Dr. John Meis (00:34.841)
Hey everybody, welcome to The Double Your Production Podcast. I'm Dr. John Meis here with my partner, Wendy Briggs. Hey Wendy, how you doing?
Wendy Briggs (01:21.548)
I'm great, Dr. John. Looking forward to a good conversation today.
Dr. John Meis (01:25.049)
Yeah, awesome. So one of the things that is a great way to communicate and educate patients is talking about risk. So this episode is all about the risks that we need to inform our patients about and help them to make better treatment decisions. So where should we start, Wendy?
Wendy Briggs (01:45.964)
Yes. Well, one of the core standards of care that we help practices implement is establishing a carries risk assessment. This is something that we focus on and establish day one when we coach new clients and new practices. And I think the reason for that is it really drives a higher level of awareness and engagement with patients and drives their acceptance of many of the services and products and procedures that they desperately need to minimize their future risk.
I think when I look back at standards of care, the ADA, the clinical standards that they talk about, risk assessment has always been one of the top three, but in many practices, it isn't really a part of our systematic processes that we provide in hygiene. And I think there's a variety of reasons for that. It could be that we just have so much to do and not enough time to do it. There's a lot of reasons, but when we actually establish risk assessment tools as a part of this process and as a part of our standard of care. It's amazing what happens and what shifts in the practice.
Dr. John Meis (02:52.623)
Yeah, it's selling preventive services when people don't understand the risk is really, really challenging. And I know when we instituted your carries risk assessment into my own practice that there was really a big shift in people's attitude about preventive services. So it really does work. So tell us about how this risk assessment works.
Wendy Briggs (03:16.13)
Yeah, I think it's important that patients understand that caries is a preventable disease, right? It's actually been stated in recent years that it can be reversible as well. And I think a lot of patients don't really understand that. They don't understand that they can have an impact at their decisions and their behavior. And certainly they know brushing and flossing is important, but there's other factors involved. And too often patients come in the door with the attitude of, gosh, you know, I got more cavities. That's just bad luck. Well, actually it's not bad luck.
It's more than that. And when we open the conversation that their dental future doesn't have to be as frustrating as what they've experienced in the past, if we change our approach, it really opens their mind to a new world of possibility. And I think this is really the right thing to do for most of our patients because too often they come in and their attitude is, if insurance doesn't cover it, I don't want it.
Or bad teeth just run in my family and it's just the luck of the draw. And when they understand that that's not true. And the fact that just because it's not covered by insurance doesn't mean it's not a valuable service that can benefit them. It really does change our approach as clinicians, but it certainly also changes their willingness to listen and move forward with things that they may have declined repeatedly in the past. So we do see a tremendous shift.
Dr. John Meis (04:34.031)
And I think a lot of people think that their caries risk is consistent over their lifetime, but it's not. It changes as we age, it changes with medications, changes in diet, et cetera. And so I think the tool is a really, really, really useful way to help patients understand that in a way that is very, simple to do and just takes a minute or two.
Wendy Briggs (04:56.108)
Yeah. And it's interesting because when we look at the trend in today's world, know, so many patients don't understand their own personal risk. And what we see as well when we establish this and hygienists begin having these conversations in dentistry, historically, if we look at our approach, a lot of times we'll make a note that someone has rampant caries when it's too late for them, right? They've already got a mouthful of disease. And in recent years, we're seeing know, the World Health Organization and the CDC and a lot of these organizations are saying dental caries is still the number one disease of mankind. And so even though we've had, you know, probably 40, 50 years, maybe even longer at this point of a focus on preventive services, and we've had resources to help minimize and mitigate risk, it's still a significant problem for many of our patients.
And just because they haven't had cavities in the last few years doesn't mean they're not at risk. And just as you mentioned, all it takes sometimes is one change, new medication or xerostomia or a new habit, right? So kids graduate from high school and go to college and all of a sudden they're pounding energy drinks and they come home with a mouthful of cavities and parents are shocked and they're frustrated and they don't understand that a different conversation may have helped the patient achieve a better result.
Just as we've said, when we start having these conversations with patients, everything changes. But what I also love about establishing a process for risk assessment is what happens to the provider's mindset. Because now, instead of waiting until the disease is prevalent and rampant, we recognize those risk factors early on, and we're being more proactive in taking steps to prevent that risk from occurring. And I think that's a tremendous win for everybody.
