Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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945 Iowa FIND Project with Maren Lenhart MPH CDA, Deb Hoyle Iowa Practice Opps. Coord., and Jarod Johnson DDS : Dentistry Uncensored with Howard Farran

945 Iowa FIND Project with Maren Lenhart MPH CDA, Deb Hoyle Iowa Practice Opps. Coord., and Jarod Johnson DDS : Dentistry Uncensored with Howard Farran

2/12/2018 1:00:29 PM   |   Comments: 0   |   Views: 195

945 Iowa find Project with Maren Lenhart MPH CDA, Deb Hoyle, Iowa Practice Opps. Coord., and Jarod Johnson DDS : Dentistry Uncensored with Howard Farran

The FIND Project is committed to connecting dentists and underserved communities with the resources needed to combat Iowa’s dental shortage, so that dental care is close to home for every Iowan.

FIND collaborates with communities and dentists on the recruitment and establishment of private practice dental offices located in underserved areas in Iowa.

VIDEO - DUwHF #945 - Iowa FIND Project

AUDIO - DUwHF #945 - Iowa FIND Project


Howard: It is just a huge honor for me today to be podcast interviewing Jarod Johnson, a Board certified pediatric dentist in Iowa. We had him two years ago, November 2015. He was Episode 221, and I wanted to bring him back, ‘coz I think what he's doing is amazing. He's Arctic Dental, owned and managed by Dr. Jarod Johnson. Dr. Jarod has received advanced training in behavior management, sedation, hospital dentistry, trauma, special healthcare needs, interceptive orthodontics, space maintainers, oral hygiene and dietary consulting. 

He enjoys educating children and their families on the importance of oral health, so they can establish good habits for a lifetime of smiles. His goal is to develop relationships with each of his patients to establish a dental home that is welcoming from infancy through adolescence. He earned his dental degree, Bachelor of Science and Biomedical Engineering, University of Iowa, Doctor of Dental Surgery, University of Iowa, where he is sitting right now, next to Deb Hoyle, who's the Iowa Practice Opportunities Coordinator, and she's been doing it for eleven years. That's amazing. In 2006, the University of Iowa College of Dentistry and Dental Clinics received a grant from Delta Dental of Iowa - and that's the lady to the right, Maren Lenhart - to start the Office of Iowa Practice Opportunities and hire a full-time Iowa Practice Opportunities Coordinator. A coordinator was hired in January 2007 to manage the office and facilitate communication between students, dentists and communities. The Office of Iowa Practice Opportunities, OIPO, has become an integral component in recruiting and retaining dentists in the State of Iowa. 

It is the first place many students go to when they are beginning the process of deciding what to do after graduation. Since its inception, the OIPO has helped facilitate one hundred and seventy-three placements with seventy-eight of those placements in rural Iowa communities. That is so amazing. And then we have Maren Lenhart, and she's in Johnston, Iowa, a suburb of Des Moines, and she's going to talk about how Delta Dental has got involved with this. You know, it's so sad that half ... you know, there's three hundred and twenty-three million Americans and half of them live in a hundred and forty-seven metros and the other half live in nineteen thousand and eight towns, but two thirds of the dentists go to the urban, where only half the people are. And I was born and raised in Wichita, Kansas. There are several cities out in the rural areas of two, three, four thousand people that don't have one dentist. If all the dentists would evenly spread out, it would be so much better for everyone. I mean, you're never going to go see eleven Burger Kings on one corner. I mean, you know, they spread out, you know, three miles apart. But the dentists, my g*d, you can find medical dental buildings in Phoenix that have twenty dentists in one building. There's a dental office in downtown San Francisco ... how many is in that building do you remember? Oh, it's like a hundred and ... I think ... it's the craziest corner, I think it's on Sutton Street. It's like a hundred and twenty dentists in one building. And then on the way to Reno, or Lake Tahoe, you'll drive through towns of two thousand and three thousand that don't even have a dentist. So, thanks for coming on the show. Who wants to start talking about this?


Jarod: We're all ready. I think what I wanted to kind of highlight, Howard, is kind of what you talked about, that the University of Iowa and Delta Dental, you know, this thing didn't happen on its own. This is a multi-collaborative event that occurred back, you know, almost eleven years ago, that the University of Iowa and Delta Dental said, "Hey, we see this problem, we need a solution. We just can't sit back", and Deb Hoyle actually has lectures integrated into the curriculum to help students and Delta Dental has a great presence with their FIND Project - which I was a recipient of - that actually, you know, goes above and says, "This can actually happen. You can make this happen. And this program can work, and it's been working in Iowa for quite some time."


Howard: Why did Delta Dental get involved with this?


Jarod: Delta Dental's a non-profit, but I'll let Maren jump in here.


Maren: Yeah, I was just going to say, Delta Dental's a non-profit, and as part of our mission to give back, we obviously want to have dentists throughout Iowa, so that there's access to all throughout the State and that's part of our social welfare mission. This was a really good chance to stay connected with the dentist - we know that there's a lot of good talent - and helping keep them in the State, and also successful. To your point of having multiple dentists in metropolitan areas, this is extremely advantageous to go out into rural areas where you might be the only provider and able to have a very successful business.


