign an affidavit to write for vicodin um but I see the death rate still really high at 50 000 and any toxicology report I see on the death rate it never says oh he died of hydrocodone it's like no there was fentanyl in there it's always fentanyl and you know that was never in the walgreens vicodin that's all this illegal stuff do you think that the whole illegality the trade-off of illegality of all this stuff makes the problem worse than if we just uh did kind of what portugal did and said portugal said well you know it seems like america the more money they spend the bigger the problem they get so we're just going to take the same money but spend the same money on treatment and social issues and from what they tell the world and from what I can tell portugal brought down their addiction uh further and faster than anyone in europe the key being though that they spent the same amount of money in the illegal um you know lock them up throw them away in a cage on the social service when in portugal if they find two people shooting up underneath the bridge you know they try to say what's wrong well they're homeless they don't have a job they don't have you know they try to pick them back up on their feet so I know that's a long-winded question but do you think portugal is the better direction than the american criminal justice system and I know you work in the criminal justice system so I know you're probably sitting here thinking should I get fired to answer this question or should I just shut the hell up and uh change the channel definitely a long-winded discourse that you just gave me um I really think that it requires collaboration and I don't know Howard honestly if it's one answer or the other I think that we have so many uh you know social issues poverty homelessness um despair unemployment and from a public health model it's really trying to bridge all the gaps that exist you know we sometimes like to treat things in isolation or if there are islands in the of themselves and that's really not the way it is you know we all have to kind of work together whether it's through you know improving access to mental health services improving homelessness having job equity so I think it's a multiple response by multiple uh departments um I’m gonna I’m gonna read you a um question uh a post on dental town and I just want to see and um I I really um love following this person and they're actually from uh California uh so maybe uh um where'd he go right here she goes hi guys I work in a medicaid clinic where we get a lot of referrals from drug recovery programs and and I have to say I’m getting very frustrated with gross decay meth mouth cases and the treatment planning clinical work associated with doing these cases a lot of these patients have teeth with the type of decay that wraps around the whole tooth around the gum line so decent isolation is extremely difficult to obtain having to do this for every tooth in the quadrant drains me mentally and physically and I don't know how to control this on some cases it seems like even after I do the fillings there's plaque and recurrent carries forming around existing fillings so I just keep on adding more to the treatment plan and the process gets extended much longer than planned I know communication with the patient ohi instructions are very important but some patients only do so much how do you guys deal with these cases and what should I be doing to make the whole process smoother thanks no really good question and it is challenging you know when someone opens their mouth and you're seeing you know uh you know blackened broken crumbling teeth you don't know where to start you don't know how to prioritize the care and I think it's many things I think as a dentist sometimes we kind of jump in and we need to a little bit hold back I think you know you've got to get some things in place in order for treatment to be successful you've got to really tighten up preventive services having a patient be given oral hygiene instructions use disclosing tablets show them where the plaque is have them on a three-month recall pull out your topical fluorides your five percent sodium fluoride that you can apply and at least start to promote remineralization utilize silver diamine fluoride uh to arrest the decay and then uh find out where is that patient in the recovery phase um how long will they be in a rehabilitation program because that provides you with a time frame of when you actually might be able to kind of capture them and hold them for that care the other thing is utilizing a glass ionomer which is a wonderful material because it does everything you need it to do so you know do your carries control and your initial fillings whether they be interim on large class twos or permanent on small class twos or class fives and class three utilize the material that's going to do what you need it to do which is re-mineralize and also you can utilize it very well gingivally as well subgingivally because the material that tolerates moisture very well so I and don't do heroics you know I think sometimes we restore teeth that are um so damaged there's not enough to structure after you remove the decay just to adequately support a filling or a crown I think being very logical being very linear if you've got a short amount of time with these patients prioritize the care and focus on teeth that have a good prognosis um when you wrote the book I mean what would I know I um I’ve written a book before and I have four kids and I always said writing a book takes longer than making a child I mean you can make a child in nine months it's hard to do that but what was your process in writing the book and when you're writing