Disease Prevention & Wine Tasting

Episode #577 with Kirk Behrendt & Katrina Sanders

Your practice can save lives. With routine care and education, you can help patients prevent many of the diseases they present with. So, how can you make the most of this opportunity? Today, Kirk Behrendt is back with Katrina Sanders, The Dental WINEgenist, to share advice for building value to the preventive care and treatment you provide. Help your hygienists do what they were trained for! To hear more about Katrina’s course and how it can help you optimize disease prevention, listen to Episode 577 of The Best Practices Show!

Episode Resources:

• Katrina’s website: https://katrinasanders.com
• Katrina’s email: katrina@katrinasanders.com 
• Katrina’s Facebook: https://www.facebook.com/katrina.sanders.948
• Katrina’s social media: @thedentalwinegenist
• Tooth or Dare social media: @toothordare.podcast
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Links Mentioned in This Episode:

Register for Katrina’s next Disease Prevention & Wine Tasting course (October 5-6, 2023): https://www.eventbrite.com/e/act-dental-hygienists-live-course-october-5-6-2023-tickets-368595568267

The Trust Edge by David Horsager: https://www.simonandschuster.com/books/The-Trust-Edge/David-Horsager/9781476711379

Main Takeaways:

Trust is the currency of business, and core values are the pillars of trust.

Don't limit the opportunities for disease prevention in your practice.

Support your hygienists by being engaged in their education.

Help patients value their preventive care appointment.

Hygienists are not “just teeth cleaners”.

Quotes:

“A recommendation would be, ‘You should go to the gym every day.’ A recommendation would be, ‘Have five servings of fruits and vegetables.’ Those are recommendations. We use that “recommendation” word when we’re talking about treatment modalities that need to be done in order to address an active infection for the patient. And when we use the word recommendation, somehow, inside of the lizard brain of our patients, they think, ‘So, I have the option to not do it.’ Now, we know inside of autonomy, the patient always has an option not to do it. They could easily walk out. If you're in a hospital, and you've got a gunshot wound, and you choose not to have that treatment done, if you can walk out, you can walk out. They have autonomy inside of that. But the idea is, we need to be coloring this picture to help our patients understand that the treatment that we are talking about is a prescription from a licensed practitioner — because that's what it is.” (6:51—7:48)

“You have to have leadership. You have to have a culture inside of the practice, and you have to be very crystal clear about your core values.” (8:13—8:21)

“It’s called The Trust Edge, and this book is absolutely unbelievable. Inside of the book, it talks about the fact that trust is the true currency of business. It is. Because people will buy if they trust. They will actively seek out a Starbucks because they trust that logo. They trust that there's going to be consistency in what they order, that I can go to a Starbucks here in Milwaukee, I can go to a Starbucks in Honolulu, and I can order the same drink and get it prepared exactly the same way. There's consistency. I see a lot of trust inside of businesses that have worked and focused to maintain that trust. And then, you see things — I'll use an example. Southwest Airlines had a big issue with trust because they were not consistent. They lacked some competency in what was happening over the holiday season with flights and things like that. And because of that, because of that decline in trust, they see a decline in their overall revenue. Trust is the currency of business.” (8:33—9:37)

“This is what's crazy about [The Trust Edge]. He talks about the eight pillars of trust. There are eight specific pillars of trust. And inside of that, you have to be able to build those pillars of trust. He says that a critical aspect to that trust is knowing your core values. That's a huge piece. In the book, the author says that if you, as a business owner, practice owner, whatever, if you are not communicating your core values and your mission statement to your team every 30 days — every 30 days — your team members cannot recite that back to you. Now, that's important. Because in a dental practice, if you think about AZPerio, I mentioned I walk through the entire process of care. The doctor comes in at the end. So, who’s conveying those core values to the patient? Myself, the assistant in the operatory with me, the front office team member, even the website. These are all touchpoints before the doctor even has the opportunity to communicate with the patient.” (9:42—10:42)

“If we don't know the core values of the practice, then I don't have a scaffolding — I don't have a framework — for how to behave inside of this.” (11:03—11:10)

“This is the important piece of what AZPerio does. We look at numbers. We look at production. Every day, we've got our big, hairy, audacious goal. We look at, what do we want to see? What percentage are we on our way to our goal? What opportunities do we have? What openings does the doctor have? The masculine energy around a lot of that, those processes are built out. That is the framework. That framework is intended to protect so that when something like this happens — the bone material falls out, the sutures don't go in, the patient’s anesthesia isn't working as readily as possible — that the framework protects us inside of that. But it also means that we have to be okay when we’re not productive because, at the end of the day, we’re not taking care of people’s insurance plans and billing, we’re taking care of humans — humans with beautiful, robust lives. And our job is to be a part of that and to make it better for them.” (17:15—18:13)