Howard: Plus, I would think if you're going to raise kids, I mean, I'd rather raise kids in a house where you can go out the back door and shoot a .410 shotgun. You know, every time my boys did that in Phoenix, the police were there usually within fifteen minutes. I just think it's a great lifestyle. So, explain the breadth of the problem. I mean, like, how many communities in Iowa today don't even have a dentist?


Deb: We actually have three counties. We do a lot of looking at things by county versus by community, but we have three counties currently in the State that do not have dentists, and we're actively working to recruit dentists to there.


Howard: And how many people probably live in these three counties, or each one of those counties?


Deb: At least ten thousand to each county.


Howard: Wow! I mean, that dentist wouldn't have to do much advertising and marketing, would they?


Deb: Correct.


Howard: Ten thousand people, and you're the only rodeo in town. I mean, why? And these dentists graduate with $300,000 in student loans and then they go decide they're going to go down Des Moines and be the tenth dentist in a medical dental billing; and then here's a county with ten thousand people that doesn't even have a dentist. I mean, I just don't get it.


Deb: Well, so, another partner in the FIND Project is Iowa Area Development Group, and they work with and partner with the rural electric cooperatives and independent telecommunications companies in our State, and with their resources that they have available, they're able to help annihilate completely ... just cut that out, what I just said.


Howard: No, you're good.


Deb: Part of what they do with their partners is they're very involved in business and community development, and so, one of the things that is recognized is that having a strong healthcare infrastructure in a community, not only does it help to attract new business growth, but it also play a very large part in retaining the existing employers that are currently there. And so, they took an interest in collaborating with us on this project, and it started out looking at the matching funds for the loan repayment, but there's also the advantage of they can help connect new dentists to - well, and even existing dentists - low-interest loans through revolving loan funds that exist in different communities in the State. They also are able to help with the application for, you know, what comes as a grant to the rural electric cooperative or to the independent telecommunications group, and it passes through as a zero percent interest loan to the dentist, and they're able to use that to buy equipment, to renovate a structure, to help build a structure, and when you're looking at a zero percent interest or really low interest, given the debt load that they are already carrying for the student loans, that can really benefit someone in getting started out in one of these communities.


Howard: So, you're saying they should get a zero interest loan, the max they can borrow, buy all of it, put all that in Bitcoin and then thirty days later you'll double your money?! Is that what you're saying?


Deb: That's a bit outside my area of expertise, but, you know, it's not something that's guaranteed, but it's something that they are willing to, and interested in helping to try to secure and to help make up the financial package for building or taking over a practice.


Howard: Some people say that if rural communities want to have dentists and physicians live in their town, that it starts at the dental schools and medical schools. You have to take students from those small towns. There's a lot of people that say you can't, you know, fill up your class with a bunch of city slickers from Des Moines and Council Bluffs and then have them go back to these small towns. Do you see that or is that not true?


Deb: I see a mix, but I have definitely seen, in the time since I've been doing this, that we are seeing more people who are wanting to practice in a more rural community or outside of a more urban area, in part because they know the advantage of doing so, but also in part because we've been, along the way, helping to education them about what are the benefits, not just as a professional but also personally or for a family to do so. I've also been engaging in working with the communities, as well as Iowa Area Development, they're doing that as well, and helping to educate them and so they are part of the process of recruiting a new dentist to those communities, which also helps people to choose to go that direction.


Howard: So, what's the biggest city in Iowa and how many people?


Jarod: That'll be Des Moines.


Howard: Des Moines. How many people live in Des Moines? Two hundred and fifteen thousand. But you do ... you are seeing kids that were born in Des Moines, with two hundred and fifteen thousand, and in your eleven years seeing some of these kids go out to towns of two or three thousand?


Jarod: So, I was born in Nebraska, but my parents live in Iowa City, where we are now, and that's about forty-five minutes from where I practice and live. It's a good spot for us, we're close to family, I'm not competing against, you know, every other dentist. I would have said if I would have gone and tried to open up a pediatric dental office in Iowa City, it probably wouldn't have been as successful as where I am now. So, I think, having a family and, you know, you're not going to be out doing the party life when you're, you know, opening a dental office and have a family anymore, so, being able to travel and do those things on a weekend if you have to, you can definitely make it work in a smaller town.


Howard: And you probably know where the Sheriff is at all times, right, so you can just avoid them?


Jarod: I know, I see them every day probably, on my drive to work.


Howard: So, what kind of resources are available to these students to go rural? What is the State doing? What is Delta doing? What kind of resources are available?


