Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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813 Oral Cancer Awareness with Vicki L. Munday, RDH, BS : Dentistry Uncensored with Howard Farran

813 Oral Cancer Awareness with Vicki L. Munday, RDH, BS : Dentistry Uncensored with Howard Farran

8/19/2017 4:24:18 PM   |   Comments: 0   |   Views: 209

813 Oral Cancer Awareness with Vicki L. Munday, RDH, BS : Dentistry Uncensored with Howard Farran

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813 Oral Cancer Awareness with Vicki L. Munday, RDH, BS : Dentistry Uncensored with Howard Farran

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AUDIO - DUwHF #813 - Vicki Munday

Vicki Munday, RDH, BS graduated from Shoreline C.C. Dental Hygiene Program in 1992 and from O’Hehir University in 2015.  She has been a member of ADHA/WDHA all of her professional life.  Vicki was co-recipient of the Most Inspirational Award as voted on by her classmates at Shoreline.  Vicki was president of WDHA (Washington State Dental Hygienist’s Assoc.) in 2000, served as a delegate to ADHA for many years and was elected to serve on both the Ethic and Finance Committees for ADHA. She has had 5 articles published in RDH, and Op-Ed in Access and digitally in DPR.  Vicki has a passion for making a difference.  She is the founder of Smiles for Veterans, which has provided nearly $75,000.00 in care over the last 5 years. She is the regional coordinator for the Oral Cancer Foundation.  Vicki was one of the 2014 Sunstar/RDH Distinguished Hygienist Award winners.  She also received the 2015 ADHA/Colgate Community Service Award and the Young Caring Clinician Award.  She recently joined the team at Fidalab to provide education, marketing and sales from a dental hygiene point of view.  Prior to her position at Fidalab Vicki was in sales with OralID and PDT.

Howard:  It is just a huge honour for me today to be podcast interviewing Vicki Munday, RDH, BS.  She graduated from Shoreline C.C Dental Hygiene Program in 1992 and from O'Hehir University in 2015.  She has been a member of ADHA/WDHA all of her professional life.  Vicki was co-recipient of the Most Inspirational Award as voted on by her classmates at Shoreline.  Vicki was president of Washington State Dental Hygienist's Association, in 2000, served as a delegate to American Dental Hygiene Association for many years and was elected to serve on both the Ethnic and Finance Committees for ADHA.  She has had 5 articles published in RDH, and Op-Ed in Access and digitally in DPR.  Vicki has a passion for making a difference.  She is the founder of Smiles for Veterans, which has provided nearly $75,000.00 in care over the last 5 years.  She is the regional coordinator for the Oral Cancer Foundation.  Vicki was one of the 2014 Sunstar/RDH Distinguished Hygienist Award winners.  She also received the 2015 ADHA/Colgate Community Service Award and the Young Caring Clinical Award.  She recently joined the team at Fidalab to provide education, marketing and sales from a dental hygiene point of view.  Prior to her position at Fidlab, Vicki was in sales with OralID and PDT.

My God, you are just a wonderful person!

Vicki:  Thank you.

Howard:  Do you ever sleep?

Vicki:  Yes, I do!

Howard:  When?  So, you're in Redmond, Washington, a suburb of Seattle.  My gosh, I don’t even know where to start but, basically for you and I, when I got out of school 30 years ago, oral cancer just, you had it coming.  You were smoking and drinking.  It was almost like a judgemental thing.  You’re a bad person, you smoke, you drink and now oral cancer is really turning a lot of attention to HPV.

Vicki:  Exactly.  Exactly.  We're finding that more and more of oroPharyngeal throat cancer is caused by HPV 16 or 18 and the demographics are changing of those that we look at and consider to be at high risk for oral cancer, so it's not those smokers and drinkers that are over 50 years old.  It's younger people that typically aren’t smokers.

Howard:  Look at oral cancer today, I mean, for 30 years, if I get any type of oral cancer exam, no insurance company would pay for it.  Could you imagine if medical insurance said, "oh, we're going to stop doing pap smears on women.  It's no longer covered."  I mean, why is there so much insurance support for other cancer screens but not oral cancer from our own non-profit dental insurance companies like Delta?

Vicki:  I don’t know.  I would really love to know.  We need to get the insurance industry to change their positions on things because we all know early detection saves lives.  I mean, I know I had a conversation with an ENT a while back about, "oh, we can have you drop a scope down somebody's throat and look for a precancerous lesion on somebody's HPV 16 positive and you could do a blazon, a laser therapy, something to get rid of that before it becomes cancerous" and he looked at me and he says, "no, I'm going to wait for it to be cancer and then I'll cut."  I was blown away.

Howard:  It is crazy, and yet the other crazy thing, like, you’re an RDH so you went to college for 4 years, right?

Vicki:  Yes.

Howard:  If you were a nurse you could give an HPV vaccine shot, if you are a hygienist you can’t even give a flu shot, but if I went to Walgreens or CBS, a pharmacy Tech that went to 9 months of school can give me a flu shot.  And when they look at the 8 000 - 58 000 deaths in America each year from the flu and they say, when did these people enter the healthcare system last, dentistry are, for a hygiene visit, is always in the top 3.  And it's like why is a hygienist screening for gingivitis and periodontal disease and not asking grandpa if he had his flu shot because he's probably not going to die of gingivitis in the next 6 months but he might not make the flu season, and now only one state, the grand state of Tennessee has made it legal for dentists to give a flu shot.  I mean, it just seems like this oral systemic health has a long way to go.