Dr. John Meis (06:42.689)
Absolutely. So one of the steps that we can take has been in the news a lot lately, right? So we've got another wave of anti-fluoridation talk going on, people talking about studies. There was this study that is of questionable science, but there's a study on how fluoride affects IQ.
And so there's all this stuff coming out. It seems like every 10, 12 years, there's another wave of anti-fluoridationists. And so we're in another one. But it's getting quite a bit of attention. There are cities that have stopped fluoridating water. Your state of Utah is making some changes as well. So what should people know? And how do we talk to patients about this?
Wendy Briggs (07:32.686)
Well, it's a great question. And we're hearing a lot, like you said, chatter. And you know what I find interesting in this most recent wave is how many dental professionals are hopping on the bandwagon, right? And I think, you know, maybe because we have alternative products that they think may be as effective where we didn't have those prior, they're saying, why risk it, right? Well, I think it's important that we really dig in to what we know about it, number one. And number two, once we do risk assessment with patients, all of sudden they're thinking differently about our solutions. And fluoride happens to be one of the solutions we can offer. We have a menu of eight to 10 different preventive services that we often teach practices to implement, but fluoride's at the top of that list. And we long taught that fluoride should become part of our standard of care. Like it should be a given and we should be achieving acceptance above the 90th percentile, you know, amongst adults. And that's becoming more challenging because of the things that you just referenced.
But when we look at the impact that fluoride in water supplies has had, it's been really powerful. So, you know, a lot of the peer-reviewed studies and a lot of the, I guess, highly respected scientific community still recommends fluoridating city water supplies. And a lot of people don't understand that fluoride is naturally occurring in water, right? It's in all water sources on the planet. It's in rainwater, it's in oceans and rivers and streams.
And when we began as a society to, I guess, process water and have community water, it tends to get stripped out. And so when they put fluoride back in the water, it's to replace this natural mineral that does a lot of good for our patients. And so when we first started fluoridating water supplies, when we look at the impact it had, it initially slapped kids' cavity rates by 50 to 70 % and adults by staggering 20 to 40%. So this vastly reduced disease, pain, infection and loss and, and I guess the thinking is now that we have more resources and more access to fluoride. So we've got toothpaste and beverages that we can get fluoride in. And so the thinking is, the group think is, well, if there's any risk of harm, let people that want it choose and not fluoridate everyone.
But the challenge with that thinking is that often the people that are hit the hardest are the low socioeconomic communities, the people that may not have the financial access to these other choices and these other opportunities. When we look at what the, I guess, experts are saying, both the CDC and the American Dental Association emphasize that fluoridating the water still remains a significant benefit, meaningfully shrinks dental health disparities.
There's a couple other quotes that I think you mentioned in the news. My state of Utah took it out. RFK nationally is taking it out of the water. There's a lot of people that are questioning whether or not it's still a value. And when I look at RFK, if I can quote him for a second, I think it's important to look at what he says, right? Because I think he's not the only one. Other government officials are spreading some shaky health claims about fluoridated water and causing people to doubt or question whether it's valuable or a value. And so a lot of people are saying they don't want it. A lot of dental professionals are getting on the bandwagon too. And so I think it's interesting.
RFK said fluoride is an industrial waste associated with arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders and thyroid disease. And what's fascinating is he's right about all of those things. He is right about all except one. I would argue that fluoride is not necessarily industrial waste, right? It's on the periodic table of elements. It is a naturally occurring element in our water. So I would argue that point. But he's right about all the other risks that exist.
But what they miss is it's all about the dosage amount, right? So anything in an improper dosage amount can cause harm and fluoride's no different. And so a lot of the studies that showed, like you mentioned, they were somewhat questionable, those research papers, they often studied fluoride in municipal water supply and often more than double what the actual recommended dosage is. And so a lot of those studies, know, done in rural villages in China. And one of those only had like 50 participants, right? And we're quoting these studies and making significant changes that can have a negative impact on health. And again, I might remind our listeners that caries is still the number one disease of mankind. And so it's not like we've made tremendous progress and we don't need the help anymore. It really is helpful.