Maren: Yeah, so, this actual, the FIND Award is up to a hundred thousand, and that up to a hundred thousand is made up of a State appropriation that is $25,000, Delta Dental contributes $50,000 per recipient, and then there's a community matching piece that Jarod mentioned, where initially it's a $5,000 investment and can be up to twenty-five thousand, and so part of that, the reason we've done that is really to have the community invested in the dentist and also some skin in the game for the dentist. It's really easy to ... we don't want a dentist to have loan repayment and get up and leave in five years. Obviously, the intent is to stay there and keep providing for that community long after the five years. But it's pretty easy to call me in Des Moines area and say, "I'm leaving this community", but it's harder to do that once you know your community has invested in you. So, that's why there's that requirement of at least the $5,000. Some choose to fundraise above and beyond that. We have one in southeast Iowa who is ... she's done all of her fundraising and had over twenty-five thousand, I believe. So, we say it's an $80,000 award up to a hundred thousand, and a lot of dentists do receive that full one hundred thousand.


Howard: And how many $50,000 awards has Delta given to this program over the years?


Maren: We've had forty-three dentists that were awarded, so that's a little over two, I think it's two million, two point one, and then, of course, that would be just Delta's funds, and then total I would have to do the math on that for you. [00:12:46] [Sounds like: We start at] [0.0] probation, and then it varies based on what the community has given. A lot of times the communities will give a small match, year after year, for those five years. Some people give it all up front. It just kind of depends who the local community partner is, and, as Deb mentioned, our partners with Iowa Area Development Group are very successful in helping identify some funds that either local [00:13:07] [sounds like: tacos, RSEs], [2.0] folks that understand why it's important to have the business in their hometown and prevent retail leakage.


Howard: Now, does the dentist have to be from Iowa or an Iowa dental school, or could some kid listening to this in New Jersey come do this?


Maren: Anybody who wants to come and live, it doesn't matter what school you went to. We do have, you had mentioned you went to Creighton, we do have some Creighton grads. I think it's really, the dentists that typically apply for this or more public health-minded dentists, they want to serve in these areas, they realize there's under-served folks as well that need help. Part of the requirement, so, a lot of times people ask, you know, "What's the string attached to this money?" and really, it's not any more than what I think a typical dentist is doing is, we ask for them to be seeing new under-served patients every quarter, we have them do quarterly reports where they just provide us under-served numbers compared to their total patient base. Dr. Johnson can tell you if that's a hard process. I don't believe it is. I haven't had anybody tell me that to this day. And then they collect those numbers so that we can report back to stakeholders, groups like you, as well as our legislators, to say, "Here's the good work that they're doing throughout Iowa.".


Howard: Now, if they're listening to this and they want more information, is it the Iowa FIND Project? Is that the best website for that?


Maren: That is, and that actually gets you access to, not only the FIND loan repayment project, but as ... Deb has a fantastic map or section on their website where you can look for practice opportunities, so even if you're just looking to come to a rural part, you can have access through that website.


Howard: So, Deb, I'm looking at your map now.


Deb: Yes.


Howard: I take it your favorite color is various shades of blue? So, talk about that map.


Deb: So, with that map, it's very interactive. If someone takes the mouse and start scrolling over the States, sorry, each county, there are three points of information that will pop up in a little box and one of the things that pop up with that is whether or not there is an opportunity in the county. Another way to find out if there is an opportunity in the county is there is an overlay that you can click on that will highlight each county that has an opportunity, and then if someone goes ahead and clicks on one of the counties, it will open up into a new page and there's all kinds of demographic information about that county. It gives insight as to the number of specialists, the number of dentists. It talks about other healthcare entities, such as hospitals, physicians in the area. It talks about economic demographics, and so on and so forth. But it also then has ... it lists each opportunity that's available in that county, and somebody can click on that link to it to have, in another window, information about the opportunity appear.


Howard: And who built that website?


Deb: We built that here at the University of Iowa. I was part of it with the map, in particular. We had a programmer from our public policy center who built that and then the database for the practice opportunities was actually a programmer here in the College of Dentistry. Our web designer helped with the layout here at the College. So, it's all us.


Howard: Would you agree that programmers became programmers because they didn't have enough personality to become an accountant?


Deb: I don't know, I haven't had that conversation with [00:16:50] them. I [UNCLEAR] [0.0] myself.


Howard: I mean, that's something that all fifty States should have. I always thought it was silly that, even like the big suppliers, like Henry Schein or Patterson, you would think it would be in their best interests to have all the demographics, so, you wouldn't want to sell some kid $100,000 of dental equipment, then have them end up in your thirty, sixty, ninety account receivables because you put them in an overcrowded, saturated area. I always thought the American Dental Association should have done this thirty years ago, but you guys did it for the State of Iowa. Are you familiar with any other States that have a website this sophisticated?


Deb: I would love to tell you there are, however, no. We're the only one that's taken it to this level.


Howard: I mean, that is just amazing. I mean, I wonder if you could get Deltas in all fifty States, how many different Deltas are there now?


Maren: Oh, they're statewide, I would have to check.


Howard: I mean, there's like twenty ...


Maren: Forty-three, forty-three.


Howard: Forty-three?


Maren: Maybe, I would need to check on that for you.


