Dentistry Uncensored with Howard Farran
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218 Making Hygiene Fun with Heidi Glastetter : Dentistry Uncensored with Howard Farran

218 Making Hygiene Fun with Heidi Glastetter : Dentistry Uncensored with Howard Farran

11/5/2015 8:11:57 AM   |   Comments: 0   |   Views: 629



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AUDIO - HSP #218 - Heidi Glastetter


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Making Hygiene Fun covers the importance of preventive dentistry with Kolibree's innovative toothbrushing technology.




Heidi practiced as a clinical dental hygienist for over 22 years in Washington State and Switzerland, before pursuing her MBA at The George Washington University. She also worked at the University of Washington Graduate Periodontics Clinic, served as a clinical dental hygiene Board Examiner for Washington State, along with teaching local anesthesia administration and amalgam/composite placement at Shoreline Community College. Heidi has held various offices in the Washington State Dental Hygiene Association, the American Dental Hygiene Association, the Swiss Dental Hygiene Association, and is a member of the International Federation of Dental Hygienists. She has lectured extensively in the United States and Europe, while serving as a Professional Educator for Philips Sonicare, and is currently the Director of Dental Sales and Education for Kolibree, the amazing Bluetooth-connected sonic toothbrush.




Howard: It is a huge honor today to be interviewing Heidi Glastetter. You're a hygienist, an RDH, I'm a DDS, and we both have an MBA. We both have a love for the clinical dentistry and the business of dentistry. 

Heidi: Absolutely. 

Howard: I'm so excited to interview you, because I've done a couple hundred of these podcasts and they've exploded. People love multitasking. Instead of sitting in a lecture, where you had to close the office and go sit and learn for a day or doing a study club after work when you're tired and exhausted, now they're just listening to these things while they commute an hour to work or on the treadmill. Too many of my podcasts are about fixing disease, placing implants, doing root canals. We've had a dozen implantologists, a dozen endodontists and all this stuff. That's really not what dentistry is about. Dentistry is about preventing disease, and you're really excited about an electric toothbrush. I can't wait to talk to you about it, the Kolibree. It's www dot K-O-L-I-B-R-E-E dot com. 

We tell all of our patients ... I'm going to start with this, Heidi. We tell all of our patients to ... Well, I've got to read your intro first. You're amazing. Heidi practiced as a clinical dental hygienist for over 22 years in Washington state and Switzerland before pursuing her MBA at the George Washington University. I don't know if a hygienist should go to George Washington University when he had wooden teeth, but we'll let that one slide. She also worked at the University of Washington Graduate Peridontics Clinic, served as clinical dental hygiene board examiner for Washington State, along with teaching local anesthesia administration and amalgam composite placement at Shoreline Community College. 

Heidi has held various offices in the Washington State Dental Hygiene Association, the American Dental Hygiene Association, the Swiss Dental Hygiene Association, and is a member of the International Federation of Dental Hygienists. She has lectured extensively in the United States and Europe while serving as a professional educator for Philips Sonicare and is currently the Director of Dental Sales and Education for Kolibree, the amazing Bluetooth connected sonic toothbrush. That's what's got me so excited because hell, we're doing a podcast on an iPhone right now. It's Bluetooth. I use that in the car and to my speakers at the house. The million dollar question that everybody who will listen to this will want to know: Does an electric toothbrush really remove more plaque than manual? 

Heidi: Yes. The studies are abundant in that case. Other companies have done studies. We've done our own studies, but Sonicare has existed for over 17 years. They did a lot of studies on the efficacy of sonic technology, how it's a better technology than just manual tooth brushing alone or use of oscillating toothbrushes. Unfortunately, they fell off the patent cliff. Any wonderful company out there, ours included, can use a sonic technology for their toothbrushes. Our toothbrush is just a little bit less aggressive, if you will, than the Sonicare brush, but it uses a similar technology. 

Howard: That's what's coming up, is that this patent from Sonicare is expired? 

Heidi: Mm-hmm (affirmative), yeah. 

Howard: That's what we also see in orthodontics, where it sounds like the Invisalign patents are expiring. You see all these other clear retainers popping up and all that stuff. Basically why does sonic energy ... Why does it remove plaque better than manual brushing? 

Heidi: Well, if you look at the sonic wave motion under slow motion, you can see it's brushing on its own back and forth. If you use 22,000 waves per minute, it's going to have more brushing power. It's going to be just going back and forth against the tooth surface, removing that gingival plaque layer a lot more efficiently and a lot more thoroughly than just manual brushing alone. 

Howard: You said 22,000 waves per minute, or per second? 

Heidi: Yeah, per minute. 

Howard: Per minute? Huh. I'm very familiar with slow motion, especially when I'm just looking at myself in the mirror. I've spent 53 years in slow motion. What is Kolibree, and where did you get that name? K-O-L-I-B-R-E-E, Kolibree. Is that the name of the founder? 

Heidi: Well, our brush is based out of Paris, Neuilly-sur-Seine, which is a suburb of Paris. Colibree with a C is the name for hummingbird. Kolibree with a K is the name for [inaudible 00:05:04]. 

Howard: For what?

Heidi: For a hummingbird in Spanish and I believe even in Italian, but I'd have to double check that. Universally, it's like a little hummingbird in your mouth, if you will.

Howard: In French it's Colibree with a C? 

Heidi: It's with a C. 

Howard: Why did you go K? 

Heidi: Well, it wasn't me that chose the name, but our founder thought that that would be a good idea because it would be more universal. It's German. He just liked the look of it. 

