Very Dental: A Conversation with The Badass Hygienist (aka: Melissa Obrotka)

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[00:01:31] This is a production of the Very Dental Podcast Network. This is the Very Dental Podcast. Welcome to the Very Dental Podcast, where you'll find entertaining and relevant conversations with visionaries, clinicians, and your friends in the dental space. Now, here's your host, Dr. Alan Mead.

[00:01:58] Very Dental people, welcome to another episode of the Very Dental Podcast, coming to you recorded in person, not live because it's not streaming, in person at the Chicago Midwinter. Joining me, she was on the show. Last year, not that long ago, Melissa Obraca. Melissa, welcome to the show. Hey, thanks for having me. She is, she's got a great social media presence. Give them your handle on Instagram. Sure. My handle is It's the Badass Hygienist.

[00:02:26] It is. And if you, I will tell you this, if you look up badass, it'll come up. I'm just saying, you know, the search function is functional. That's how I find it. I'm like, I know it's badass. I'll just put that in. So that's how I find it. Awesome.

[00:02:47] When I got into dentistry, I just fell in love with it. I knew it was in the right place. And I always wanted to just do things 1% better. Like I looked at, got here, looked around, felt comfortable enough as a baby hygienist. Then I'm like, all right, how do we do this a little bit better? How do we make patients not hate it as much? Mm-hmm.

[00:03:32] Some of the more progressive things I was doing and I would seek out more progressive practices. And 13 years in, I landed in periopross. And I thought I was pretty well prepared for it. But when I got there, I realized I wasn't. Mm-hmm. And that was really where those things kind of led forward. So when I realized that I really didn't have the skill set to meet the needs of these advanced implant patients, I was treated. As far as what they need from you, periopross is about the peak, right? Yeah, totally.

[00:04:00] Because they didn't get there because they were taking great care of their teeth. Exactly. But now, because they've committed to a serious treatment, they need serious maintenance. Absolutely. Is that how you'd describe it? A hundred percent. They need to... Okay. So you're spending probably way more time with oral hygiene instruction with these people because if they don't take care of it, they're going to lose it. Yep. But this is not someone who can just, you know, I flossed before I came to the office. And they're literally going to lose their stuff. So that's interesting. So you've seen a lot of stuff. I've seen a lot of stuff. Stuff that I never...

[00:04:29] I wasn't prepared for at all. Yeah. The first time I saw a hybrid case, I nearly fell off my chair. Sure, sure. Because I was like, what the hell is that? Yeah, yeah. Oh, my gosh. And hybrid cases are classic because, I mean, I don't do them. But when I talk to people that do, you're like, oh, yeah, there's a lot of people that don't really know how to design these so they're easy to clean. I'm like, oh, I can smell that from here. Absolutely. Yeah, yeah. Yeah. And I mean, I was working with the one prosthodontist. He was old school. Like, he went to Switzerland to get trained. Weren't allowed to place implants without going through that training. Yeah, yeah, yeah.

[00:04:58] The whole brand mark thing. So, like, he was doing... He had some, like, high water old school hybrid cases. So, like, you know, and all I knew when I got there was like, oh, yeah, implants don't get calculus. Well, poo-poo, that's not true. Yeah. Farthest thing from the truth. So, but what I was noticing as I was trying to treat these patients, plastic scalers did nothing. Yeah. I had my magnetostrictive with a little cover on it, not to scratch. But then I saw plastic particles just flowing everywhere. Yeah, yeah, yeah. And it did next to nothing to get the calculus off.

[00:05:28] Yeah, yeah. So, here I'm literally hanging my head upside down. Trying to, like, see and adapt and help these patients. Because they're telling me stories about how they've remortgaged their homes to pay for this. Yeah. Oh, my God. That's... I can only imagine. That's like, no pressure. Yeah, exactly. Or like, oh, hey, I had bone taken out of my hip and put on my jaw to make sure that they could do this. Because it was way back in the day before, you know, we had... And you're seeing a case and they've got calculus and you're like, that's wild. That is wild. What do I do with this? Yeah, yeah, yeah. You know? So, I just kept on realizing things weren't working, things weren't working.

[00:05:56] And I was trying to actually design an implant scaler. And because we had, you know, these scalers that were designed for teeth that we just made plastic or titanium. They tried to make it work. I get it. But it doesn't work. No, you're right. So, I just... And I would go with my docs to these courses and try to learn and sit with them. And he was really cool when they would do like breakouts and, oh, the hygienist would go here. He's like, no, no, no. You stay with me. Yeah, that's awesome. So, you know, like I had really great support in that aspect. And asked a million questions. And he was always there to answer.