Howard: I mean, maybe that's a program where you can get the forty-three Deltas to start implementing this program, because it's just a win-win. It's a win for the dentists, it's a win for the community, it's a win for everybody. I mean, it's in nobody's best interest to have a bunch of highly competitive dental zones where dentists aren't paying their bills and, you know, I mean, it's just ... it's not a win for anyone.


Maren: Right. There are some other Deltas - Delta Dental of South Dakota comes to mind, top of mind. [00:18:24] [Sounds like: Everyone [0.9] in Minnesota is looking to do a similar program. [00:18:27] Everyone [0.9] operates them a little bit differently. So, ours we really like this collaboration piece just because it's not ... there's a lot of folks that are in the game and it's really trying to help the dentist be more successful.


Howard: Yeah, on the Delta website it says there are thirty-nine Delta Dental companies.


Maren: Yeah, thirty-nine.


Howard: And it's funny because people always talk about Delta like it's like McDonald's, like everyone's the same. I mean, dentists talk about like Delta Dental's just like this one insurance company, and it's really thirty-nine different companies.


Maren: Yeah, there's different member companies. We provide care and benefits to Iowa-based companies. While we still have that name of Delta Dental of Iowa, Delta Dental of Washington might be serving a different population. We operate foundations completely different, but we do share ideas.


Howard: Yeah. So, Deb, when do dental students start thinking about things like this? Are they thinking about this freshman year, or is this a last-minute freak-out senior year of dental school when they realize they're about to graduate and they have no idea what they're going to do? When do they start getting interested in this?


Deb: Through the years I've seen some change with this as well. I encourage students to start thinking about it their very first year that they're starting, because it's a process, and it's a process that takes time if you want to essentially end up on the right path for yourself. So, I do have freshman that will come in to start talking about down the road and connecting them to dentists who are practicing in the State as mentors, and then I usually see an uptick in the junior year. I'm seeing more and more juniors come in than I used to see, and in January each year they get a community analysis project, which, part of that project is choosing a community that they might have an interest in practicing in and analyzing it to see, can it support another dentist? And so, that will, if they haven't thought about it before, that will usually start to spark that idea of starting to look and start initiating conversations, not only with me, but with dentists and with communities, so that, hopefully, by the end of their fourth year, it's all been decided and secured for them.


Howard: So, Jarod, talk about your article. You wrote an article in November Dentaltown magazine called 'The Loan Arrangers', by Dr. Jarod Johnson. Talk about that - and thanks so much for writing that for us.


Jarod: And great for Muscatine in featuring our community. I think it got a lot of buzz going around town, so we really appreciate it. But I was a recipient of the FIND Project, and it's made a big impact on my practice and the patients I see and the families and their lives, and I just wanted to put this out there for everyone to see the collaboration that happens and this project, it's taken a lot of work. You've got all the partners, you've got University of Iowa, Delta Dental, you have my community contribution from Muscatine Health Support Foundation. It's just all these pieces coming together, it's such a great thing. Why are we not doing this everywhere? I mean, you have the ADA, they've got that action on people going to the emergency room and what are they going to do there for a toothache? This is the kind of population that this can help get those people out of the emergency room, get them their care, and it also benefits the community. Having dentists and providers, quality healthcare in a community, keeps those people in town and keeps employers there, and it also can help prevent money from going out of the community. If you go up and have your dental visit in Iowa City, and have to go up there, you're going to be buying gas, you're probably going to stop at the store and buy groceries, you're probably going to buy a bite to eat. That's all money that left the community. So, if you can have that stay there and maybe even bring some people from the surrounding area to come to your community and give those other businesses an opportunity to have people buy gas, eat food, get their groceries before they leave, that can provide opportunity for other businesses. My office is right across from the Dairy Queen. I bet they're the happiest people that a kids' dentist is across the street, because you know everyone's taking their kid over there for an ice-cream cone afterwards. But it's just little things like that that you don't think about where small communities can have a big impact, not just our dental care, which is important, but there's other aspects to this project that I think, you know, need to be highlighted.


Howard: You know, it is a black eye to dentistry when you look at the data that shows 8 percent of emergency room visits are tooth, odontogenic, in origin. I mean, what does that say to a country when eight out of every one hundred people that go to the emergency room it's for a toothache? And I also think it's very bizarre. I could go in the emergency room and they could do a bypass, they could remove a brain tumor, fix a broken leg, but they can't fix a tooth. I just think that's weird, that they could remove my gallbladder but not my wisdom tooth. Isn't that ...


Jarod: Yeah, I think it's a challenging problem and I know as dentists now we're facing all this opioid crisis, but what do they do when they go to the emergency room. They give them an antibiotic and they give them an opioid. So, we're kind of training these patients, you know, to have that habit when they come to us. So, I think, if everyone did their share and, you know, maybe saw a few of these under-served patients and took care of them in their office rather than having a big bill for our taxpayers ...


Howard: Is the opioid a crisis in Iowa too? I mean, is that a epidemic in Iowa?