the book who was that who was who were you aiming at who was your ideal reader I definitely never thought you know Howard that you know it wasn't on my bucket list to write a book um but you know after I would you know speak I’d have people come up to me and say oh I wish my dental team had come to hear your presentation or I wish that my son had heard your presentation or I have um audience members come up and share with me the loss in their life uh from a loved one who succumbed to addiction and I realized that I wanted I felt this information so important because we are in this epidemic of addiction whether it be methamphetamine or opioids I wanted this information to get out for also from the perspective and from the lens of a dental practitioner so I wrote the book to really provide access to information that people may not be able to get if they're unable for whatever reason to attend a presentation so that was really um I think the main point and also the fact that this is so important the process for writing the book you know I had a lot of people tell me you know record what you want to say or write every single day what I decided to do was last year I had a window of time really from like the end of may to maybe really the end of june and I literally marked off 30 days I wasn't speaking work was going to be relatively light I was speaking in montreal and I got on the plane headed home and I started writing and I wrote every single day for 30 days and then I turned it over to an editor on july 1st so you could make a baby in 30 days that is wild um when you talk about it being a silent epidemic in dental practices is that because it's illegal I mean I’ve heard that alcohol kills 80 000 people you do and that meth is um that um opioids are killing 50 000 so alcohol of course it's legal on every corner at every 7-11 so is nicotine and so is sugar so you got you got um you know caffeine uh starbucks you got nicotine marlboro you got glucose coca-cola in every corner do you do you think that um it's a silent epidemic and and only uh 50 000 die of uh opioids and 80 000 diet alcohol because alcohol is more legal and you can talk to your you might feel safer talking to your dentist that you're an alcoholic then you're doing something illegal like meth I think it's a silent epidemic power really because there's a lot of stigma around addiction and I refer to a silent epidemic I really am talking about what's happening in the dental office you know we oftentimes as providers do recognize the clues that a patient might have a substance use disorder it might be something that's on our health history it could be changes in behavior that we're noticing their physical appearance what happens when we look in their mouth when we do a clinical exam but rather than discussing it and bringing it to the open we let the patient leave and then we all huddle in the front office and we whisper about that patient oh I smelled alcohol in the patient's breath or I think the patient was high because once again all of our emotional garbage around addiction comes up whether it's the shame or the denial or the helplessness so it becomes this silent presence in our practice and it's so important that not be silent because we're missing out an opportunity to help these patients we're missing out on the opportunity to develop treatment plans that actually might be successful we're missing out on opportunities to be responsible prescribers of medication we're missing out on the opportunity to utilize appropriate material so as so it's silent amongst us as a profession and even the medical profession less than 3 000 physicians have actual training in addiction medicine and so we have to kind of um you know acknowledge it and recognize it and address our own discomfort because it's our discomfort which is really creating the silence in our practice yeah and you know I got uh it's amazing how one conversation from some a doctor in authority continued life I had so many grandmas get mad at me they go I I told my husband I quit smoking for 20 years and you told him one time and he quit and um and I remember in dental school I had one conversation I had one of those little whispering huddles with one of my teachers an oral surgeon his name was uh Dr brett uh ferguson who went on to be the president of the uh american association of oral maxillofacial surgeons I said well do you think he was in a fight or did this and then he said hey he said right right now we're in uh we're in the oral surgery department and we're past that I don't give a crap we got a person we got an injury and right now he needs a doctor he doesn't need a lawyer he doesn't need a judge he doesn't need a pastor a minister his mom or his dad I’m an oral surgeon shut the blank up and let's go do our job and if he needs a minister or a lawyer or his mom he can do that later but right now we're in umkz oral surgery clinic and I just like that's so true I mean I’m not I didn't go to school eight years to be his mom his lawyer is advisor I’m here to find out what you know what's going on um so why um so I um so methylmethane is it is it math because I remember um reading in history that um during war two uh the uh the germans ran off um a lot of their intelligence scientists and einstein came over here and we end up developing the nuclear bomb and it kind of makes me laugh when people say well america was the first um to land on the moon yeah with all captured german scientists it's kind of like when boston won the stanley cup not one of their hockey players was born in the united states and everybody's in boston's like oh we won the stanley cup and I’m like no I’m pretty sure it was canada the ukraine