[00:06:25] I would sit and sometimes if I had a cancellation, I'd watch him do surgery. So, I got to kind of like understand it better. Understand where it was coming from, yeah. Yeah. So, like, you know, and then when I started telling my colleagues, oh, I'm doing this. Or, you know, hey, I found this technology and I talked to him about it. Because that's when I found GBT. Actually, it wasn't even GBT at that point. No, it's before... Yeah, you were pre... Before they had a good branding. That's exactly right. I remember those times. Yeah. Yeah, it was pre-GBT. So, I finally found this and I'm like, this is the solution. This is what I need.

[00:06:54] And it was, you know, it was hard to get them in and explain to him that we need to use this technology. And, hey, BT dubs, it's going to cost you 10 grand. Well, that's the thing, you know. Like, I think dentists are perfectly happy to hear the hygienist out until there's a huge price tag on it. And they're like, you know, I got a life to live. Here we go. Right. But, I mean, so then you have to be really good at explaining the why. Yes. You know, your patients are going to do better with this doctor. That sort of thing. It's interesting. I'm sure that was quite a conversation. It was, actually.

[00:07:23] Well, because before that, I broke our ProfiJet because I put smaller powder core parts into it. Yeah, yeah. No, I get it. Exactly. Yeah, of course. So, I already broke his device. Yeah. I just want to say to him, like, hey, I found what we're going to replace it with. I love it. But it's going to cost 10 times more than what you were thinking. Oh, my gosh. That's funny. But, you know, when he came into the room, he's got all the things, right, in the office. I mean, at that point, he was, like, one of the first people doing PRFG. Yeah, yeah. We were doing the centrifuge in the office. He was spinning, okay, yeah, yeah, yeah. So, we had all the things.

[00:07:52] When you think about, when did you get into dentistry? What year about? 99. 99. So, that's your contemporary of mine. We've seen a lot of stuff. Yeah. Like, there's a lot of stuff that is commonplace now that, like, didn't exist when we started. It's freaking amazing when you think about that. It's crazy. Yeah. Yep. It's very cool. So, yeah. So, I had the rep come in and demo us the unit and everything. And he's like, well, how much does this cost? And I'm like, it's $10,000. And he's from Mexico. So, he's like, what? Yeah. Very animated. Yeah. And I just looked at him dead in the eye.

[00:08:22] I go, you know what, Doc? We're charging a lot of money for these all-in-x cases. I said, and I need to support them and make sure that we're taking care of them. It's our responsibility to have the right equipment that does that. And then I shut up. And it was very awkward. Yeah. But then he said, get me financing. And he walked out of the room. Yeah, yeah, yeah. And that was how I started. So, was that an EMS product at the time? It was. Okay. Yes. Yes, yes. So. I remember when he, did you know that EMS at one point had, this is such a tangent, but it's hilarious. They had a water-cooled curing light. No way.

[00:08:51] Like, it was so powerful. It was water-cured. Wow. And everyone laughed at it. I don't think it sold very well. But I remember EMS from going, that is outside the box. That is outside, like literally a water. This light creates so much heat, it needs to be water-cooled. I'll have to go back and see if I can find any literature on it. Because clearly LED lights are, but for curing composite, you're like, whoa. And I remember that's when, that's kind of around the time they started putting this thing out there. And it was. It's before the GBT marketing.

[00:09:21] It's before the, I mean, honestly, EMS, they've got some really cool technology, but their marketing is next freaking level. It really is. Like, that hooks people in like, you know the story. I mean, I'm sorry. Total tangent. That's okay. I do that too. So, you started using this a while ago. Yes. You were early adopter of this technology. In 2016, I started. Okay. And that's kind of where I got the nickname, you know. People would say to me, oh my gosh, you got that into your office? That's so badass. Yeah.

[00:09:47] Or, oh, you're doing, you're disclosing your patients and using this airflow technology? That's so badass. So, that's kind of where that all came from. But yeah, it revolutionized the way that patients perceive the care. It also allowed me, like, I got to be a better clinician because of it. Because I got into it just for implant maintenance. But what I really realized real quickly was that, you know, it's all about the biofilm and the inflammation.

[00:10:13] And my patients that had, you know, maybe they had a hybrid on the maxilla, natural teeth on the mandible when I started using it with them. And they came back three, six months later. Like, their tissue is firmer, pinker. And I'm like, what are you doing differently? And they're like, absolutely nothing. Interesting. And I'm like, whoa, there's something going on here. And, you know, then they would say things to me like, hey, you know what? I don't mean to insult you because I know you always worked hard to be so gentle. But whatever you're doing differently now, like, amazing. Interesting. Love it. Yeah. So, it was just all this positive feedback. Yeah, yeah.

[00:10:43] And, I mean, it wasn't easy. There was no training. There was nothing when I integrated. So, I had to teach myself basically how to use it. And, you know, the other device went in the garbage. There was no turning back. Yeah. And I went from magnetostrictive to Piazon technology, which is totally different. Mm-hmm. But I would never turn back at this point. Oh, that's awesome. Couldn't even practice that way. I had to do it, actually, for a few months after COVID. Mm-hmm. And I literally just wanted to die. Mm-hmm. Oh, wow. Yeah, because they were so worried about aerosols. Oh, my God. I'm just flashing back right now.