Jarod: Yeah, we've got ... Iowa Dental Association just came out with a blog post recently on it. It’s a big problem.


Howard: Yeah. It's always something. I mean, it's a meth crisis or it's an opioid. It seems like when you start to deal with one drug, another one pops up. Now there are ... what are they adding? Fentanyl to these opioids? So, it's no longer just OxyContin or Hydrocodone or Oxycodone, now it's with Fentanyl. That's amazing. And then to see some of these celebrities, when their toxicology report comes back. I mean, they're like a mini-pharmacy inside of ‘em.


Jarod: And if we can take care of these patients through programs like these, you know, we can, I'm sure most dentists can take out a tooth, but it's not ... maybe it's hard for, you know, but like pulling teeth, but I think it would be a good service if we could.


Howard: I want to talk about another ... there's no way I can have a pediatric dentist on the program without talking about the 400,000-pound elephant in the room, which is silver diamine fluoride. It seems like ... here in Arizona, we just lost a three-year-old child last week being put to sleep for dentistry and, of course, she didn't wake up. And three years ago, there was another little girl right up the street from where I live. What is your thoughts on silver diamine fluoride, ‘coz some people say a lot of these kids being put to sleep, you could've just painted silver diamine fluoride on their cavity every six months? What is your thoughts on silver diamine fluoride? And are you doing it?


Jarod: Yes, I do do it. I think, in pediatric dentistry, we're kind of heading kind of a few different ways. One is on, you know, the treatment of the cavity and we have things like Hall crowns and silver diamine fluoride, which, you know, aren't as aesthetic in nature, but they can avoid some things such as sedation; and then we also have the parental concerns about behavior and, you know, they don't want their child to have a bad experience, but then they also want the child to have a white tooth, and, you know, all these things can't always come together. Yeah, we'd ideally like your child to sit there, open, not move, but it's not always possible. And some of these kids that I'm seeing are coming to me with, you know, twelve cavities and silver diamine fluoride won't work on everything. It'll work on smaller stuff, but in my experience, I was using it quite a bit a few years ago, back when we did the other podcast, and I had one kid come in, I was treating - I thought it was a small occlusal lesion on a tooth - came in with huge cellulitis a few months after we started the treatment, and that was kind of the time where, you know, I kind of realized maybe I shouldn't be ... you've got to kind of use case selection and not every case is a case for it, so, that child ended up needing sedation to get a tooth removed. So, you can't always stop it. You know, if we're painting this on teeth that are dead, it's not going to do anything. The infection's still going to be there at the end of the root. So, there’s limitations to everything, I think it's a great tool for us as pediatric dentists to have in our toolbox. I do a lot of alternative, you know, techniques to try and avoid sedation. It's probably one of the scariest things that I do is, you know, when they go to a hospital, they have great providers, but you know, things don't always go the way we want it, and I think we've had quite a bit of publicity on sedation deaths within the last year - more than enough to make any provider have a little concern about it.


Howard: Well, you know, Facebook has really changed that because these cases used to go on but they didn't make the news or it was a local play, but now a story like that can go viral on Facebook and, you know, someone can post it on Facebook and the next thing you know one million people read it, you know.


Jarod: I think, for dentists, we're treated a little differently than another provider. There's kids that go undergo, you know, surgical procedures every day, anesthesia is very safe, but we don't really hear about if something happens when someone has tubes put in or, you know, has tonsils removed, things like that. I think sedation can be safe and there are safe ways to do it, but any time we do something there's always risk to it.


Howard: And the dentist is always the bad guy and the journalists never ask the question, "Mom, how did your three-year-old have twelve cavities?" And, you know, Mom's standing there with a Mountain Dew in her hand, and it's like, you know, I mean ... what city are you in, Jarod?


Jarod: I'm in Muscatine, Iowa.


Howard: Muscatine, Iowa. Well, how would you describe the decay rate there?


Jarod: So, I think, personally I see about 70 percent Medicaid in my office right now. I started about two years ago. I take Illinois and Iowa Medicaid. I get a lot of referrals. People coming to me, you know, three hours away in Illinois, and, you know, it's ... there's a lot of decay. The 80/20 rule, you know, 20 percent of the kids have 80 percent of the decay, and that's what I see.


Howard: And do you think it's more diet or home care? What do you think?


Jarod: I think it's a combination of everything. You know, how well they take care of their teeth and what they eat. We can't always, you know, control ... kids don't get to buy the groceries, you know, they'll eat what their parents buy and what Grandma and Grandpa by too, and that can be part of the problem as well.


Howard: That was the Law of Unintended Consequences in the Chinese policy of one child per family. I met the first pediatric dentist to open - I also the first one in New Delhi - but basically, think about that, you only have one child, so Mom and Dad are spoiling it, and then each parent has a Grandma and Grandpa. So, you actually have six adults spoiling this little kid, and these Chinese people, the candy, the American candy and Coke, it's all a new thing, and they would bring their kids in to the dentist shocked, like, "Why?" You know, Mom and Dad never had a cavity. Grandma and Grandpa never had a cavity. And now this kid’s got twelve cavities and they're having to learn the hard way that Hershey's chocolate and Coca-Cola is, you know, it's a big, new deal in China.


