Gordon J. Christensen is Founder and Chief Executive Officer of Practical Clinical Courses (PCC), Chief Executive Officer of Clinicians Report Foundation (CR), and a Practicing Prosthodontist in Provo, Utah. Gordon and Dr. Rella Christensen are co-founders of the non-profit CLINICIANS REPORT FOUNDATION (previously named CRA). Currently, Dr. Rella Christensen is the Director of the TRAC Research Division of the CR Foundation. Since 1976, they have conducted research in all areas of dentistry and published the findings to the profession in the well-known CRA Newsletter now called CLINICIANS REPORT.
VIDEO - DUwHF #1378 - Gordon & Rella Christensen
AUDIO - DUwHF #1378 - Gordon & Rella Christensen
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Howard: it is just a huge honor today to be podcast interviewing Dr.’s Gordon and Rella Christensen the two people who do not need an introduction but I'll introduce them anyway to come talk about the emergency situation of Covid 19 affecting dentistry Gordon J Christian is founder and director of plant practical clinical courses CEO of clinicians Report Foundation and a practicing prosthodontist in Provo Utah Gordon enroll a Christian are cofounders of the nonprofit clinicians report foundation that I grew up thinking it was known CRA but now it's clinicians report Foundation which were all it directed for many years since 1976 they have conducted research in all areas of Dentistry and published the findings to the profession in the well-known CRA newsletter and alcohol clinicians report Gordon's degrees include University of Southern California MSD University of Washington PhD University of Denver and two honorary doctorates early in his career Gordon helped initiate the University of Kentucky it just goes on and on let's Dr. Rella Christian co-founded the CRA in 76 and for 27 years directed this well-known dental product testing Institute subsequently she served as chairman of its board currently she is a team leader of a non profit Institute dedicated to in-depth and long-term clinical studies of restorative materials dental caries preventative dentistry known as technologies and restoratives and caries research track research in 1960 Rella Christian received a Bachelor of Science in dental hygiene from the University of Southern California and practiced dental hygiene for 25 years she worked as a dental laboratory technician for three years she founded the bachelor's degree program for the University of Colorado she earned a PhD in physiology and an emphasis on microbiology for Brigham Young University in 1986 and that is a and she completed a postgraduate course an anaerobic microbiology at Virginia Polytech State University she has presented over 1040 dental continuing education programs totaling 5,200 hours at us and international locations she has made seven videos on control of infectious diseases in the dental offices which have been in universities and clinical practices worldwide so Rella my gosh you guys are the modern-day equivalents of GV Black and Pierre Fishard all wrapped up into one marriage so the dentists are have never seen anything like this and I'm getting feedback even from a friend of yours up the street in Utah dan Fisher I mean he said that when the a DA said that they recommended that we only go to emergency treatments the phones have stopped ringing and dentistry is that a standstill so they want to hear from you what do you guys ladies first it's St. Patrick's Day so all of my first question St. Patrick drove all the snakes out of Ireland can he drive the coronavirus out –
Dr.’s Gordon and Rella Christensen apparently not
Howard: well you you're you've been studying microbiology and dental offices longer than anybody who's listening to this program right now what is your take on this COVID nineteen coronavirus
Dr.’s Gordon and Rella Christensen : well you know it is a real first in dentistry but it's been something that we have anticipated anybody who studied microbiology even as an undergraduate student was taught that not a serious viral particularly viral pandemic was always around the corner most of the people who are listening to this presentation I have already lived through a tremendous pandemic with the AIDS 36 million people died with the AIDS and it's still very much alive and they've lived through of course SARS and MERS and Ebola and they're going to be others this this is one it's not going to be the last one there is a certain amount of fear because we we don't have good numbers on the best rate it isn't so much the infection rate it's the death rate and it varies from country we won't really know good numbers on that until frankly everything is kind of settled and over and it is it does make good sense to close things down I know that people the leadership in China was so criticized for that because of about 50 million people in several large cities but it's about all you can do is try to look or try to isolate people so that it doesn't spread and it isn't forever it's for a period of weeks or months and this too will subside but it'll be back I promise you it will be back this virus will circulate for years it's elemental it'll be back its predictable well it'll be back in the fall even if there is a vaccine the problem with viruses is they really aren't alive in the sense of the word they can't do anything until they enter yourself there they take over the machinery makes protein in your cell DNA RNA apparatus and they make viruses which are then released in various ways this happens to be what we call an envelope virus and so they do just bit of the envelope with the cell with them which is part of the protein happily that means that they're easier to inactivate with disinfectants and the sort unhappily it means that their they circulate very very easily this has been the problem with this is they're very easily transmitted from person to person and in the fall we won't know if they mutate up or down but even with a vaccine for example most of you probably remember the what was called the Mexican flu or the swine flu out of the respect work for pigs and for the country of Mexico they finally just gave up and called it h1n1 and some people may not realize that those two letters stand for the proteins that are part of the virus the hemagglutinin and the pyramid ace I'm when you've got a one after them it means it's the first time around circulation and those are always who certainly we don't have immunity which means it's going to be more dangerous so that's it in a nutshell when
Howard: you were saying it was gonna come back in the fall are you expecting this corona virus to be seasonal I mean we hear that they live year-round in the tropics but in North America is it seasonal do you expect this one to be seasonal burnout in the summer heat and come back in the fall
Dr.’s Gordon and Rella Christensen other viruses there are many many in that categorization and they they do tend for reasons that are that nobody knows for sure but or hypothetical that things tend to slow down not necessarily go away but slow down in the hotter the month so that would be July and August may be June but you'll notice with the h1n1 that that particular virus starts earlier in the year we used to think the virus season went from October until about April whereas the h1n1 it is tended to start long about late August and September so if we're going to have to see but generally with the warmer weather and bear in mind the warmer weather it comes different times of the year and different parts of the globe and it's nice and warm up here in the northern hemisphere it's cold in the southern and vice versa so people traveling could face some very different situations depending on where they go but I think the important take-home lesson is to know that it's going to circulate it's not going away even if there's a vaccine there's a good element of control but it doesn't mean annihilation because the virus will mutate and be able to work around the vaccine when did you are you know another thing is the infection control so right now the ETA in all these states are saying