“Disease prevention is something that dental hygienists focus on in our training. And yet, we get out into the real world after we graduate from hygiene school, and I think we’re so limited on what our opportunities are inside of disease prevention. We’re looking at a myriad of diseases that we can see in the oral cavity or that patients are going to present with in the operatory and talk about what our role is inside of that. We’re going to do this from a team perspective because we need our doctors, we need our front office team members, we need our practice managers to understand that when a patient comes in and they have periodontitis, that we have to be treating this disease fully and thoroughly. We need the time to effectively treat these cases. We need the products. We need the medicaments. We need the entire scaffolding of what that process of care looks like for a periodontally diseased patient to occur. We need the same thing with caries. We need the same thing with oral pathological lesions, oral cancers, tethered oral tissues, airway complications, infection control that, inside of all of this, these are all of the ways that we contribute to preventing disease, and we have to be able to break apart what these modalities look like so that we can understand what are some of the modern trends or techniques inside of delivering care for our patients.” (18:45—20:05)

“This is what's so crazy. The average statistic right now is that one in three individuals who have dental insurance use it routinely. So, we already know that there is a small portion of our population that will come in and receive routine dental care. And by “routine”, I think we’re all in alignment that this is a patient who comes in for their every-six-monther. I tell this story all the time, but where did that six months come from? This drives me crazy. In the 1950s, there was a toothpaste called Ipana Toothpaste. That spokesbeaver, Bucky Beaver, says, ‘Brush-a, brush-a, brush-a. Here’s the new Ipana.’ And then, at the end of the commercial, he says, ‘Brush your teeth with Ipana Toothpaste and see your dentist twice a year.’ Now, that was done by Ipana Toothpaste as a means of encouraging these individuals, the general public, to go in, see a dental hygienist, and have that dental hygienist say, ‘Oh my gosh, the Ipana Toothpaste commercial brought you in? Absolutely, you need to be brushing with Ipana.’ It was an interesting marketing strategy, was it not? Well, that was in the 1950s. And here we are 70 years later, and most individuals across the United States think it’s completely normal to see your dentist twice a year.” (20:22—21:35)

“If you see my very first slide in this program, it’s going to say, “That's how we've always done it.” That is the toxic statement that we have said inside of dentistry. In fact, I think that is the most disease-ridden statement. Dirty mouth? You've got to clean up that.” (21:40—21:55)

“We have seen an evolution inside of dentistry. And we’ll talk about that this afternoon, how we’ve evolved in dentistry in a myriad of ways: disease prevention, infection control, technology. There are so many ways that we’ve seen a change. And yet, it doesn't matter because, at the end of the day, we are still doing the same procedures. If you're using a rubber cup polisher, and you're using hand instruments, and you're treating your patients every six months, no matter what the complexity of the disease looks like, we are not delivering the correct layer of care for that patient.” (22:04—22:32)

“[When] we look at the prevalence of oral disease, currently, the statistic is about one in two adults between the ages of 30 and 79 have some form of periodontitis. Dental caries is the number-one chronic childhood disease. It is five times more prevalent than asthma. And every hour, one individual will lose their life to the ramifications of oral cancer. So, when you take a look at that, the reality is the disease is not stopping. Porphyromonas gingivalis isn't like, ‘Oh, I'm sorry. I didn't realize that you guys were all banding together and trying to help.’ The disease is still occurring. The disease is showing up in our chairs and across our communities. And so, when we take a look at what it is we understand about prevention, the first step in that is, what are we doing to actually prevent this? Because there's such an activity of the disease right now.” (22:33—23:22)

“It has to start at the top . . . And [by the doctor not being involved], what you're doing is you're bringing in a team member and now expecting that team member to transform the entirety of the scaffolding of your hygiene department, including how you're diagnosing periodontitis, diagnosing incipient decay versus active decay, identifying modalities in how to detect oral cancer, looking at pathological lesions, transforming the way we look at oral and subsequent systemic disease. You are expecting one individual — or maybe you send your two hygienists — you're expecting two individuals to go to a workshop, come back after three hours, and implement this when these individuals are not going to have the support from the top.” (24:10—24:54)

“I've worked with doctors who are very fixated in high-end cosmetics. ‘I want to be over here. I want to cut and prep veneers all day long. That's what I want to do. I want my hygienist to really be the wheelhouse of the practice, and I'm going to give him or her everything they need. So, I'm going to send them to this workshop. And then, afterwards, I'm going to sit down with them. I'm going to say, walk me through the pieces that you learned that you find to be impactful inside of our practice. What pieces of equipment do you need? How much more time do you need in the patient hour in order to be able to implement these strategies? What support do you need from our front office team members? What ways do we need to change some of the protocols? What needs to be done in the clinical notes? What types of conversations do we need to be transforming? What needs to be added to the website?’ When you implement a change in the practice, it has to go through every step. That change is like hot potato. It has to touch every hand.” (24:58—25:55)