poland and russia but whatever you want to believe but they said that during world war ii that the japanese scientists were well aware that the american army was handing out amphetamine uh white cross chris uh white cross amphetamine and they would stay up a long time and the japanese developed crystal methyl memphetamine which made him stay up any longer um and that's on wikipedia so when you talk about meth mouth is that the crystal methyl memphetamine invented by the japanese in world war ii or is that the american army uh white cross uh amphetamine well you know it methamphetamine definitely has kind of evolved and emerged you know chemically since the 1930s and the 1940s and so you know some of the key ingredients that used to be in methamphetamine the pseudoephedrine the ephedrine the female propanolamine has now been replaced with you know something called p2p which is a more potent form so the chemistry of methamphetamine has definitely changed and evolved since the world war ii days when the fighters were you know utilizing methamphetamine to fly to long distances and stay awake and stay alert on their missions so the drug keeps getting uh more potent and more um with all you know I keep reading papers that since the pandemic hit 40 million americans have lost their jobs this is going to affect dentistry because when I talk to my insurance ceo friends they say yeah 40 million lost their job but 30 million of them had dental insurance and there's a ton of research showing that people with dental insurance through their employer the government um they're far more likely to utilize everything the ada is saying that you know that um we're only back up to about 70 percent of pre-pandemic levels um I keep reading articles that mental health issues have tripled during the pandemic so are you kind of looking uh is so is this gonna be a real bad time for your department and substance abuse and mental illness and all things all things that you do is this is just gonna get worse for the next year you know they're definitely uh we're definitely seeing you know upticks in mental health issues increase in the number of people calling crisis lines suicides are up alcohol sales are up and so you know we are seeing two pandemics really collide with with one another right the COVID-19 pandemic colliding with the pandemic of addiction and its epidemic use here in this country so you know the the bad news is is that as people are experiencing job loss and housing insecurity and food scarcity and disconnect from their support systems we are likely going to be seeing an increase in substance use whether it's the initiation you know for creating a new generation of users or for those who have been in recovery these stresses have created you know a relapse but we also can look at this Howard as an opportunity an opportunity to start addressing these these issues in our practice um you know through education through conversations through uh communication with our patients through appropriate treatment plans and even through referral so I see this as an opportunity for us as a profession to really rally around substance use disorders because we can make a difference um my gosh so we got the uh um the sars virus hitting a an um an addiction pandemic and now we're gonna go through an economic um restructuring I mean nobody can predict the future but I mean um my gosh I’ve lived through four economic contractions and if you remember long before march the whole year before remember warren buffett wasn't buying any stocks he was sitting on cash everybody was saying hey it's been 10 years since lehman's day which was 10 years since the y2k which was 10 years since black uh yeah black monday or black thursday in 1987 and so we were expecting um you know um the austrian uh um economist schumter in his book business cycle says the reason we have business cycles because you have a bunch of humans making all the decisions and after seven ten years of making decisions um there's they're going to get corrected on where they're wrong so we kind of got an economic a virus and a drug pandemic is that going to be the perfect storm yes yes it's a perfect storm that's why we need to be prepared and so so let's uh bring this down to basics so um we're you're in a dental office I’m she's listening to you right now she's a hygienist she's a receptionist how is she supposed to recognize um meth mouth uh or that she's uh the person using methyl memphetamine all right so um first thing you know is obviously I have got a great resource my book a state of decay which is available on amazon but in the book and even in the you know presentations that I give I do teach the dental team the rcts it's not root canal therapy recognition communication treatment on some easy ways to recognize who these patients are in your practice and so um you know clearly there are some physical signs associated with methamphetamine abuse whether it's a patient who presents very kind of malnourished or patient that you've known for years but all of a sudden you're noticing some very severe weight loss that really can't easily be explained through diet or exercise uh you'll have some vital uh sign changes you know increases in blood pressure increases in pulse you can also utilize your health history form as a wonderful screening and diagnostic tool for substance use disorders you know hopefully and I talk about that in the book and I talk about how that question should present on your health history form but I’m hoping that um every dentist listening to this podcast if they don't already have a question that specifically asks about a history of substance abuse that they will add that question