Howard: no one's told everyone to stop I mean we're you know we're still doctors not everything is elective the hospitals are open they're open for emergencies until they're told not to is what everyone is saying but the CDC guidelines on infection control a lot of people are confused and I wanted to know if you could clear it up there I post yesterday a study where human coronaviruses can remain infectious on inanimate surfaces for up to nine days surface infection with 0.1% sodium hypochlorite or sixty-two to 71 percent ethanol significantly reduces coronavirus and effectivity on surfaces within one minute of exposure you know that was from Professor Gunther Kampf in Germany what what what if if someone's seen if your staffs concerned that we don't know who's sick and you're seeing an emergency does this change any of the infection protocol or is what Gordon and you guys were saying at the beginning that we've been getting stronger and stronger from the HIV outbreak in 89 SARS MERS h1n1 and this Covid 19 were ready for with what we're already doing with universal precautions or does this call for more
Dr.’s Gordon and Rella Christensen let me give you an idea in front of you now is a special report it's going out as I speak and we have spent a long time getting it together this will come if you want it from clinicians report one long word clinicians report all lowercase dot-org and what have we got in there we've got a heading as you can see and then it follows up with a whole list that you can't read it anyway a whole list of practical do's and don'ts we gleaned that for many many articles in fact on this piece which is for five pages you will have more than one we've got about seven or eight references for you that you may want to take the time to look at since a DA is saying take three weeks off except for emergencies and I was strongly suggest you meet some of those because you have to make your own opinions all we're doing is reading them using well as expertise in she is an international authority and trying to make some conclusions I will say very candidly and I hope you're hearing it and I hope CDC's here I was just on the phone 30 minutes ago with John Suzuki was an immunologist for the CDC and is had dental FDA most of you know John you heard him speak he's buried honest well well well respected so he's even disturbed I can't speak for him but he's disturbed about the CDC recommendations in a minute I'm going to have Rella over and tell you what how she feels about that the CDC recommendations are when we say it back many years when you heard her speak you'll hear that so she's going to give me some practical information also in this piece a very very practical orientation or as directed right at Dennis and there are many things that are being said that are wrong I'll just give you a typical example if I bump her with my coat here guess what six seven eight days I also carry the city virus there are many theories going about I just had one that presented to me several hours ago thick pieces of mail that might come to you the virus we think from the research is staying on thick pieces of paper for several days is that how it's getting into homes should we be wearing gloves or open the mail we have no idea bottom line is there are quite a few things going on I I'm highly concerned about the hysteria that has been created by the press and well it has her strong opinions about the press as I do they exacerbated this is the point where you have no idea what you do there's a confounding suggestions this thing that that CR has put together now Sarah they're very very educated and well-known oral surgeon has been the lead author and there have been another fifteen of us that have been gaining information and putting the information into it right I suggest you go to clinicians report on long word or can pull this thing up it'll come to either dry-fit now who's the expert you recommended John Tsuzuki what who no parrot is on our staff yes he's an oral surgeon named Nile ni el es Niles Herod herrr he's the one that has been responsible for putting this together along with myself Derek Hynd and many other people who have contributed it's directed straight at dentists looked at do's and dont's sort of practice it's got prevention do's and don'ts what's the best thing on your elective procedures you know most up don't have a facemask it's adequate that's an example and then it's it goes into the lay public for your family what about self-protection and there about 25 points there some of which directly with youth lesbian go to you and so I suggest you look at that I'm concerned that the public was misinformed over and over and over again by the press just this morning on Fox you probably saw however this we don't know what didn't believe it or not but they're claiming and a man on who lives in in China in a Caucasian and he's directly stating that they're now going back to work person in my church unit has companies all over China met with him over the weekend and he's claiming that his operations are back to full right now he said there's still limitations they're still being quarantine if they had positive characteristics but he's thinking and I talked to John Tsuzuki about this minutes ago that's what John Tsuzuki how do you suppose just like it sounds Suzuki Jo Jo Ann Co jo-ann jo-ann suc su z 9 UK our Suzuki John teaches pareo and are in our hands-on courses and he and I are giving courses right now on in flat failure which is another major crisis flowing in the profession at this moment and so on you learn how to take care of that these are your inner there so if you look at the practical do's and don'ts for practice I think you get enough out of that to thinking to faith of the time going to the Internet we would like to stay that it's pretty strongly the best prevention is to suspend all elective procedures that's the ada that is basically CDC so we're we're stating get your Fanny out of there and even when you go in you better use proper proper control you are Nichelle and that's listed in this handout as well that's fine dissolve confession ice even get a day
Howard: how much but what letter grade would you give the 211,000 living dint license dentists in America with their current universal precautions that they've been using since HIV SARS MERS h1n1 as we go into this new COVID