Howard: Oh, Colibree is German too? 

Heidi: German also. It's a [crosstalk 00:05:37]

Howard: For hummingbird? 

Heidi: Mm-hmm (affirmative), yeah. 

Howard: Wow. I wonder how the Germans and the French ... Because the French is a romance language. It comes from Rome. That's the root of the languages in Romania, Italian, French, Portuguese, and Spanish. 

Heidi: Romansh as well. 

Howard: The Germans was a completely different language, but they came up with the same word, huh? 

Heidi: Mm-hmm (affirmative). 

Howard: Colibree. Huh, that's very interesting. That hummingbird, just that vibrating motion, and the hummingbird getting the ... Yeah, well know, it's really great in branding. That's why I named my book "Uncomplicate Business," because uncomplicate's not a word. When you type in a Word document, it sends you to spell check. It's totally unique. That's why they went with words like Xerox and just names ... That's why all the pharmaceutical prescriptions all have an X, Y, and Z in there, because they're all made up words. 

Heidi: Haagen Dazs. 

Howard: Tell us how your brush works, and how is your brush different than Sonicare? 

Heidi: Well, our brush works using the sonic connected gaming technology and most of all position awareness, to not only show patients where to brush, but to know where in space they have been brushing. We have an app for an iPhone or Android product [crosstalk 00:06:56]

Howard: Okay, so how do we get that app? You go to your iPhone's app store? 

Heidi: Right. Just go to the [crosstalk 00:07:03]

Howard: Type in Kolibree? 

Heidi: Mm-hmm (affirmative). 

Howard: K-O-L-I-B-R-E-E, or hummingbird, and then you download the app. How much does the app cost to download? 

Heidi: The app is free to download [crosstalk 00:07:12]

Howard: By downloading that app ... Tell me about that app. 

Heidi: The app has two subapplications. You have two games, if you will. I call it more than a game and more than a toothbrush. You have a pirate, Go Pirate app, and then a Coach app. The Coach is, I say it's more for your sophisticated clients. People who would need to systematically learn how to brush their teeth, but they don't really want a game. You're just leading them through all the sextants of their mouth, the occlusal, buccal, lingual surfaces. If they follow this pattern successfully, then they'll get points and they are told ... They get feedback, real time feedback, on how well they're brushing. 

Then we have the Go Pirate app, which I just think is adorable. I usually show that to people as much as I can. You'll see a pirate that's running down a boardwalk. The app indicates that he should run to the left or brush on the lower left area. With the Kolibree toothbrush, you'd be brushing on the lower left and watching the application. Then he'll run to the right, and you can see on the application that you should be brushing on the lower right or the upper right buccals. It leads you through all the areas of your mouth. 

After following the pirate along and brushing with the indicated areas that he's running, in two minutes you'll systemically have brushed all the areas of your teeth. It's great as far as distracting kids or people who are using the app and also engaging them at the same time. 

Howard: You know, you've seen these patients every six months for 20 years and every single time they miss the same area. You know when they go brush their teeth, they're not thinking about ... What did you say, six sectants? Are there a certain number of sectants? 

Heidi: The coach breaks down the mouth into sextants, so there's six. The pirate application will have you brushing in quadrants. That's the difference between [crosstalk 00:09:24]

Howard: That's what a great athlete is. A great athlete knows where there body is in time and space. You know what I mean? Most people, especially children, don't have any concept of where that toothbrush is and if they're removing plaque and all that stuff. This is exciting. Is this the first one that's a Bluetooth connected electric toothbrush? 

Heidi: Well, we were the first to develop this technology and the first to achieve patents in certain areas. You might hear other people saying, "Well, we have Bluetooth technology as well." It's true, there are a couple toothbrushes, very well-known toothbrushes, that have come out with their own model of Bluetooth connectability but what really differentiates our brush from any other brush that you'll see on the market right now is that not only do we show the patient where to brush, so that they can systematically brush their teeth in two minutes, but we know where they are brushing. 

I would say that our technology is something that would really be appreciated by NASA more than the common consumer, because we use a gyroscope, a six axis accelerometer. We know where in the mouth the patient is brushing their teeth, and we do give that real time feedback. Some other Bluetooth connected brushes will say brush to the left or right, but they don't know if you're doing it. There's no connectability other than knowing that the toothbrush is on. 

Howard: Then when that kid comes back for a six month cleaning, do you look at his app? Do you look at the data? Does the hygienist and the dentist look at this? 

Heidi: Well, we're developing technology right now that would allow ... If the parents would want that or if the children ... If you want your children's data to be shared with your dental professional, that could be a possibility in the near future. We could sign up for a program through the dental office. You'd say, "I don't know what to do. I can't get Johnny's teeth brushed. Would you be able to help us?" Then the dental office would be able to offer that toothbrush to the parent and say, "Well, we can track how well they're brushing. We can send little reminders. We can even have Mary the dental assistant or Susie the dental hygienist give a quick call every now and then and say, "Hey, are you having any problems brushing your teeth?" 

There can be an added benefit for going to this dental practice and having an extra layer of prevention on top of just the six month recall. 

Howard: Do you remember that little controversy a little while back where a hygienist on Dentaltown, actually, was talking about the blue sparkles in one of the toothpastes. She was finding that the sparkles were still there. They weren't dissolving. Do you remember that? 

Heidi: I missed that, no. Tell me about it. 