on their health history forms really one of them one of the most important questions to have on your health issue form you have some behavioral clues you know a patient who uh presents they're very demanding uh might be very uh irritable their anxiety might not necessarily match the clinical scenario um they might be experiencing some degree of psychosis or hallucinations and then obviously the oral manifestations of what you see when a patient opens his mouth and you're looking at teeth with a lot of class 3 class 5 lesions it carries his blackened you see a lot of anterior tooth involvement so I want everyone to understand it's not just one thing it's looking at a myriad of things that will allow you to recognize and you have to pull all those things together um when someone says the um opioid crisis um it's kind of specific to an opioid that doesn't include meth do you not like that term when people talk about the opioid crisis is it better to have a more inclusive word like an addiction crisis or what would it or what what what do you what are you thinking when you when you have the book the number one selling book on meth mouth and you hear people talk about opioid addiction are you like hey hey uh that is does opioid in your mind include meth or when people talk about opioid addiction should they be using another word like um addiction crisis or something you know I’m not um bothered and i'll tell you why Howard because when you know at the end of the day when people you know the opioid addiction just brought it into focus for people that we have an epidemic of addiction in this country and so it created conversations it created rallying and development of mental health support for people who have substance use disorder so I don't feel any degree of competitiveness whether we're talking opioid addiction or methamphetamine addiction now the reality um you know is oftentimes what gets attention and what gets what drives policy is what happens on the east coast and so the opioid addiction really plagued the east coast and as a result it became a topic point and policy and decisions were made around it but once again it created conversation and those conversations help anyone who's addicted whether they're addicted to alcohol methamphetamine or opioids so I’m happy that we are able to start having these conversations and is brought into a clear focus the travesty of substance use disorders in this country and and you were saying earlier you know that um um you know if they're you know they have issues that might have genetic components to it their culture that where they were born family issues abuse is it also true that I mean if you're having this issue if you run out of opioids you might switch to math if you can't find methyl opoid you'll go get a 12 pack I mean so oh so it's really is it just kind of like this is the fastest easiest lowest cost drug I could find immediately so you know an opioid um just happens to be the the drug they most easily available for that moment and and the next month it could be something else um you know I think it's a couple of things I think that users oftentimes have a preferred drug you know alcohol is which is a depressant has a very calming effect um opioids can create a very numbing uh reality for people can make life very uncomplicated methamphetamine can make you feel like the life of the party and you're in charge and you're invincible so they create a different feeling for the user most users have a preferred drug of choice but oftentimes they will co-abuse with other drugs to either one it's accessible or they're trying to counter the effect of their primary drug of choice so someone might be primarily a meth user but then they might co-abuse with alcohol to help them come down off of that methyl or someone who is primarily an opioid user may need to kind of get up and go and then they'll use a stimulant to counter the action of the opioid so most users do have a preferred drug of choice so did you ever answer huey lewis's question I need a new drug one that won't keep me up all night one that won't let me sleep all day you know what I love the most about that huey lewis song he's the only singer who made the american top 40 who aced the s.a.t test perfect score on the math not the reading but the math and so here's the only guy and and I heard this on casey kasem so that's uh you know that's that's uh yeah I mean my gosh if casey kasem said it that's better than pubmed but um um he's saying a whole song that he needed a new drug I mean um um I know this is a dangerous question but do you think some drugs are better than others I mean do you think some are going to lead you off a cliff faster than others what would you tell huey lewis if he was saying that song to you I wouldn't use the word better I would say there are some drugs that are definitely more potent and more addictive and methamphetamine is one of the most potent and addictive drugs because it releases more dopamine which is the neural chemical that conveys a feeling of happiness and pleasure than um any other drug so there's you know definitely drugs that give a more powerful bang for the buck but I definitely wouldn't use the word better yeah he says I want a new drug one that won't make me sick one that won't make me crash my car or make me feel feet feet thick I don't even what would that mean or make me feel feet feet feet thick I want a new drug one that won't hurt my head one that won't make my mouth too dry um or make my eyes too red so the mouth to dry that would be meth right but you know you'll yes it's math it could also be alcohol it could be opioids they all have a zero stomach effect we're going to keep going