“As a hygienist, if I go to a disease prevention workshop and I learn about how great probiotics are for oral disease, and I come back and I want to implement that, and the doctor says, ‘Yeah, go ahead. That’s great,’ now, I need the doctor to understand what these probiotics are, why these probiotics are important, why patients who not only have gingivitis but periodontitis, periimplantitis decay, risk for candida, are all going to be terrific candidates for that. I need the doctor to be on board so that when I prescribe this, the doctor comes in behind me and says, ‘Absolutely, Katrina is correct. Here’s why we need to integrate this into the practice.’ I need whoever the lead is who is ordering products to be able to order these products, stock them in the practice. I need my front office team to understand how we bill for that. I need to know, how do we integrate this into an explosion code so that any time that I'm diagnosing a patient with gingivitis, periodontitis, periimplantitis, decay, candida risk, that these are automatically exploding into the patient’s care plan. I also need support from the front office team in the event that the patient calls in and says, ‘Hey, I don't exactly remember. How often am I supposed to be taking that probiotic? Once a day? Twice a day? I'm not quite sure,’ because it’s going to be different depending on the patient. I might need an administrative team member to help me print out even postoperative instructions so I can send the patient out with it. I need every single team member to be involved in that tiny protocol.” (25:55—27:16)

“I travel all the time. I'm speaking, I'm presenting, I'm delivering. I can't tell you how many times a hygienist will come up to me and say, ‘All of this was amazing. I wish my doctor were here.’ I think doctors have this thought, number one, that hygienists want to be empowered to do this. And we do. But we want to be supported by our doctors. We want to be backed up by our doctors.” (27:20—27:42)

“People talk about The French Laundry all the time. It’s the amazing three-Michelin star experience . . . But when you go to a restaurant like that, it is choreographed. There is no room for issues. It’s just ships passing in the night. The drink comes down, the empty glass gets taken away. It’s not cumbersome. It’s not clunky. But you will go to a restaurant sometimes and experience this where it’s like, ‘Where is the waitress? What's going on?’ Well, how many times do you leave a patient sitting in the operatory, everybody is running behind, and the patient is just sitting there staring at the wall, going, ‘Where is everybody? Did they just leave me in here?’” (30:05—30:48)

“It's those little nuances that an intellectual human being is going to observe. And they won't be able to put their finger on it but, ‘I walked in, and nobody greeted me. Everybody at the front desk, they were all on the phone. So, I just sat down. Then, when somebody got off the phone, nobody said hello, so I had to be the one to get up and say, hi, I'm here for my 9:00. Then, I'm sitting here. It’s 9:05. Nobody is coming back to get me. Nobody has said anything. It’s 9:10. By the way, none of these magazines are up to date. They're all from the 1990s. So, what am I supposed to do? So, I'm just sitting with my phone. My phone has a clock on it, so I'm watching as I'm playing a game on my phone, or on Instagram, aimlessly scrolling. And nobody’s brought me back.’ All of these little inconsistencies — and that's before anybody has actually said anything. That's before I'm interacting with the clinical competence that I expect to see, tiny, tiny little things that we are casting judgment on right away.” (30:49—31:45)

“It drives me crazy when I would work in clinical practice, I'd be working on a patient, front desk would come back — I'm literally working with a patient, and the front desk would say, ‘Oh, Doctor is buying Panera today. What do you want?’ That's so weird. You're going to have me list off my lunch order while delivering clinical care to a patient? It’s those little micro nuances that completely erode and break it down. So, when we come together, when we bring the entirety of the team, when they hear a speaker say, ‘Here’s why we need to integrate this into clinical practice,’ I'm going to give you and the team time to now say, ‘How do we take this? How do we integrate this?’ so that anybody who has a touch point with a patient experiencing this disease modality understands why we’re approaching care this way.” (32:23—33:10)

“People make decisions based on emotion.” (35:51—35:55)

“It’s the invisible things that people will comment on.” (36:11—36:13)

“When you think about the brilliance of what happens inside of a practice — think about it. You have patients that come in and see your dental or hygiene departments every three, four, or six months. These patients, for one reason or another, do trust you. And the biggest issue that I see is that dentistry doesn't necessarily fully understand that with these individuals, these patients who come in three, four, or six months, that these individuals, at a minimum, are experiencing risk factors associated with oral disease.” (38:07—38:38)

“It is unbelievable what we’re unpacking inside of that oral and subsequent systemic disease profile. And this is where, I think, we have to change that conversation. Because our patients are so used to seeing us as, ‘I've been going in every six months. I get my teeth cleaned.’ Okay. Well, language issue number one, we don't clean teeth. I'm not a tooth cleaner. That's not what I do. I'm not a cleaning lady.” (40:20—40:43)

“The vast majority of the issue that I see inside of patients’ declining treatment plans across the United States is a lack of value and trust in what we do . . . These individuals see our value as, ‘I have dental insurance. The dentist I go to takes my dental insurance, so I'm going to use my free coupon.’” (41:00—41:21)

“These patients come in, and this is what they see. It’s transactional. ‘I'm going to...