Dr.’s Gordon and Rella Christensen she has been laboring on this heifer life doing research on organisms that are difficult to kill polio tuberculosis where most of the tests that have been promoted to you and me have been done on organisms I could do that with and Kyoto relativity theory well one of the problems has been the inadequacy of the very products that we depend on to protect ourselves you're definitely gonna want an employee covering and a mask that has a tight peripheral fit all the way around not just over the nose so that there's no leakage around the periphery of it and and they're only two brand names out there right now by prospect and by alpha protect that that make that kind of mask is been covered by a patent for many years all of you on I know that our listening inner aware that gloves have manufacturing leaks and this is a reason for considering double gloving because it would be a unusual wear two holes would actually overlap each other not impossible but unusual so we've had infection control products that really don't need the expectations of the clinicians and this is what we worked so long on starting back in 1980 frankly up to the present anything that a dental office was using an infection control has been through a lot of hands-on testing both clinically and in our lab with with actual organisms at track research and was set up with very sophisticated microbiology capability and technology and this has been going on for years and he's taken these these findings to the IAD on eight ADR that would be the International and American research community but it's been difficult how are you asked how well we've done in dentistry and frankly I'm going to use one of the best examples of that and that would be the pre wept wipes that come in a can where you pick them up much like a Kleenex tissue dispensing this type of product is originally brought on the market many years ago to white children's hands and to white babies butts if you will and and has never really been designed for health care and particularly any kind of a surgical or Hospital type of thing but has been brought in by the the women who use them at home and to try to convince people that these really are inappropriate has has been impossible to do because they love the convenience they love the smell but they don't kill and if he went down the line this has been a problem historically every single product starting with i covering going to face mask we the kind of clothing it's one these some things that you call scrubs are really not scrubs they are the under clothes one under a true surgical I'm very lucky for saving CDC recommends high neck and long sleeves all that 1% of you listening to this are doing that I made introduction control video or taking the CDC requirements and I know I'm getting yourself in trouble saying I'm saying but we called the profession to see how many of those CDC requirements were being accepted by the profession CA that's a problem we need more real world people who've actually walked in your shoes and gone through 20 30 40 patients in a day if I did all of those things exactly as they Barone that's all I ever do it would be my hobby there would be no revenue so we know we have problems here and well I have before for just a second on one of the pages of this handout I'm going to read this to you and then I'm going to promote relish stuff under disinfection listen carefully because it's you got to read through this little bit we need no more lawsuits use disinfectant to wipe debris first you know you're told to wipe it off with whatever use disinfectant to wipe degree then disinfect again oversee disinfection so you get me telling this use disposable gloves and electing wipes and sprays now listen carefully preferred CDC disinfectant is blah blah blah blah you know it as low as I it is hypochlorite hydrogen peroxide and spécicorn chloride and they're claiming chlorhexidine is not effective it is attractive for some aspects this disease is upset with that one as well so anyway then there is an asterisk and that leads you to how many of your publications would be put in by over sixty five or six several peer-reviewed blends right out of and so forth so please when you get this thing take a look at what CDC is saying and I respect CDC others that are getting on there now will hopefully get us some more accurate information but then read some of the research that uses more virulent organisms and advises well Howard the problem it always the discussion seems to always Center on disinfectants but I'll tell you honestly in I'm talking about this situation I feel there are three levels so that the first level is your immune system there's the best infection control that you have and I think in America we don't get enough sleep to rejuvenate our bodies at night and there are a lot of things that people do that it's tough on their body so your remember your immune system is your first line of defense and certainly healthcare providers being up to date and all of the adult vaccines those are listed on the CDC website we could send them to you electronically as well the second most important thing now this is my opinion in the transmission of particularly viruses and of this type is going to be the air the air that you breathe and the aerosol said regenerate as dental clinicians with any kind of an air driven instrument what we're really doing is picking up the saliva in the oral cavity and when you when you do that that that I can't even describe to you the amount of material that enters the air particularly when multiple clinicians are practicing at the same time there are keys astray I say gonna go back you we did a study just a while on air purifiers and you wouldn't believe I mean we got another five or six yes and every time some cleans their mrs. teacher so we did a study on it recently and then we got what's every major air purifier air filter companies and dentists and own staff and veterinarians have the most polluted hypotheses of any workers including sewer workers so what she's in what was it dentist veteran who that Dennis L SAP and veterinary so second we're first we're the worst one in a dental office you have all these droplets that she's just been describing and they're loaded with organisms s later office smells pretty putrid after just a few years from collecting all this stuff in drapes and carpets and chairs every everywhere so to say that we're in a sterile environment is a joke in fact the Chinese he's after this major episode a mentor have said clearly don't even see that it's unless assisted dire emergency because we have this stuff floating everywhere right now I was talking about the priorities in trying to operate in a dental office I mentioned first of all the near immune system to take better care of ourselves so particularly getting enough sleep secondly was the air quality and years ago we studied this quite in detail there is an organization we refer to it as ASHRAE it has to do with air quality in general and all types of buildings how much circulation and so on should be there and again dentistry is a problem because of the aerosols that we can't help but create so the question is how to clean them up and Borden is correct I do you so air filtration in our home and also in our clinics in our microbiology lab we use virtual clean premium HEPA filter system I don't think that's necessary in the dental office but I think we can do a lot better and also it has to do believe it or not with something as everyday or as engine high-velocity suction learning to suction properly can take care of a huge percentage of those aerosols over 90% of them and by properly what I'm saying here is that the suction tip needs to be opposite the instrument whether is water-cooled handpiece or whether it's an ultrasonic scaler or whether it's something like a perfect jet and we don't operate that way usually the assistants will come in from the top and actually suction the coolant water and so on off before it ever gets to you but what you want to be if the dog is operating from the facial that suction needs to come from the lingual to pull that water right across the tooth so and we have a little test we worked with engineers on how can a dentist know if his suction is adequate and it all you need is is a liter bottle it can be an old pop bottle it can be a milk bottle of a liter bottle this empty and fill it up with tap water and they turn all of your suction off and all of your operatories but one I would go into whatever you consider your main operatory turn on the suction and put the tip