Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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952 Hygiene Benchmarks with Kim Miller, RDH, BSDH of Inspired Hygiene : Dentistry Uncensored with Howard Farran

952 Hygiene Benchmarks with Kim Miller, RDH, BSDH of Inspired Hygiene : Dentistry Uncensored with Howard Farran

2/18/2018 2:40:37 PM   |   Comments: 1   |   Views: 670

952 Hygiene Benchmarks with Kim Miller, RDH, BSDH of Inspired Hygiene : Dentistry Uncensored with Howard Farran

Kim Miller received her Bachelors Degree in Dental Hygiene in 1981 from Loma Linda University.  She has over 25 years of coaching and in office training experience. Kim is a Lead Profitability Coach with Inspired Hygiene, an international speaker, monthly columnist for RDH magazine and Kim serves on the editorial board for Modern Dental Hygiene magazine. She is also a four time graduate of the Bale Doneen Preceptorship Course which features medical systemic concerns with cardio vascular disease and periodontal disease.  Kim is passionate about helping clinicians save lives by adopting solid science-based principles and treatment philosophies resulting in exceptional treatment outcomes, healthier patients and happier more satisfied clinicians.


VIDEO - DUwHF #952 - Kim Miller

AUDIO - DUwHF #952 - Kim Miller

Howard: It is just a huge honor for me to be podcast interviewing Kim Miller. She received her bachelor's degree in dental hygiene in 1981 from Loma Linda University.


She has over twenty-five years of coaching and in-office training experience. Kim is a Lead Profitability Coach with Inspired Hygiene, an international speaker, monthly columnist for RDH magazine and Kim serves on the editorial board for Modern Dental Hygiene magazine. She is also a four-time graduate of the Bale Dornier preceptorship course, which features—


Kim: Bale Doneen.


Howard: Yeah and I've had him on the show.


Kim: Oh, Bradley Bale? Have you?


Howard: Yeah, yeah. Sorry I couldn't read that. At fifty-five I'm senile and can't read very well even with readers on. I'm reading typos. She's a four-time graduate of the Bale Doneen preceptorship course, which features medical systemic concerns with cardiovascular disease and periodontal disease. Kim is passionate about helping clinicians save lives by adopting solid science-based principles and treatment philosophies resulting in exceptional treatment outcomes, healthier patients, and healthier, more satisfied conditions.


Thank you so much for coming on the show. A little background; we both live in the Phoenix Metro. I'm in Phoenix, but I'm actually south of the mountain. They call it Ahwatukee. If you ever come to Phoenix, there's this hundred-block long mountain park that goes from 48th Street to 51st Avenue, so it's hundred blocks long. About 10% of Phoenix is south of that, so I can't see Kim right now because there's a mountain in our way, but you're up by the Arizona Cardinals Football Stadium in Glendale. You're in Peoria.


Kim: I absolutely am. I can almost see the stadium from my back porch.


Howard: Which looks like a huge UFO landed.


Kim: It does. It's like a giant balloon.


Howard: I know, it's a silver balloon. I swear if you were drunk in the middle of the night in a taxi or in an Uber, you would think a UFO landed over there. But I mean you have so many things to talk about: periodontal disease, medical systemic links and all that stuff. I know my homies. I mean, I'm on Dentaltown and Hygienetown all day, every day. I wanted to start first with the four-thousand pound-elephant in the room and that is my dental office, this is February 2018, on September 11, just a few months ago, my dental office celebrated its thirty year anniversary here in Ahwatukee, here at 48th and Elliot.


Kim: Fabulous. Congratulations.


Howard: And thirty years ago, I set my own fees and Delta just paid a percentage. They pay a 100% of cleaning exams and X-rays, 80% of fillings and root canals, 50% for crowns. So my hygienists, I paid bank, I charged a healthy fee for hygiene and now 30 years later I get six-fifty for a crown.


I mean my hygiene, what they're paying for hygiene goes down every year, but every time the earth goes around the sun, the staff all want a raise, you have about one and a half, 2% inflation on all your costs of electricity and supplies and all that kind of stuff. And there are so many dentists out there that think, "My gosh, it's just macro-economically my hygiene department runs at a loss, so now I don't love it anymore. I don't like paying a hygienist $40 an hour to do a cleaning that Delta is going to pay me $55 on in a dental office was 65% overhead." So first address the ugly: is it just going to be that hygiene runs at a loss or can it actually break even? Can it be a profit center? Talk economics first.


Kim: Let me first make a comment about insurance companies, if I may. While the topic you bring up is the elephant in the room, often times insurance companies kind of get the brunt of our dismay over this issue, and I just want to say this, that if it wasn't for insurance companies and if employers didn't purchase insurance for their employees, there would be a lot of people that would never seek dental care.


Howard: True.


Kim: So from that perspective, I'm happy that we have insurance companies because it does get people who need care into the dental office.


So, having said that, let me go back really to the original question, which was does hygiene needs to run at a loss leader? And I'm going to tell you absolutely it does not. The hygiene practices or the hygiene departments that we see running at a loss are hygienists or hygiene departments that are primarily providing pro-fees.


Now part of this is inherent in the way we are trained as hygienists because in hygiene school we learned that in order to put a patient into a scaling and root planning procedure that they have to have deep pockets and calculus on the root surfaces.


But I am here to tell you that what I have learned over the last five years from the medical systemic relationship, is that if the patient has an active infection in their mouth, that means their gums are bleeding. Regardless of pocket depth, the hygienist needs to take action and recommend some treatment, of course in alignment with what the doctor would support and recommend. And when that happens, you can have a hygiene department that is doing 50% or greater periodontal services.


So if the hygiene department is doing 2% perio services, they are going to be running at a loss and I work with a lot of practices that start there. But I also work with a lot of practices who have stuck with coaching and over the years are now running at 50, 55%, 60% perio percentages, which means 60% of what they're billing out of their hygiene department falls under the four-thousand codes for the perio related services and we are always going to get reimbursed at a greater rate and we're able to charge a more significant fee for perio related services.


Howard: So my homies listening to this, you are with Inspired Hygiene?


Kim: Yes, I have a cup to prove it, see?


Howard: So what is your program? I mean, if they go to your website, who are you helping? Who's your regular customer? I mean, do they call you up because, is it generally someone with one hygienist and they think they're trying to expand to two, or is that they already have two hygienists, they think they're losing money? How much does this cost? What is the program like? Is it initially two days and once a month? Talk about what you're actually doing, because I know you've been doing this; I mean I don't want to say you're old because we're the same age so I think you're a young little youngin, but who's your regular clientele and what are you doing for them?


Kim: Okay, that's a great question. Okay so our regular clientele is any dentist who wants to improve their hygiene services, elevate their profits, and improve the health of their patients. So that's a pretty big umbrella that could apply to any dentist in the country. I would say that our ideal client is somebody who has probably done coaching in the past, but not always. I think some doctors tend to shy away from coaching thinking they can't afford it or they're not a good candidate for coaching clients or to be a coach or to be coached.


All right, so let me say that again.  Not every dentist wants to be coached, but we find that the clients that we work with, they improve their hygiene profitabilities anywhere from $10 to $30 per hour per hygienist. Of course, that's based upon their level of implementation and the doctor has to take on a leadership role and we'll support the doctor and help the doctor through that. Let's see, what was the next question?


Howard: How much is the cost?


Kim: Our programs range from about $18,000 to $35,000 depending upon what timeframe you choose.


Howard: Eighteen to thirty-five?


Kim: Yeah. I'm kind of giving you the low-end and the high-end. But we have several different options of how a client can start working with us. We have something called a Kick Start program which is kind of for the self-starter. It's a shorter program; it's three to four months in length and it's going to be on the lower spectrum of the B and then we have all the way up to our Masters Academy, that program is eighteen months in length and you can only qualify for our masters program if you've been through either our Kick Start or our Elevate program. So I don't want to muddy this with all of the different names, but we have a four month coaching program, a twelve month coaching program and then we have coaching programs that extend ongoingly up to eighteen months at a time as you sign up against for them.


