Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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771 Life is Short - Follow Your Passion! with Susan Wingrove, RDH, BS : Dentistry Uncensored with Howard Farran

771 Life is Short - Follow Your Passion! with Susan Wingrove, RDH, BS : Dentistry Uncensored with Howard Farran

7/14/2017 10:24:30 AM   |   Comments: 3   |   Views: 301

771 Life is Short - Follow Your Passion! with Susan Wingrove, RDH, BS : Dentistry Uncensored with Howard Farran

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771 Life is Short - Follow Your Passion! with Susan Wingrove, RDH, BS : Dentistry Uncensored with Howard Farran

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VIDEO - DUwHF #771 - Susan Wingrove

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AUDIO - DUwHF #771 - Susan Wingrove

Susan Wingrove, RDH, BS, dynamic innovator, writer, International speaker, & 2016 Sunstar RDH Award of Distinction recipient. Co-designer of the Wingrove Titanium Implant Set, ACE probes, & Queen of Hearts instruments (PDT, Inc.) Susan is member of the American Dental Hygienist’s Association, International Federation of Dental Hygienists, Western Society of Periodontology, Academy of Osseointegration & Master Professor for Institute of Stomatology Tuscany Italy. Published author for multiple journals, Scientific Panel for ACP Clinical Practice Guidelines, as well as current textbook: Peri-Implant Therapy for the Dental Hygienist: Clinical Guide to Maintenance and Disease Complications, Wiley / Blackwell. Resides in Missoula MT. 

Howard: It is just a huge honor for me today to be podcast interviewing Susan Wingrove, RDH, BS with She's a dynamic innovator, writer, international speaker, and 2016 Sunstar/RDH Award of Distinction recipient; co-designer of the Wingrove Titanium Implant Set, Ace Probes, and Queen of Hearts Instruments, PDT, Inc.

Susan is a member of the American Dental Hygienists Association, International Federation of Dental Hygienists, the Western Society of Periodontology, Academy of Osseointegration, and Master Professor for the Institute of Stomatology to Scanno, Italy; published author for multiple journals, scientific panel for ACP Clinical Practice Guidelines, as well as her current textbook, Peri-Implant Therapy for the Dental Hygienist: Clinical Guide to Maintenance and Disease Complications. And it's available from Wiley? Do you have that book? They can get it on your website or Amazon, correct?

Susan: Yes, that's correct.

Howard: And where would you rather them get it? From your website or from Amazon?

Susan: Well, it doesn't matter. It's available through or Amazon. But there is a button to go to the site on my website.

Howard: Okay. And Amazon's just so ... there are so many dentists have that Amazon Prime on their phone and they got that one-touch click.

So on your website, where if they ... I'm on your website now on your phone. But now where's the book on your website? Do I have to tap the menu? [crosstalk 00:01:50] And then hit ... Okay so you got to tap the menu. Okay, so that is an amazing book.

"Susan Wingrove, author of Peri-Implant Therapy for the Dental Hygienist. Peri-Implant Therapy for the Dental Hygienist is my passion on paper. A special thank you to my friends, colleagues and companies contributing to this evidence-based book. I hope that offices embrace it as a resource for implant maintenance, therapy regeneration, and home care for implants to be successful for a lifetime. Click on the picture to order a copy of the textbook or eBook."

So here's the problem we have. You know the old man comes in with three liver spots; he had an implant placed 10 years ago, it's got peri-implantitis all around it, and you tell him, "You know dude, this has got to come out; we need to put a new one."

But there's no pain. He can go to Long John Silver's and eat all the pizza he wants, and he just wants to keep it.

What is your advice on treating peri-implantitis?

Susan: There's guidelines for that Howard. Once it gets to a certain point and there's not as much bone available, it can be a little bit of an oral systemic threat to the patient if it's not in a healthy situation. They might be able to go and eat and things, but you got to look at the whole body, and if there's some oral systemic reasons why that needs to come out and a new one put in, there's guidelines by Dr. Froum that has excellent guidelines on that in the textbook. I've got a whole protocol on that. When you need to refer, when does it need to come out, and here's what we can do to save it though. There's many different saving options now for peri-implantitis, even cement implantitis where you can go in and you can get that treated and ... flapped open, treated, guided bone regeneration, put back in place. And it only takes about three months to heal.

That's the ideal situation.

Howard: You know, it's so funny because you see all these ads for implants that say, "Yeah, we only have a 1.5 percent failure rate." Okay, maybe out of the gate, but 10 years later what do you think the peri-implantitis rate-

Susan: The peri-implantitis rate is higher, especially after five years. We seem to notice the peri-implantitis a lot between five and ten years out, so when I'm talking to hygienists or new students or the universities that I talk to, the treatment is you just really need to catch it early. And you need to really be on the top of your game between five years and ten years to really look for some signs to see if they're going to have implantitis develop.

Howard: And do you think it's obviously the problem is that some teeth are lost for dental decay, failed root canals, and some teeth are lost from periodontal disease, and it's just a whole different ball of wax when you're placing implants for teeth that were lost from trauma or decay, versus from teeth that were lost from perio?

Susan: No, it's about the same. Once you've got the infection cleaned up, it would be treated the same. You need a good foundation; you need a good guided bone probably regeneration treatment, or socket preservation, and then the implant placed for it to be really successful.

I think it's about the same, but the difference is that somebody that has that kind of a background, or lost the teeth because of that, just needs to be on a shorter re-care; to come in and see the hygienist. They actually have some statistics, like 43% of people will get some form of peri-implantitis if they don't go and see their hygienist at least every six months. That's only 18% of them will develop peri-implantitis if they're treated really well, with a hygienist or a dentist that's monitoring them and cleaning them the right way.