into the bottle and the actual bottle should be emptied in about eight seconds if your suction is adjusted so that it's not too high so that you suction out last and it's not too low so that you can take care of a lot of these aerosols so there's your air quality but you said the suction needs to be just succinctly again the suction needs to be at the same angle as the high speed or the Profi it is perfect it needs to be opposite it so that so that it's coming across the tube and and you're picking up everything but you need to be close and you need to be opposite the handpiece you don't want to take the handpiece coolant water and something does suction it off before it cools to and a lot of assistants do that look under magnification you see the water never touches the tooth so the assistant follows the dentist the dentist goes where he needs to go on to have access and the assistant follows and tries to be opposite wherever they pointed for interests of the dentist's ears with the suction and then like I said the suction needs to have enough suck but not too much that would be eight seconds for a leaders just time it what's your of your phone see if you can make that work and then the third area is the things that you touch and in in this case this isn't always true but in this case this virus is transmitted down on surfaces and that's where things start to get scary because we all touch everything and one when she brought me here and she wiped their way everything before she who said that I know but that's because I'm a microbiologist and we're all we're all crazy so I understand that I can't ask like that earlier but you would be surprised what what you touch one of the first things that you learn as a microbiologist in 101 as you walk in the lab is don't touch your face and I'm glad to see that that's being trans minute bye-bye via the experts that are being interviewed and it's making its way into the press don't touch your eyes nose mouth because all of these are major portal and portals of entry for viruses and as far as this virus is concerned I think another thing that it's a little frightening about it is is that it can be so mild we just had a case right here in Utah somebody at Park City they've come in to ski they they met some friends that are at a bar in Park City and a person was at the front door to check IDs and that person happened to be coded 19 positive and didn't know it had come to work safe that way and touched everyone's ID great breeze on those people and and this woman describes it in our one of our local papers newspapers here about how they went in and sat with friends in the bar for maybe an hour and how that was on March 7 which was a Saturday and by the middle of the next week every one of them was was positive for the virus but the symptoms they were having Howard were more like a like that like a cold they had body aches and pains and chills headache malaise and and weren't really having any just critical chest congestion and so on but they weren't having a nasal discharge and yet every one of them within about four to five days had had one that were testing positive from that brief encounter and this woman that they interviewed was saying that what was frightening was just how easily it was transmitted all of this happened without anybody guessing there was a problem on Saturday night March 7
Howard: meeting looks like a genius they shut it down and the Vancouver Dental conference went on and and they had four new cases and now dr. Bonnie Henry is asking all dentist in British Columbia to self isolate for 14 days so there is no dentistry available in British Columbia from a dental conference
Dr.’s Gordon and Rella Christensen: thing that's frightening I think to any dentist Howard into any person is you have team members and staff members and the payroll goes on but the income is going to be suspended even if you had your practice something we're finding a number of patients are cancelling anyway just trying to see what what direction and there are things can go here as a person that works with viruses and works in this area all the time I can tell you from what it looks to me is that we are in the beginning tail of the curve it will probably peak I'm guessing tear gas I'm guessing end of April early May those sort of everybody and then it'll start to gradually go down and you'll have another tail little last all summer and about the time you're feeling pretty good about things comes though this ball will be here and you'll be into needing to get the flu vaccine for influenza A and B and most likely the styles are and circulate too so it I think the take-home lesson is is to come up with strategies that allow you to live with it because that's what we're going to have to do right now again on get on their seasonal nough
Howard: start contracting slowing down when and when do you expect it to pick up and how do you wear well the way
Dr.’s Gordon and Rella Christensen I said it is that this is just strictly my opinion based on what we know about viruses and epidemics but here I'm only talking about here not talking about other countries I'm talking about what's going on here in the u.s. right now it looks like we are in the beginning tale of a true bell curve and that the peak of that curve I'm going to estimate is going to be end of April early May or maybe even a little later into May and I'm hoping that that will be seeing the ending tale as June July August and August you're going to have to look at the beginning they're due at the beginning of the tales of influenza A and B let's look at let's look at h1n1 we touched on that when we got off of it the swine flu Mexican flu h1n1 whatever you call it all the names for what did you say what names well it started being called the Mexican flu and it was called the swine flu and finally they just said look let's just call it h1n1 but it was all the same flu was about 10 years ago and we are still receiving strains of that in our nearly vaccines these viruses don't just come and go they circulate and they mutate and they and they keep moving as in what causes their mutation is as they move through people they're picking up different components and lots of different people's DNA this particular virus happens to be an RNA virus but the same principles apply because the human cell makes both DNA and RNA the RNA manufacturing the actual proteins so we're going to have to learn how to cope better on the date basis I doubt people are going to be anxious to shake hands or kiss no they're going to be a lot more conscious of the things that that they touch I mean
Howard: do you think this coronavirus is why no one's ever swiped right on my tender profile could be it absolutely could be but it's all coming together now so roll it but what would you what would you be advising again this country North America where you have this background of of experience would you do only emergency dentistry would you do elective dentistry or would it only be emergency or would you self isolate
Dr.’s Gordon and Rella Christensen well honestly Howard what everybody is waiting for right now is to see the direction of things looking at the the momentum how quickly it's going to pick up it's not going to go away right now and we're looking at the momentum to to try to estimate there were going from here the only way to slow the momentum this is honestly to close down so that people don't have people-to-people contact and that's very difficult to do so well so naturally it's a killer and as far
Howard: as economics is concerned to me this looks like 911 Lehman's brother and the y2k all into one it looks like the perfect trifecta