[00:11:13] That was a rough time. It was. It was a rough time. Do you believe it was five years ago already? It was. Literally, it is February right now. So, they closed us down in March. Yeah. So, it's like five years ago. It's like... It seems like yesterday, and then it seems like 20 years ago. At the same time. Kind of at the same time. Yeah. It's freaking wild. 100%. But do you remember... Oh, my gosh. It's a great segue into what else we're going to talk about. Do you remember how fucking toxic social media was at this point? Yes.

[00:11:37] First off, aerosols are going to kill every hygienist is in the highest risk category of life and death. And there are hygienists that left the field because of social media bullshit, in my opinion. Yes. We've been creating aerosols in dentistry forever. COVID was an unknown. I get it. But on some level, this created rifts, crazy rifts between dentists and hygienists and hygienists and hygienists.

[00:12:04] And I just remember thinking to myself, all this is, is like the cost of compliance for every dental office just went up, you know, a thousand percent. And we don't really know anything. And I can only imagine for... You literally... The reason your thing works is because it's creating an aerosol. Absolutely. I mean, that's like... That's what it does. I mean, that's what the tool does. I can't even imagine what that was like. What was that like for you? It was awful. It was absolutely awful. And you couldn't...

[00:12:31] You didn't feel like you could defend yourself because everyone's like, well, you're killing people or something like that. It was just craziness. Yeah. Like, you just didn't know what to do. Yeah. It's like, I wanted to be able to put my head on the pillow at night and know that I'm still treating patients accordingly. But then at the same time, like, what risk factors am I increasing? Because we just didn't know. Yeah. Right? Yeah. So it's crazy. But, you know, I was pre-rinsing patients before COVID. Yeah. Because that's what we're supposed to do. Yeah. That makes sense. You know, and so, like, that didn't really change for me.

[00:12:59] The stupid masks and all the other stuff was a pain in the ass. But, you know... Did you have any of those little elephant nose things that go over the... I mean, I know a lot of people bought those. We're convinced they're the greatest thing. A few people still use them because they really like them. Yeah. A lot of dentists found it to be annoying and stuff. But you think about all the PPE that we bought and didn't use. I suspect I still haven't bought masks. We bought... We bought so many masks. We bought so many masks because when you were able to, you're like, hell yes! I'm all in! You know? Yeah.

[00:13:26] So I don't think I've bought masks in five years because we still have crates of them down in the basement. It's nuts. That's hilarious. But I think something was uncovered during COVID. And I think the root of it was this, like, animosity between hygienists and dentists. And I hate that because we should be on the same damn team. And I think that, you know, it depends, too, on the philosophy of the practice. This, you know, everybody's personalities come into play.

[00:13:53] And attracting the people that are going to be aligned with your mission and vision for your ethics and your patient care. That all matters on both sides. But, you know, like right now, I just think I hate what's going on. I hate to see, you know, I understand we have a problem and I understand we're trying to find a solution. I think this is the wrong road for dentistry. The solution. Tell me what you, in as few words as humanly possible, because it's really hard. What problem? What problem do you specifically mean?

[00:14:23] Because I think that it can, there's a lot of stuff you could dig into. But in reality, you said we have a problem and we're going, tell me what problem you specifically mean. I think that we're filling the void of the hygiene shortage in the wrong way. I think having dental students come in and do hygiene is not the solution. I think foreign trained dentists who are not licensed in the United States is not the solution. And I do not think that a dental assistant who gets a weekend course can now scale is the solution either.

[00:14:49] And part of the problem, and I know this is going to be inflammatory, pun intended, part of the problem is us. Because we're charging really premium high dollars to basically scale and polish teeth. And we're not providing therapy. So I really want to help inspire other dental hygienists to flip the switch on what they're doing. Don't be, you know, polishing a paycheck hygienist. Be a healthcare provider that you took an oath to take, to do. And let's lift the bar up. Let's do...

[00:15:18] I have to tell you, when I heard that states, and God, isn't the ADA, we're starting to talk about the dental student and foreign trained dentist thing. And I thought to myself, okay, this is like, I thought I was reading The Onion. I'm like, this is, no one's really saying that. Okay. Let me just, let me just, just from a fully practical point, I was a dental student. I didn't have any fucking time to do that. Right? When I was a senior, I had enough time to work in a coffee shop for like four hours a week. Where am I going to go and clean teeth? Give me a break.

[00:15:47] And I'm sure people are saying, well, it's great to get paid. Great. They're dental students. They don't have time for that shit. Right. They don't. They really don't. And can I ask you an honest question? How much time did you spend in your curriculum on hygiene skillset? Oh, I mean, actually a ton. A ton. I mean, perio is very common. A ton. I don't know that they do now. Okay. But also, let's think about it. If you're a fourth year student that's had 70 perio appointments and you wanted, that's one thing.

