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870: The Oral-Systemic Myth – Katrina Sanders

You may have a healthy practice. But do you have healthy patients? In this episode of Clinical Edge Fridays, Kirk Behrendt brings back Katrina Sanders, The Dental WINEgenist, to expose some of the biggest myths of the oral-systemic link. Doing the bare minimum is not enough! To help patients achieve better health and a better quality of life, listen to Episode 870 of The Best Practices Show!

Learn More About Katrina:

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Main Takeaways:

  • If you see something, say something. Don't wait for other doctors to address it.
  • Believing that you're doing enough for your patients is the biggest myth.
  • Go beyond the bare minimum when doing health history exams.
  • Don't assume your patients know about the oral-systemic link.
  • Make your dentistry transformational, not transactional.
  • Define what 100% health looks like for your patients.

Quotes:

“I believe the biggest myth in all that we know about the oral-systemic link is that we think we're doing enough. The reality is if we understand, for example, that 47.2% of our adult patients between the ages of 30 and 79 have periodontitis, and yet you look at the statistic of the number of times that a dental practice actually does perio treatment on those patients versus the number of times that we're performing a prophy on those same diseased patients, you understand that although we know oral inflammation is bad through both the direct and indirect pathways that the oral-systemic components move in tandem, what are we actually doing about it?” (5:43—6:32) -Katrina

“We can talk about airway all day long, about looking down the airway of our patients, getting a Mallampati score, learning about snoring habits, asking our patients about the amount of caffeine they're consuming, doing an acronym like STOP BANG, looking at all those things. But unless we're doing something about it, unless we're empowering our patients to capture that referral and being the squeaky wheel to say to that primary care physician, ‘We need to get a sleep test done on this patient,’ we believe we're doing enough. And the reality is, if it's in the research and we're not doing anything about it, then it stays there. It stays in those journals and in that paperwork, and it doesn't make its way to actually impacting our patients.” (6:32—7:19) -Katrina

“When we do things like a very cursory health history exam where we're just skimming everything and going, ‘Any changes?’ ‘Nope.’ ‘Okay. Let's move on,’ and we don't take the time to stop, pause, look at the medications our patients are on, look at the cardiovascular disease risk components that are riddled throughout that health history exam, if we're telling our patients all day long, ‘I'm concerned about your heart, and you need to have this gum disease treatment done to treat your heart,’ but we're not routinely taking blood pressures on our patients, then the reality is we're not doing enough. So, the myth inside of all of this is the fact that although we know these things and we get so obsessed about the oral-systemic link, the myth is rooted, I think, in how does this actually change what we do in clinical practice? How does this actually impact our patients?” (7:20—8:17) -Katrina

“Unfortunately, one of the limitations of what we're doing today is we're using production numbers — and even perio percentage scores, in a way — as our way of identifying a healthy or successful practice. We can say, ‘If your numbers are this, you have a healthy practice.’ But my question is, do you have healthy patients? You're doing these numbers. You're making this. But do you have healthy patients? Period.” (10:05—10:28) -Katrina

“What does 100% health look like? I think it's different, unfortunately, for everybody. I think one of the most eye-opening things . . . when you're hosting your next meeting with your clinical team, ask them to write out, what does 100% health look like? Your hygienists will all say different things. I think they'll start with very superficial metrics like, ‘I think that my patients should not have bone loss.’ Okay. That's very basic. We need to dive into that a little bit more. Are we talking about patients that maybe have gingivitis? So, is gingivitis then considered healthy? Is that considered 100% health? Oh, it's not. So, you don't want a patient that has bone loss. You also don't want a patient that has bleeding in the mouth. What else? What if that patient has exposed root surfaces? So, now, maybe not radiologic bone loss, but they have clinical attachment. Is that considered 100% health? What do their vital signs look like? What does the medical history look like of a 100% healthy patient? What you're doing is you're creating a different kind of goal. Instead of the goal being, ‘We want to produce $1 million this month,’ and that's the goal that I'm holding my team to and, ‘You all need to work as hard as possible to get as close to $1 million a month as possible’ . . . instead of changing that goal, that vision to, ‘This is how much money we need to make,’ the vision needs to be, ‘This is where we want all of our patients.’” (11:40—13:27) -Katrina

“When I went out and I spoke on the perio-systemic link, we were diving into all of this research about diabetes, cardiovascular disease, and stroke. Those are things that people have known for a significant portion of time. Question number one is, just because you know that, do your patients know that? And how are you communicating that to your patients? I think we are so focused around, ‘We're going to sit back and wait for the primary care physician or the cardiologist to tell us.’ So, one of the things that I unpacked in my coursework is, you have patients sitting in your chair consistently who — I'm just going to use cardiovascular disease as the example — present with cardiovascular disease risk. I paint the picture like, inflammation is a fire. The more risk assessment pieces that are identified, it’s like a gallon of fuel being tossed on that inflammatory fire. So, although your patient may not have checked ‘Yes, I have high blood pressure,’ and, ‘Yes, I have high cholesterol,’ they may not have checked those boxes. But if you're taking blood pressure routinely in the practice, can you screen for high blood pressure? The answer is, yes, you can.” (15:49—17:09) -Katrina