Howard: So the Kick Start's three to four, what was the second one?


Kim: Elevate.


Howard: Elevate is how long? Twelve months?


Kim: Twelve months.


Howard: And then the last one was the Masters?


Kim: We have a Masters Academy and there are three levels of our Masters Academy. We have a Basic level that does not include any in-office or on-site training. And then we have our Masters Gold which has two days of in-office training and it's twelve months and the Masters Basic is twelve months, too. And then we have our Masters Platinum, which of course is not only the best value, but you get the most training. It includes four days of in-office training and eighteen months of coaching and we're in constant contact with our clients via video conferencing, text messaging, telephone calls, coaching calls, whatever the client needs. We do everything we can to support them.


Howard: Okay, so now I have to give a rant because I get so frustrated with my homies. They don't blink spending a $145,000 on a CAD/CAM when I can give you a list of a thousand dental offices that do a million dollars a year collection and the doc takes home three hundred and fifty to four hundred without it. And then they don't blink at buying a $100,000 CBCT, they don't blink at buying a $130,000 LANAP laser or a BIOLASE laser.


I mean by God, if I owned your company, I would say that on the Masters Academy, if you sign up for the $35,000 program, I will give you a shiny box with a lot of dials on it and blinking lights and some antennas on it because the number one return on investment is always a dental consultant for your business and they think the way I'm going to fix my failed hygiene deal is to go study LANAP or to go buy a Millennium laser or go buy instruments that don't ever have to sharpened because they're so ego-driven.


Howard: They're like, "I'm a doctor. I know everything. How could a consultant?" I mean, I'm telling you guys that everybody I know that does $3,000,000 to $5,000,000 a year and has been practicing for thirty years like me, not only have they used a practice management consultant after thirty years, they've used six, eight, ten. I mean I was talking to a guy the other day and he was sixty and he was telling me that. I said, "What keeps you up at night?" and he goes, "There's really nothing new in consulting. There's no consultants I haven't used." So he's just looking.


I mean, so if you give someone like you're talking about your program, $18,000 to $35,000 and then you increase the production $10 to $30 an hour for a hygienist that works forty hours a week, fifty weeks a year, two-thousand hours a year. So two-thousand hours times ten would be twenty grand. If you got the thirty there, it'd be sixty grand and that's cash back in the same calendar year. I mean they just--


Kim: So I can't leave this out because one of the things that we also work on his restorative enrollment. My personal motto is if the doctor ain't happy, ain't nobody happy, which means if I'm not as the hygienist co-diagnosing or pre-diagnosing, whatever you want to call it, restorative issues before you come into the operatory to do the exam, I'm not doing my job. So what we're talking about is a solid return on investment through production or collectible production. But the part that's harder to track is how much the high genesis contributing to that restorative component, night guards, all of those things that the doctor really wants to do above and beyond taking care of the patient's perio.


Howard: Back to the hygienist. So many people will tell me these wild stats and then I shall say, "Wow, that's amazing. You've got to source on that?" "No, it's my gut feeling." Dude, guts are filled with fecal matter, keep your thoughts to yourself. Whereas on Dentaltown you can create your own poll. So on a message board, if it's the first post, you can make a post, you could drop any YouTube video, you can do anything, but you can also create a poll.


So for twenty years, all these polls have been created and plus Dentaltown has a poll on the side. But if you ask all the dentists from here to Katmandu: what keeps you up at night the most? It's never how do you do a root canal? It's never should I've done a filling? It's always staff number one and then number two, patients. It's people.


So these dentists, after they get done doing a root canal, they run for their office and shut the door because they don't even want to deal with the hygienist and the assistant and the receptionist. So how do you pick a right hygienist and how do you get them happy and I'm embarrassed at how many posts on Dentaltown are like, "Okay, my hygienist has just come in and she asked me for a raise, blah, blah, blah, blah, blah, blah. What should I say to her?" I'm like, "Dude, you're running." I mean, so address HR hiring the right hygienist; it's obviously a huge stress on my homies' lives.


Kim: So let me address the asking for a raise salary issue first because it's pretty easy to do that. We have a weekly meeting among our coaches within Inspired Hygiene and we are constantly talking about these kinds of issues and refining our approach. But I will tell you that industry standard says that a hygienist should produce three times their salary plus their benefit package. So some offices have a nice benefit package including a 401k and regular bonuses and pay days off and some offices have no benefit package for hygienists.


So take your hygienists salary and add on the benefit package and then you might even add on $300 a day for expenditures like, ultrasonic inserts and equipment purchases, that kind of thing for the hygiene department and do the math. Your hygienist should be producing approximately three times their salary plus their benefit package.


Now because of the huge influx of PPOs and because of the reduction across the country in insurance reimbursement, this is becoming more and more challenging and we're probably going to have to be shooting for three and a half to a four to one ratio to compensate for that. So sometimes I go into offices and hygienists are being way over paid and they're under producing.


But I'm going to go back to something I referenced earlier, which was that the under producing hygienist is probably doing a day full of pro-fees. So from that salary perspective, it's a three to one. That's kind of what we want to look at. That would be what we would consider a breakeven point. Your hygienist is covering their salaries so 30% goes to the hygienist in terms of salary, 30% goes to overhead costs and expenditures including payroll taxes, which is part of the doctor doing business and then 30% goes back to the doctor. So a three to one. Now you ask--


Howard: But three to one of salary plus benefits?


Kim: That's correct. Salary plus benefits. It's important to remind hygienist annually during their growth conference, what their benefits are. Sometimes benefits are uniforms and they don't really think of that as a benefit. Sometimes benefits are the dentistry, the free dentistry that your children get all year long and so on.


Howard: Can I interrupt you one thing on the benefits? I can't tell you how many dentists make this one mistake. You'll go in there and their overhead size, as the fees have drifted down, staff salaries have gone up and now it seems like one of the most reoccurring problems when you talk to dentists is where labor plus FICA matching, benefits, everything should be 25%. It's drifted to twenty-eight to thirty to thirty-two. You see people at 35%, I know one guy that's at forty and then you go back to that deal and they're paying for the benefits.


So we go back and say one way to lower the benefits cost is that the employee has to pay 20% of their health insurance. And so many dentists are so sad because they got all these girls that had been working with them ten, twenty, thirty years and half of them say, "Well then I don't even want it because my husband gets insurance at his union job and I don't even use it." And he's sitting there almost like, "Oh my God, you don't even want it!"


And then it's the same thing with associates. They'll say, "Okay, I'll pay you 25% and I'll pay the lab bill." Well, if he doesn't have any skin in the game, the minute you go in there and say, "Well, instead of paying you 25%, I'll pay you 30%, but you pay half the lab bill." Oh, now he switches to Glidewell! Oh, funny how you use the lab to charge $155 a unit and then when you had to pay half, now you're doing them for $99 at Glidewell. And it's the same thing with these, I don't like talking about religion, sex, politics or violence, but just when it comes to dentistry, there's so many people thinking healthcare should be free.


You and I are in Arizona where all the dental clinics are completely free. Medicaid clinics, a lot of mineralization; it's 50%, don't even show up for their appointment. And if you said you have to pay $10 to make an appointment out of your pocket to come get your free clean examine X-ray, that no-show cancellation rate would drop to 5% and then when you tell somebody in government that's what you suggest, they think you're a Nazi. "Oh my God, they're poor!"