one that won't make me nervous wondering what to do one that makes me feel like I feel like when I’m with you uh so that gives them they can talk better at bars right uh I mean they're coming they're coming out of their shell I want to switch to the dentist side of you I know you're an author and lecturer and speaker but let's go back to dentistry because they're they're asking on this thread um you know I felt really horrible that I charged his dad a root canal buildup and crown on eight molars and another eight by cuspids and two years later I’m doing a full denture and some did us on this thread saying you know you need to start transitioning meth mouth to dentures and then and the next guy uh was saying well just try to save the canines and the second molars you said something very uh japanese where uh switched to glass ionomer and and lecturing in 50 countries I was amazed at a very young age how in australia new zealand and japan they like to do their fillings with an active ingredient glyconamer they do sandwiches they put glass on them or gc on the floor then just put a layer of resin on the top so where are you at or is it if they're if they're you know or would you want to go full removable would you want to save the canines and second molars or do you want to repair it all with glass anomer obviously it's a case by case but how do you wrap your mind around the diagnosis and treatment plan of that you know it's definitely case by case I can't I’m not going to give a blanket recommendation because I don't know the you know individual situation the periodontal health etc of the patient um I would you know and as I said you know you've got to put a lot of things into place where is this patient relative to their use or their recovery is are they currently actively in recovery are they actively using those are all important ingredients to understand um you know when you're dealing with you know 28 teeth that are grossly decayed you have to ask yourself and you've got a patient who's actively using whose oral hygiene might be poor um you have to ask yourself you know is doing 28 root canals and crowns and bridges and the right treatment or do you need to begin to kind of prioritize as I’m hearing some of the dentists are starting to think you know prioritize about what has the best restorative prognosis what has the best periodontal stability and make decisions around that um often times you know if tooth is so far gone or they're so compromised periodontally and inadequately endodontically you do need to consider extracting these teeth um I always you know some of my patients say well you know when I get out of jail I’m gonna go get implants and I always say if you're driving the pinto your next car is not a tesla it's not a rolls royce get something that's uh you know reliable and oftentimes that might be that partial denture and that provides a degree of stability for the occlusion it can address the aesthetic issues and then you can see where that patient goes over a period of time in terms of their oral hygiene their ability to maintain their recall appointments whether or not you're slowing down the decay before you get into complicated treatment plans I really you know when you've got an active meth mouth case I really want the dentist to hold back a little bit and make their treatment plan a little less complicated this is not when you start throwing in implants so I always say be very measured and being very cautious um you um are in pubmed um congratulations on that um my gosh uh I wouldn't even know how to uh I wouldn't know what I’d write about if I was trying to get published in pubmed so good for you Ronnie um so talk about your journey you um you had a research project in collaboration with ucla ucsf on the oral effects of math um it was um and your article uh mal um meth mouse severity in response to drug use patterns and dental access and uh methamphetamine users uh cda um tell us about that journey and and what did the cda think about that did were they um were they as concerned about this as you or was it something um where they might have been um you know we want to do something on root canals um again I if you listen to my show for four years or heard me lecture I’ve always been extremely sensitivity um there's when I got out of school there were eight specialties now there's 12 and they always talk about root canals fillings crowns pediatric dentistry they talk about silver diamine fluoride all day long and it's like where's dental public health I mean we have a and it's it's kind of a weird um space I remember when I got out of school I started going to these uh classes and I don't want to mention any of their names because they might get back to the pink institute but I remember the the first day's lecture you know I got this big old lecture about how there were a patients b patients c d and f and how you just want to focus on a and I’m sitting there thinking well the entire faran family tree in wichita kansas um is c d and f I mean so you're telling me to go learn how to do dentistry and I couldn't even treat my own family tree I mean I I’ve always said whenever we have a family reunion the cdc should show up and swab and look for dna or whatever but you know yeah I get it um people buy mercedes benz and they buy 25 000 arch all on fours but my favorite especially is dental public health and I think everybody needs to be a dental public health I mean when eight percent of the emergency room visits in Arizona are adontogenic in origin when dentists tell me well you know they don't even treat me like a real doctor I say well you're not a real doctor because on sunday if you fall off your bike and break