Howard: So what's got you passionate these days? How long have you been in hygiene? How long have you been a hygienist?

Susan: I've been in the dental profession over 40 years, but I was a surgical assistant first, and then I went into hygiene. So hygiene I've probably done more than 25 years?

Howard: So after 25 years, and podcasters they're so young, you know. People our age read textbooks, and I can't wait to read your textbook. But the young kids love the podcasts and the online CE's and YouTube and all that stuff. What lessons would you tell the hygienists that are all rolling out of school right now? We just graduated a whole bunch of them this week. What would you tell them as they're embarking on a career in dental hygiene?

Susan: I'd like to see them know that that was where they got their start; that's where they got their basics, but now they have to continue to be lifelong learners because it's a regeneration dentistry era. So they need to continue to listen to podcasts like yours, go to CE's, do the things that are necessary to keep up to date on what's changing, because regeneration for dentistry is changing so dramatically all the time. So they need to know that they started, they have a good basis, but now they've got to continue their education and find out what they're passionate about. I think they will start to develop their passion once they're out and working. 

Howard: And what do you mean by regeneration, and why has that got you so excited?

Susan: Well, I started in regeneration research in 1995, working with FDA trials for tissue and bone regeneration; did the dog trials. I'm a freelance writer, so I wrote up the different clinical trials and it really lit a spark in me to see that we can regenerate the tissue that we thought we couldn't before. We were taught in school: it's lost, it's lost. It's not lost. So it's really nice that we can regenerate that tissue and bone back. And now I'm all charged up about biofilm; getting rid of biofilm all the time, and the implications of overall health. Every year I get into another passion I think in another area.

Howard: What are you regenerating with today? I mean, how is regeneration working today?

Susan: Well, hygienists, we can't do the regeneration that's out there yet. I'm working with some trials to see if we can get a process through that hygienists will be able to do regenerative therapy for periodontal disease. But right now, it's in the hands of the specialists. But it is possible to regenerate periodontal disease, and there's guidelines for that, and I teach classes on that all the time. But us as hygienists we have to wait until we have our process that we can actually do. We can't regenerate at this point, but we can be the first responders and get them over to the specialist at the right time to have this done.

Howard: I wish you would make an online CE course on that on Dental Town. That would be an amazing course, because the dentist has to watch it, but the hygienist and the receptionist and the assistant has to watch it. Because when you look at the questions being asked and answered, it's actually the people at the front desk that are getting most of the clinical dentistry questions. So when you sit there and just educate a dentist or a periodontist, the patient probably won't even get to the dentist or the periodontist, because they've already asked the questions to the lady answering the phone, not when they're in their getting cleaning, or the assistant. So the whole team's got to know. That would be an amazing course for you to put on Dental Town. I'd love to see that. Any chance at that?

Susan: Sure, sure. I do courses like that and enjoy them, all over the country, and love it. That's my passion is to teach and to get the whole office excited about it, excited about what era we're in right now.

The hygienists coming out of school and the young dentists coming out of school just don't know how exciting it really is that they are coming out into this profession at this time, with all the new advances and all the new possibilities for them. It's amazing.

Howard: You know humans tend to think linear, like when housing prices go from $100,000 to $200,000, everybody thinks, "Oh, it's going to go from 200 to 300." They don't realize that it's in a bubble and it's going to go back down. They do it in stocks. And I think of all the nine specialties, I think the periodontal specialty changed the most in my 30 years since I graduated in '87, and I saw the pendulum swing towards implants like, "Well, if in doubt." "Oh, it's got a deep pocket." "Oh, it's got a trifurcation, just treat it with titanium."

And so many periodontal surgeries switched over to extractions and implants, but now I'm seeing the pendulum coming back. And a lot of it's driven by the patient who just, when you say, "Well let's pull your tooth and place an implant," they're kind of emotional, like, "Well I don't want to pull a tooth." "Is there anything else you can do?"

And it's almost like periodontal therapies are like last resort for emotional people that can't have an extraction. But now the dentists are starting to see, "You know what, let's try to keep this thing, because implants aren't as awesome as everyone thinks they are."

Do you think there's a bias by a lot of dentists who just think an implant is more predictable than treating a molar that has periodontal disease?

Susan: That just depends. I think all teeth, if you can keep them in the mouth and they're healthy and there's no oral systemic threat to the patient. With the biofilm knowledge that we have today, we have to be very careful. If they're treated with a regenerative periodontal disease treatment, which means they have bone, and they've only got pockets about three millimeters deep, then they're going to be overall body healthy.

If they're leaving very deep pockets and deep areas in the mouth or furcations that are too deep, that's a different thing now. We know too much now on how that's going to increase their chances for oral systemic diseases down the line. Really what we need to be looking at, Howard, is an overall healthy mouth. How is that? Evaluate it; I've got several different protocols in the textbook on how to evaluate that for periodontal disease and for peri-implant disease, and I think the hygienist can be real key on this, but the dentist should also be very, very involved in monitoring any tissue loss and any bone loss in the mouth. And doing that, first and foremost, to save the teeth. So there's a lot of bone and a lot of tissue regeneration we can do to save the teeth, and have a healthy situation that don't need to do implants right away.

Howard: Dentists, hygienists, specialists. They've gone to a lot of years of school and read a lot of books. So they're very cynical. I think they're the first people on the internet to discredit fake news. But there are dentists out there, and hygienists out there who say that this oral systemic link, it's correlation not cause and effect. How come every time I make coffee in the morning the sun comes up? It's a correlation; my coffee pot didn't make it come up. What would you say to a cynic who said, "Those are all correlations; they're not really cause and effect." Which oral systemic disease do you think there's credible research links to and it's not correlation?