It's not about they're poor, it's how do you manage people and hygienist staff should have a cut of their benefits, dentists should have a cut of their lab and everybody on Medicare. You ask anybody, they'll come into Medicare and they'll have a hip replacement, "Well, how much should it cost you?" "I don't know, Medicare paid everything." Oh, well, guess what? If you would've had to pay 5% of the bill, you would have called six different hospitals and possibly a driven to Tucson to save money. And Medicare can't even grasp the obvious that the reason dental insurance companies have co-payments is because it really retards demand. And when you say you got to pay 20%, they start really thinking about whether they want to do this. Sorry for that rant off to the side, but.


Kim: You're exactly right. And I think that part of the problem is the way we've educated our dental patients. We use words like your insurance coverage. Well, it's not coverage! When has it ever been? It's always been a benefit package and patients don't understand that that benefit package is brought to them by their employer. The employer chooses what level of reimbursement they get in their dental benefit package as well as their medical health benefit package.


So team members, we need to be savvy. This is no longer a casual come in and clean teeth or come in and assist the doctor. Dental team members need to be savvy, they need to understand the current research and technology and they need to understand how to communicate to patients that the work that we're doing has benefit to them above and beyond just having a healthy mouth. That's a great segue by the way, to talk about that medical systemic relationship. I can tell you that


Howard: I knew you were itching to get back there. I knew you were looking for a Segway. I know it's your passion.


Kim: So let's back up one step. When I graduated from dental hygiene school in 1981, you know what I was passionate about? One thing. Can you think what it might be?


Howard: Gum disease. (inaudible 00:22:39).


Kim: Well, okay so gum disease. Yes, but I thought my role as a hygienist was to remove calculus. That's what I thought I went to school and train for, was to remove calculus because that was the big push and that was how I got my license was, was I capable of removing calculus and if there are any dental hygienists listening, they're going to crack up about this. But in your dental hygiene school, many schools gave out the Golden Scaler Award. 


Howard: The Hu-Friedy Golden Scaler Award. 


Kim: Oh and who got that? The hygienist who could remove calculus the best. Well, I think now in schools, they ought to be giving out the medical systemic award, the hygienist who can identify infection in the absence of calculus. So it's pretty easy to identify that a patient has sub-gingival calculus that needs to be route planned off the root surfaces, but it's more difficult to ascertain through a risk assessment paradigm: how much risk does this have patient have for a future cardiovascular event, a diabetic event, an auto-immune disorder, cancers?


I could give you a whole library of research that says that these things are related to periodontal disease. And the Bale/Doneen group published an article last year talking about the medical systemic connection that these pathogens, they are high risk. When they enter the bloodstream; they can cause a heart attack, they can cause a stroke and they have more than five-thousand six-hundred cases to substantiate this kind of data.


So I was passionate about removing calculus. I'll tell you what I'm passionate about today. That's saving lives and I believe that we can do that through dentistry. We have an opportunity to save lives. The mouth is the gateway to the rest of the body and if the mouth ain't healthy, the rest of the body is not going to be healthy. It's going to suffer in one way or another.


Howard: Well, the only way we're different so far is in 1981, you were passionate about calculus and I was passionate about geometry. Other than that. You know why I was most passionate about geometry?


Kim: That was funny. That was really funny.


Howard: But do you know why I was the most passionate about geometry? Do you know that that was a religion? It was about 600 BC, this one guy started figuring out geometry and they thought it was this connection, this order to the other side. So I joined this big cult and it was a monastic. My oldest sister is a cloistered Carmelite monk. It was a monastery; for three-hundred years, they worked out every geomet--because they knew it was so much order back. I mean, could you imagine living in 600 BC in Greece? You don't even know who are we, where are we from, what the hell's going on? And it took three-hundred years before they walked away and said, "Well, I think it's just geometry."


It was actually a religion. But anyway. We live in a weird society. I don't mean this to sound bad or we never have to talk about religion, sex, politics or violence and this insinuates sex. But when you have gum disease, that surface of the gums would be the surface of your hand if your hand was just oozing blood and pus, you know something's wrong and you get these people where the number one goal of a species is to survive and reproduce, have offspring and I got two grandkids walking and two in the oven. How many do you got?


Kim: I have three grandkids. Five, three and one year.


Howard: Yeah, but you have any in the oven?


Kim: Not in the oven.


Howard: Oh, then I am evolutionary. I'm beating you.


Kim: Oh, okay. You're better than me?


Howard: It's four to three, I'm going to get more DNA down the road than you. But the bottom line is when their not only gums are bleeding, do they not get it but look at erectile dysfunction with men. I mean, when they get erectile dysfunction, they just want to go get a pill and take Cialis and Viagra and the epidemiologists scream like, "Dude, that's your number one goal to reproduce and have offspring, it doesn't work."


And Bale/Doneen talked about that in that book. Well, why does it not work? Because you have heart disease, you have atherosclerosis, you have diabetes, you have obesity, you don't exercise, you're an alcoholic and I'm just talking about all my things for my health history, but what does an American do? Oh, I'll just take a pill. We only have this high morbidity rate.


Kim: We've been indoctrinated to that pharmaceutical aspect of get a pill and fix your problem.


Howard: And you know what's the most hypocritical thing about every dentist I know in America? If somebody comes out and says that there are holistic dentists and alternative dentists, they're just like, "Oh my God, he's voodoo, he's a whack job" and then the minute that doctor gets high blood pressure, the minute that doctor gets pre-diabetic or whatever, he doesn't take a pill.


She's the first person to say, "Well, my doctor said I needed to take a Statin for high cholesterol and I need to take these three prescriptions. Screw that, I'm going to change my diet and start exercising and I'm going to change all my," and I'm like, "Oh, so you're one of those wacko, holistic people who's going to naturally cure everything?" So there's a big schism between how doctors think and how they act and they are very holistic.


Kim: The American Heart Association had a big meeting in Anaheim in November of 2017 and one of the pieces of research that they submitted was that if you treat periodontal disease, active infection, you can lower systolic and diastolic blood pressure by thirteen and ten points, respectively, which is the equivalent of a medication.


So I mean, you're onto something there when you talk about some of these holistic ways of treating some of these physical manifestations. Erectile dysfunction is endothelial dysfunction; the endothelium lines are cardiovascular system and we have six-thousand miles of cardiovascular ture. And if you have dangerous periodontal bacteria running through your cardiovascular system, it causes damage to the endothelial lining and it doesn't function properly. So the last place it's going to send blood is to your penis, I'm just saying. 


Howard: Why are you looking at me when you're saying all this? She's staring right at me, right? How did she know? Did you tell her? But you know how you cure endothelial lining disease inflammatory the best Smoking, the carbon monoxide heals.


Kim: So what are you saying we should all smoke?


Howard: That was an attempt at being funny. But yeah, we have a thread on Dentaltown. One of the categories is oral systemic link and I mean every gosh darn week, someone's posting another study, periodontal’s link to liver cancer, intestinal cancer, Alzheimer's, dementia. I mean, it's just all over the place.


Kim: Can I just make a recommendation to your listeners?


Howard: Absolutely.


Kim: See these are laminated articles, articles that speak to these issues. I suggest that my clients laminate these and make these available for their clients to look at, for their patients to look at and it's so easy to do. Anybody can contact me at, I would be more than happy to point you in the right direction for specific information. But this one in particular, can you see this one? 


Howard: Yes, landmark Bale/Doneen study discovers new, treatable cause of heart disease.


Kim: Okay and on the backs there are four bullet points and I'm going to read you the last bullet point. This is me. It says share this study with your dentist because this science is so new, your dentist probably isn't aware of it so you should take this to your dentist and encourage him or her to join your heart attack and stroke prevention team.


So this article is calling us in the dental industry on the carpet and saying, "Hey, we need to pay attention that there is a treatable cause." It talks about this nine year study that people who never flossed had a 30% higher death rate. Okay so you know that news reporter that said we didn't need to floss, that it was all a sham and all these years we've been telling people to floss, don't floss. Well if you don't floss, you're going to die 30% sooner than someone who does.