Howard: There's a toothpaste that had these little sparkles in them and they were an FDA food product, but hygienists and dentists were finding them underneath the tissue and these things were there. The toothpaste company actually decided they were going to quit using them. I had mixed feelings about that, because for kids, the biggest thing is you want to motivate them. I was sitting there thinking well, if your toothpaste sparkles or it tastes good or whatever, anything to make them brush. 

Heidi: Absolutely. 

Howard: I think the biggest issue is they just don't brush. 

Heidi: Well, they don't know how. I mean, they haven't learned. It's a learned skill. We have found that the kids that use this Kolibree Go Pirate app are thrilled to use it. I don't have kids myself, but the moms that have used the toothbrush and gotten back with me say they race to the bathroom to be able to use the toothbrush. They argue about who will get to use the toothbrush first if they only have one brush until they get another one for the second kid. They just are really engaged with it. It's shocking. I've got kids that have done testimonials and they're thrilled with it. They like it because it provides a small level of competitiveness. They compete with their parents, who's got the best score for brushing for that day or if they beat their sister. It just puts fun into the whole experience. 

Howard: When you say you don't have kids, does that mean you're also MENSA and a millionaire? Does that just go hand in hand that you were just too smart [crosstalk 00:14:05] to fall for that trick? You're a what? 

Heidi: I'm a lot of fun. I'm a DINK: double income, no kids. 

Howard: Double income, no kids. My point is that in dentistry, everyone wants to talk clinical dentistry. They all want to talk about how to do a root canal or an implant or gum surgery or whatever. The bottom line is two out of three cavities diagnosed are never filled and most of your state dental societies won't even give credit for courses on practice management that teach you the business side of it. Too much of dentistry is focused on drilling and filling and billing as opposed to preventing. I think it's funny how ... Your whole career as a hygienist was invented by a toothpaste company. It was Amos and Andy getting on those TV's when they only had three channels. They were on every one saying, "Brush your teeth with Ipana and get your teeth cleaned every six months." Somebody in marketing just pulled that out of thin air. I mean, it wasn't based on anything. It was just like, "Well, you should get your teeth cleaned twice a year." 

It was so pervasive that even the dental insurance company said, "Well, we'll cover your cleaning twice a year." Now it's exciting to see a toothbrush company leading the way of trying to prevent more disease. 

Heidi: Absolutely. Well, I've always been thrilled with your philosophy about the importance of good practice management and just the love of business is what has led me to get more involved with business and get my MBA. If we can do anything to help kids prevent decay, it's going to be good for society at large, but it's also going to be a good practice draw. Quite [inaudible 00:15:50] if you have something [inaudible 00:15:52] your patients that the practice next door doesn't, the word's going to get around. It goes pretty viral pretty quickly. A lot of people are just very excited about these opportunities that are coming up. 

Howard: I remember when Bob Barker, who was the first dentist to be going around trying to talk dentists into setting up hygiene departments and all my dentist friends who are like 90 years old would be telling him that. He would go lecture that. Most of the people in the room would say, "I don't have time for that crap. I do 10 dentures a week and you want me to set up a hygiene department. How do I got time for a hygiene department when I'm doing 10 dentures a week?" They didn't even get it that well maybe if you had a hygiene department, you wouldn't be doing 10. The reason you never see a house on fire is because most of the time, the firemen are going around doing building inspections and fire codes. It's all about prevention with the fire department. They don't want to go into a house on fire. 

I think it's real exciting. Does it sound like the Go Pirate is more for pediatric patients and the Coach app would be more for people who have adults that are fighting periodontal disease? 

Heidi: Well, yes. That's the obvious breakdown. Your more sophisticated client, like I mentioned, the adult that would feel the need to have a little bit more coaching as to where they're brushing would go for the Coach app. Kids are just in love with the Go Pirate app. There's other markets that I would like to explore a bit more as well. DD clients, developmentally disabled patients, kids with more severe autism have been really engaged when they see the Go Pirate app. There's also a completely untapped market. The baby boomer generation is aging, and people are living longer. They're not necessarily healthy up until the very end of their days. Patients that find themselves in assisted care facilities oftentimes are not capable of brushing their own teeth. 

When we give that care up to a third party and we have Mary coming in to brush five different clients' teeth, it's nice to be able to track if that's being done. If you are the general manager of the assisted care facility and you really want to see if the teeth are being cleaned by your caregiver, you can just look at the data. We can have up to five clients on each phone and then just pull the data randomly and do a random screening. If that is not in place yet in the assisted care facility and you wanted to do that for your own mom, you get them a smartphone, you get them a toothbrush, and you say, "Listen, I'm paying to get her teeth cleaned on a daily basis. I want to know that this is what's being done. Here you go. This is another tool, and I'd like to come in here on a weekly basis or just randomly and double check it myself." You can do that. 

Howard: With both of us an MBA, the one thing they drill in our heads, if you don't measure, you can't manage it. 

Heidi: You can't manage it. 

Howard: Nothing gets done until you start measuring. 

Heidi: That's true. 

Howard: The NFL. The score is so important, they have six refs on the field. The score is everything. When you go to a dental office, you walk in there. They don't know what their break even point is for the day. They don't know if they made money, lost money. When I was looking at kids and stuff, I was just thinking, well the main thing is kids just don't brush. Period. I mean, they even tell you. Do you brush your teeth before you go to bed? They're like what? Just having an app that just said did you pick up a damn toothbrush or not would just be huge and monumental. 

Heidi: Absolutely. 