Dr.’s Gordon and Rella Christensen no absolutely because nobody knows how long it's going to last but I would say I certainly would would do only the emergency dentistry video and now on the end of the month see see the way things are going I don't I don't know that people are going to want come in where are the my office is open today and they're the they're still come and just saying okay there's 19 reported cases there's no –
Howard: it's all hysteria it's all hype I don't have any employees you don't want to work I don't have any patience I don't want to come in I'm going back there right after this that's not the case for everybody Howard right yeah there are states right now as a service morning um that are going to be paying unemployment to staff members I all will be among them that they will not compensate the dentist they gave only the staff maybe so I've canceled everything out for the next two weeks we're going to be watching and obviously you have my heart's at the no
Dr.’s Gordon and Rella Christensen we run courses all over the world they're over 20 major donators canceled including Yemen in most major what it goes we've canceled for many of our courses in practical clinical courses we we are going digital and I mean they will be to digital programs where you can interact with them our first one is whatever the sort of course is coming up the end of next week and that will be all digital right you sit at home and watch it and have questions and III see the future very very clearly on that because there's so many things you touch you think about it this morning is I got a knowing I was going to do this little thing with either night yeah I counted the times I touched something before I even got in the car it was 25 times that I actually touched something and he heard Rella on an inanimate credit card think that went over and that adamant object how many of those that we chose I went out for less today and I was very conscious oh I haven't touched the handle how many hundred people touch the door handle to go into that restaurant and think about what's on that door handle it well and I were in charge of the religious center and many years ago we had a thousand visitors a day and I was even conscious of again I wouldn't touch that right hand during that entire day I wouldn't touch myself because some of them were wet and some of them were dry has some looked like they had diseases are unbelievable he touch scenes all day that was just the morning for me before going to work I don't know if I counted everything all day would be several hundred touches not knowing need to be clear
Howard: is your advice to stop elective treatment now and what about would you stop emergency care
Dr.’s Gordon and Rella Christensen to I don't think you can read signal prevention practical do's and don'ts the best prevention is to sustain all elective procedures and there's a during that and dermatology we're doing it ophthalmology unless you really got the sincere challenge one of the states and I don't want to get involved with with the politics there the governor stated that although they have three or four reported cases I can remember the number was a very small that his medical advisors claim there must meet thousands of people in that state they're already infected well they think they have they think they have a cold yeah look what I described about the lady that went to the bar I mean you know what these are symptoms that I think a lot of people experience relatively often body aches headache malaise I mean we're not talking here sore throat or we're not talking fever lung growth I'm not talking congestion I mean these things were pretty mild symptoms and yet she tested positive and most people would power through that and but will world the person she and tricks' be mothers and it is the shutdown forever Howard it's a shutdown for a period of time to pause a gap to hopefully stop your review or transmission so you're looking at a period of a few weeks you're not looking at a period I have year or what what Gordon and you started talking about with China if you if you look at that if people are going back to work now it started in December so they had December January February and now in March they're starting to go back again that that's that's three months time very very encouraging yeah I don't know what it's still on Fox I go back and forth with Fox and CNN and that's it's like totally different inspections of a given topic but at least Fox was saying this morning as I'm going to do we started this man who actually lives there is stating that they're definitely on the downside by their own one case this yesterday and it used to be hundreds just not many many days ago so it looks like they're on the downside and you know this is the big people and we will be on the bad side I don't like I would hate to say I predicted I will see some kind of super expert but that would be a that would be a reasonable amount of time for on that bail encouraged to develop and now and then begin begin to subside think about her to you and Dad would be seeing at least 20 faces with hygiene and my age I was seeing a 70 a day with all the staff and multiply that out to their family of an average afford and then multiply the four out to others and you see this exponential solution for you how are your are you schools in Arizona close
Howard: yeah the schools have closed on they closed Monday so all the schools have closed thank you
Dr.’s Gordon and Rella Christensen what's that same with Utah they closed on Monday and digitally but if you if you log on to dental town right now
Howard: I mean I um you know I've been on that every day for since night actually today st. Patrick's Day we actually launched it on st. Patrick's Day in 1999 so this is this is our 21 year anniversary and my gift is talking to you too and but if you go to the today's act two topics my gosh every single thread there's 2,000 posts a day just on coronavirus and it's it's kind of the the politics of fear I mean it's just fear I mean they've never lived through a pandemic and they're panicking and
Dr.’s Gordon and Rella Christensen Howard they they could have have given a clearer picture of government of what the symptoms were and and what they what they could be if they were mild and moderate and severe and and a person it is true that that we were we were caught shy in this country for an arsonist as far as to have a quick test they have a chest but it's not a quick test it takes take some laboratory work and so you can run the tests but they may have a big backup in the lab until they can do the chemistry that develops the tests and so it's easy to criticize I hurt a lot of earlier today heard a lot of criticism of where we shut the borders down no link but then I heard when we shut them down too early yeah I I don't think that's the point I think honestly the point is that people are afraid because they don't know what to believe but I think it's been well established that there are a lot of cases that that aren't being reported and that are mild and the other goal is growing and and people would power on if it weren't for for going in and so like I need to keep holding you to the floor but yes or no if would you self isolate right now
Howard: for the next two weeks or would you see emergency patients see patients
Dr.’s Gordon and Rella Christensen I would you see you would see emergency people who are in pain dire pain to pain not to fakie when this bear had minor thing for six months and they just decided to come in Howard there before if we get to do it you have done more good in a fairly tactful way although some eight you some eight me too but my bottom line is you've done more good than any other single person and I congratulate you and dental town for doing the things you do and to get you to do so stay around well you know I'm gonna stay around I may never die so so back to emergency care you're saying that it's only for patients that are in pain severe pain what would your extinct