Howard: It's actually six years sooner, if you don't floss.


Kim: These studies go on that if you don't brush your teeth at night before you go to bed, you increase your risk of death by 25%. You're going to die 25% earlier than your counterparts. And then there was another statistic here that says people who haven't gone to the dentist in the previous year so if you don't visit your dentist at least once a year, people who haven't gone had a 50% higher mortality rate than those people who went two times or more annually to the dentist. So I think we can show through the statistics and through the research that going to the dentist on a regular basis can actually extend your lifetime and maybe in some cases, save your life.


Howard: When you look at healthcare financing, the big finances are in cosmetic surgery like eyelids and tummy tucks and breast jobs, another one is like All-on-Four, another one is bariatric surgery and then the other one is fertility. So that's the 80/20 rule. So 80% of patient financing is cosmetic surgeries, dentistry, bariatric and fertility and the women that go to fertility clinics that don't floss daily, it's four times less likely to get pregnant. And they're paying $35,000 to get pregnant when I can give him Ryan for free. In fact, I pay him $35,000 just to come over here and take Ryan and just getting ready. It's okay I can tease Ryan, he's dead inside. He's my son. All my children are. But they're paying $35,000 for to get fertile and they've got gum disease which raises their c-reactive protein and inflammation, they're not even going to get pregnant.


Kim: Time out. What does that say to you about these fertility clinics? They're missing a really big piece. It's really easy to do a swish and spit; spit into this tube, in a few days we're going to have a result and we'll know if you have dangerous high risk pathogens. If you have those dangerous high risk pathogens in your mouth, you need to eliminate those before we start any fertility processes. And oh by the way, whoever you're swapping spit with, those pathogens need to be eliminated as well. So that typically indicates the spouse or what do they call it now?


Howard: Well, I'll tell you one advice on dental square now. I'm not getting married again because number one, after paying $3.8 million for my divorce, I don't think I could ever love again.


Kim: You can't afford to love again.


Howard: Oh my God. But you know, I'm waiting for a droid. I'm going to marry the first artificial intelligent droid and then I don't have to worry about her spit because she'll just be like some kind of computer, artificial intelligence thing. So what I liked the most about the medical systemic link is it's about managing people.


And like I say, we talked earlier, when you have free health care, no one cares. 50% of people don't show up, but your team has to have purpose. They have to have passion. They can't go in there. The people that go in there and work on an assembly line and all they do is screw a bolt into a hole. God, they're chewing Skoal tobacco that has LSD blotter acid poured in there, sneaking the vodka. They're just watching the clock and killing time.


When you go into any business, any business from A to Z, instill any type of purpose and passion and vision, and you're elevating the dental office from saving teeth and gums to saving lives. It just makes them run twenty red lights on the way to work and that is the only return on investment from a CAD/CAM, a LANAP, a laser.


The only thing that you can get from that is if that's the toy in the bathtub that makes your two-year-old stay in there longer till he gets all squiggly fingers and his nails are clean, then buy the damn toys. If the only thing that'll get them to go play in the sandbox are some Tonka trucks buy the damn Tonka trucks.


If the only thing that makes you passionate about dentistry is anything, you've got to do it because burnout's huge. And when you've got a team, you know what his religion? It's about being a part of something greater than yourself. I don't care if the guy has a name, it's spiritual whatever. But when you get the whole office trying to be a part of something bigger than any individual of the team, they just like to go to work.


Kim: Yes. Simon Sinek, you know who he is?


Howard: Sure.


Kim: He wrote the book Start With Why, he wrote Leaders Eat Last. My husband and I watch a lot of TedTalks and so we always like to see Simon on TedTalk. But when he did these Start With Why video and anybody can access that on TedTalk. I often show that to my teams when I'm coaching because if you don't have a why, if you don't have a collective purpose as a team; just like you said, a reason to go to work every day.


We are not just saving teeth and making smiles look beautiful. We are saving lives and I think it's time that the dental community wrap their brain around that and stepped up to the plate and really embraced that whole saving lives aspect of what we do.


Howard: Having lectured around, having practiced thirty years, whatever and even periodontal disease, losing teeth causes death. I mean America used to always have about thirty-thousand people a year die on autos and drunk driving was a major cause ten-thousand but now it's inched up to forty-thousand because of distraction from smartphones. People are just texting. So these smartphones and texting and Facebook, they're killing ten-thousand more people here. It's tripped up to forty. You tell them about thirty-thousand a year on accidents, but you look at that suicide stuff, the thirty-thousand people a year commit suicide and a lot of women who lost all their teeth and got dentures, that was the last straw.


And in the thirty years I've had, I've had some ladies telling me stuff that made me so sad. They say, "You know what Howard? It was like ten years ago, I got the denture and it slipped and slide and I couldn't wear it at night. So I told my husband; he's always snoring and kicking. So I kicked him out my bedroom and made him sleep in the other room. I locked the door because I had to take them out at night and soak them in water and I didn't want him to see me without my teeth and within a year he was gone and I realized that if I would have saved my teeth, I would have saved my marriage. I still have my honey bunny."


I've had dentists tell me that over the years, they realized looking back how many of their denture patients, the lady was crying coming in, didn't like him and then find out later she killed herself. So losing all your teeth is an incident of suicide. It's an incident of a killing intimacy which leads to a downward pressure on your marriage to divorce so it's a lot of stuff on that.


39.48 Kim: Well, I'll tell you just real quickly to address that, something similar to that. My husband and I have been married thirty-seven years and neither one of us wear dentures and I'm planning to keep it that way.


Howard: You know what if you would've killed him on the first date, you'd already be out of jail by now.


Kim: No way, I have a great guy. I'm keeping him.


Howard: They only give you twenty-five years for murder.


Kim: I'm still keeping him.


Howard: You're still keeping him? Now since you are so brave and comfortable in your own skin and can talk about erectile dysfunction, I want to talk to you about the other four thousand pound gorilla in the room, where I'm getting requests to podcast people from CDC and all these people and that is the fact that oral cancer. When we were little, when we got out of school, it was smoking and drinking caused oral cancer.


Now we have a whole new beast as HPV oropharyngeal and these dentists will not and the hygienists will not, when they got a ten-year-old kid in the chair, get the mom in there and say, "You need an HPV vaccine. The cancer in our area, it will prevent." And my gosh, the oral and pharyngeal cancer is going up and up and up and you never see it on CNN or Fox or MSNBC. You hardly ever see any articles about that stuff. What are your thoughts on dentists not being able to bring up that uncomfortable conversation about HPV vaccine?


Kim: Well, my thoughts on not being able to bring up the conversation is that we need to get over that and in my world as a coach, some role-playing exercises typically do that. Now, usually people run screaming from the room when I mention role-playing because nobody likes to do it, but until you practice the words and you hear the words coming out of your own mouth and you find a comfortable way to say them, you're never going to do it.


So you have to practice how you want to communicate this important information. Not only is HPV a component and that the intra-oral cancers are going up every year. In fact, it's the only cancer that's not reducing in numbers on an annual rate. It's going up. Squamous cell carcinoma, head and neck squamous cell carcinoma is a really big player in this as well.


So one of the things that we teach at Inspired Hygiene, and that I am particularly passionate about, is making sure that the clinicians I work with are all doing external head and neck exams as well as internal exams with a fluorescing device. I think I mentioned to you that my Mom is a three-time cancer survivor and two of those were head and neck cancers. So, this visual aid is something that I make available to all of my clients. 


Howard: I watched you on a YouTube video do this. Do you want us to put that YouTube video at the end of this?


Kim: Sure.


Howard: Because I really liked that video.