Susan: We've got, and I know this is sometimes controversial, but it shouldn't be anymore. There's a direct link to cardiovascular disease. You've got the book, "Beat the Heart Attack Gene." That's a fabulous book if people want to look at something like that. There's a good diabetes patients, really, really good information on the link for diabetic patients. There's several links, Howard; it's getting to be more and more of them are linked to periodontal disease. I think we really need to take this seriously. There's blood tests they can take that are CRP blood tests. There's other evaluation blood tests that patients can take. Do I have any inflammation going on in my mouth? So if they're a cynic about it and they have a very high inflammation level in their body, they can clearly see on a saliva test or a blood test. That may be more convincing to them then.

Howard: And it's tough because we're trying to explain this to our patient. Whenever I tell some man that it's gum disease that could affect his heart, he always says, "Don't worry, my ex-wife already totaled my heart." But we're trying to tell them these oral systemic links, and then the New York Times is publishing articles that there's no evidence to even recommend flossing. You know what I mean? It's like, "Thank you media, thank you; I finally was getting grandpa to floss, and now you're telling them there's not even any research."

What are some ... for young kids who don't have the verbal skills ... what would you help them say to patients when they said, "I read in the New York Times, the L.A. Times, there's no evidence for your floss." What would you say to that?

Susan: That's a hard one, and I think it's hard for hygienists because they get asked that question all the time, I'm sure, since that thought came up.

I think that we have to look, overall. If they're not flossing, they have to be doing something else then. They have to be doing interdental cleaners; they have to do a Waterpik, or they have to be doing something else. But somehow, they need to get rid of the biofilm in their mouths on a daily basis, and we have to do some education with our patients on that. 

And I think the saliva test ... There's a new ... It's kind of a campaign called "Connected Oral Health." And Dr. Tony Hashemian out of A.T. Stills University in Arizona is heading it up, and I'm helping him promote his program of pH to OH. And it's connecting the young people on their smart phones, where they can test their pH level and take it, note it, chart it onto their phones. Oral-B has an Oral-B app for that, that's also monitoring and charting and identifying where any plaque or biofilm is in the mouth.

All of things are kind of leading to using your smart phone, all the different technology out there. And I think the young people like that. If they can see it on their smart phone and they can do it easily with what we call an oral health app. You know, getting them into a little bit of that; monitoring their own health. They all use Fitbits and all those kind of different devices. It's no different than checking your saliva. So if you can get them excited about monitoring their health themselves, and then they see it; they see it charted, they see it on their graphs on their phone. And then they're more likely to take your recommendations.

Howard: Tony Hashemian, he's a buddy of mine, because I'm in Phoenix and he's in the dental school right here in Mesa; Associate Dean for Global Oral Health at A.T. Still. It is such a changing world.

Another common question ... I notice you keep saying biofilm.  Am I just showing that I'm a grandpa twice when I still say plaque? Is plaque the wrong word? Should we start all saying biofilm instead of plaque? 

Susan: Yes, biofilm is now the new word. It is dental plaque in the mouth, but we were pretty guilty of just treating our patients from the neck up, as physicians were treating people from the neck down. And now everybody's going to be together with this connected oral health and just general health movement. And it's all going to be biofilm. So now we're going on just biofilm as the terminology, because it does go through your whole body, not just your mouth.

Howard: I always called it tartar, because I got a "D" in calculus. So I couldn't say calculus because it reminded me of flunking those tests.

So plaque's out, because plaque was biofilm on the teeth, but there's actually biofilm all throughout the body.

Susan: That's right. So now the new term is just biofilm, because we're doing total body health now, not just looking at the mouth. We're trying to get the patients so that they're overall healthy.

So the hygienists, this is kind of a paradigm shift for them. They have to think about how are they going to remove the biofilm in the mouth and the calculus in the mouth? Where before they were just primarily worried about getting that tartar off the teeth.  But now, we've found it's more important to get rid of the biofilm than anything else, and they have different tools for that, like the subgingival air polisher; the Air-N-Go Easy by Acteon is an excellent one that is the one that will treat mucositis, which is gingivitis for implants as well. So they can use it for natural teeth, getting rid of the biofilm on every patient, and then use it on implants to get rid of the mucositis or biofilm around implants. That's a new tool; kind of a new shift in hygiene that they should get aboard with and do in their office. 

Howard: My God, that book, "Beating the Heart Attack Gene." If you talk to three dentists, one's already read it. What do you think about that?

Susan: I think it's excellent. They have preceptorships that hygienists can take as well. They can go into a course and do a preceptorship all on inflammation. And I know that's where we're heading. We're basically headed for inflammation elimination as much as possible in the mouth. That means checking the tissues, checking the bone levels, making sure that the patient understands some really good ways to get rid of the biofilm in the mouth, like your Oral-B power toothbrush used daily. All that kind of thing. Anything like that, that you can get rid of the biofilm on a daily basis, we're going to try to emphasize with patients. And then we have to do that as well at our appointments.

Howard: You just said Oral-B. It just seems totally intuitive that a power saw can cut through wood more than a manual saw. Do you think an electric toothbrush, saying Oral-B, is a power saw or a table saw, as opposed to a manual saw? Do you think when we're trying to get these people to remove the biofilm, that an easy, obvious answer is to switch from manual to electric, or do you think manual and electric are pretty much even?

Susan: You know they had some research out that they were even for years, and now, with the new evidence for biofilm and sticky biofilm and getting total elimination of inflammation in the mouth, we're now, what I would say, in the power tool era, where all the power the better. The Waterpik, the electric toothbrush. And Oral-B has the most scientific research on theirs, and the most tips. Dr. Masoud did a really good job of helping them design some tips for implants, so they have the implant tips and regular tips for the mouth to use with a power toothbrush.