So I think that's important. And I also think it's important when we're in the office and we're talking about fluoride that we highlight the difference between systemic and topically applied. Topically applied fluoride varnish in the practice is incredibly effective. And because of the varnish delivery systems that we have today, very little of that is ingested. So it also can help overcome the objections of patients if we say, we place it just on the teeth that need it. You're really not ingesting much at all. And it provides a significant benefit. Those patients that are high risk, if we've already done the risk assessment, see, they have a different reason to consider doing that today.
Dr. John Meis (12:50.895)
Yep. Yeah, that's great. So the news has given them somewhat a reason not to. And if we're going to be effective as preventive therapists, we have to give them a good reason for. And the risk assessment tool that you developed is a way that the patients self-discover their risk. It's not we're telling them their risk. They self-discover by using this simple sheet risk assessment. All right. Very good. So.
Wendy Briggs (13:18.606)
Yeah, and then also, Dr. John, another thing before we move on from this is, you I mentioned a lot of health professionals are getting behind other options. You know, there's a lot of people saying, just use the anti-hydroxyapatite, but, and that does help remineralize, but it does not have the same long-term impact that fluoride does. So think we've got to be cautious. You know, we are scientific professionals and we should really closely follow the science, not just what the group think is on Facebook, you know, we've got to make sure that we're carefully looking at some of those things.
And so one of the things that I've put together for our coaches and our practices certainly is a quick reference at a glance, all the things that you can know about fluoride. And certainly we talk at length about this, we do in-office trainings and we spend about an hour going through all of this research and then talking about the three ways to propose fluoride to patients that can help improve acceptance.
And we see practices go from you know, less than 10 % acceptance to 80 % acceptance overnight. And it's really remarkable that entire approach, right? It's not just those things, but it's the combination of the risk assessment plus the conversations about fluoride. But I would say that there is value in having an all-natural fluoride alternative for those patients who are vehemently opposed. You know, we wanna meet patients where they are.
And although I'm a huge proponent of fluoride, I also have been involved in recent years, as you well know, in creating a product line that we actually use as an all natural fluoride alternative because it has a therapeutic dose of xylitol in it. We're not gonna have time to talk too much about it, but I am proud to report we actually made the CRA buying guide, the best products for 2025 are essential oils product line made that. And so we actually have practices that are using that as their all natural fluoride alternative. The polish the teeth with MI paste.
Dr. John Meis (14:55.131)
Nice! I didn't know!
Wendy Briggs (15:04.322)
They crack open a bottle of Essential Smiles, have the patient rinse with it chair side and take the bottle home. And so in a way, like I said, you're meeting the patient where they are, you're providing them with a therapeutic dose of xylitol, which is beneficial in some way in helping them accomplish their goals of a better dental future. So be open and willing to look at those alternatives for those who just won't move forward with fluoride. Because what we find is that helps us really just not lose a whole lot of the productive impact from this current alarming trend. And again, we're honoring our responsibility to do our best for the patient.
Dr. John Meis (15:40.421)
Yep, yep. No, I love it. I love it. Educating the patient on what the options are, let them choose and respect their decision. So love it. Love it. All right, very good. So shall we move on to other risks that patients have? Shall we move on to periodontal disease?
Wendy Briggs (15:56.29)
Yeah, I think that's important for us to talk about as well, simply because of all the research that's come out that when we talk, know, back when I went through school, when we talked about risks associated with periodontal disease, it's all about bone loss and tooth loss. And now we've seen the risk factors really shifting and a wider understanding that we're not just talking about bone loss and tooth loss, we're actually talking about serious systemic health threats that exist when we have infection in the mouth.
And for many of our patients, you know, the thinking that we just hold on to the teeth as long as we can and let them deteriorate slowly and take them out one at a time, as dangerous thinking now with everything that we know about risk factors that exist, especially when we have a bacterial load that's out of control. So our management of these risk factors of periodontal disease has changed as our awareness of the science has also changed.
Dr. John Meis (16:47.739)
Yeah, for sure. There was a time when we had a terminal dentition, meaning it was beyond, it was not stable, it was declining, and no matter what we did, it was gonna continue to decline. We just kinda let those be, you know? And now we understand, maybe that's not such a great idea because of the risk of the inflammation and infection and the systemic effects of that. And so how do we help patients understand this?
Wendy Briggs (17:16.653)
Yeah.