Kim: Yeah, let’s put that video. And if any of your listeners want the visual aid that goes with it just email me and I’ll happily send you the PDF. Believe it or not, this was a black and white just a schematic of lymph nodes and I physically put in all of these little red dots. It took me hours to put all those red dots in there and then just capture it as a PDF so that it’s a reminder to the hygienist the areas that I need to check and it allows the patient to see from a value perspective, how valuable this is for the hygienist or the dentist to do this.


And you know Howard, I ask audiences all the time, how often have you seen or have you been to a physician where you've had a head and neck exam like this? And I rarely get people say, "Oh yeah, I've had a doctor do an exam that's this thorough." And here's the rub. You learned in dental school, I learned it in dental hygiene school and so did every other dentist and so did every other hygienists and we don't do it when we get out of school. Do you know why hygienists don't do it?


Howard: Why?


Kim: Because they're worried about removing the calculus. So they skipped the head and neck exam and dive right in and start flicking off pieces of calculus and I promise you, nobody's life is saved by removing calculus. But their life can be saved by uncovering head and neck cancers, squamous cell carcinomas on the outside or the inside of the head and neck and I'm a big believer in fluorescing devices; you can't see with your eyeballs what you can't see.


Howard: That's not what Stevie Wonder said. I want to interrupt you a little bit. When you were talking about the other end, a physical examination and checking for head and neck examination. When they're ten years old, I mean that age, you remember when we were little Farrah Fawcett? Was she married to the six-million-dollar man or something?


Kim: Sounds right.


Howard: You remember Farrah Fawcett?


Kim: Of course, I remember Farrah Fawcett.


Howard: You know what she died from?


Kim: Yeah, rectal cancer.


Howard: Yeah and that HPV vaccine is not just preventive of oral cancer, cervical cancer, vaginal cancer, vulvar, anal, genital warts. I mean, talk about our dentist molar mechanics and hygienists trying to remove calculus and geometry and trig and switching to a physician of the mouth. And I mean, gosh, I couldn’t think of anything greater than driving home from work and saying I got one Mom to vaccinate her two girls, ages ten and eight for Gardasil, which is made by Merck. And when you look at the data on what increased the longevity of the seven and a half billion humans in the last century, the number one thing they say is vaccination, not antibiotics.


You didn't make the herd grow longer with penicillin; it was vaccinations, clean water and sewage. If you get all these kids vaccinated and you get them to poop in a toilet that takes it away and washed your hand, that's the majority gains that we got and the one vaccine in our area, HPV oral cancer, has not even taken out.


In fact, it makes me crazy. Flu! The hygienists removing calculus. Well if that lady’s over seventy years old, the number one chance you won’t see her in 6 months is the flu. It kills eight thousand to thirty thousand people a year and in Arizona she's not even licensed or legal. The hygienist at the dentist’s to give grandma a flu shot, but she can walk over to Walgreens or CVS and a pharmacy tech, who went to nine months of training, can give a flu shot and the HPV vaccine.


But I'm a doctor with nine years of college, I can’t. My hygienists have 4 years of college, they can't. Only one state has got it. I think it's only Tennessee that the doctors demand that they can give flu shots and HPV vaccines and that needs to take off coast to coast because if I was driving home and I thought, my God, I saw grandpa and I got them a flu shot.


And then what's so funny is this is 2018. If you go back a century, back to 1918, we would have already had the influenza, which dropped 5% of the entire planet. Philadelphia Eagles just won the super bowl, Philadelphia Eagles, but the first steam tractor, the first steam locomotive tractor and it was to dig ditches for the bodies of the Spanish influenza because they couldn't get the graves fast enough. So that was the first city in America to buy steam operated digging machine. And every day, the fire departments back with horse and buggies would go down the street and you're supposed to lay the dead bodies by the edge of the street. They would pick them up and then take them down to their new steam engine to dig.


And then what do we got now? All these anti-vaccinators. It's like, you know what I hope they don't give vaccines and Darwin can do his work. I mean, if your best idea is not to give your baby a vaccine, maybe you shouldn't be in the gene pool. But we really got to get this Gardasil HPV vaccine information out more along with your exam.


Kim: No doubt that hygienists play a role, not only in recommending the HPV vaccine, but once people are beyond that in their age group is making sure that they're doing an accurate intra-oral and extra-oral exam. And Howard, I just don't see it happening at the hygiene chair. I observe in hygiene departments and in dental offices all over the country three weeks out of the month and I just don't see it happening on a regular basis.


Howard: Well, a big part of that is because social animals they're controlling. Like when someone says, oh, that girl's controlling, Well, all social animal’s controlling. It helps with their survival and you have the four-thousand pound gorilla all the way to the bully that they beat up.


You're talking about TedTalks. I watched all of his TedTalks, but I love that TedTalk about where they realize that if they take out the monkey or ape and especially with apes; bonobos, gorillas, chimpanzees, orangutans, then they pull out the bottom guy and put him in another tribe. It's the number of apes of that tribe determines the statistics that he'll be the bully again and they just picked the next guy on the bottom. So everybody's controlling.


So it's the dentist natural hardwired to say to the hygienist, “Well, you can’t diagnose that's against the law. You just sit there and scale and everything. You can't make a diagnosis and all this up.” And I'm one of those guys who think all laws were written by idiots, by politicians, by thieves and I consider all laws just a suggestion and I say to dentists, “Are there any hygienists in Arizona today serving time for reading an X-ray?”


Because when I go in there in my office, if the assistant has an emergency patient and she takes an FMX and she takes each picture, she diagnosis it and explains it because she's building rapport and trust and they trust the hygienist more than the guy who lives in a mansion. So I go into offices and the hygienists will say, “Oh, you might want to check there’s a little something on the upper right.” I'm like, “A little something on the upper right? Is that a hygiene term I didn't learn in school?” and I go there and sub bombed out number three and I'm like, my office. You would've taken a PA, a bite wing, diagnosed and told her we can extract this. We can do a root canal and crown. If you extracted, we can revisit it with an implant. So maybe what I mean, the whole thing's done. And then she'll call the front desk and they'll come in and do the financial arrangement and get it all done and all I do is make it legal and say, “Yeah, you're right.”


Kim: Right. You come in and give the head nod. So if I may be so bold as to make a recommendation of how a hygienist could communicate that in a really comfortable way? Because Howard, you know as well as I do, there are a percentage of dentists and I can tee up that treatment to perfection and the dentist will walk in and say to me, “Let's watch that.” Right? Well, yes, you know that.


Howard: I know, I know.


Kim: And so at that point in time as the hygienist, you know what I just learned? I ain't never going to do that for you again, doc. You just threw me under the bus. The patient thinks now that I was making something up. Okay, so that's the worst case scenario.


The best case scenario would be for me to use my intra-oral camera, show the patient the lesion on the tooth or the cracked tooth syndrome, something, whatever it is that I'm concerned about and say to the patient, “You know Howard, not only am I concerned about this tooth in your mouth or these four teeth in your mouth, but Dr. Smith is going to be concerned as well.” And here's what I know, Dr. Smith will always recommend the most conservative treatment, but in another patient's mouth, I've seen a similar situation and doctor has recommended one of these three things. Either potentially repair the tooth; if the decay is too deep in the tooth, can't be repaired, you may need to have the tooth extracted or you could look at doing a root canal or you could do an implant.


So I could introduce those things from the standpoint of doctor’s going to be concerned and here’s what might be coming down the path for this tooth. Here are the options that are potentially available to you to save this tooth and to get you out of pain.


So I agree with you that clinical assistants and hygienists are both not only capable of co-diagnosing, but I think it's expected. If the doctor walked in and there was a missing cusp off of the tooth and I didn't notice it, that's bad on me. I should be seeing those things and I should be pre-diagnosing and co-diagnosing those with the patients.