[00:16:14] If you're a third year student who's like seen a couple patients, that's very much another thing. Yeah. They're both dental students. Right. Like, so, I mean, if you were taking that really seriously, there's a lot to dig into there. I mean, like, as you know, hygienists have different skill sets. Dentists have different skill sets. But I can only imagine, like, trust me, no one would have paid me anything as a third year student to clean teeth. I was lucky I didn't hurt anyone. You know, that's real. That's absolutely real. Absolutely.

[00:16:42] And as adjunct faculty, I've seen many foreign dentists come through our program to now work in the U.S. as a hygienist. And it's harder teaching them sometimes because they already have this foundation that is not in alignment with what we do. A lot of them, they're already trained as restorative dentists. I mean, you mentioned an endodontist in another country coming in and saying, yeah, I'm going to do some hygiene. That just doesn't make any sense to me. No, zero. So, I mean, that's a whole other conversation that maybe those laws need to change as well. But, I mean, I just don't...

[00:17:11] I want to see us just rise up and give great care to the patients that we have the honor of serving. Well, I'm going to... Okay, so I'm going to play the devil's advocate here because as a dentist, I'm also an employer. And the reality is that if you're doing what you're doing, you can't charge what we are normally charging for stuff. Like, a prophy isn't spinning a cup with some pumice and patting them on the head and saying, good job. You know, this is like...

[00:17:40] What you're talking about is a much different animal. Absolutely. But the reality is, you know, if someone is in network with someone, there's no difference between if a prophy... Classic. This is my classic thing. A prophy on a patient... Let's just say that they don't have real perio issues. Their gums might be a little inflamed, but they're a hot mess restoratively. They have high decay or whatever. A prophy on that person versus a prophy on someone who actually flosses and takes really good care and is the most boring hygiene patient in the world.

[00:18:10] If they have the same insurance, you get paid the same thing for that. Which is also a problem. As a hygienist, is that the same patient? Are you doing the same thing? Not even close. Not even close. It's not even close. But we've commoditized it in such a way. You're right. So the reality is, is like what you're doing is worth being paid more. But as an employer, as someone who has to deal with insurance companies, it's really hard to do that. It's hard to pay a hygienist that much if they can't generate that much.

[00:18:39] Now, realistically, I suspect you have a lot of answers to that. But I know that as a dentist employers, they're like, this is the problem. I mean, I can only get so much for what I'm doing. It is. And it's hard, too, because they're kind of restricting you with that as well. So it's like, again, what is your philosophy for patient care? Like, why did you come to this? Why did you want to do dentistry and serve your patients? So I think there's a lot of stuff that we just have to look a little bit inward and decide. Because for hygienists, you practice with a doctor that you align with.

[00:19:09] I don't practice in an insurance practice because I want to be able to provide really great care for my patients. I did for the bulk of my career. And it actually messed with my brain a little bit when I got to fee-for-service because I was like, wow, I don't have to, like, have the conversation the same way. Like, these people are ready to go. Like, if you tell them it's going to hurt their health to not take action, they're like, I'm going to write a check. Let's do this. So it's a different outlook in care. And look, we all have different philosophies of what we want to do.

[00:19:38] So I think, like, there's tiers with different practices. But there's always going to be a lot of patients that are here to use their benefits. Because you can't really hate someone who wants to do that. You can't. So on some level, the answer, a simplified answer that I've heard from a lot of hygienists, this is simple, Doc. Just go out and network and then we can charge more. For some docs, it's just not simple. It's not the answer. Yeah. I guess demographics and all of that stuff play a big part in it.

[00:20:06] But if it comes down to figuring out, you know, can you go back to the insurance company? If that's something that you have to have in your practice, can you renegotiate those fees somehow? Like, is there someone on your admin team that can look into that? Maybe. Maybe. But I mean, if the answer is just get out of insurance, that's a simple answer. But I guarantee you it doesn't work for a lot of people. No, you're right. But like, why are we... Here's something. So oral hygiene instruction, full periodontal charting, head and neck screening.

[00:20:33] So like, yeah, if you're on a volume-based care, you don't have time to do any of those things, right? But those are the things that create lasting value and build trust with your patients that they come back and they share with their friends and family that you need to go see Dr. Mead because he does all these things that no other dentist ever did for me, right? So like, that's the other side of the coin. So if you have 60 minutes and you're getting crappy insurance reimbursements, but we're doing all these value-added things that standard of care we're supposed to be doing anyway, why aren't we charging for them?

[00:21:03] Right? Like, that doesn't make any sense to me. There should be charges for all of those things and not just a charge for a prophy or a gingivitis or a periomainance, right? For sure. Now, okay. So yes. Okay. So I, what did I, I just had something where I had, I have a patient who, I have a patient who's in chemotherapy right now and she's just super dry mouth. She's got a lot of old dentistry and it's, it's failing.