Howard:what would your exact definition of emergency care be
Dr.’s Gordon and Rella Christensen yeah I have a problem and if some dumb clown that came off you know a few months ago or its maybe a aspirin burn that they put on thinking it would be helpful to say they're just some ridiculous things with somebody who really has pain I just had one yesterday day before where they don't woman and when we did the card game on her that one sign is clear and the other one I have never seen a total sinus field on the Columbia is so you know it's easy framing this face is swollen that's true emergency so antibiotics aggression again I'll see you in a few more days
Howard: yeah and then just to be clear on that if you so if you were only gonna mean somebody has to be a doctor and see someone I mean the hospitals are gonna be open um if so if someone's in pain they come into your office they are really in pain and you're saying that to use eyewear plus a face shield mask gloves and long sleeves this thing
Dr.’s Gordon and Rella Christensen we've got special things there and then I doubt if more than one out of a hundred of you facemask is adequate right now not talking about what never talked about I'm talking about an n95 high filtration facemask there most of you don't even know what I'm talking about so you need something that actually will block pieces these things are less than one micron some of the glasses as much as a tenth of a micron you think about that the red blood cell is five microns even their diameters 50 microns so they are infinitely small so we've got to recognize how many places could they be that you're going to be touching their faces looking innovation making an aerosol this yourself well protected if you're going to see an emergency patient anything to add for the dent like I taught you in a world surge on Sunday and yo J was telling me out now I am he's booked all week with non-elective care means he's an oral surgeon in LA
Howard: what would what would you recommend for an office did you mean on oh yeah non-elective you know yes okay yeah be better protected zone well
Dr.’s Gordon and Rella Christensen Howard you know I've been a patient for many years at Mayo Clinic and and you have one right there in Arizona but I go to Minnesota and and there are there are ways to help a patient where you may or may not have to see them they ask for photographs that can be sent on the computer or they can be texted out by phone they try to make the judgments some on what needs to happen you can of course subscribe based on symptoms such as what others do in condemning if you if you if the main thing how it is to be careful because as a health care provider you've had years of training that's very valuable and if you get sick you're of no use to anyone your dreams I was invasions and roll it up and the it isn't forever we're talking here right now we're shut down for two weeks to watch and see what happens with the opportunity to shut down another two weeks or whatever we feel is needed I think come I wouldn't take it casually if you're older it seems to have a propensity to be serious in people who are 60 and older other many other ages have contracted it but have not been as likely to die from Howard: it why this seems like it's more men than women it was not just China in Italy –
Dr.’s Gordon and Rella Christensen it has been stated about China and I don't know about the other places I that's been part of what's caused the fear is that the information has been spotty and contradictory and so it sort makes you afraid you don't know what - what can we concentrate on I know President Trump had said don't rush to the grocery stores and in stock up but but on the on the other hand they tell you if you test positive now you've got to isolate and you're not be able or the grocery stores will deliver many of them well this is very nice Amazon is great that way now but the grocery store this very night because of always freakish in hysteria for one of my columns coming up next month I'm writing on what to do for the next one we're going to get over this one will get over mentioned if you start humming again so eventually we'll be over this but there'll be another one so what do you do and already I've got about 20 things they need to be they're not extravagant or not they're not something you can't do they're not expensive they're common sense and that shows you how I feel about we're relatively compared she's stored enough food there's a
Howard: some of my friends own lots of offices I've been talking to Rick work many as a thousand Heartland dental Steve thorns almost got a thousand Bob Fontana's got a thousand to those three gentlemen have all been on the show what would you tell Rick Steve and Bob right now you mean Express is the question mark Bob Fontana is CEO of Aspen's thousand offices Rick workman heartland thousand Steve thorn what would you tell the three largest captains of dental delivery today what would you tell them among those three you have upwards of 3,000 practices you know doctor and you take 3,000 practices times 2,000 patients per practice and you see it's an atomic bomb there you go on I
Dr.’s Gordon and Rella Christensen: I would suggest that I know this is ridiculous to you because many of you are suffering already we're suffering we lost just in CE we lost $100,000 last week so I'm not talking to my TV we've closed now and I think they need to take the similar kinds of precautions you know if I'd have whatever in a course you think about 200 you're an employer you know it comes to courses and multiply that goes out gets going on bathroom toilet flushes et cetera et cetera let's help the control let's help to level the curve and I'm waiting at least two weeks for a reconsideration we had a case a man reported here in Utah man went to Colorado to a business course and returned home and the people of course let him know that some people at the course had tested positive and going to he didn't test positive and he is in he was stating how guilty he felt because he was saying he was an index patient he had brought disease into Utah which at that time mom only had a couple of people's new ships returned home and he had a young son that the problems with asthma and you know he described that he knew on the airplane and at the airport and in other contexts that he had exposed a number of other people he doesn't know how many become sick because of their exposure to him but nevertheless he picked it up but of course brought it back and there it goes and that that's I think what we've said over and over in this interview how it is that not to take it casually and and as gordon pointed out to to do your part to slow things down and yes this point is going to have economic implications absolutely in your in your experience you've been in this arena with in the Howard: microworld for three decades today US researchers gave the first shot in a first experimental corona vaccine do you think do you think that this is something when do you think something like this
Dr.’s Gordon and Rella Christensen: could most likely be available the vaccine that they tested today they now have an experimental vaccine in Seattle which is the episode of America's recovery and they delivered it this this week so those patients had to assure that they were okay taking this experimental vaccine so it's already brewing in the side effects and