Howard: But while you're dancing around all this stuff just saying, “Okay, that is a cavity.” When you say that is a cavity and here's your options, and then it's like, “Well, you can’t say that's a cavity because diagnose.” I mean, dude, right now about twice a day someone drives past your dental office with 3 pounds of marijuana in his trunk and you can't lay your damn hygienists diagnose and X-ray.


I mean, dude, take a risk. Take a walk on the wild side. I mean I'm not asking you to cross the Mexican border with three pounds of cocaine in a backpack. I'm just talking about letting your dental assistant diagnose because what I know is when the dental assistants say, “Well this tooth had to be pulled,” they feel comfortable, they trust her more and they feel comfortable to ask you questions.


Kim: That’s right.


Howard: And then when I go in there and say, “Do you have any questions?” They say no, and then I leave and then they talked to my assistants and hygienists for half an hour.


Kim: Absolutely.


Howard: So you have to free the staff and if your assistant has been assisting you for 5 years and can't diagnose an X-ray, a cavity, if the tooth needs to be pulled, extracted, a root canal then she has a head injury and she should seek help. I mean it's a black dot on an X-ray. Is she blind?


The other thing that really gripes from my gears is dentists on just radiographic bite wing cavity diagnosis. They only drill, fill and bill 38%. I mean, I don't want my four kids and four grandkids going to a dentist where if three of them walked in there and each had a cavity, you can only convince one to do it, fix that.


And then you ask me what bonding agent do I use? I just remove all the decay and fill it with butter. You can't get the patient to remove the infection. Just get the infection out of there. And all their questions are about, “Well, hat filling do you use? What composite do you use?” Who gives a shit? Buy it on eBay. You can't get them to remove two out of three carious lesions that are number four (unclear 00:55:47) taking out oatmeal and you're asking me what bonding agent I'm using.


Kim: So I think part of the reason for that is the way we communicate in dentistry. I once stood outside a doctor's operatory at his request during a new patient exam and in a twenty minute exam, Howard, I want you to guess how many times the dentist use the word ‘little?’ Little problem, little crack, little decay, little issue. How many times in twenty minutes?


Howard: Twenty times.


Kim: Twenty-one times, more than one time a minute. So if we the patients to take us seriously then we have to use language that communicates a serious problem and saying just a, only, little, little decay, little crack, little fracture, little bleeding, little bone loss. Oh, that’s like being a little bit pregnant. We've got to use the language that communicates to the patient and I'll tell you one other thing. I hear clinicians say all over the country is, ‘I've found.’


So you come in and you sit in the dental office and how many times have you had a patient cross their arms and say to you or say to your hygienist or dental assistant, “I don't want any X-rays today. I don't want an exam today.” And if you ask them why, what do they say? “Because you always find something wrong.” You know who taught them that? I did and you did and every other dental professional out there because the doctor walks in and says, “So Kim, how's it going for Bob today?” “Well, Dr. today I found some six millimeter pockets and I found a cracked tooth and I found decay.” It's like we’re on a scavenger hunt! We've given patients the wrong impression. I'm not on a scavenger hunt. I can't find something you didn't walk in the door with.


So I always tell my clients, replace the words ‘I've found’ with ‘you have’ and then “Bob, you have” and “it's in your best interest to “blah, blah, blah. Instead of “you need to fix this, it's in your best interest to fix it.” A part of this dilemma that you're describing is on us. We're not doing a good job communicating the urgency of treatment to the patient and we do that because we don't want to be disliked. We want our patients to like us. So we use these softening words.


Howard: I just had a physical done yesterday, my physician told me he found a little virus.


Kim: Hello? What the heck is that?


Howard: I’ve got to ask you a couple more questions. Can I keep going for a little while?


Kim: Please.


Howard: A lot of dentists work in dental offices, whether they be DSOs or whatever and they're told that if there's a six millimeter pocket they got to use a Arestin or a PerioChip or an Atridox because there's a co-payment. I mean, if you want more of something, that's what dental benefits do.


There’s no such thing as dental insurance, it's only a dental benefit, as you say, paid by the employer or the government or the Indiana public health service. I mean, there's no such thing as insurance, insurance is an actuarial risk analysis versus moral hazard. Everybody in Phoenix has home insurance on their house for fire, but only a few drunk Irish people are smoking in bed and burn their house down and make a claim. So you spread the risk for a few claims.


But in dentistry, there's no way to spread the risk because everybody has a mouth, everybody has teeth, everybody has gums, everybody needs a cleaning, everybody needs exam, but that's the reason why the average dentist makes a $175,000 a year because everybody needs a dentist and everybody will eventually see a dentist. Whether it's six months or six years, you're eventually going to go to a dental office and that's why dentists have such great businesses because the supply and demand is at a 100% of the people are going to eventually have to see you.


But when they invented the radiograph, dentists didn't even look at it. And then when the Longshoreman's Club started dental insurance in 1958, which turned into Delta and covered X-rays at a 100%; it was a domino effect across the country. Every dentist bought a damn X-ray machine. They have been following codes for payment all around the world for a century. So there's codes. Are there codes for Atridox, Arestin and PerioChips on dental, do you think any of them have a benefit or they don't interest you?


Kim: Yes, the code for any kind of sub-gingival, anti-microbial placement or sub-gingival local placement of antibiotics is D4381.


Howard: D4381?


Kim: Right so Arestin would fall under that code, Atridox would fall under that code. What else did you say?


Howard: PerioChip.


Kim: PerioChip, I'm not sure because it's chlorhexidine. Chlorhexidine is an anti-microbial not an antibiotic so I would have to look into that a little further, but I don't really know anybody that's using PerioChip anymore. Mostly Arestin for locally applied antibiotics. I'm sorry, yes?


Howard: So what do you like more Arestin or Atridox?


Kim: Oh, Arestin. Atridox, we mix it together with two syringes and there is no pre-prescribed dosage where Arestin comes in a dosage already pre-measured at 1 milligram. You put the applicator in the sulcus and you pull the trigger and it pops it in there as a powder and turns to a gel.


Howard: What is your average job PPO pay? By the way, I don't really call them dental interns and I don't even like. When you look at PPOs on Delta's website, they say 95% of dentists take Delta. That's on their website and they set the fees so the reality is 95% of the dentists take a PPO. So what does like your average Delta pay for D4381 like in Arestin?


Kim: Well, that's a good question and the problem with me answering that in a blanket statement is that Delta is not Delta. Delta of Washington State is not Delta of Illinois; they have so many different variations of Delta dental benefit plans in so many different tiers. Really, truly in my experiences that most insurance companies don't assist with a locally applied antibiotic. I tell all of my clients if you're going to place it, which I think you should because it's a good product it does what it says, collected as a fee for service, bill the insurance company, if there is some reimbursement then Hallelujah. If there's not, then you've already gotten it paid for.


Now Orpharma does have a prescription plan where you can tap into the patient's medical insurance through their prescription plan and that works really well for some people.


Howard: So you're absolutely a genius. There are fifty states and there are thirty-nine Delta dental companies and they have right now seventy-four million patients enrolled in their thirty-nine affiliate programs. They're all different. So the code, the price would be different, but you are or not a big fan?


Kim: I am a fan. I think antibiotics are a good thing. Are you a fan?


Howard: I give my hygienists a lot of autonomy, you know what I mean? And one of the things I always tell people who have associates is that when you hire employees that are millennials, it's a lot of turnover. It doesn't matter if you're at Facebook, Apple, Amazon. Do you know that the biggest growth stocks are FAANGM? Facebook, Apple, Amazon, Netflix, Google, Microsoft. Their average employees only stay one to two years. So when these kids go into DSOs, they only last one or two years.


So when they're going out there and saying, “Well, I don't really want to start my practice, I think I'm just going to work at a DSO.” It's like, well, everyone that graduated two years before you already thought the same thing and quit. But when they do stay, they like diagnostic autonomy. They don't want an office manager saying, “Hey, that lady has five, six millimeter pockets, go back there and just take Arestin.” They don't like that. They like diagnostic autonomy and they like mentorship.