[00:21:32] And the reality is, is we've got a lot of work to do. She's got a lot of treatment. She's, she's really struggling with a lot of treatment, but like, I'm like, if we don't do some of this stuff, you're going to lose these teeth to carries. So I'm like, let's do long-term provisional crowns to hold these teeth while you're finishing your chemo. We'll get you back. And, and so of course we want, she has insurance. They don't, that's not a covered benefit. It's the, the, the provisional crown is, is part of the, the restoration.

[00:22:00] I'm like, look, listen, we're not ready. We're not, we can't do that now. And she couldn't tolerate it anyhow. And you're just sort of like, I mean, every insurance based thing, there's exceptions for everything, which is exactly what you're saying. Like the reality is it's like health versus insurance companies. And, and a lot of administrators are not interested in that. They're interested in, in checking the boxes and, and, you know, writing the smallest checks as they possibly can. It's all real.

[00:22:26] And I'm not, I'm not saying, I'm not pushing back on that as much as it's, there's a lot of difficulty there. There's a lot of difficulty there. And that's, that might be, do you think that's the crux of where the, where the, the concern is between hygienists and dentists? I think a lot of it has to do with that because we're not trained to think like business owners. So we don't understand the burden that you guys are carrying. And, you know, having all of that on your back, on top of it, like we don't really get why you're making certain decisions.

[00:22:54] We're just pissed off that we're still scaling teeth with dull instruments. Right. Or nobody's bought me a new Cavitron in 16 years and I can't really do my job with this. And everybody hates my guts because I'm hurting them. Mm-hmm. Mm-hmm. And at the same time, like, okay, now, hey, we just got a scanner. Now I want you to scan. So like we see you guys buying stuff for your end of the office but not making any investments in hygiene. So it's hard.

[00:23:31] Mm-hmm. they can also help you get more restorative work going because people are sick. There's an abundance of sickness out there. Yeah, there for sure is. And it breaks my heart where you just shared about your patient because that's bullshit that she can't get help she needs because somebody else. No, she did get the help. I just didn't get paid is actually what happened. But the reality is, is like... Well, that's because you're a good person. Well, I mean, like, like I'm going to friggin... Yeah, exactly. And she's a sweet person. We're going to do the work eventually. But, you know, chemotherapy's a bitch. Yeah. It's like literally... Oh, it was... I think I did it on Thursday.

[00:24:00] I'm like, I think I'm going to lose my mind because, of course, it was an upper left quadrant. It was 13, 14, 15. And we're just prepping crowns. And she, like, you would get close to a tooth and she'd go... Oh, jeez. I mean, like, chemotherapy is like... Oh, poor thing. It's like, it like makes a huge... Everything is nauseous. Nothing tastes good. Everything like that. So we're... And I'm working on 15. And poor lady. But the other thing is, I'm like, she's going to lose these teeth if we don't do this. Yeah, yeah. And we explained it to her. I'm okay with that. I'm okay taking the hit. But the reality is, yes, the human stuff is really important.

[00:24:30] And it's hard sometimes to separate from the financial pressures. It really is. And sometimes the financial pressures don't let you do that, you know? Right. I'm in a position where I can do that. But God, what a mess. It's a hot mess. And it's just... It's sort of a... The arguments are sort of black and white. And of course, the world's gray. That's the thing. You know, that's part of it. Yeah. Because I also, like, you know, my bias is sitting on a place where we're in a fee-for-service practice. I've been practicing this way for so long.

[00:24:56] And it's a patient population that is, you know, they have funds to pay for these things. And sometimes, like the insurance... Like I said before, it's not even a conversation we have to worry about for a majority of our patients. So it's a different perspective. But at the end of the day, it's... I want to advocate for my colleagues to be able to do things like oral cancer screenings. Because no one's going to die from one little tiny piece of calculus. But they are going to die if you miss something because you didn't look.

[00:25:25] So like, these are the things that I really want to advocate for our profession to kind of shift. And I think that, you know, a lot of it goes back to what's the problem here? Is it the dentist and the hygienist? Or is it this other entity that dictates how we do things? 100%. 100%. Yeah. You know? So it's like... So knowing that, how do we come up with a solution? Like, how do we kind of bridge the gap? So providers like you who have a heart and do what's right and maybe not thinking about the financial because you know that this is what you need to do right now.

[00:25:55] Yeah, yeah, yeah. You know, like, I'm lucky I work with someone like that too. But how do we get... How do we... As a profession, how do we change that? Like... I don't know. I don't know either. I don't know. And I mean, the conversations... I don't mind segueing because I talk about this a lot. Social media is a complete shit show. Not helping. No, it's not. Not helping. I mean, but in what's worse is then you're... I don't know. Like, probably when you say, what's the solution? That's not the solution.