Jarod: And, you know, like you said, it's a preventable disease, and Delta Dental is actually doing a lot of things outside of the FIND Project that are relating to prevention. Maren approached me about trying to look out for the next cycle to have - you know the water stations, you can get those installed, where people can fill their water bottles? They've got a grant for people to install those in the schools so high schoolers and middle schoolers are choosing healthier drinks, rather than, you know, the Gatorade and all that kind of thing, so, Delta Dental's been on top. They also have a program for getting children into the dentist by age one, so maybe we can catch some of these things and educate the parents about all these things that you've just talked about are not the greatest things for our teeth.


Howard: So, is it safe to say that you're using less silver diamine fluoride today than you were two years ago?


Jarod: I'm doing a lot more Hall crowns and ...


Howard: Explain what a Hall crown is.


Jarod: Well, I posted a little case on Pediatric Dentistry Forum. I call it 'socks on a rooster'. It's a technique where - it's from England, Dr. Norna Hall invented it - basically, it's taking a stainless steel crown and cementing it onto the tooth without doing any anesthesia, without doing any drilling to the tooth, and what that does, if it's small enough and the tooth's not already dead or, you know, inflamed, it will stop the cavity from getting sugar and stop it from growing. That's a technique that we use quite a bit on two- and three-year-olds that we, you know, don't want to use sedation on, because obviously there's risk to that and for one tooth, maybe that's not worth it to put a kid under. In my mind, you know, I would do this for my child. So, [00:31:52] [UNCLEAR] [0.1] kids I'll usually put in dental separators, orthodontic separators, and then two days later have the kid come back and fit the best crown I can, and off we go. So, Maren, is there a code for silver diamine fluoride, and is Delta of Iowa seeing more people using it or less? What does silver diamine fluoride look like from your end?


Maren: I know that we just started covering that as of this year. Since my job is primarily in the Foundation, I would be happy to refer you to the folks. I don't know about frequency of use for that code. I do know that in the past year, year and a half, we've had ... our provider relations team has brought in Dr. Jeremy Horst, which I'm sure you've had on your podcast before, who is one of the experts and researchers behind silver diamine fluoride and providing opportunities for other providers to learn about that and feel comfortable using it in their offices. But I would need to get that information for you since I don't know off top of mind.


Howard: Well, Jarod, what do you think? Do you think it's a fad that's growing, flat, shrinking? Where do you see the silver diamine?


Jarod: I think, right now, we're growing. I don't think we have all the information that we need to figure out what it's going to work on and what it won't work on, but if it doesn't work we still have traditional dentistry and traditional means to take care of the problem. So, I see it as another tool in a dentist's toolbox to use. It's very good that we're starting to see some reimbursement from insurance companies that helps patients with patient treatment acceptance, and definitely, with the sedation risk and things, I think it's a trend that we're going to continue to see grow and once we know how it works, I think there will be a perfect fit for it in dentistry.


Howard: And you know how you said 20 percent of the kids have 80 percent of the cavities? I still think we're at a ... you know, when HIV came out, the entire planet learned almost overnight that STDs are real, and you can, you know ... when I was little, it was mostly they were afraid of getting pregnant, but with AIDS, the whole world understood STDs. But back to the other end - the mouth - I still think decay is like an oral communicable disease, because when I see these kids with ten, fourteen cavities, Mom's got bombed out teeth, Dad has bombed out teeth, Grandma's got gum disease, and they're all kissing each other and they're all sharing utensils and they all lived together, I think that you have to, in order to stop the decay - because there are plenty of kids who have horrible diets without any decay. We've all seen these kids. I think it's you've got to go in and treat the whole family. I mean, if Mom's kissing you three times a day and she's got, you know, six billion Streptococcus mutans in every kiss that she gives you, this kid doesn't have a chance, and so, I see it as a family disease.


Maren: I think Dr. Johnson had pointed out the 'Dentist by 1' program and that's something we are trying to speak with families and get them this information early on. With the 'Dentist by 1' program, not only are we trying to help remind parents and caregivers to take their child to the dentist by age one, but also to your point on sharing utensils and that you can pass cavity-causing bacteria back and forth. So, that's one of the points to that too, trying to get that message early and, of course, not going into bed with juice in a bottle. Things that dentists know to tell their patients. But that is something we try to do and instill early, before those habits are formed. I don't know how I'm going to get Mom's to stop kissing babies - that's too hard!


Howard: But back to my HIV point, I don't even think Grandma and Grandpa, I don't even think they realize it's a concept.


Maren: Yeah, right.


Howard: That Grandma, you know, she's lost half of her teeth, she wears a partial, she's got gum disease, she hasn't been to a dentist in five years and she doesn't realize that those kisses ... I think a standard Grandma kiss is like eighty million bacteria, funguses, viruses, parasites being transferred. I mean, seventy million just for, you know, a quick kiss, and every time you have that baby, they're just passing that baby around the family and Grandma's kissing it and Grandpa, everybody's kissing this baby and it's that environment where everybody in the family has multiple cavities.