your leg the ambulance shows up he takes you to the hospital they're all staffed but if he broke his front tooth nobody could find you you're unlisted there's nobody oh there's 3.8 million people in phoenix and there's not one dentist open on sunday and so um and that's why the emergency room which has real doctors has to treat your patient because you're unlisted so if you want to be a real doctor and by the way you you don't have to do the root canal you don't have to treat them at mouth but you got to triage it you got to know enough information to sit there and say I’m a doctor you're not here's an emergency I can't do this molar root canal but I can open it up and give you some powder treatment I I can do something but you know you gotta you gotta dental public health my especially that's why I’m always trying to that's why I was so honored that you came on this show but um what would you tell some kid who's in school and he's thinking about a career in dental public health and is that in his other choices um to be the 14 000 orthodontist doing invisalign well I love I love dental public health you know Howard when I was in dental school um I always gravitated to dental public health opportunities those extramural rotations that took me to you know health clinics where I was able to spend time educating patients teaching them how to brush their teeth and just uh you know interacting with patients who are having challenges accessing just basic uh oral health services so I love dental public health when I graduated you know it wasn't something that was really discussed in dental school there wasn't really a lot of discussion about what she could do with it so you know I was uh taught that when you graduate from dental school you associated for a few years and you went into private practice and you know I really knew that that was not my career path so for the new graduate you know dental public health is definitely uh more discussed in the dental school curriculum um there's more opportunities for uh both dental students as well as graduates through like aegd programs to work in uh you know federally qualified health clinics and have that type of exposure but I love delaware public health I love being able to look at things from a much broader lens I like to be at the table of conversations when people are discussing policies and strategic plans for counties um so it's been a very rewarding career and it has allowed me to do research and have great partnerships such as ucla and uc san Francisco and to be able to work with the California association as it was looking at some policy changes as it related to the opioid epidemic so it allows you to wear many different hats um and do many different things so I would highly encourage a dental student who is interested in it to really investigate it and seek out the opportunities and that's why I was going with that question that um when you were um you know published a research project in collaboration with ucla ucfs on oral effects of methamphetamine in a journal California dental association that's why I was saying was it hard to get space to get your dental public health in there when they get so much people wanting to put in the traditional implants and endo and silver diamine fluoride and do you do you feel like kind of the redheaded stepchild uh of the uh of the orphanage no I don't you know so you know the publishing process is just it's just that I mean you um it's a very rigorous peer-reviewed process that you know I was submitting a primary clinical study uh for publication I uh pitched it to uh the general California dental association because of the journal that I highly respect but you have to go through a peer review process so there's really no guarantees and it was a pretty arduous process where you know peers who have expertise in the field uh gave me feedback and it was up to me to respond to their feedback and recalibrate some of my research in response to that so it wasn't really a guarantee you pitch it to a journal and they come back ultimately with the decision of either acceptance or rejection and um the article uh was accepted and it's been well received I think it's been you know read uh across the world I have about 700 reads I’ve got 10 citations and articles including systematic reviews so I think it feels good to be able to contribute information about methamphetamine to the research community and is that is that um is that effect at the end related to the very beginning like why did you even choose to become a dentist I mean do those two points line up like a line why did you become a dentist I became a dentist well you know who knows why I became a deaf but um you know really actually Howard when I went to uh college I wanted to become a child psychologist and because I love psychology and um I decided to major in psychobiology because I also love science and I felt that that would provide me with a little bit more option to kind of leverage me a little bit and I think maybe my second year undergrad I went to the career center and was looking up what it would take to become a psychologist and then at the bottom of the page was how much they made and I was like a phd and that's that's that and at the same same time very coincidentally I had a friend who was a year ahead of me in college who was applying to dental school and I never had thought about being a dentist but I also had always had fantastic experiences going to a dentist I began to volunteer at the dental school and realize that this was a profession that really for me bridges the science with the psychology and here I am and I’m still bridging those two things the psychology of my patients