[00:26:23] The snarky back and forth on social media, which I think everyone's probably guilty of or at least has read, you know, grabs the popcorn and reads even if they don't join in. That's real. Yeah. And that's not probably helping much. I don't know. I don't know. What do you... I mean, you've thought about this a lot. Where do you see it going? What does it look like in five years? That's a great question. I hope... What I hope for is that my profession will really kind of dig their heels in and do what we were taught to do and practice to the highest level of the capacity of their license

[00:26:52] and stay at that standard of care. When I work with the students at school before they leave and I'm like, remember everything we taught you? Yeah. Because this is your true north. Yeah. You know, if people are asking you to do something that you know in your gut is not right, you have to come back to the standard of care. There's a reason why we do it. There's a reason why we teach it to you this way. So, you know, I just... We know so much more now about systemic health and the mouth has to be brought back to the body.

[00:27:21] And we can help people reduce so many life-altering risks. And that's where I want to see our profession go. I want us to have a seat at that table. I want us to be able to, you know, say, hey, over here, dentistry, like, you know, salivary diagnostics, all of these things that we now know and have use for, reducing inflammation, like that's what we're about in hygiene. And that's what I think that we have to shift our focus on. It's not about polishing teeth. It's not about flicking super gingival calculus off.

[00:27:50] It's about managing inflammation. And that's centered in biofilm. What's interesting, I heard someone say, this is again, this is a total devil's advocate because I'm on board with the GBT, all that stuff. Someone said, yeah, but okay, so you knock the biofilm off in hygiene. In two days, they've got it back again. What's the answer to that? I know that this is a question that you've been asked before. A million times. It's like a softball, but I had to throw it out there. That's okay. I appreciate it.

[00:28:17] So yeah, it is, but it's not as aggressive as it was after your conventional pro fee because you left 50% of that behind. So that community just kept on growing. It's really interesting too, because how do you know if you left it behind? Oh, the purple shit. That's what that, I mean, like disclosing is part of this thing, not because you're, uh, you're trying to harken back to your dental hygiene school days. It's because it actually does something. It actually shows you something and you're using your eyes and you're seeing stuff because the reality is, uh, okay.

[00:28:46] Anyone who thinks that's not true, go ahead and go ahead and do, do your best. Like go in there, do your best. Dentist, hygienist, anything, do your best. Clean those teeth like they've never been cleaned before. Then disclose them. And then look at the clock too when you started and when you finished. Yeah, exactly. Because it's probably going to be an hour and a half and it's still going to be there. But yeah. And if you look at the disclosing, you're like, oh, that's, that's, that's just wrong. But like I, most hygiene, I mean, disclosing was a waste of time. And now I grew up, I'm, you know, they gave you the little tablets and stuff like that and everything.

[00:29:16] I mean, it's still a real thing, you know, but it's, but I think it just, I mean, most I tell my patients to buy them on Amazon on the regular. Yeah. I mean, exactly. I have my kids do it and I'm like, oh my God. Yeah. So it's like a, it's, it's real. And actually the other thing is it's, it's a measure. It's an objective measure that people don't, you know, I do a great job cleaning teeth. I'm like, well, you know, are you sure? I thought that too. Then I started disclosing. Yeah. Right-handed provider, just listen to the left side of the mouth, totally suck out. Isn't that funny?

[00:29:45] It like literally shows you this stuff. I mean, it makes sense too. It's a GPS for your treatment. It is. And you know, you, you actually do what we teach. We teach to not over-treat, under-treat. It's individualized care. You're able to do that because you know it's gone and you know where you missed. Do you ever disclose patients that do a really good job and they just don't have that much? Is that a real thing? Absolutely. I had a patient yesterday. It was phenomenal. Yeah. It's great. 10 minutes. What's funny about that though, is that you're like, again, when I've said, you know, there's

[00:30:13] this percentage of patients in my office that are healthy no matter what we do. They do a good job, but they also, they're, they've got, they've got good genes. They've got, they've got keratinized tissue all, you know, out to their ear blobes, you know, they got it and they're healthy. Maybe even when it's a 17 year old boy, they're healthy in spite of themselves, honestly, on some level. Those probably disclose dramatically typically, but, but the reality is, is the health is there. It is an interesting thing because we make a lot of assumptions with our eyes when we don't do that. That's real. That's real.

[00:30:42] And unfortunately, even if you think, oh, I'm not going to take the time to do that. Well, great. But you're missing stuff. You really are. And I didn't, I pushed back on it because again, I was self-taught. So then when I started watching webinars and learning about it, I was like, oh, who's going to want to touch that shit? I haven't touched it since high school. I love it. I love it that you, I love it that that wasn't, I mean, and of course this is kind of where their marketing stuff is really brilliant. And you were really, you knew how this stuff worked, but disclosing wasn't because it wasn't something that was part of hygiene at that point. I was like, I had PTSD from school about it because that's how my professor checked me and made sure I did a good job.