Howard: The kids are just so into video games. That's why I thought this was just so exciting. I never thought of the nursing home though. I've actually gone into a dozen nursing homes and spent time with the CNA's. Oh, my God. These poor girls. I mean, they'll be in charge of ... Number one, they're usually like 5' 1" and 100 pounds. They'll be in charge of 20 people in a wing. They've got to bathe them and shower them and feed them and brush their teeth. You couldn't do what they're supposed to do if they had a gun to their head. If you're a big heavy person ... If I'm ever in a nursing home, I fall out of bed, no CNA's going to get me back up in the bed. They literally call the fire department sometimes. Did you know that? 

Heidi: Yeah. 

Howard: Big, heavy people will fall down in the shower and they'll go get another CNA and between two little 5' 1" 100 pounders, they don't know what to do. They have to call the damn fire department. I think that's amazing. What is it, 4.6 percent of all Americans will spend the last years of their life in a nursing home. That's one out of every 20. [crosstalk 00:20:42] How much does this thing cost, and how are sales going? 

Heidi: Well, sales are picking up all the time. I mean, we've got quite a lot of people who are interested in the brush. Right now, the price point is $149 per brush. That includes the charger. We have an inductive charger. The toothbrush itself, obviously it has two handles ... Or one handle and two brush heads. All the information is in the handle. The apps, as we mentioned before, are free to download off the web. 

Howard: This is all based out of Paris, France, you said? 

Heidi: It's based out of Paris. We have three offices. We have one in Neuilly-sur-Seine, right outside of Paris. 

Howard: What's the city outside of Paris? 

Heidi: It's Neuilly-sur-Seine. 

Howard: Huh. That is a hard language. Outside of Paris [crosstalk 00:21:32]

Heidi: Just right in the suburb there. Then we also have an office on Madison Avenue in New York. I'm based out of Gig Harbor, which is right next to Seattle. I cover the West Coast and a little bit on the East Coast as well. We do have an office near our factories that manufacture the base in Hong Kong. 

Howard: What I love about you the most, you live in Seattle and you're still an Arizona Cardinals fan and you hate the Seahawks. That just touches my heart. 

Heidi: No comment.

Howard: That just touches my heart. Tell me about the website, the dental practitioner's website, www.smart ... what is that, hyphen, oralcare.com? Smart-oralcare.com? What do you call that little ... 

Heidi: Correct. Smart-oralcare. Yeah. 

Howard: Smart-oralcare.com. Tell us, who is that for? Is that for dentists and hygienists? 

Heidi: Exactly. It's for dental practitioners, dentists, hygienists primarily or dental assistants can join. Anyone who works in a dental office can join the dental practitioner program. We are developing it more and more all the time. I referred to it previously when I mentioned that there will be very soon a means of if the patient wants to have their data shared with that particular office. The office could either provide the toothbrush for the patients and then monitor how well they're brushing, do data collection, do surveys and studies in the office based on the data that they have collected on their patients and then provide that real time feedback to the patients on how they're doing, send out weekly reports if they want, check on their brushing habits when they come in for the three to six month [inaudible 00:23:23]. 

There's any number of things that you could do with that, but then also just by signing up as a member of the smartoralcare.com dental practitioner program, we'll be able to connect with practitioners and hear their feedback on our product and hear ways that we can improve it for all dental practitioners that are involved. 

Howard: You should start a thread on Dentaltown. I know you're a townie. You should start a thread discussing this, because like I say, we need to move the ball to ... Dentists can't spend all their time on how to put out a fire. They need to spend more time thinking about how do you prevent disease with community water fluoridation with fluoride in the toothpaste, with [crosstalk 00:24:03]. When you see the American Dental Association putting out a gazillion social media advertisements all over and they're doing so good, it's always the same message: Brush two minutes twice a day. 

What does two minutes twice a day mean if some are doing it with manual toothbrushes, some are doing electric toothbrushes? On yours, does it take two minutes also? Does two minutes twice a day apply if you're doing manual or electric? 

Heidi: Well, yes. We still recommend that patients brush at least two minutes two times a day. There's a lot of studies out there that do prove that by brushing more, you're going to be doing a better job. With the sonic technology, you're going to automatically be brushing your teeth more efficiently, more effectively. Being able to track if you're doing that or not is very important. If a patient is only brushing once every four days and that's the data that comes up on the phone, then we know that we should be having a better conversation with them. 

Howard: Also, what other protocols are you thinking about? There's a hygienist, Trisha O'Hehir... 

Heidi: I love Trisha. 

Howard: She always made me so aware of the research showing that you actually don't even need toothpaste. When you brush for two minutes ... She calls it dry brushing. 

Heidi: Dry brushing, mm-hmm (affirmative). 

Howard: One of her deals that she put into my head the most is that everybody always wants to talk about toothpaste. They'll even say to dentists all the time, "Well, what toothpaste do you recommend? Do you use Crest or Colgate or this or that?" The bottom line is that you don't need any toothpaste to remove the plaque. 

Heidi: You've just got to get the plaque off the teeth. You need manual remove of the plaque. If you could have a dental hygienist come in and polish your teeth every day, I suppose, that would be one way of doing it but if you can use sonic technology to systematically brush all areas of your teeth and you can track that that's being done, that's a wonderful way of doing it. We also have little messages that can pop up on the screen. "Don't forget to floss. Brush your tongue. Brush the roof of your mouth. Fluoride is good for you. Limit your sweets." 

Howard: Do you personally yourself ... Do you dry brush, or do you use a toothpaste? 