Kim: Can I qualify the five and six millimeter pockets always needing treatment? I'm going to tell you right off the bat, there are people that will take issue with me on this, but I will tell you that if a five millimeter pocket does not have an active infection, if it's not bleeding, what are you going to do to it by putting Arestin in that pocket? Nothing. You're not going to willing to improve that area for the patient at all.


On the other hand, Howard, if the patient has one, two and three millimeter pockets that are gushing with blood. When I see them that's allowing bacteria into their cardiovascular system and—


Howard: Well man, we're into triple overtime. We’re at an hour and seven minutes. What were you saying, though?


Kim: That’s because you're such a great interviewer. We're having a great time. Well, to have somebody tell you to treat by pocket depth, to treat periodontal disease based on pocket depth alone is a very old model. You and I would know that as soft tissue management and it makes me shiver when I hear those words.


According to the American Academy of Periodontology, we should be customizing the periodontal care that we provide for our patients based on their risk factors and how much risk they have of their perio getting worse and the medical systemic connection. The only time a pocket is an issue is if it's bleeding and if it's bleeding, it's letting bacteria into the cardiovascular system. So a six millimeter pocket that's just sitting there doing nothing requires no treatment. That pocket is in remission. There's no active disease going on.


On the other hand, oftentimes what's missed are those shallow pockets that are bleeding, that are not in remission but are in a state of active infection that could be causing the patient a problem. So it's time for us to step up and really look at periodontal disease. What is an active infection versus somebody who might be in remission with previous periodontal damage? You see what I'm saying? The difference in that? That's a really sticking point.


Howard: Another sticking point: you're going into overtime with me.


Kim: How much lower overtime are we going into? I billed by the minute, you know.


Howard: When I asked dentists, clinically what keeps them up at night, what really stressed out. So when you and I were little, it was (unclear 01:07:34), there was a lot of four quarter and gum surgery, pocket elimination. Then implants came out, they told everybody that 98% success rates so everybody's like, “Screw perio surgery, let's just cure that gum disease with forceps and titanium.”


So they started sinking all these implants and now all the literature says that by 60 months, 20% of these implants have peri-implantitis and there's not even an agreed upon protocol for that and by nine years, over one-third of implants have peri-implantitis. And now you're starting to see a shift back to, “Hey, periodontal disease is not easy to cure with an extraction.” And you starting to see a lot of the old school now they’re saying to the periodontist, “No, I don't want you to pull the teeth and place implants, I want you to try and treat the periodontal disease because if you're going to just pull all those molars and put implants, I know what I'm going to be looking at in five years: a bunch of implants and peri-implantitis. So we're going to back to square one.” So do you agree with that assessment?


Kim: I do and I have a spin on that. Here’s my spin is that I believe that before implants are placed that the patient who is going to be receiving those implants should have an oral microbial pathogen test. What pathogens are in your mouth right now that would contribute to perio-implantitis and periodontal disease at large? Let's clear those pathogens from the mouth before we put an implant in place.


Howard: Wait, are you talking like oral DNA? Is that where you're going?


Kim: Yeah, absolutely.


Howard: Is that your go-to, the oral DNA?


Kim: Yeah. Oral DNA labs is my go-to. You do a microbial test, you need to know which pathogens are present in the mouth and you need to eliminate those pathogens through the periodontal treatment. I agree with you, but then you have to retest to make sure that those pathogens are cleared. Once those pathogens are cleared, placing an implant in a pathogen, a reduced micro, what's the word?


Howard: Biofilm?


Kim: Well, but it's the infectious part of the biofilm. You’re never going to get rid of the biofilm, but we want to get rid of the baddest of the bad bugs. And I'll tell you the other product that I really appreciate is Perio Protect trays.


We should do another podcast and just talk about products. I'm well-versed in a lot of products that are out there, but Perio Protect trays.


Howard: I wish you’d write me an article for Dentaltown. You’re always writing for RDH, right? And I'm in your backyard. Write me an article on all the Perio products because by the way, my homies thank you for following me on Twitter. I got twenty-four thousand followers on Twitter. I just retweeted oral DNA so you know that and then I also retweeted Inspired Hygiene even though Inspired Hygiene does not follow me. I thought be I'll still be the bigger man and retweet you even though you don't follow me. Isn’t that humbling me, right? To retweet someone that doesn't follow me. I'm just teasing.


So I retweeted she's at Inspired Hygiene for the length. But so you like Perio Protect, you said.


Kim: Well, I'll tell you my daughter's a perfect example. She has four millimeter pockets, no bone loss. She's the perfect gingivitis case. This new code, this D4346 that we have? She's a perfect candidate for that code. She goes in, her gums were bleeding, she's got four millimeter pockets or less, no bone loss radiographically; she's the perfect candidate for one full mouth prophy and Perio Protect trays.


Now I said to her, “Katie, you need to do a pathogen test. Let's see which bacteria you have” and I was shocked when those four millimeter pockets came back with AA. She had an AA infection in her mouth in shallow pockets and treatment alone very often does not manage that kind of an infection and the Perio Protect trays did a beautiful job of lowering her gram negative, high-risk pathogens and she's got a lot of familial risk for not only heart disease, high blood pressure stroke, but also for cancer and diabetes. So she couldn't afford to be running around with those gram negative bacteria in her mouth and just for the record, her husband wore trays also. So it's important if you treat the goose, you treat the gander.


Howard: So I’m in Phoenix (unclear 01:12:35) they have all these gum diseases and they have all these six millimeter pockets and they had twelve cavities and when they go up front, they just sign up for the bleaching. That’s Phoenix for you. So any other products that you like?


Kim: Well, there another product that I'd like to throw out there called StellaLife. StellaLife is a homeopathic rinse and the whole purpose of the CEO's inception of this product is to reduce the opioid use in our country after dental procedures.


So Stella Life has as I mentioned, homeopathic. All of their ingredients are from the ORAC scale, which is all plant-based. So Arnica, Echinacea, Calendula, some of those names you might recognize as being all plant-based, reduce inflammation, as effective as rinsing with chlorhexidine for bactericidal effects. Did you catch that? As effective as chlorhexidine and by the way, chlorhexidine is no bueno. I'm pulling up some Spanish here. We're in the Phoenix Valley.


Howard: No good, so no buenos, no good.


Kim: Chlorhexidine kills osteoblasts which make bone and it kills fibroblasts, which make collagen and so the last thing I want to do is get my patient on chlorhexidine for any extended period of time. It's not going to help them heal. In fact, it hinders healing. So Stella Life is a great product that I would encourage people to try.


Howard: I just retweeted them, too for you. That's @StellaLifeHill on Twitter and then I retweeted Perio Protect, they are @PerioProtect and then I did @InspiredHygiene and then I did at @oralDNA. Were there any others?


Kim: Well certainly, there are a ton of others, but I think in relationship to what we've been discussing, those—OralID? We were talking about oral cancer identification. I think that the OralID light is my go-to device. I love the OralID light. It's easy to use. It's a small flashlight. The patient can be involved in it.


Howard: What’s their Twitter? OralID?


Kim: I don't know what their Twitter is. I'm not very good at twittering.


Howard: You're not tweeting all day? You know why I love Twitter?


Kim: Tell me.


Howard: Well, I mean, first of all your president, I'd say only got there because he realized that at primetime at night, only a million or watching CNN and three million are watching Fox News and he had 30 million Twitter followers. So I mean he was fifty times more powerful on Twitter than CNN. But Facebook, when you post on Facebook, they only show it to about 6% of your followers unless boost the posts.