the psychology of addiction with the science of dentistry well here's a psychology question for you the covid class of 2020. they graduated in may 6 500 of them I got two dental schools right in my backyard I’m in phoenix so mesa has at still glendale has uh midwestern they're unemployed they can't find a job to tell you historically and give you some numbers uh dental sound went uh live in 99 it's got free classifieds it's always had about 1 000 dental practices for sale and 5 000 jobs for an associate now it's 2 000 practices for sale and only 1 000 jobs because a lot of dentists are 60 and over when they start looking at all this ppe and all this stuff and they're just like you know what I’m I’m out of here and they're selling their practices my my practice transition broker friends they're just they're doing 12-hour days seven days a week non-stop and it's all a bunch of old guys like me I mean I was watching monday night football last night and they ruined the whole show by right at the beginning saying this is our 50th anniversary of monday night live football I’m like damn I’m eight years older than monday night football why did you have to tell me that couldn't you told me that after the game so what would be your career what would be your psycho biological advice to the covid class of 2020 who's really got a lot of fear a lot of depression a lot of sad I mean it's tough for him it is it's a challenging time and it's a challenging time for everybody I think my advice would be a couple things you know is to get up and pick up the phone and start making people calls invite start talking to dentists whether it's you're going to deliver lunch to them and you're gonna get on the phone you're gonna talk to them and interview them find out about what their challenges are find out what their needs are find out why they became a dentist and start establishing and developing relationships with them because this will give the dental student information about how they can position themselves to solve the problem that the dentists have you know I mentor many students at the dental school and I sometimes will ask me to look at their resume and their resume never answers this question it never answers what problem they can solve for a potential employer and I think by starting to be in relationship and be in conversation with dentists picking up the phone doing virtual lunch with them they can start identifying what problems the dentist is having and then they can start positioning themselves as to how I can solve that problem for the dentist my other advice is make sure that you know your mentorship is like a cross where you've got the vertical relationship where they are uh you know being mentored by someone who has experience you know someone like you someone like me who has kind of been down the road has years of experience to share and wisdom but also have a horizontal relationship with your peers because your peers oftentimes you can be very transparent with you can be very honest with sometimes even more so than you might feel with that vertical mentorship but your peers can really help you quite a bit whether someone's really good at the business side someone's really good at the clinical side someone's really good with you know behavioral and personality issues but I think mentorship needs to be both vertical and horizontal but I would tell the don't student get up and get going okay that's that's the advice you're giving them what was the best advice anyone gave you you know I think the best advice someone has ever given me is that there's never the right time I think I’m sometimes you know i'll wait i'll wait till it's the right time I kind of always felt that like even with the book you know someday i'll write a book you know and um I realized you know life is short and I think as we all are experiencing covid there's no right time but now so there's something that you want to do don't wait for the right time there's no perfect time if you have a desire and you can seize the opportunity do it right now and you got a couple of websites you got Dr Ronnie brown and you um um if they're looking for you to speak um would that be the website they go to yes yes and um so are you are you speaking out virtually I mean are are you so are most of your engagements now virtual yeah I just did a webinar this morning for the massachusetts dental society so a lot of the um meetings are going virtual obviously in response to coven and I think as we move forward meeting planners are trying to come up with some creative ways to host meetings especially given the financial impact that attending meetings is to have for many attendees I’ve been doing a lot of virtual webinars for states national as well as local dental societies as well as study clubs as well and it's been um it's been fun I think with a virtual experience you can definitely reach a wider audience than you can um in a convention home you know massachusetts um upsets me because it's right next to connecticut and I’m reliving this trauma with my grandkids you know when they can't spell connecticut you just say it's just connect I cut but massachusetts still hasn't explained to anyone how you spell that and albuquerque they just need to call that the city of new Mexico because no one has a chance of doing that um so last and final question um you know you're uh a speaker um um so these people are are planning their meeting um why would they want to have a course on meth mouth as opposed to silver diamine fluoride or finding the mb2 why do you think um and then and then I want to start this with uh I’ve been a speaker for a long time and when you talk to uh i'll never forget this lady