Again, there's another approach that we can take where we do a risk assessment in regards to periodontal disease. And there's some really amazing companies out there that are helping us do this better and faster. And I hope to interview one of those companies, they actually are going to be attending our upcoming summit and hopefully they'll be on the stage competing for our Big Edea trophy. We have two Big Edea trophies that we do at the Summit. Those that have been to our Summits know that one of them is for our clients and they'll share the most impactful idea from the previous year. And you get so many great ideas in a short amount of time. It's really powerful.
But last year we had our first ever Partner Big Idea, and we invited companies that were changing dentistry to participate for and compete for their Big Idea trophy. Last year, Dr. Haley and Dr. Goli Abivardi from vVardis won the trophy with their innovative release of Curodant to dentistry. This year, one of our companies that will be competing is leveraging AI to provide a more seamless process for us to assess risk. And it's really kind of an innovative tool. It actually integrates with your practice software and creates risk profiles automatically. One of those is for periodontal disease. So it's going in and finding all of the medications, the medical history that the patient's on. They're looking at former period charting and they're giving you, at a glance, an idea of how at risk this patient is for periodontal disease.
Now we've never had anything like this before. And I think, as we talk about the changes in technology, AI is really, really promising and helping us create shortcuts because up until now, what we've had people do is almost a worksheet. You know, what, what are we seeing in their mouth? Are we seeing bleeding pockets? Do they have bone loss? Is there radiographic calculus? You know, we're taking an assessment of all these things and each patient is given a score. We still do that in practices and that score helps us ascertain is this a healthy mouth? Is this a patient that needs gingivitis therapy and some education about risks with early stage inflammation or infection or is this a patient that actually already has periodontal disease?
All of those help us identify the risk profile going forward and maybe take actions today that can help prevent the disease from getting worse. On that worksheet, there is a small area that talks about medications and medical concerns. However, it's necessary, I think, in today's world to really look beyond that worksheet that's looking at where they are today and trying to calculate, are they at risk for developing some of these problems?
And if so, what can we do today to make sure that the disease doesn't progress or they don't end up with gingivitis or periodontitis in the first place? And I think up until now, we really haven't had a very solid way to do that. And I'm encouraged by the promise of some of these AI tools that can help us do a better job in that area.
Dr. John Meis (20:14.917)
Yeah, boy, if we can assess the risk, if we can have support on radiographic analysis, which also helps us with reimbursement so that if we are doing perio, we get reimbursement that the patients deserve. There really is some exciting things going on with AI. And so I love that. And so if we can help our patients understand the risks, if we can help them understand what the consequences are of not taking care of the things in their mouth, we are in a much better position at helping them accept the care that they need. All right, so that's it for this episode of The Double Your Production Podcast. Well done, Wendy. Appreciate all of your wisdom.
Wendy Briggs (20:57.292)
Well, it's always great to have these conversations and there's so many more that we can have. And like we said, I think one of our short to be recorded podcasts is about innovative technologies. So we hope you'll join us for that one as well.
Dr. John Meis (21:09.137)
Sounds good. We'll see you.
Wendy Briggs (00:01.058)
When it comes to having risk assessment conversations with patients, one of the most common concerns we hear from hygienists and the doctors alike is that there's just not enough time to do these things. And that's one of the reasons I am so excited about the AI that will be talked through at the Summit on the Big Idea stage is because it helps us understand how to utilize our time more effectively. And if some of this stuff can be automated, then that's a win for everybody involved as well.
One other thing we are talking about, in my lecture at the summit, we're going to be talking about, the anatomy of an appointment and how to structure the hygiene visits in such a way that we are providing world-class care in a timely manner. This is one of the hot topics in dentistry again. We talked about fluoride being a hot topic. This is a hot topic too. How do we structure our hygiene appointments? How much time should we allow? How do we get all of these things done? And that's going to be one of the big takeaways from my lecture at the Summit. So we'd love to have you join us at the Summit. We've talked about it a couple of times on today's podcast.
To get information about the Summit, certainly we'll have it in our show notes page, our homepage for the podcast, but you can also go to www.championsofdentistry.com and get all the information there.
For those that are thinking, I don't want to join you in person, although again, in person, Austin, Texas is always a great event, a great meeting. We also do have virtual tickets as well. We have a lot of our international practices join us virtually. So that's another great option. Again, Champions of Dentistry for that information. And we will also include that for you on our podcast homepage. So we hope to have you join us at the Summit this year.