Heidi: Well, it really depends on the day. I mean, sometimes I'll dry brush. Sometimes I'll brush with water. Sometimes I'll brush with toothpaste. The trick is just getting in there and brushing your teeth, and brushing efficiently and thoroughly and not with a heavy hand, but doing an efficient job. 

Howard: I want to ask you ... This is dentistry uncensored, so I'm always in search of the most uncensored complicated questions. There was a controversy awhile back, and I think it was a year or two ago, when you hit 53, the first thing that goes seriously is your memory of time. I'll tell my four boys, "Remember five years ago when we did that?" They'll say, "Dad, that was 10 years ago." 

Heidi: Is that selective memory? 

Howard: Yeah, I don't know, but it was just awhile back. I'm thinking it was a year ago, but that might mean three or four. Anyway, one of the mouthwash companies, I believe it was Listerine, was saying that if you swish with Listerine, you don't even need to floss. When you looked at the research, they had the research obviously to back up what they were saying. Of course, it ruffled all the feathers of all the hygienists. No one wanted to hear anybody saying you don't have to floss. What do you think about mouthwash? Do you think that's an effective protocol of home care and for pediatric kids and/or adults with gum disease or without gum disease? Are you recommending of what you know ... Do you think mouthwash is an important part of your home care routine? 

Heidi: What's that saying, there's lies, damn lies and statistics? I suppose you can always find something if you're looking hard enough, but I still am an advocate of flossing. I showed patients how to floss for years. I will disclose the patients, too, before they came in. We could see right along the margins of the teeth where they were missing with their flossing and missing brushing. I'm an advocate of getting all the plaque off. I think any tool that a person can use to do that is great. If a person physically, for whatever reason, they cannot use their hands well then use rinses, then that's fine. Just use mouthwash. 

I like interproximal brushes. I like floss. I think that in some areas where you have real large embrasure spaces, sometimes an interproximal brush might do even more than floss for certain patients, but by disclosing them, by looking at where the plaque is, then we can really modify the behavior based on the patients' needs. It all comes down to the individualization of the patients' needs. 

Howard: I want you to talk about tongue scrapers. There are some hygienists who are always pushing tongue scrapers, and then there are other hygienists who have never mentioned it. There are dental offices that have never even brought it up over a 30-year career. What are your thoughts about tongue scraping? Also, do you think that's an effective part of reducing disease, missing and filled teeth, and periodontal disease? 

Heidi: I think anything that you can do to reduce the bacterial load in the mouth is going to be good. I think tongue scraping is fine. I personally brush my tongue, and I encourage patients to brush their tongue. If you have a shag carpet in there, but there's no bacteria on it, that's all right. If you can reduce that and keep it clean and you've got a little linoleum surface in there, then you're going to have less plaque sticking to that. 

Howard: Heidi, you just gave away your age saying shag carpet. I don't think there's any woman over 39 years old that knows that shag ... Under 39 that knows what shag carpet is. You want me to go back and edit that part out? Hey, I want to talk about the other uncomplicated question that's not just uncomplicated in the patients' view, but of dentists and hygienists around the world. There still is a massive debate about abfractions. I mean, some people look at those abfractions and say that they're sawing back and forth with their toothbrush and that's toothbrush abrasion. Then there's dentists who work on animals at the zoo, and they say, "Okay, look. How do all these zebras and gazelles, how do they all have the exact same abfractions and they are never seen brushing their teeth in a sawing motion?" It's the flexure of the tooth and that occlusion and biting and the flexing of the tooth is popping off the neck. Take a coat hanger, you can't pull it apart with tinsel string but if you start abfracting it back and forth, it just breaks in half. 

The bone is holding in the root. The teeth are clenching and grinding and where they pivot, the neck is popping off of that fraction. What are your thoughts on it? What do these big toothpaste companies and Sonicares and Crest and Colgates, what is your thoughts on the abfraction? 

Heidi: Interesting. That wasn't a question that I had anticipated. I can speak to it having worked in St. Moritz, Switzerland for four years. The doctor that I worked for did not do a lot of crown and bridge, so you could actually see longitudinally the wear in all areas of the mouth. He did some crown and bridge, but he didn't overdo it. He didn't do a lot of full mouth cases. We did see abfraction on certain patients, severe in some cases and not at all in others. It was very interesting to see wear patterns in the mouth. I would say that, again, case by case, there are some people that they bite their teeth down and for whatever psychological reasons, they thrust their tongue forward or they just flex back and forth, or they grind like nobody's business so everything is completely flat as a pancake. 

I think that some perio can be certainly influenced by the occlusal forces that patients create themselves in their own head. Then there is some other wear that I would see that was from the use, in my opinion, I felt very strongly it was the use of oscillating toothbrushes. I won't name names, but there were some patients that would use round oscillating toothbrushes and they would use hard bristles. The wear that you would find along the gingiva there was just atrocious. I would always try to get them to switch over to a sonic brush, sonic based technology. It was not as popular in Switzerland, so it was difficult to find that brush, but those patients seemed to do a lot better with that when they came back in. Again, I would always disclose and I would do a little plaque chart and always a perio chart. I saw where people did improve and where they got worse, but usually they improved.

Howard: You know, I love lecturing. I always think lecturing in another country is a vacation. I never consider it work. I never forget lecturing in Geneva, Switzerland. I was looking at this beautiful mountain. The guy said, "That's the Matterhorn." I go, "Matterhorn? That's the roller coaster at Disneyland." I had no idea that's what [crosstalk 00:33:30]

Heidi: It's real? 