Anytime we can get them on a power toothbrush, they now recommend that we ... Had a scientific panel, Howard, that met in 2015; we published in 2016, the American College of Prosthodontic Guidelines. And they were for healthy teeth, but they were for implant-borne restorations and tooth-borne restorations. So basically, everybody, somebody that has any kind of restoration they have in their mouth. But not disease. This is just for healthy mouths. And the recommendations were all power tools now for the recommended tools to recommend to patients for anyone with a restoration in their mouth. So it's definitely gone in that way now.

Howard: What's your favorite electric toothbrush?

Susan: The Oral-B. I like the new 5000 or the Genius, because it actually shows the patient on their phone where they've missed. And it used to be, "Okay, where they missed, or the D-plaque or whatever." We've talked about that for years, but now we understand that we don't want to leave any biofilm behind on a daily basis. So how are we going to do that? We're not going to use disclosing things at home and all that, but we can certainly use our phones, and it connected up to the toothbrush, and the toothbrush shows you exactly where you've missed. So it's like plaque detection via your smart phone. It will say, "Okay you missed it here." You go, you do it, it says, "100, yeah." You've got them all. So now you've done at least that elimination at least once a day that way with your phone, and know that you've eliminated all of the biofilm.

Howard: Well, yeah that Oral-B Genius. So you like that ... It's gone to the round spinning head. I remember when Interplak came out. It was actually the same size, bristle shape as a toothbrush, you know the more rectangular. But you like the round.

Susan: Yeah, well they've done a lot of research on that. In fact, I think, if I remember what I was using for my statistics on different articles, it's about 32% better, Howard, than the other shape or form of using a power toothbrush. And if you get them a combination of that with doing the Bass technique, you know, hitting every two teeth with the round rotary brush. You show the patient how to do that, that's ideal. And they've got programs for that. They've got these test-drive things now for Oral-B where they give them a toothbrush in their office with the sleeves, with everything they need. They'll supply that whole office, they just have to request it. And people can test-drive these things in their mouths right at the appointment, and see how much better they do. And that's pretty neat.

Howard: Have you met a lot of these people on the Oral-B team?

Susan: Yes. 

Howard: The Oral-B Genius?

Susan: Yes, yes.

Howard: You connecting it up to your smart phone, is that starting to take off? Are they getting any market penetration, or how is that rolling out?

Susan: Yes, I think it's going well. They actually came out with the 5000 and the 7000 internationally. It was the 7000, and here it was the 5000. And both of those took off just like lightening fire. And now the new Genius is even one step up from that even better. But if they can get any of those power toothbrushes and then use the Oral-B app with them, they'll be in better shape.

And you can use any Oral-B you have, even if you have an older Oral-B. You can get the new tips for that, so that's kind of a nice thing to tell a patient too.

Howard: A lot of the dentists and hygienists, they see a lot of advertisement for things they can put locally in the pocket, when people have pockets. There's all kinds of minocycline. Are you fans of any of those local chips or impregnated floss, or anything to deliver something locally?

Susan: The new guidelines, Howard, are pretty clear. At 5mm bleeding pocket that you do an SRP on and you treat it, you can use those products. But you only get 1.3mm to 1.8mm attachment regenerated with that. You don't get any bone. You only get long, epithelial attachment with that. So it's not regeneration by any means. It will help a 5mm pocket, but anything deeper than that, no, I'm not a fan. Because then you need bone. You need something in there that's going to regenerate bone.

Howard: And what is that?

Susan: Like an emodine is out there right now. Very popular to use to regenerate bone and tissue for periodontal disease.

Howard: Amdogane?

Susan: Amdogane by Straumann.

Susan: Tell us about it.  Amdogane by Straumann. Straumann is the dental implant system out of South Korea, Dr. Parks.  Yes, and it's a-

Howard: How do you spell it, Amogane?

Susan: Amdogane yeah.

Howard: Endogane?

Susan: Emdogane.

Howard: Spell it.

Susan: I think it's Emodine?

Howard: Emodine from Straumann.

Susan: Yes, that's one of the most popular ones right now, Howard. There's several new ones coming soon. But for right now, that's the leading one in my opinion. They have to regenerate the periodontal ligament, and get new bone and new cementum in order to really hold those pockets for those people who have a 6mm or deeper pocket.

Howard: How long have you been watching this Emodine Straumann bone regeneration?

Susan: How long has that been going on?

Howard: Yeah, how long have you been watching that?

Susan: Oh that's been years, Howard. That's been out for at least four or five years now. So that's been one of the leading ones for quite a long time. Mostly done in a dentist's hands at the moment; we can't do it as hygienists. Some hygienists are able to use it in specific states, but most of the time it's in the hands of the dentist or the specialist.

Howard: Okay, very good. We should do an article on that on Dental Town. We probably haven't done that for a long time. What do you think?

Susan: Yeah, and I've done several columns on that: managed repair, regenerate. I just did an article on that and it was republished again recently. It's something that I truly believe in. We need to be providing our patients with the best that we can, and anything deeper than a six really needs guided bone regeneration. We really need to start thinking about that and having a specialist or somebody in our area that we can refer to, to do that. Or the dentists themselves can take a course on how to do that, and do it in their office.

Howard: So what else are you passionate about?

Susan: Well, I don't know. My big passion is teaching ... I like to teach the students; I've done a lot of international teaching for students, and I'd like to do more here. I've worked with a lost of Master's students on their projects. I like working at O'Hehir University for hygienists to be able to get their bachelor's degrees online. That's been kind of my passion lately is working on that and working on regenerative projects.