“I had a patient yesterday who came in to see me, and his blood pressure was 157/90. Quite high. Like, through the roof. Once we get to 160 in our office, that's where we really start to get concerned. I could still treat him that day. So, if all I was doing was taking blood pressure just to find out if I could treat him today, and that's where I ended the story, we're missing the opportunity. Here's where the myth comes in. Then, I think I'm doing enough — because I have taken your blood pressure. You're okay. It's not quite hit the limit. All right. Let's move on to our treatment. It's out of my hands. I'm done. You know what? I'll let your cardiologist or somebody else deal with that. That's the myth, that we think that that's what we need to do.” (18:32—19:14) -Katrina

“How many times do we have our patients fill out all this stuff [on their health history] and we never call back to it? So, is it really important? We never put a spotlight on it. It makes sense why patients would say, ‘I'm not going to waste my time filling out another updated piece of paperwork for you.’ Or even better, when I ask my patients, ‘Any changes to your health history?’ and they say, ‘Nothing that affects my mouth.’ So, we assume that our healthcare colleagues know, believe, and are implementing those things. The reality is they're not. Which dives into a deeper challenge, which is, I don't think we can assume that our patients know about the oral-systemic link.” (28:07—28:47) -Katrina

“If what we're doing is looking at our Dentrix, Eaglesoft, Curve, Open, whatever it is, your appointment book, and you're going, ‘These are the procedures today,’ and if your practice is essentially assigning clinicians to a column and saying, ‘You are responsible for this. These are the things that you need to do,’ the average clinician, the average hygienist, just wants to make sure that they complete the things they need to do so that doctor, practice owner, office manager is happy, and we've done the procedures. But what's in between those procedures? When a patient comes in for a prophy, a D1110, I implore you to consider that we're doing other things aside from a prophy during that prophy appointment.” (29:23—30:04) -Katrina

“Patients are living longer. They're living longer with their natural teeth. So, we are observing them in hygiene chairs, in dental practices, over a long spectrum of time. But if you look at the spectrum of life and the spectrum of quality of life, I will tell you patients are living longer, but they're more specifically dying longer. The amount of time at the end of their life that they are experiencing severe chronic diseases that are negatively impacting their quality of life, we recognize that we have a role in that. So, the conversation really curls back to, instead of, ‘All right. So, what are you going to do on your 8:00 a.m. patient named Kirk this morning?’ The conversation is, ‘What opportunities do we have to help improve Kirk's health?’” (33:08—34:02) -Katrina

“We're starting to see a trend or a shift in our patient population. Patients, now more than ever, feel unheard. They are seeking ways of empowering themselves with knowledge about themselves. We are in an age now where disease prevention is a big focus. People are taking supplements. They're learning about things on TikTok from influencers about salivary tests they can do to learn about if they can eat tomatoes and green bell peppers or not. People are curious and we are beginning to recognize that there is a huge void in the patient support system. They're doing things like full-body MRIs just to look around for things. People are empowering themselves with risk assessment knowledge. They're curious and doing 23andMe because they want to be able to understand their risk, their heritage, their position in the world. We have an opportunity as dental providers, and those of us who are focused on the preventive mission that the oral-systemic link is, to really change the dynamic of what we've done in the past. In order to step out of this myth of assuming that we're doing enough, we have to start listening. We have to start asking. And in order to be able to do that, we have to know how we, as oral health care providers, can help shape a high-quality future for our patients.” (36:15—37:55) -Katrina

Snippets:

0:00 Introduction.

1:55 Katrina’s background.

4:54 Why this is an important topic.

8:53 What does 100% health look like?

14:14 The perio-systemic link, explained.

23:37 Do your patients understand the oral-systemic link?

28:57 Go beyond a prophy during a prophy appointment.

34:04 Don't just fix teeth, change lives.

35:55 Final thoughts.

39:47 More about Katrina and how to get in touch.

Katrina M. Sanders RDH, BSDH, M.Ed, RF Bio:

In the ever-changing world of dental science where research, technology, and techniques for patient care are constantly evolving, dental professionals look to continuing education to provide insight, deliver actionable steps, empower, and create a dramatic impact within their clinical practice.

With wit, charm, and a dash of humor, Katrina Sanders enchants dental professionals with her course deliverables, insightful content, and delightful inspiration. Her message of empowerment rings mighty throughout her lectures and stirs a deep sense of motivation amongst course participants.

Katrina is the Clinical Liaison for AZPerio, the country's largest periodontal practice. She performs clinically, working alongside Diplomates to the American Board of Periodontology in the surgical operatory. Katrina perfected techniques during L.A.N.A.P. surgery, suture placement, IV therapy, and blood draws. She instructs on collaborative professionalism and standard-of-care protocols while delivering education through hygiene boot camps and study clubs. 
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