Howard: Yeah, I had no idea that was a real mountain, so I went there. How did you get all the way over to Switzerland? They say you only go to a different country ... Only one percent of the seven billion earthlings today live in a country they weren't born in, and they say that they only leave the country for three reasons. It's love, it's money, economics or a job, or they're running from the law. 

Heidi: Well, I wasn't running from the law. 

Howard: Oh, come on Heidi. This is dentistry uncensored. You can tell us why the sheriff put you on a one-way plane to Switzerland. Was it from not flossing? How'd you get over there? Was it love or money? How'd you get all the way on the other side of the pond? 

Heidi: Well, I think I fall out of the bell curve on that one. People have asked me that a lot, and I would say that truly the only answer that I could legitimately come up with that resonated was that my name is Heidi and I've just always ... You know, you hear the story as a kid. Switzerland [crosstalk 00:34:28] 

Howard: Heidi is a Switzerland name? 

Heidi: It's typically Swiss. Swiss-German, German. Yeah. 

Howard: Now I remember Switzerland as basically it's ... Half of it is touching Germany and they're all German speaking and the other half is touching France. It's like two suburbs of France and Germany rolled up in one country. Is that fair to say, or not really? Did I just piss off everyone in Switzerland? 

Heidi: No, I don't think so. There's some people who are cheering and some people who are a little upset. There's four official languages in Switzerland: Swiss-German and French, which is pretty true to the classic French, and Italian down towards the border of Italy, and then Romansh, which is an area up in the mountainous section next to St. Moritz in the Engadin Valley. That is a Roman-based language, just like you were mentioning earlier. 

Howard: Well, I have to tell my Swiss listeners, because every show is being downloaded by a couple hundred countries. It's funny how I'm sharing my perception of when I went to your country. You know what I mean? I always laugh when people say, "Oh, yeah. I visited America. I love it." The first thing I say is, "Where did you go?" It's always going to be if they're from Asia, they went to San Fran. If they're from Europe, they went to Manhattan. If they're from Central South America, they went to Miami. That's the only place they saw. Here I grew up in Kansas, well Manhattan's not quite how a hundred million people live. You know what I mean? When you fly into a country and you just see this one little sampling ... 

I want to go onto mouthwash, toothpaste. Do you think any of those are better than others, or do you think that's not a deal breaker? When patients ask you, do you use Crest, Colgate, Close-Up, what do you tell them? 

Heidi: Well I try not to micromanage my patients in the areas that I think didn't matter too much one way or the other. I would, unfortunately, say that mouthwash fell into that category. I would say if you like it, if it makes your breath smell better, it makes your mouth taste better, that's great. There have been some people who have spoken about some of the strong mints in mouth rinses actually numbing the tongue so it feels smoother and feels cleaner. I think that that's not here nor there. If a patient loves it, then that's great. If it's really cutting into their budget and they're spending a lot of money, I don't want anybody to buy snake oil either. I'm not real big on telling them that they should definitely use one type of mouth rinse or definitely not use anything. 

Howard: What I've been doing is telling my patients to quit brushing for two minutes and start doing 20 minutes of coconut oil swishing, oil pulling. I've read on the internet ... Have you been seeing that on the internet? 

Heidi: I've seen several studies [crosstalk 00:37:27]

Howard: Oh, my God. Really? Your solution is not to brush for two minutes but to swish for 20? You can't get anybody to brush for two. Who the hell is going to swish coconut oil for 20 minutes? Back to this toothbrush. Do you recommend that the patient buys the sell? Are you just telling your patients go to K-O-L-I-B-R-E-E, go to Kolibree.com and buy it yourself or do you think it's more successful when the dentist sells it in their office? If they do go through selling it in their office, do they have any skin in the game? Do they make any money off this? When you talk about the price, since in economics, MBA school ... 

Heidi: Absolutely. 

Howard: If you're trying to get your MBA, and you're taking a test and you don't know the answer, and you just circle price, you'll be right almost 80 percent of the time. That was my walk in MBA school. If in doubt, just circle price. Talk about the price and the distribution. 

Heidi: Well, right now patients and dental offices can find our brush directly on the website, www.Kolibree.com or on Amazon. You can pick it up on Amazon as well. We are running a special for dental practitioners. If they put in the code HGTHIRTY, so H-G-T-H-I-R-T-Y, it recalculates the cost to $115 and that includes shipping. 

Howard: Where'd you get HGTHIRTY? 

Heidi: That's my code. 

Howard: Oh, that's Heidi. 

Heidi: Heidi Glastetter. 

Howard: What's 30? 

Heidi: That reduces the price of the brush by 30 percent. 

Howard: Oh, I see. Can they buy it on that smart-oralcare.com? 

Heidi: They would actually go directly to the website and then go to purchase on the website. If they go to smart-oralcare.com, they can then link to our website directly there. 

Howard: Again, I'm sorry ... For my older brain. What's the difference mainly between smart-oralcare.com and Kolibree.com? 

Heidi: The smart-oralcare.com is a site that we're setting up specifically for the dental practitioner. 

Howard: To teach them how it all works?

Heidi: Yeah, exactly. 

Howard: The Kolibree ... 

Heidi: It's like a club [crosstalk 00:39:42]

Howard: Would you say the smart-oralcare is the b to b, business to business, dentist to dentist website and the Kolibree is the b to c, business to consumer site?

Heidi: Yes. 

Howard: Okay, so that's that. I want to also ask you ... You taught local anesthesia administration and amalgamate composite placement at Shoreline Community College. Was that an expanded duty, function assistant program? 