Howard: some people are asking about poor Queen that's going around the internet big time chlora clean that's the drug i think they used for malaria isn't it
Dr.’s Gordon and Rella Christensen: I can't comment Howard because I don't know about that malaria the malaria drug help let me tell you they're using four different AIDS antivirals on what their whole thing to do is to stop each replication of the virus probably the most promising thing I've heard of what was going on at MIT where they were trying to construct a the RNA pattern man-made and and how the have the body respond to it without it actually causing disease if you could put together vaccine of that type you could make it very rapidly and get it out very rapidly but the typical vaccine you're using the live virus that you have to grow them up in great quantities and then you have to you have to attenuate it and then you have to test it because you never know if it's going to say Corre
Howard: you said your you said this has already cost you a hundred thousand dollars in business how long do you think the average dental office could cashflow their bills and employees with an office closed down before the corona virus killed the office
Dr.’s Gordon and Rella Christensen: first that is definitely part of my article of mine and tonight I think this is my opinion I think they need at least two months save money practice money not on money I've got another thought on that two months for staff salaries and for Dennis generations their salary they don't have to be at their writing salary for at least two months some would say more heart but if you've got two months usually a typical problem will go away maybe you've had a death in the family you get whatever those things go away relatively fast if you've had two months now see we've been hyper on this thing about that wrong and there was starting to get a hold of it even out of the states are giving money to staff and so forth so that that would be something now at home no one knows how I feel we should have a similar kind of a salary it's fun and even some cash in case bank score I'm not suggesting doomsday I don't believe it but in case banks have a problem that simple stuff like that I see games growing up buying a new car and they own one hubcap on the Clark they own the doorknob on the outside it's stupidity a driver in my mind you need to have a store of facemask we need to have a store alcohol containing and materials for disinfecting about 20 things that you need and my thought is if they don't have that it's not even home fraud that was the hysteria we saw at any grocery store I went to the grocery store nearly a week this week and I just walked out the line was at least 200 feet long was taking two hour if you people go through now if they Darren even part of what as you said I didn't even talk about food stories you don't mean nine years of that we need at least a couple of months of food storage so we're negligent as a profession we spend too much most of those things how it can be stored the things that that are sensitive the storage would be operating gloves for layers and the reason the operating gloves that aren't latex or a store a little bit better but things like mass and I covering and your disinfectants they they should store just fine what do you think this means the death of the Cabot Ron was the first casualty of war from the coronavirus I mean you've been a hygienist for a long time are you gonna go to the Cavett Ron's funeral or I think it means I think it means another look and high-velocity options sir Howard we we actually set up a whole operatory and then when they laser particle counter and ran a whole bunch of experiments long before this this was period of years ago and you can do amazing things with high velocity suction that is functioning properly the office staff and the dentist's need to understand the suction column you have staff members that had never been with the suction pump is generally it's it's located in places in the basement where the spiders name them and nobody wants to change the filters and so they aren't well taken care of that it's not at all the these things can all see be handled in a very reasonable way as Fortin said we perhaps in negligence
Howard: I want to ask is when tele dentistry started I think um smiles direct club got it on all the newspapers and it's been the most controversial issue in all of dentistry for probably the last year smiles direct Club alone but now it looks like tell adenosine he is much much safer than in-person dentistry
Dr.’s Gordon and Rella Christensen: oh no question no question yeah that's fair Gordon you know practice properly there's there's the key we need to really look at what we're doing Howard and how we do it you know the emphasis for quite a while now has been on speed nice and speed and you know we need to go back and re-evaluate and and see what we've had to give up and of course all of that is based on on overhead and income but it doesn't mean giving things up and going back to the dark ages are not doing dentistry or whatever it means re-evaluating because I think we have the tools there I really do he met with my convenience adjacent staff this morning better we have a staff of 50 who sits in there and they continue education and we that is a team so we do not want to do away with hands-on courses obviously these eliminated those fearing these crisis people want the interactions when they need the interaction that they run to one another as much as they were maybe being Arella and of course so we're not trying to abolish hands-on don't look very carefully at those courses that could be done without hands on there are some practice management there quite a few I would rather sit in my pajamas sound sipping a soda and and watching the course taking notes and has to get on there
Howard: I want to ask another thing there seems that this outbreak seems to have been very different in China versus Italy versus Iran versus now and what would you say Ground Zero is would you say it was for North America the United States would you say it was Seattle
Dr.’s Gordon and Rella Christensen: well Seattle I think we have to realize that most of the problem is in one location or measurement and and you get a group of people who are already number one older number two debilitated and you don't really want to go below to room number three that you've got staff thus getting infected and so now you're down to half your staff you've got a real time bomb there was reading about one family where the the father he has six kids he's an older man he had gone in actually for rehab for a foot and knee surgery and injury that he had but in the meantime he was also had a little dementia I mean and he didn't seem well I mean he didn't he didn't see well enough to operate a phone and basically he wasn't a real resident of that particular facility and he found himself trapped there well he was called impossible and and these kids were actually yelling in doing through an open window and instantly was hard of hearing as well but you can see how the people in a situation like one how that's a worst-case scenario on they're in jail where you have a lot of people crammed into a small area they're older they're debilitated and that that's most of Washington so most of the cases in Washington have come from that that facility now early on now who knows what's
Howard: San Francisco is talking about closing down the quarantine starting tonight for three weeks what do you make of that