[00:31:12] And it always showed that I missed somewhere. Were you allowed to disclose first and do it or did they only do it after that? Oh yeah, no, you had to do it first and then they'd come and do your check and okay, get the solution back out. Put it on and oh, wow. Oh, great. Yeah. That's funny. That sounds like general school too. So yeah, no, I didn't want to do it at first and I didn't really see the value in it, but I kept watching these different webinars and everybody was talking about it over in Europe. So I was like, all right, I'm going to give it a try. And I ordered it and I did it. And the first patient I did it on, patient of record every three months, really great hygiene, like very good home care.

[00:31:43] And I was like, holy shit, dude, there's so much more here than I ever anticipated. Yeah. And he, I gave him the mirror and he was a little bit taken back at first. So it was. I'm doing a good job. I'm doing everything you told me to do. Exactly. So I had to learn too, how to kind of like have that conversation where it wasn't aggressive and you know, this is just data. You know, that's what I say now. But that also guides your, your oral hygiene instruction. Like as you said, what if a patient does a whole lot better on the left than the right? They probably don't know that.

[00:32:10] They probably don't know that, you know, they maybe cause they're for whatever reason, but you can tell them. Yeah. Yeah. I say to them, I'm like, you're right-handed, aren't you? They're like, how did you know? Yeah. I'm like, see the biofilm? Yeah. It's heavy here. No, it's real. And that's like, like, that's all, all these things are, there's just, this is a tool that, I mean, I would suspect, I could be wrong, but most people aren't using right now. Yeah. Unless they're doing GBT, they're probably not using it. They probably aren't. Yeah, they're probably not. Yeah. And here's the thing.

[00:32:37] It becomes like, here's, here's where we have this bigger impact on the people's lives that we get to serve. Atomic Habits, amazing book. And he talks about habit stacking. So when you do your disclosing for patients and you show them and you teach them the connection between the inflammation, like, hey, I just did your periodontal charting and I use voice activated. So they hear me call everything out and I explain what they're listening for ahead of time. Which is kind of brilliant. The whole, yeah. It's amazing. It's explicit, but it's also in an indirect way. Yes.

[00:33:06] It's not like you're saying, you have a five. It's that, it's that they're hearing you measure. They're just hearing it. Yeah. It's brilliant. I hold the probe up on my finger. I show them the lines. I explain to them what it means. You want to hear me say ones, twos, and threes. If you hear me say four or five, you know, just be aware that's inflammation. If I don't say bleeding, that's a good thing. But if you hear me say bleeding, that means we have active infection. And we'll talk more about that after. So they already know. Like before I even start. Yeah, you prime them. So that's oral hygiene instruction, except before you ever do oral hygiene instruction.

[00:33:34] Because you're just letting them know about their condition. It's like I'm telling them a story in their appointment. But the story is about them and how they can be healthy and how we can help them get out there and how we can help prevent diseases that like non-communicable diseases like Alzheimer's, dementia. So we go through that whole thing. And then when I disclose them, I can say, remember where I said, you heard me say four or five and bleeding. See where this is dark. Yeah. That's mature biofilm. That's been sitting there for more than two days. That's causing this inflammatory response. And that's why your gums are bleeding.

[00:34:03] When your gums are bleeding, the barrier is now broken. And these bacteria, I don't know what they are unless I take a test to identify specifically who they are. But these guys are not good. And they're now getting in your bloodstream. And every time your heart pumps, they're traveling through your body. And where they go, you know, it depends on your genetics and how your body responds to that. Your immune system, everything. But the reality is that people don't think about that stuff that way. They don't. And once they start thinking about it, all of a sudden, maybe they use more floss. Maybe they spend more time. They do.

[00:34:31] And that's what I've observed with my patients is that like they make these, like if we can get them to floss or if we can get them to brush, I'm like, look, you're already brushing your teeth twice a day, right? Yes, I am. I said, okay, let's tweak it. Let's make sure you're more effective now. And then I'll just give them that to work on. And then when they come back, you know, three, four, six months later, okay, great. You're doing better brushing because now the disclosing shows me that. And I take a picture every time they come in so we can gauge. You're doing better with the brushing. See, now we've got this darker bacteria between your teeth.

[00:34:59] I want you to just take this tiny little brush to stick this between your teeth and tell me what, you know, let's see what happens. And nine times out of 10, a geyser of blood comes flying out. Right. And now I didn't make them bleed. They made themselves bleed. But now I'm like reinforcing this disease that's there. This is still inflammation because your brush doesn't reach here. So now do you think you could take this little pick and use this maybe once or twice a day? That's a lot easier than flossing. So as long as they're disrupting the bacteria, I don't give a shit how they do it. To be honest.

[00:35:26] Just get in there and disrupt it so it can't continue to grow and become pathogenic. So I've kind of shifted that game for myself. And I tell them too, like when I'm enrolling somebody into non-surgical periodontal therapy, instead of saying like, I want your pockets to shrink. Because if somebody's got bone loss, I'm not going to get pockets to shrink everywhere. My new goal now is I want you at 0% bleeding. And my charting system shows me their percentage when I'm done. Because I'm not good at math. So it's nice.