Heidi: No, this was before we had the EFDA program in Washington state. Washington hygienists, since I want to say 1973, correct me if I'm wrong, have had the ability to place restoration. We could place composites and amalgamate [crosstalk 00:40:28]

Howard: They could do that since 1973? 

Heidi: Yeah, I believe it was '73 or '75, right in there. 

Howard: I wouldn't know because I wasn't born at that time yet. I was born in the '80s. What I'm wondering, because I'm in a state that doesn't have EFDA, but we just passed it. Arizona just passed it. We don't have any yet because once the politicians passed it, they went to the two dental schools and they said, can you create a program to educate them and teach them and license them and all that stuff. Now the dental schools are trying to put together a program. I was just wondering, how successful a program ... What percent of the dentists actually said in Washington, "Yeah, I'll just do the irreversible stuff. I'll just go in there and prep the tooth and then I'll leave and delegate someone to come in and place that." What kind of penetration did it get? 

Heidi: That's something that I personally haven't measured, and I haven't seen any studies actually done on that, but I can tell you just from my personal experience, I was a restorative hygienist for many years. It wasn't exclusively restorations that I did. Basically it would be if you had a patient that came in to the practice and they needed a little filling, one, two, three surface composite and the doctor that I was working for felt comfortable in my abilities, then I would just go ahead and anesthetize them because we do that in Washington state. Then I'd place a rubber dam, put the clamp, basically prep the tooth any way that the doctor wanted it to be prepped for his preparation himself. 

He would come in, he/she would come in, and then do the work with the bur and finish it up, and describe how they would like it to be finished at that point. I'd put a little bit of Dycal in or liner or base or whatever they thought would be good. We'd talk about it and then fill it up and then I'd have them come in and take a look at it at the end. 

Howard: Why would one dentist on earth be against this? I just can't figure it out. 

Heidi: Psychology is not my forte, but I would say any number of reasons. I don't know. Maybe they just weren't aware of what training I'd receive or other hygienists had received. The dentist that I worked for that wanted me to do restorative in their practice, they were happy with the results. 

Howard: I almost stayed in Kansas and didn't come to Arizona. I wanted to come to Arizona because it was an exploding town back in '87 and I was from Wichita. It hadn't had any growth since Fred Flintstone. The reason I almost didn't go is because Kansas had that expanded duty function. I would go to dental offices and my mentors when I was in middle school and high school, they would go numb, numb, numb. Then they would go prep, prep, prep. Then they'd go sit in their office and read the newspaper for half an hour while three assistants did all the work. I just think it was an amazing thing. Then I also thought the strangest boogie man in dentistry uncensored was all the crazy talk about when hygienists are trying to get independent practitioners. 

What the dentists don't get is that the oral surgeon and the endodontist love it when they get a referral from a general dentist to do a root canal or a pull. All those towns in Colorado where there was an independent hygienist, every time she saw something wrong, she had her little prescription pad and referred it to a dentist up the street. The dentist up the street just loved her. Everybody was courting her, sending her doughnuts, wanting to be her best friend because ... I just don't understand how anybody could not think ... As a dentist, I think the focus is on the patient and the most important thing we have to do is make dentistry available and accessible and affordable. 

I'm more excited about what you're doing with the new iPhone and Droid and Samsung and connecting that up ... This is like Star Wars stuff. A gyroscope, a six sector gyroscope and getting measurements back. I just think the preventive side of this profession is 10 times more important than the drill, fill, and bill side. 

Heidi: It's lucrative as well. If you had a dentist that really promotes prevention in the office, patients are going to like that. Patients don't come to the office specifically to get anesthetized and filled. Anything that they can do to prevent that from the patients' point of view is going to be a good thing. If the practice is prevention oriented, then patients are going to flock. 

Howard: Do you recommend the patient go to the site and buy it themselves, or do you recommend the dentist buys them and sells them at the office? 

Heidi: Well, it really depends on what the practice wants to do. If the dentist wants to not carry any stock, what we can do as I had mentioned a few moments ago, my code is HGTHIRTY. If the dentist or patient puts in that code, then they can have 30 percent reduction in cost. It brings it down to $115. If the doctor wants to present the patient with this option of having toothbrushes in the office, they're Kolibree brushes and they just love the brush, they want more of their patients to get Kolibree, then we can get that code for the doctor as well. The doctor can just give the patient the Kolibree brush. If the doctor, of course, wants to hold stock we can always negotiate that with them, too, and get them an even lower price as well. They can contact us directly on the website. 

Howard: I think all people are mostly excited about the next generation, the little kids, the pediatrics as opposed to grandma and grandpa. Do you have a famous pediatric dentist product champion that's behind this? 

Heidi: Well, we do have pediatric dentists in France that are behind it. We have a consultation group of dentists that have helped design the brush from its inception in Paris. Pediatrics, orthodontics, prosthodontics are all involved. 

Howard: Dentaltown has 205,000 registered dentists on it. The most viewed and listened to pediatric dentist is Josh Wren. You should send me an email, Howard@dentaltown.com and I'll reply back to you and Josh. If Josh got behind this thing, and he really loved it, that would be explosive. 

Heidi: That would be fantastic. We'd love that too. 

Howard: I think everybody listening to this ... When Josh Wren puts up a pediatric dentistry course, it's taken all day everywhere. You wake up and they were taking it on the other side of the planet. It's amazing. I be you a lot of people are wondering what Josh thinks about this. 

Heidi: I'd love that. 

Howard: He's a good old boy from Mississippi. I'm not sure they have electric toothbrushes in Mississippi. This might be the first one down there. I've only got you for 10 more minutes. Is there anything I didn't ask or should've asked or ... Have I covered all the bases? 