Jarod: And back to your point, Howard. I think some of that you were talking about, the silver diamine fluoride, and, you know, how many of these parents and grandparents I have, the parents of the children in my chair, they say, "I don't want them to have the same experience that I had when I was a kid." And maybe they don't go to the dentist because we didn't offer something in a comfortable way. We can't always do that, given the infection or the pain that the child's having, but we want to try to, and make things so that maybe we can flip some of that, you know, being scared of the dentist or intimidated from the dentist, maybe we can provide better experiences with some of these alternative techniques, and maybe sedation is necessary to provide them with a comfortable experience. Every kid's different. And that's our main goal, is to have a child infection-free and also be happy.


Howard: What's the status of water fluoridation in the State of Iowa?


Maren: Water fluoridation, we're just at about 90 percent of community water systems which we're very happy with. There has been some rollback with equipment as equipment starts to get older - a lot of it was installed in the '80s through some funding that was provided and now that needs to be replaced or updated. So, we are trying to maintain that. The Foundation works with the Iowa Public Health Association strongly, have a great partnership actually, and we offer some grant funding to communities who need updated equipment and provide funds to be able to do that so that they can continue providing optimally fluoridated water for their residents. The other part of that, with instilling good oral health behaviors, drinking tap water that's good for you. As Jarod mentioned, the 'Rethink Your Drink' program that we've launched this past year, helping schools, especially schools with older drinking fountains, have those updated, and then we provided refillable bottles and toothbrushes for students and teachers in those classrooms, so that they can remember to be drinking water throughout the day, and not have those sugar-sweetened beverages, Gatorade, things like that. Those compliment a lot of other efforts going on in the State to be five fruits and vegetables, healthy food, drinking water. So, that's something ... we're fortunate to have such a high fluoridation, optimally fluoridated State compared to some others.


Howard: You know, I worked on the original fluoride campaign in Arizona in 1989 and then, the way they set up, it expired, went into sunset after twenty years; so, we had to do it again, and I still can't get a gauge on what percent of Arizona is against it. I mean, we got it '89 and again just a few years ago, but is it just ... what's it like in Iowa, is it just a vocal minority against water fluoridation or do you think there's ... what do you think the pushback is on water fluoridation?


Maren: I think we've been pretty good in this State. Part of that's educating our communities on the benefits of that, so that involves ... we can do that from the State level with the Department of Public Health - they are very involved - the Iowa Dental Association, of course, all the providers, so Dr. Johnson, I know, will be communicating with parents on why it's important to drink tap water and optimally fluoridated water and why that's a benefit. So, I think, right now we've had some, you know, pretty success, there hasn't been a lot of vocal pushback right now. I think part of that, a lot of that, it's in talking about it and being proactive and especially credit to our providers for talking about it while they're seeing patients and even healthcare providers, we try to share that message with them too.


Howard: Man, and it all went south when Senator Joseph McCarthy went on the House floor with a diagram of the human brain, where there was a red dot where he said, "That's the area that, when you drink optimally fluoridated water, it makes you more susceptible to communist ideology", and it's like, wow! And we're still fighting that forty years later. Isn't that just amazing?


Maren: Yeah. It's incredible.


Howard: Yeah, there's just a lot of crazy people. I don't know what percent of Americans are completely crazy, but I still think they need to do a movie on the ... did you guys ever hear about the story of when Grand Rapids became the first city in America to fluoridate? I think it was January 20th, 1945, something like that. Did you ever hear the story of the first day?


Maren: No.


Howard: It was the most genius story. This guy knew that people were crazy. I mean, and so, what he did, he was starting to hear rumbling, you know, so what he did is they announced that Monday morning that, you know, they would start fluoridating, and just like he knew, people were having anaphylactic shock and going to the emergency rooms and fainting and he didn't say a word, and people were calling his office saying, "You know, you need to reply to this", but he just laid low. It got even worse Day Two. Finally, Day Three, the governor and everybody is like, "You have to do a press conference. You have to address these concerns." He walks out there and says, "I knew this would happen. That's why we didn't turn it on. We're going to go ahead and turn it on tomorrow." So, all this three days of chaos and noise, you're crazy, and we're going to start water fluoridation on Thursday. Is that just the most classic story ever from a dentist in public health?


Maren: Good one.


Howard: I mean, I just think that's one of the greatest water fluoridation stories ever. So, people listening to you right now, who's a good candidate? Who should go to Iowa FIND project? What is an ideal candidate?