of the ada she did the most exit interviews of every convention the 88 ever did and said the number one complaint of every meeting the ada ever had was all the meetings are aimed at the doctor and there's nothing there for the staff so if you're ever um so my first question to you is obviously um is this something is your presentation doctors only or is there anything for the staff there's absolutely this is my presentations are for the entire dental team because there's a role for every single member from the front office to the back office on how to recognize how to communicate and how to treat patients who are addicted to methamphetamine or any other um addictive drug you know the front office plays a huge role in being able to recognize some behavioral patterns that might present themselves in the waiting room and signaling those behavioral patterns to the dentist of a hygienist a hygienist is the prevention coordinator of the office and plays a huge role in trying to re-establish oral hygiene and you know practices that will support the work of the dentist the assistant is oftentimes alone in the room with the patient and the patient might be sharing things with the assistant information that might be very important and critical for dentists to know so my presentations are really well attended by every member of the dental team um you ask me I think what maybe makes me different about my presentations and I think there's a couple things that make me a little bit different you know I am a clinician I am a researcher I’m someone who is actually working on patients who have meth mouth every single day my clinical work informs my research the research informs my clinical work and I try to share in my presentation stories which I think is a great way to provide information because in terms of adult learning people really remember stories so there is a little bit of an entertaining aspect but I also try to convey science in a way that's relevant I want audience members to leave not just with wow I learned a lot about the pharmacology of methamphetamine that doesn't make a difference when they go back into their practice on monday morning when patients leave my my presentations they have action items they know what to say they know how to say it they have know how to keep their practices and their patients safe they know how to develop office policies they know what their health history should look like um and they know how to educate and I think that's what makes the difference I want people to attend my presentations I want them to have an experience but I also want that experience to translate into real change for their patients when they walk back into their practices on monday morning my final question I know we've gone over an hour i could talk to you for 40 days and 40 nights my final question is this really a u.s problem or are you finding it in other continents i mean I I doubt antarctica has a big meth penguin problem but um other than antarctica is this a global problem or mainly a u.s problem it is a global problem according to the united nations office of drug use and crimes 34 million people around the world use methamphetamine and that positions the drug as the second most widely abused illegal drug in the world so it's not a problem just confined to the united states is a problem throughout the world but was I right about the penguins is antarctica I think you're right about the penguins well you know what actually uh antarctica I podcast interview the um the only practicing dentist in um antarctica um um and um there's 4 000 people there and to tell you how intense that is the russian camp had to ban chess because you know they're frozen it's dark for four months and uh I guess there was a chess match going on and when it was over the guy who lost shot and killed the other guy so uh they're like uh so I’m I’m sure there's I’m sure with only 4 000 people living in antarctica I’m sure there's someone sub if you shoot someone during a chess game I’m sure there's vodka involved uh but uh Ronnie thank you so much for coming on the show um I always like to get public health people as opposed just endodontists and orthodontist I think your book is amazing uh the reviews are amazing uh thank you for being the champion for the down and out addict um because he needs more love and support not more handcuffs and prison cages so thank you so much for all your work and thank you for coming on the show Howard thank you so much I’ve enjoyed listening to your podcast I did send you an autographed copy of the book that hopefully if you haven't yet received it it should be in the in in your hands over the next couple days I’ve enjoyed our conversation and uh I appreciate this opportunity all right we'll have a rocket and one last thing one last thing you're in san fran so do you know that where that um big tower is on that hill with a big radio tower with all the cell phone towers on it is it fight tower it's it's the biggest tower it's a tower you can see it from anywhere in the valley have you seen that big tower so it started off as like one radio tower then two but then when it got to four somebody got the idea well let's just turn it into a building they put a platform then anyway it's the biggest radio tower in the world I got four boys my two oldest boys have been about 800 feet up that tower for the last year um installing equipment and welding and all that kind of stuff so now every time you see that tower remember there might be uh one of my two boys on there so you can just wave to eric greg okay so thank you so much and we'll talk to you later all right thank you so much
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