Heidi: I think that's pretty much it. I hope that I've remembered to cover everything that was important. I'd love to ship you out a brush so you could try it out as well. 

Howard: You know, I was born and raised in Kansas so I quit brushing my teeth 20 years ago, just like all my uncles and cousins. I think the last technical thing is ... I've got to cover this. I'm sure there's a lot of listeners who don't know what Bluetooth even actually means. What is Bluetooth? I graduated in '87. I live in a house with five dentists, five dental students, for four years. Do you know four of those five never use the internet to this day? 

Heidi: Oh, that's interesting. 

Howard: Dentists are one of the last enabled people with secretaries. When they came out with the answering machine, three million secretaries lost their job. It was one of the most disruptive technologies in the labor force. It was 10 times worse than the ATM machine was for banking. Dentists, since they have a business that requires front office ... I asked my roommates, how do you buy a book? "Well, I just go give a note to Emma and she buys it." Well, how did you buy the plane tickets to come to the townie meeting? "I don't know. Emma does it." Every dentist has two receptionists, so a lot of the older guys, they don't need to get on the internet. They don't want to buy anything on Amazon. They probably don't even know what Bluetooth is. What exactly is Bluetooth? 

Heidi: Well I think you hit on it when you referenced the internet. It's a wave that communicates between two different devices. If you have your iPhone and you walk into Starbucks and you say, "Well, I don't want to use my minutes from AT&T or Verizon," I'm going to hook onto the wi-fi connection in Starbucks. Well then, there's information that's being shared over that invisible wavelength. Bluetooth technology, I am absolutely not a computer engineer, but Bluetooth technology operates in a similar manner. It allows two devices to communicate. You'll have the phone and you'll have your device. They'll be able to communicate. The phone will tell me to brush on the left side or brush on the right side and the toothbrush will then tell the phone if I'm doing it. 

Howard: That is interesting. Again, tell the listeners out there ... I know it gets exciting to learn about different implants and bone grafting. We're always looking at CBCT's and surgical guides and all we want to do is put out fires, but we need to spend a hell of a lot more time preventing fires. We need to spend ... It's still a tragedy that 30 percent of the 19,022 towns in America don't even have community water fluoridation. How can you be in a town of 5,000 and go work 40 hours a week drilling, filling, and billing when you don't even have fluoride in the water? Getting your kids fired up to go learn how to brush and floss. You're marrying a Bluetooth, you're marrying a video game, an electronic toothbrush, a sonic wave. This is just really exciting stuff. Doc, you've got to get more excited about preventing disease than putting out disease. 

You don't want to be a fireman. Every morning he gets up at 8:00 and it's a five-alarm fire that he's going to go throw water on all day. You've got to get to a point where hey, yesterday nothing burned down in Phoenix. In Seattle, we want the only fire to be the Seahawks stadium. That's a whole other subject, right? 

Heidi: Absolutely. 

Howard: Okay. [crosstalk 00:51:41] Go ahead. 

Heidi: Howard, if I could just add that if you're going to be putting this podcast on in the next few days, I don't know when it's scheduled to be released, but we are at the American Dental Association conference in Washington, DC today. We just set our booth up. We're also going to be at the greater New York dental conference in a couple of weeks at the end of November. We'd love people to swing by our booth and answer some questions. 

Howard: My son, Ryan, does that. Ryan, can you put her in the que to go out next? She's actually podcasting from the ADA in DC. Instead of putting her in the que and not coming out for a long time, can we push her out tomorrow? 

Ryan: Yeah. 

Heidi: That would be fantastic. [crosstalk 00:52:20] I'm in a hotel room. 

Howard: That's why you're in a hotel room? Okay. Well, again, Heidi .. By the way, just for my listeners, this isn't a commercial. Heidi didn't give me money to pitch her product. By the way, I contacted Heidi and Heidi's response was, "Howard who?" 

Heidi: I was thrilled. 

Howard: It was Howard who? She said, "I thought you died 10 years ago. You're still alive?" Anyway, yeah, this is a public service announcement because I'm real excited about what you're doing. I'm real excited about all this. On behalf of my 3-year-old granddaughter, who I'm going to vote for Hillary just because I don't want her to think all the presidents are men. A lot of my guy friends are extremely upset that I'm going to vote for Hillary. It's about my granddaughter. It's not about which lying politician that you're going to vote for. Every dental office ... My Today's Dental, I have a merry-go-round for free on those little three-horse things that goes in a circle. It's right by the front door, and people drive by. I think it's a big practice builder. They think oh, he must like kids. 

The bottom line is, kids are the most stressful part of my practice. I mean, I'd rather do anything than treat a 3-year-old which should make you even more excited about trying to get that 3-year-old to play a video game on the iPhone to brush and floss so that you don't have to do fillings and pulpotomies and [cromasil 00:53:45] crowns. That is absolutely the worst part of dentistry, is doing a pulpotomy on a 3-year-old. It's horrible. Who wants to have that as a job. Heidi, I really congratulate you on what you're doing. I think you're a wonderful person and your pedigree is amazing. I wish you the best of luck. Anything I can do to help lower the world's diseased, missing, and filled teeth rate I'm excited about. Thank you for all that you do for dentistry. 

Heidi: Thank you. You're fantastic. We really appreciate you having us on. I'm personally thrilled. Thank you. 

Howard: All right. Bye-bye. Have a great day. 

Heidi: Bye.

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