The only direct feeds where you post, everybody sees it is Twitter, Instagram and LinkedIn. So Twitter, I got twenty-four followers, I send that tweet, all twenty-four thousand see it. On Facebook I have three-hundred thousand followers, but if I post it, they wouldn't even show it to a thousand unless I give them money. And Instagram, the only reason Instagram has direct feed and it's owned by Facebook is because they're leaving it a direct feed until SnapChat is completely dead and then it'll be pay to play. So when I post this podcast on Dentaltown, Hygienetown, Orthotown Twitter, Instagram and Linkedin, it'll go to all the members. When I post it on Facebook, it'll go to no one unless I give them money.


Kim: May I mention one more thing?


Howard: Sure.


Kim: When I was talking to Ryan and we were getting this all organized, I was asking him if this podcast would air before or around April and as you know, April is oral cancer awareness month. So I do want to give a shout out to Oral Cancer Cause and the Oral Cancer Foundation. Now the Oral Cancer Cause is a non-profit organization that actually helps oral cancer survivors and people that are diagnosed with oral cancer. They will financially help these people through the process of getting their oral cancers treated. Sometimes people have to quit their jobs, they undergo multiple types of surgeries that really can, in some cases, disfigure them and they have a new thing that they're doing called the Bubble Gum Challenge.


Howard: Right.


Kim: Yeah, you know about the Bubble Gum Challenge?


Howard: I found the OralID on Twitter. It was ForwardScience_ and I retweeted that. But what's the website for the Bubble Gum Challenge?


Kim: Well, let's see. I'm not sure if it's Oral Cancer Cause or if they have—


Howard: Is that Linda Miles’ deal?


Kim: Yes!


Howard: We podcasted her.


Kim: Yeah, so I'm sure she talked about this. You buy a box, a Bubble Gum Challenge box. You put it on your counter in your reception room and the idea is that you can increase your own social media for your practice by having patients blow a bubble for those who can't and then they take a picture of themselves blowing the bubble with those ovals? I have some on my wall behind me, right?


Howard: Yes.


Kim: We love our patients, my hygienist rocks, some of those bubbles that we use on social media?


Howard: It says we love our patients. What’s the other one say?


Kim: My hygienist rocks.


Howard: Nice.


Kim: Yeah, so you get some ovals like that and you can have your patients post pictures so it ramps up your social media. Then the idea is that you give a donation back to the Oral Cancer Cause. So I wanted to make sure we mentioned them, too. Every office should be taking an opportunity in the month of April to do something for their patient base and even open them up to their community.


And the Oral Cancer Foundation, which is a separate website than Oral Cancer Cause has a whole media kit that they'll send you at no cost to set up your own oral cancer awareness event during the month of April.


Howard: And their Twitter is @OralCancerBlows. How cool. And I love the fact, breast cancer is pink and colon cancer I assume was brown. I don't know. But the Bubble Challenge, you guys went with purple. That's a cool color. Ryan was all right on the color for colon cancer. It was just a guess. But yeah, so the Bubble Challenge at @OralCancerBlows blowing bubbles for those who can’t. How cool is that?


But hey, I just want to say that I've been a fan of you. I've been a fan of Rachel. I've been a big fan of yours. I mean, how many articles have you written over the years?


Kim: I don’t know.


Howard: And blogs and lectures and we live in the same town, Ahwatukee and Peoria. Hope to do more with you. You got to come over and visit us at Dentaltown and I can't believe we went 23 minutes overtime, that shows you how magnetic you are.


Kim: (inaudible 01:20:30) fun we had, right?


Howard: I just want to tell you I'm sorry you only have three grandkids. Maybe someday you can have four like me and I'm sorry that my Emma was cuter than all of yours. But seriously, anything you ever want to do in the future I’d love to take you to lunch, dinner, I’d love to show you Dentaltown, Hygienetown, Orthotown and all that stuff. Big fan and I'm sure all my homies really loved listening to you today. Thanks again. I hope you have a rocking hot day.


Kim: Thank you.



Kim: David, today included with your hygiene visit, with your cleaning, doctor’s asked me to go ahead and do a head and neck exam for you.


David: Okay.


Kim: I'm going to give you this graph. This actually will show you all of the lymph nodes that I'm going to be checking and in addition, I'm going to be checking your jaw joint, the joint that allows your jaw to open and close.


Now this is a complimentary service for you today. There's no charge for this and the reason we're doing it is because the morbidity rate that is the incidents and head and neck cancers as well as the mortality rate, the number of deaths that occur from head and neck cancers, has been going up every year. So we're doing this as a service to our patients.


David: Sounds serious.


Kim: Well, it's not serious, but it's a really good screening tool. It would be serious if you had a problem.


David: Okay.


Kim: So we're going to screen and make sure you don't have one. Now I've just washed my hands, so if you don't mind, I'll do your exam without gloves on?


David: Sure.


Kim: It'll be more comfortable for you and I'll be able to actually feel better. I am going to ask you however, to remove your headset and your glasses and I can just put those on the counter for you.


David: Thank you.


Kim: Thank you. Okay, go ahead and rest your head back against the chair and I'm going to start right here at your jaw joint. I'm going to ask you to go ahead and open, close, open, nice and wide, big as you can. There you go and close and I felt a little clunky when you opened that time. Where do you feel that?


David: Right side.


Kim: Do you feel any pain or discomfort?


David: A little bit on the left.


Kim: A little bit on the left. Do you know if you clench or grind your teeth at night?


David: I might clench a little.


Kim: Do you wake up with a tired jaw in the morning?


David: Sometimes.


Kim: Sometimes you do. Okay, let me check the muscles here. Squeeze your teeth together and release. This is your masseter muscle. Any pain here?


David: No.


Kim: Okay, let's try this one. Squeeze. This is your anterior temporalis. Just release. Any pain here?


David: On the left side.


Kim: On the left side a bit of pain. Okay and your posterior temporalis muscles. Squeeze, release. How about here? Any pain?


David: No.


Kim: Okay, so the right anterior temporalis and the masseter and the jaw joint, we'll have doctor check that when he comes in. Now I'm going to start on the lymph nodes and I'm going to start here around your ears. As you can see on that graph you're holding, there's lymph nodes in front of and behind your ears. I'm going to check the lymph nodes that come out underneath your cheekbones. Most people don't even know you have lymph nodes here. And I'm going to feel underneath the jaw for these lymph nodes as well. I’m going to come right down in the front of your neck, feel your Adam's apple and the thyroid. Do you have any family history of thyroid issues that you're aware of?


David: Not that I know of.


Kim: Swallow for me. Swallowing on command is kind of hard to do, isn’t it? And I'm going to feel the lymph nodes that go all the way around your collarbone, so I'm going to be just right inside your collar bone between your neck and collarbone, and I’m going to press pretty firmly. I'm feeling for any abnormalities again from side to side. Anything that's hard, lumpy, bumpy, that doesn't belong there.


Turn your head to the right, just let me have support it here, I’m going to feel down the back of your neck. And lift your head up. This is your sternocleidomastoid muscle and I'm going to feel right down this muscle, also.


Now while I have your head turned to the side, I'm going to do a skin cancer check behind the ear and along the hairline for any suspicious looking lesions that don't belong there. Do you wear sunscreen?


David: Yes.


Kim: A good idea. You're very fair complected, what with your reddish hair and your blue eyes so it’s a good idea to keep sunscreen on. Lift your head up again real quick. There you go. Rest back. Identifying that sternocleidomastoid muscle.


All right, and now just looking straight ahead and rest your head back into my hands, I'm going to feel the lymph nodes here at the base of the skull; these are the occipital lymph nodes.


Okay, good news. I didn't feel anything that was asymmetrical from side to side, no lumps or bumps that you need to be worried about. We’ll be doing this exam for you once a year during your hygiene visits.


David: Okay.


Kim: All right so you can look forward to that.


David: Thanks.


Kim: All right. You're welcome.

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