Howard: What is Trisha O'Hare's ... what is the website, www.o'hei ...

Susan: Yeah. Her name. Her last name-

Howard: Yeah, it's hard to spell though. O'Hare-

Susan: Ohierer. Yeah. Ohierer University.

Howard: Well tell my homies about Ohierer University.

Susan: It's an online program that hygienists can take to get their bachelor in science degrees if they haven't had it already. It's something that's just a really nice way for them, while they're working as a hygienist, if they always wanted their bachelor of science, didn't get it at the time that they went through their program. I don't care how old they are; it's all ages, it's international students and United States students.

So it's kind of fun; when they go on to these classes, they'll have international hygienists in their class as well during this. And they do clinical projects, which they can do right within their office. Things that they've always wanted to know the difference of. It's just a really neat program for oral health promotion. 

It's a nice university at a cost-effective point for a lot of hygienists to get their bachelor of science degrees.

Howard: So I know my homies are driving. Podcasters are commuting to work; they had about an hour commute. I tried to give them notes so they can find it. O'Hehir University, Trisha O'Hehir; O'Hehir is spelled O, apostrophe H-E-H-I-R. Her Twitter is @ohehiruni, for university. So I just re-tweeted. It says, "OHU grads, you can offer a $250 discount on OHU tuition to your RDH friends." And I'll retweet that. And then our next tweet was, "Vote for our suggestions for future research." I'll retweet that.

What is your Twitter?

Susan: I believe it's sswin.

Howard: Yours is sswin?

Susan: I think so, I don't have it memorized.

Howard: Sswin?

Susan: Yeah, I think so. It has a little typewriter that pops up with my name and a little typewriter shot.

Howard: I'm not getting it.

Susan: I'll have to look for-

Howard: No, it's @susanwingrove.

Susan: Could be, could be.

Howard: Yeah, there it is. So I'm retweeting you. Your last tweet was four days ago, "Great way to start off a Memorial Day weekend at Lolo Peak Brewery." Do you want me to retweet that one? Or, "Elton John in Missoula. Heading to the concert." Is that your husband?

Susan: No, no. That was just going to the concert here in Missoula. No, I'm a widow, Howard. I lost my husband in 2008. He was a periodontist. He taught at the University of Iowa, and we did regeneration research together. He's the one that-

Howard: [crosstalk 00:33:42] How long ago did he pass?

Susan: 2008. We designed the instruments together, the Wingrove Implant instruments together. So the set PDT.

Howard: How long were you married?

Susan: We were married seven years.

Howard: You were married seven years?

Susan: Yeah.

Howard: And that was almost nine years ago.

Susan: Yeah.

Howard: That's tough.

Susan: I know.

Howard: How long did it take you to recoup from that? I mean how long does the pain just knock the wind out before you start getting back to your feet?

Susan: Well, for me it took quite a while. I would have to say a good three to five years. And I finally just had to up and move. I drove the 24-foot truck out to Montana to hike and fly fish, and do whatever I wanted to do passion-wise, and write a textbook and things, and not really worry about money too much. Just do what I was passionate about, because you really can't take it with you. And you learn this when you lose someone like that and you think, "You know what, I'm just going to do what I'm passionate about." And that right now is teaching hygienists to advance in our profession, and writing. So that's what I do.

Howard: You know I wish you would create an online course for us, because on Dental Town we notice that they're watching these courses around the world, and so many of those countries don't have a hygiene department yet. There's 220 countries. I know Trish O'Hirer was instrumental in bringing hygiene school to Australia as recently as just 20 years ago.

How many countries do you think there's not even such a thing as a licensed, registered dental hygienist?

Susan: I think I've been to 15 or 20 different countries now teaching, and I would say only half of them had hygiene programs. I taught the dentists about regeneration, what we're talking about today: regeneration, implant maintenance. Because I found it's just as important to talk to the dentists about the implant maintenance. Like France, for instance, they don't have hygienists, but they're very passionate about doing the maintenance themselves. So you have to do work with the dentists then. But somebody's got to be doing it. We're trying to build a hygiene program like England's in France if we can get it started.

And Ireland is come up; Ireland's really doing well. Great hygiene program in Ireland. And I work with the Italians out of the Tuscany Institute every year. The Italian is just fantastic. And their students do clinical projects, and government funded projects, and things for oral health; like home care, that we can't necessarily get funded here, they do there. Which is wonderful. So it's just really been interesting to do both: work internationally and work here.

Howard: Why do you think the Italians and the Brits and the Irish have hygienists, and someone like France does not?

Susan: No idea, because that's where satellites started-

Howard: I mean they invented the french fry. You know those people are smart.

Susan: I know. I hope that they'll change their mind and they'll get some hygienists soon. But they have some great technology comes out of there. We've got the ... well the Acteon Company comes out of there. I think more and more now with this technology going for the subgingival air polishers and the Piezos and all the different things, maybe they'll start to get on board with that and get some hygienists too as well.

Howard: You said the Acteon Company. What product of theirs do you like?

Susan: I like their Piezo implant protect tips. They have the only Piezo tips that are safe right now to use around implants. So I really like the implant protect tips. And I like their Air-N-Go Easy subgingival air polisher that they have. They've got a new one, Howard, that the dentists should look into. They've got a new 3D machine they just came out with, with a great price point, kind of a growing unit. One where you can get the digital panorex and then grow into the 3D scan. So a lot of really neat technology coming out of there.

Howard: And how do you spell that? Action?

Susan: Acetion?

Howard: Acetion?