Maren: I think somebody very much public health-minded, somebody who wants to live in a rural area. As I mentioned, we want ... our intent is that the dentist will stay there for well beyond the years of loan repayment, but I think it's somebody who enjoys a sense of community, somebody just like Dr. Johnson, actually - and he's probably not going to tell you himself, so I'll brag for him - but he had an open house last year that I went to and, I think part of this, he's still a very young dentist, but he's been able to use his successes in already turning around and giving back to his community, and he can probably share a little bit more about the community fund that he's starting to help kids in his community, but I don't know that he would be able to do that or feel confident. I know that he still has a great amount of debt, that you have to pay back student loans and business - I understand that that takes money, but partially because of loan repayment and how the community is invested, he's already turned around and is doing philanthropic work in his community. So, that, of course, is good for a strong candidate, somebody obviously who loves dentistry, but I think just likes that lifestyle. In Iowa we're pretty close - and Deb has better numbers than I do - but you're pretty close to any major highway and interstate. You're just a short drive from the big cities, so that doesn't seem to deter folks.


Howard: And plus, that drive is gonna go away because with driverless cars literally around the corner, it's going to change the whole automobile. When you look at, I think last year in the United States sold seventeen million cars, average price is thirty-five thousand a car. Most of that cost is for the pilot to be in there steering and all that stuff. They're really going to turn into just a box with just a battery-powered engine, so if you have an hour commute, your box could be ... you could just go sit at a desk and do your e-mail, it could just be a bed, you could just, when your alarm clock goes off, you could just go lay down in your bed and take another hour nap on the way to work. So, I think when driverless cars - and I think people are gonna like the commute ‘coz imagine you're trying to work from home and you got a spouse and kids, "Daddy, Daddy, Daddy", that all, and then you when you go to work, you know, people, all those time-destroyers that go from cubicle to cubicle to cubicle, "Hey, what are you doing? What's up with you? How was your weekend?" It's like, g*d, you can't get anything done at home or at work. So, if you had an hour commute and you just got inside your little box, sat at your desk, and had one hour of interrupted time to do your e-mail and all that kind of stuff, then you could go to work, you could have your team meetings and all that kind of stuff, but then you’d look forward to your commute home. And then by the time you did all your work on the commute home, then when you came in, you could unplug. And, so, I think driverless cars are going to push a lot of urban people one or two hours out into the suburbs is what I'm trying to say.


Maren: Interesting. They have time to listen to the podcast then.


Howard: Yeah, it will be good for my podcasts. I'll sell more free episodes. So, Jarod, are you married with kids?


Jarod: Yep, I have two little ones and a wife.


Howard: Now, on the wife, did you find her in the Big City, Des Moines, and take her urban or did you go rural single and find a rural girl and marry her there?


Jarod: Actually, I kind of did both. So, we met here at the University of Iowa. She actually worked here, and we got married here. And then I dragged her out to Las Vegas for my residency; so, we took her, you know, to the urban area and then I brought her back out to the rural area. Her family's from Iowa, so we're about forty-five minutes away.


Howard: But, so, she grew up in a bigger city forty-five minutes away, but how has she liked the rural life?


Jarod: So, we can see our family quite a bit, so that's good to be close. And then she also works right now at (Inaudible: 45.54) HNI. So, she's got a great job in the community there, and wonderful place to raise our kids.


Howard: Yeah, I love the rural life. I just think it's great. So, is there anything I didn't ... I missed that we should talk about, or did we pretty much cover it all or ...?


Deb: Yeah, I think the one thing that would be good for people to know is it is possible to replicate what we have done here in Iowa, and that any of us, whether it's talking to Maren, talking to myself, talking to our partners at Iowa Area Development Group, we are happy to help people learn about how we've done things here and how they can think outside of the box in their own State and own community to make things happen. And along that line, coming - it's probably by February - there will be a new page added to our website here that will have a community recruitment guide. A lot of the economic development groups, they know how to do the recruiting of big business and what have you, and it's not necessarily dissimilar, but there are nuances in recruiting a new dentist that they maybe aren't aware of and so by creating this guide, it will be something that other communities, other schools, what have you, will be able to use and, like I said, then they'll be able to replicate this in their own areas.


Howard: So, I would, on that Iowa FIND Project, I would have that programmer go back and add some share buttons, so you could just forward that on Facebook, Twitter, LinkedIn, Google+, Pinterest, Instagram, you know. ‘Coz I think what you've done is amazing, and if that ... like, I would re-tweet it right now. I would share it all over social media, but I really wish the word would get out. Like say there’s..., if every State did this, the citizens would come out ahead, the dentists would come out ahead. You wouldn't have over-saturated areas and under-saturated areas, and might start taking a dent in that 8 percent of the emergency room visits that are odontogenic in origin. I think what you've done is just amazing, and I want to thank you so much for coming on this show. I know you guys are busy, busy, busy, and to come on the show and talk about this for an hour is outstanding. And let us know anything we can do to help spread your word.


Maren: Thank you for having us.


Howard: It was an honor. And, Jarod, don't be drinking that silver diamine fluoride.


Jarod: Yeah, well, it'll stain my teeth! I want to have white teeth.


Howard: Thank you so much for coming on the show today and talking all things Public Health Dentistry, Iowa, Delta Dental. Thank you so much everyone.

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