Dr.’s Gordon and Rella Christensen: well that's about right this is what we're describing and the end of this month end into the first third week or two of April that's what we're describing what I described is it beeping I think become prepped so the last week or so available and into May and not getting uh not getting a lot of relief until June we hope so you know it's about right on I I know that I I detect from from your comments that you really resist this and and little lover I a lot of the resistance is is your high energy your well tuned into the economic factors to the backup in patience with me and so on but it's it's
Howard: my final final question let's let's say that you're we're not gonna see patients for two weeks and that makes then to two months and you're a young dentist and you you run out of cash flow do you just what what do you do do you help your employees get an employment do you pray that the government's gonna have a bailout what what what are these young dentist with all these student loans who just bought a practice or looking at their patient flow equals cash flow if they don't see patients they have no cashflow what's your fatherly advice
Dr.’s Gordon and Rella Christensen: may I give you my mother please MOA how how would you how would you like to accidentally infect all those new patients and have that word get around in the lawsuits abounding since our parent organization has said don't do it you got it I'm in other words it's clear we're saying don't bury you do it and it's you know already there in died in Venice so if let's say a half a dozen of the cases I've noticed you have very few suits and Howard we're all in it together I I think if we can understand that I think hopefully banks will be more forgiving
Howard: one thing that I wish every dentist would do is that um you know when you say bankruptcies a lot of businesses that the number one common reason to go bankrupt is cashflow again like this you have a great business but it runs out of cash what does cashflow mean it means let's say that you do a job and you're gonna get paid a dollar and your bills cost you $1 a month but this person can't pay for three months so you have to have three dollars saved up to wait for your dollar so you run out of cash waiting for a profitable business to pay you everybody should be calling their bank about their line of credit the first thing I did when this broke out is reviewed my LOC and then I transferred the maximum you know do this now is there anything else you'd recommend so you'll call your banker get a line of credit and during an expansion get debt is leverages king but during a contraction cash is king so right now as we're contracting why are you paying your bills that you could pay late thirty sixty ninety days where you're gonna know a lot more now but right now you hang on to your cash don't you don't be normal bills I mean look I mean how many patients took 30 60 90 days to pay you you can just I would stop paying all bills until I figure out what was going on I'd rather get a late notice and have my credit dinged then run out of cash
Dr.’s Gordon and Rella Christensen: you just said what I would even say as the fatherly advice it's all about cash flow and and repenting of your previous sins and for the next pandemonium is what I call it abscent that it is it is a strong object lesson in a lot of ways the kind of old wake-up call if you will we should have been doing this all along I mean being careful well it was an honor that you guys come on is there anything that you wanted to talk about that I wasn't smart enough to ask let me just remind those who came in later those who you're gonna get this most of you take to see our report or involved with us at all you'll get this anyway on your email but if you don't get it on anymore go to there we go again all lowercase clinicians record all combined org and the front page of it that's what it's looking like the problem and there are at least 20 things for four to do in practice that we got on there and there at least 25 on self protection for you and your family and your patients and you're welcome to copy any of that stuff and give it to the patient ill and out and I think that would that would be helpful that's going to go to tens of thousands of people tonight at the month
Howard: well thank you for your decades and decades of staying on top of this and thank you for changing your schedule to come on the show during these bizarrely strange times as we all live through our first roll it do you is this already a pandemic in your mind is what yeah and what is your prediction I mean when I talk to my dentist friend I was supposed to lecture in Italy May 1 but when I when I talked to dental town townies from Italy and China and Iran it's crazy stories but what is your prediction if you could make a prediction what is it going to look like a month for now today's Saint Patrick's Day the 21st year anniversary of dental town what is it going to look like a month from today in North in the United States
Dr.’s Gordon and Rella Christensen: cases have occurred and in some will is subsided and others will be new but you'll have a lot more cases or it is what I can last but not least
Howard: I know my homies they're all gonna say but it's because the media doesn't talk about 20 to 80,000 Americans dying every year during the flu and you know that's all I'm hearing in Arizona this is only there hasn't even been one confirmed death of this but in this year's flu season it's already tens of thousands so there's a lot of young dentists who are using a lot of their so frustrations right so I'm gonna lose my office because of something that's not even half as big as the flu season this flu how would you answer that myself that's the same thing buncha cats already and I'm going to lose another couple of weeks over but
Dr.’s Gordon and Rella Christensen: I feel very confident that what we said is correct I hate what I've said I hate to be a doozy I'm not a doomsday I've said right at the beginning in this this is going to go away that may not go away totally and it may take a long time to go away it'll go away but we don't want another 36 million people dying as they did with HIV things enrolling what would your answer that same question be well Howard we're not going to know the actual percentage death rate until this has subsided you know people are just made they're giving you their opinion but we're not going to know as you pointed out in some countries the DES rate has been a lot higher they've done a lot more prominent people I'm talking particularly in some of the Arab states and Italy was it extra hard we don't know that's what makes it scary and it hasn't yet people in the US so you'd like to fight it I hear the determination in your voice but I think you've made a couple of good suggestions from from a business point of view to meet with your banker and and put things off and let the same develop but the same time
Howard: maximize your line of credit cash is king stop paying your bills this is uh this is all new thank you so much for coming on the show today it was just an honor and a privilege on the 21st birthday of Dettol town to have Pierre for chard and GV black showing up in their costumes as Gordon and Ronnie tell Mikey and will hello - how are they doing how's Mikey and world one down up in Canada
Dr.’s Gordon and Rella Christensen: in case you're wondering what's going on in Canada you shut down up there but we had a rehearse some Canadians the last hands-on course that I am using for a while we're going over tour was last week and we have some Canadians and they're Florentine listen they go back for two weeks minimum and when they go back to Canada because they've been yeah so it's it's everywhere
Howard: alright well have a great day thank you