Susan: Yes. Yep that's it. Acteon yeah.

Howard: I'm still not ... I'm sorry ... Act-

Susan: Eon.

Howard: Eon. Acteon Dental.

Susan: Yeah, and they've got a U.S. group here that's quite strong and you can get a Piezo to go right on your [inaudible 00:39:00] chair even and things like that.

Howard: Is it, the web ... Acteon Group. That's where I'm going wrong, it's Acteon Group.

Susan: Yeah, Acteon Group.

Howard: Okay. And they're out of France?  Yep they are.

Susan: Mm-hmm (affirmative).  So that company's got great technology coming out that people should look into. I think it's going to be a great one; this 3-D for general dental offices to grow with, because you can just add on without adding whole different units. They can add on to their ... add 3D when they can and things. So it's going to be really neat to see that come full circle for everybody.

Howard: I want to ask you, there's a lot of controversy in transmission of disease. Obviously below the belt, everybody on the planet agrees you can pass syphilis, gonorrhea, and all that stuff. But it seems like you still see dentists who don't believe it in the mouth. You'll go in their office; they treated mom every three months for 10 years, and no one's even seen dad. And then when you do see dad, he's got three teeth rotted off to the gumline. He's got a partial on ... he's a garbage mouth, and the dentist will say, "Well it's not transmissible when they kiss every night or share spoons."

How come below the belt bugs can transmit, but above the belt, they don't? What do you think about the transmission ability of these diseases?

Susan: No, it can so transmit to their ... You definitely gotta treat the spouse. You definitely gotta watch it, and if you're real affectionate with your dog, you can transmit it back and forth between the animals. 

Biofilm moves, it moves. And it's in your saliva, it's in your spit. So yes, definitely. If you're sharing spit with somebody, that person also needs to have good oral health or you're not going to improve your oral health any.

Howard: I mean, every dentist listening to this show could increase their hygiene department 20% if you just instituted a family policy: We're not going to treat individuals in a family. I can't treat you for chlamydia every three months for 10 years until we get your husband in here. You know what I mean?

Susan: That's right, [crosstalk 00:41:17]

Howard: And the other thing that's stressful is the pregnant girls are hearing a lot of mixed messages. Number one, they hear that the baby's gonna get streptococcus, [inaudible 00:41:28], canker sores, cold sores, herpes simplex, all that if she's kissing her baby's mouth.

Do we really need to tell pregnant moms that, "Hey, new thing; from now on when you have a baby, you never kiss it on the mouth." Is that where it's headed?

Susan: No, I don't think so. You can get your mouth in good condition. You can use antimicrobial mouth rinses for yourself that lasts for eight hours. There's no reason why they can't be as affectionate to the babies as they want to be. 

But they gotta be smart about it. They should be taking care of the baby's mouth from the time that they're born, as well as taking care of their own mouth. This is why the biofilm thing is so important, is that we have to start making that connection to our oral health and everybody around us.

Howard: What antimicrobial mouthwashes do you like?

Susan: There's several out there that are good. The CloSYS mouth rinse by Rowpar-

Howard: That's made right up the street from me.

Susan: Yep. And it's a chlorine dioxide product, so it's a natural product. It doesn't stain, it lasts for eight hours, it's an anti fungus, antimicrobial. It's got such good promise to it-

Howard: It was invented by Perry Reed, wasn't it?

Susan: I can't remember who started it.

Howard: It was Perry Reed, and now he passed away and now I think his son runs that, or-

Susan: Andy, yeah.

Howard: Is it Andy Reed with CloSYS?

Susan: Yeah. And Jim Radcliff is involved with it as well.

Howard: Jim Radcliff. It was Perry Radcliff.

Susan: Yes. And it's Jim-

Howard: Perry Radcliffe.

Susan: Yeah.

Howard: Yeah, I used to love that guy. That guy was my biggest role model periodontist, just because, talk about a character. I called him up one time and asked him a periodontal question. It was like in 1987. And he said, "Well, actually I can't answer that on the phone in five minutes." "We're gonna have to go to dinner on that one." So I said, "Okay."

We went to dinner. We ate, we drank until one o'clock in the morning. I think he explained to me every periodontal thought he had. He was so damn cool, and those are just the most amazing mentors when you're a 24 year ... I was 24 when I graduated from dental school. Opened up my own office. Here I am some punk kid, and this guy at the time might have been 60 or 65, and he talked to me for like six hours trying to-

Susan: Oh, that's great. That's great.

Howard: And now he's gone and his son Jim [inaudible 00:44:16]. 

So you like CloSYS which is called Rowpar. And I think he was also, at the beginning, he was affiliated with Omar Reed with that, wasn't he?

Susan: I don't know that if he was. But that product came into my realm when Frank and I were doing our research in '95 for the product that we're working on and it was the one that doesn't interfere with healing, but helps with healing. So it's the one that I would say for pre- and post-rinsing, you know, pre and post, that they use from now on. Move away from chlorohexadine, it won't do it. Chlorohexadine will not prevent all the disease in periodontal disease or peri-implant disease. You need to move away from chlorohexadine and move into chlorine dioxide, in my opinion. And it doesn't interfere with the osteoplastic bi[inaudible 00:45:06].

Howard: Am I too cynical when I'm sitting at ... Okay, I'm in Arizona. If you quit throwing chlorine and acid in your swimming pool, it'll turn into a green swamp. And you throw chlorine and acid in your swimming pool, and you can throw a penny in the deep end and see if it's heads up or tails up. That obviously, chlorine dioxide I mean, what the hell, nothing grows in your swimming pool if you keep throwing chlorine and acid in. I mean, that's gotta be the gold standard, doesn't it?