[00:35:55] But also it means you can measure and not think about the overall picture while you're measuring. It's better to know after the fact. So I mean, we should wrap. This was really good. But I want to ask you, for someone who is just not familiar, you had talked about, well, I use piezo now and I used to use magneto restrictive. And I think there's a lot of people probably have no idea the difference between those. I mean, I've seen them sold forever. And I'm just like, okay.

[00:36:20] So what is the difference for someone who's actually doing the clinical work? What will they know? What's the difference between them in real life? And then what's the difference? What's the experience difference? Sure. So, I mean, there is a transition in using them because you're using just the lateral sides of the PAs on technology. But the mechanism of action. So we all know the magneto restrictive moves in a figure eight. So it's essentially, why do patients say no cavitron on their chart? Because when they smack the tooth, it's uncomfortable. When it smacks the tissue, it's uncomfortable.

[00:36:49] Plus it's got cold water. So, and it's, we have to add lateral pressure on to help get that piece of calculus to pop off. With the PAs on technology, it's moving in a very precise linear motion. So it's essentially just the side of the instrument putting little micro fractures into the deposit. And the way that EMS has created their technology, it uses what's called the dynamic response. So you actually don't have to put lateral pressure against it.

[00:37:15] It just, it detects the load resistance, the calculus, and it automatically increases the amplitude of the tip. So it adds those micro fractures in and then it just releases off. So it's still going to look the same popping off. But it's a lot less labor intensive for you. You don't have to push. So when you're, when you're using it, it's going to feel how compared to if someone's used it? Like, like butter, to be honest. It's like a light exploratory kind of stroke. Okay.

[00:37:41] The hardest transition is just getting used to, you need to hold your instrument in a really good modified pen grasp. You have to have a good established fulcrum. Yeah. Because you have to be able to roll it to keep it on the lateral sides. Got it. So that's the toughest piece of the transition. Okay. But if anybody knows how to scale with a universal hand scaler, you can do this too. Yeah. It's just a little adjustment. It's anything with your brain. Just, you have to be cognizant of it initially. So it's not, it isn't, it isn't more difficult. It's just a little different in getting used to it.

[00:38:08] It's not, and it actually is simpler when you're using it. Totally. That's cool. 100%. That's cool. Saves me a ton of time. That's cool. And I don't hand instrument as much because magnetostricted by nature, as it's moving in that elliptical fashion, it's missing as you move it. Yeah, yeah, yeah. Yeah, exactly. So this is a more comprehensive calculus removal. So there's less hand scaling required. So we're preserving more tooth and tissue. Well, also, also, because you've gone through with the airflow first, your visualization's way better. Totally.

[00:38:35] If there's anything in there at all, you know where to go for it because you've removed all the other stuff. It's kind of, it's, I mean, it makes a ton of sense. So before we finish up, if someone's listening, I got to hear more about it's the badass hygienist. Where do they go? And what, like, where can they say, are you, do you have speaking gigs coming up? Do you have the, you have the podcast? Give us everything. Yeah, yeah, yeah. Give me everything. So, yeah, my podcast partner, Tabitha Akra, and I, we just started up again where our podcast is called Disrupting Dentistry.

[00:39:04] So we're going to be putting out about two episodes a month, hopefully more. Okay. And I'm actually just launching, at the end of this month, a online course for hygienists who want to become a master clinician. Okay. And just, it's basically my protocols. Okay. And how you can up-level yourself in your practice and, you know, have passion and purpose again and not just feel like a jaw janitor, tooth scraper, mouth maid, all the fun little terms. Mm-hmm. And, you know, just help our patients get healthy. Yeah.

[00:39:32] There's so much, 50% of our adult population is running around with periodontal disease. Like, it's time for us to do better. So where do they find you? Is it, is it at a website or is it on the, okay? Yeah, it's the badasshygienist.com. There you go. There you go. It's good. I'll put it all in the show notes so people can find it. Thank you. And they'll find your Instagram and all that stuff. This was good. And I think, I think it's important. And I think it's, I think, like I said, it's going to be so interesting how things move forward. Definitely. Because there's a lot, there's a lot of change coming. Yes.

[00:39:57] And not just in hygiene and, but like, I was literally just talking to someone earlier about dentistry's, I mean, it's changing in a lot of great ways. It, it might change in a lot of not so great ways because of just how things are. It's a little scary, but it's also kind of exciting. And I mean, I feel like you're kind of pushing in the right direction. Thank you. I'm trying because I feel like this is where we need to go. And we're, I agree with you. We're kind of at that tipping point where we can go either way. Yeah. Yeah. I think you're right. This was great. Thanks, Melissa. Thank you. Thanks for having me.