Susan: Well, the chlorine dioxide is a natural product, natural substance in itself. So when you recommend it to a patient, you can feel pretty comfortable about that. It doesn't have any side effects, and you don't have to look at their prescriptions or anything when you put them on it. It's great for chemotherapy patients, it's great for patients over 55. They have a new formula, I think it's called Silver. The Silver formula for over 55.

Howard: And that's the CloSYS from Rowpar?

Susan: Yeah, it just came out in March, the Silver version for 55 and older.

Howard: I have something to look forward to because I'm ... Today is my actual [00:46:16] ... I'm not kidding. Today is my 20,000-day birthday. And you don't hit 30,000 days til you're 82, but my 55 is August 29th. So I get to go out tonight and have dinner to celebrate my 20,000-day birthday, and then August 29th I'll celebrate my 55-year-old birthday with a bottle of CloSYS Silver. Because then I'll be old enough.

Do I just drink it straight with a martini, or-

Susan: Yeah, yeah, straight up.

Howard: Straight up. All right that will be my first drink. I'll say, "I'll take a CloSYS Silver to celebrate my 55 birthday."

So you like the chlorine dioxide.

Susan: I do. Because it's a natural product and you could use it lifelong in your water Waterpik when you're working on your implants; you know, for your implant patients. It's just an overall all good product, it really is.

Howard: You know what I think the problem with the Waterpik is? Seriously, listening to patients for 30 years? They'll get a Waterpik and then the wife will completely have a breakdown because when the husband uses it there's water and stain and splashes everywhere. And then the kid will come into the bathroom and do it. And I think the whole Waterpik, the whole water flosser needs to go into the shower. Remember the ShowerFloss, when you unscrewed the head of your shower and you put that in there? Because when you're Waterpik'ing in the shower, you don't give a crap where anything's going because you're in the shower.

But I think when families put the Waterpik in the bathroom, and you got a two year old playing with it and a six year old and a husband and a mom, and ... At some point in time, she just unplugs it and puts it under the cabinet because it's just a mess. And I think they should go into the shower. And I think if you just move the Waterpiks into the shower ... Because when you go into the shower, you do everything in the same order. I always brush my teeth first, I always floss my teeth, then I shave, then I pee in the drain, and then I do the other stuff. I'm just kidding [inaudible 00:48:33].

Susan: Yeah. No, but they do have a portable model that goes in the shower now.

Howard: Oh, what's the portable model called?

Susan: It's just the Waterpik Portable. It's a new one that they just launched and-

Howard: But does it plug in and take electricity?

Susan: No, no, no.

Howard: So it hooks up to your shower head?

Susan: Nope. You just carry it in with you. It's got a water reservoir in it, and you just fill up the water reservoir in it and you carry it in. It's like a battery toothbrush kind of size.

Howard: Well, what's the ... can you send me the website of that?

Speaker 3: [inaudible 00:49:00]

Susan: Sure.

Howard: What's it called? Ryan will find it.

Susan: Yeah, it's the portable unit, the portable Waterpik unit. I don't know exactly-

Howard: The portable Waterpik. Do you remember the ShowerFloss? 

Susan: Yes, and I think they have that still around for quite a while.

Howard: Will you find me the ShowerFloss too?

Susan: Yeah, they have it. I still you can still order it. 

Howard: I think the best advice is when you can implement something in your household habit, and the habit works. You know what I mean. So then it get sticky, so then they're still doing it years later down the road. You know what I mean?

Susan: Yeah, they just got the ADA Seal for Excellence because of biofilm removal.

Howard: Who did?

Susan: Waterpik has really come on strong with this biofilm removal.

Howard: So that would be your first thing is Waterpik and the movable one to the shower.

Susan: Sure, yeah, for the implants especially. You know the full-fix cases, Howard? The full-fix dental cases with implants. The best thing for them is to get them on a Waterpik, because they can get that up and into those big full arch cases, where sometimes they can't get anything else. And you've got to either use a Waterpik or floss to clean around an implant.

Howard: Oh, this is neat. I just got it now. The Waterpik Oral Health Cordless Plus Water Flosser.

Susan: Yep.

Howard: The Waterpik Cordless Plus Water Flosser is a great solution when you want the convenience of cordless water flossing. Rechargeable and portable, it's perfect for use in smaller bathrooms or for travel. Huh, I have not seen that.

Susan: Yes, it's great. I got one for each one of my sons for Christmas last year.

Howard: So your favorite Waterpik was the new one: White Waterpik Cordless Plus Water Flosser from Waterpik. That is really cool. And I had not seen that, that's really cool.

But what did you think of the ShowerFloss?

Susan: I've never used the shower one Howard. But I travel with the little traveler portable; I never leave home without it. And I have a regular Aquarius at home. I use that to get rid of all the biofilm in my mouth, as well as the power toothbrush, so I'm kind of a stickler about both. I do have it in my bathroom [inaudible 00:51:26].

Howard: You say you got your boys that for Christmas last year?

Susan: Yes, because they wanted something to take [crosstalk 00:51:31].

Howard: Is that the only thing you got them? Is that what happens when your mom's a hygienist, the only thing you get for ... Was it a stuffing stocker over the chimney, or was that the big gift?

Susan: No, that was not the big gift. That was the just "here you need this" gift.

Howard: [inaudible 00:51:48] And you also mentioned that you're working with O'Hirer University. And that's [crosstalk 00:51:53] an online. Talk about that. This is dentistry uncensored, so how much does it cost? How long does it take? How does O'Hirer University work?

Susan: It takes about six to seven-

Howard: Because I applied to O'Hirer University, and they said my GPA was too low and I was not accepted to the program.

Susan: No, it's good. It's about a seven-month program, and I just mentor for it, I don't actually ... Trisha and Tim Ives do the teaching. I mentor in occasionally with them on classes. But I strongly believe in the program because I like their approach. I like the clinical action projects that the students do, and they do it in about seven months, and they can do it even as a busy hygienist with a bunch of kids can do this. And they can get their bachelor of science. And I think that just gives them a really good feeling, and in some cases they just always wanted their bachelors. They don't really need it, but they always wanted it. Well great.

And then they can do it with international students as well in their classes, which is kind of just an overall relationship building with hygienists internationally, just like our other international friends. So I think the whole thing is just a really good program.

Howard: But Trisha lives here in Phoenix, but the other guy is Tim Ives, RDH, BSc-

Susan: He's from [inaudible 00:53:18]

Howard: -Masters, but he's from the U.K., and I'm pretty sure they don't have teeth over there. So how did that work?

Susan: No, they have excellent hygiene program and a hygiene therapist program there. So they're doing really well in England now.

Howard: How come on South Park, whenever there's a guy with really bad teeth, he's the guy from the United Kingdom?

Susan: Well I think it was in the past. In the future now, they're doing much, much better there.

Howard: Yeah. I'll never forget, true story. I can't make this up and I don't mean to offend any of my good friends in the United Kingdom. There was the first time they invited me to speak at their Royal ... What do they call it, the Royal College of Dentist, or it was some very-

Susan: In London. In London, yeah.

Howard: And it was a really prestigious gig and I was in this really nice, really nice hotel and I was there the night before, and I was sitting out there walking around, and this Jaguar pulls up, this green Jaguar. And it's just gorgeous and it pulls right up. And this girl gets out to valet park the car and she's wearing an evening gown that matches her Jag. And I'm just like, "Wow, a hot Jag, a hot woman, a hot dress." I'm just like, "Wow, I'm in London." She walks around, she comes up, and right when she walks by me I smiled at her, and she smiled, and I could see missing teeth.

Susan: Right. That's not [crosstalk 00:54:48].

Howard: That was like 25 years ago, and at that time they just didn't see it. I mean, she saw her Jag, she saw her dress; she didn't see the missing teeth. And it's funny when you go to countries, because other countries that you go to, you'll have the same experience. You're like a woman dentist, and you're talking to her and everything's great, and then she'll reach out and scratch her head and she's got like a mop of hair under her arm. A lot of it's culture. I mean some cultures don't shave their legs; some don't shave their underarms. But yeah, when I first went to London, there was a lot more people that weren't into replacing missing teeth, even if they were-

Susan: That's definitely changed. They're very-

Howard: That was true of the dentists in the audience 25 years ago too.

Susan: No, that's very much changed and it's a, as you know, one world now and we're all working together. And especially with a lot of these different connected apps and things, everybody on their technology, it's going to get to be more and more where we're going to share with all of these countries and be able to do webinars with each other. And your program goes to all these countries. So it just shows that everyone's listening and learning and doing the things for oral health.

Howard: What makes me the most high ... what makes me just get giddy, is when I go to Soweto in South Africa, and I go to Tanzania, Ethiopia, Somalia, Indonesia, Cambodia, and so many of those dentists say, "I took your online C course on Dental Town, and it would be three months wages for me to buy a airplane ticket to the United States and see that course." We make those online courses free in poor countries, and for them to be sitting there in Ethiopia listening to some of the greatest endodontists that ever lived and periodontists and all these amazing people.

And I'll never forget that girl that ... She made me cry ... it was, God, I can't remember if it was Tanzania or Somalia. Anyway, she was Islam, Muslim, and she had her garb on and she had two assistants, and all I could see was her eyes, and she told me that her whole village saved up and sent her to dental school. And she came back and she was so excited and she practiced [inaudible 00:57:01] dentistry, and she practiced for years. She thought she was the best dentist in the world because she went to the best dental school ... and I forgot the name of that port city in Somalia.

And then she discovered Dental Town. Then she found out the online C was free, because she's in a poor country. And she started taking all of these online courses and realizing what they didn't teach her in school. Then she got mad that her school had taught her this other stuff, or whatever, whatever. And then I told her that everything I learned in school is extinct by now. I mean, everything [inaudible 00:57:39] ... the shelf life of anything that's really true in dentistry is only what, five years maybe?

Susan: Yeah, something like that. That's my point. But the students, they've got to keep learning, they've got to go to the CE programs, they've got to search out the people that are in our different professional areas and listen, and keep up to date, and read. And don't take just what they learned at school and decide that they're going to practice forever just like what they learned in school. You know, that is an-

Howard: So the O'Hirer University is to get a BS, a Bachelor in Science?

Susan: Yes. Yes.

Howard: Do they have an MS too?

Susan: They were thinking of putting one in; I don't know if they've started it yet. But I know [crosstalk 00:58:26]-

Howard: How much does that program cost? You say it's about seven months. How much money does it cost? 

Susan: I think it's under $3000, Howard, which is very affordable for most people.

Howard: Under $3000, and if you put on the promo code: Susan Windgrove, RDH, BS, it's half off. Right?

Susan: I don't know.

Howard: I heard it on my own show, so it must be true.

Susan: Yeah.

Howard: Hey anytime you want to make this an online C course, write a article, I mean our magazine, Dental Town, the websites. It would always be an honor to have anything from you.

And I just want to tell you that that was the fastest hour I've ever done. I think you're amazing. I've been a big fan of yours for decades, and thank you so much for coming on the show today and teaching me new things and talking to all my homies today.

Susan: You're welcome Howard. It's been a honor. Thanks for doing it.

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