Vicki:  But we've known for years that there's a connection between oral health and total body health.  I always tell people that you've got an in and an out and everything in the middle is connected.  So, the fact that …  

Howard:  I like that.  I've never heard that part.  I really like that.

Vicki:  You can use that one, that’s a pearl for ya.

Howard:  Yeah.  We can work on the indoor and, glad I’m not working on the outdoor.

Vicki:  Yeah, yeah.  I like the indoor better myself definitely but we are the first line of defence for all kinds of health issues and I'm happy to live in Washington where we have a very progressive dent hap had since the 1970's.  Very progressive dental hygiene.  Licensure.  We were the first state to give anaesthetic.

Howard:  Really?  Washington was the first state to give?  What year was that?  Do you remember?

Vicki:  It was back in the early 70's.

Howard:  Really?

Vicki:  Yeah.

Howard:  And any correlation to also where either first state firm medical marijuana? 

Vicki:  I think Colorado beat us maybe.

Howard:  Oh, Colorado was first, okay!  Any connection between the first state to give anaesthesia and the second state to legalise marijuana?

Vicki:  Probably not but I do know that it's going to be interesting 15-20 years from now to see where all those legal pot smokers and their oral cancer are.

Howard:  Yeah and you keep seeing articles.  People are posting them on Dentaltown of pot smoker’s oral health condition is markedly worse than the non-pot smoking population.

Vicki:  The heat and the chemicals, definitely.

Howard:  Yeah, the heat and the chemicals.

Vicki:  So it’s, as dentistry evolves and hygiene evolves, we need people to be more proactive.  We need hygienist to be a little more outside the box, as you know, I'm obviously fairly outspoken and I wish more of my colleagues were because we need to go into our offices and say, "look, doctor, as a team we can make a difference in our patients lives if we're all looking and talking the same language and sharing our knowledge with our patients."

Howard:  I mean, in all reality, this is 2017.  In all reality, what percent of hygienist and dentists do you think today are telling parents that they should get their child vaccinated for HPV 16 and 18?

Vicki:  Probably less than 20%.

Howard:  So then there is, when people say, "well, dentists isn't a real doctor" then I would say, well, either it's Dr Dre, Dr Seuss, Dr Pepper.  But when you look at dentist’s actions, they're really not doctors.  I mean, they don’t, 80% of them, I mean, you've got a patient in front of you and you've got their mom and when did they want their HPV vaccines done?

Vicki:  Between like 9 years old to 12 years old.

Howard:  Yeah, and 80% of the people are looking for a hole in a rock and they want to drill it out and patch it.  It's like, they're not going to die from dental decay but they could absolutely die from HPV 16/18.  This is the craziest thing!  There are states where the state dental examiners addressed the giving of flu shot and HPV shot and it's the dentists who voted it down.  I mean, what is in your walnut brain when you're a dentist and you tell everybody you’re a doctor, doctor Ace and you just voted down giving a flu shot and, I mean, it’s like, I think they should turn in their licence.

Vicki:  They think they have to talk sex.  They’re not talking sex, they're talking cancer prevention.  I ran into a paediatric doctor at the Pacific North Less Dental Conference.  He came by the Oral Cancer Foundation table and I said, "doctor, are you having this conversation about the vaccination with your patient's parents?  You're a paediatric doctor."  And his two young children where there, and he looks at me and I said, "the guard is still, vaccination is cancer prevention.  You're not going to be talking to your patients about their children having..." And then we spelt the word out so that his children would not hear the word sex.

Howard:  So what's the vaccination you use to call it, the Gardasil?

Vicki:  Gardasil has a second generation that covers more HPV's.  It covers like 6 different ones.

Howard:  Can you spell that?

Vicki:  G-A-R-D-S-I-L.

Howard:  Oh, Gardasil.  Interesting.  And that covers HPV 16/18 and then others?

Vicki:  Yes!  It's got like 5 or 6 HPV's in it.  And we know there are over 200 kinds of HPV out there.

Howard:  Wow.  You just said it, I mean, I think you just hit a bullseye.  What percent of Americans are considered Christian?  It's over 80% and they think that this HPV has to do with sex, and the bottom line is, it has to do with body fluid.  You can get it from kissing.

Vicki:  Yes!

Howard:  I'm reading the average kiss transfers 80 million microorganisms, bacteria, fungi and parasites.

Vicki:  Yeah.

Howard:  And I mean, yeah.

Vicki:  I talk to people about doing the tongue tango.

Howard:  The tongue tango?

Vicki:  Well, French kissing just seems, it's just doesn’t roll out of my mouth easily and people talk about open mouth kissing is something that I believe the American Cancer Society's website uses that terminology and it's a lot more fun to call it the tongue tango.

Howard:  Well, and it really doesn’t have anything to do with open mouth French kissing because I remember me and my 5 sisters, when we were little, had two grandma's and we used to always love my dad's mom because grandma Nola would always kiss us on top of the head and grandma Mary would kiss us on the mouth, and when she gave you a kiss you had so much slobber on your face, it would take your whole arm to wipe off the slobber and we all thought, wow.  We were just not looking forward to seeing grandma coming or leaving and so, I mean, I'm sure grandma Mary gave me 100 million bacterial viruses and that was from a grandma kiss.

Vicki:  Yeah!  So just think about it.  I know I've had conversations with patients about the fact that you can transfer all the bacteria that you transmitted in a kiss and like, is your girlfriend a flosser?  How’s your oral health of your partner?  And I had a patient come back in to me one day from college and he says, "I look at girls differently now and it's all your fault."  And I said, "well, okay, that's probably a good thing because when you settle down and you become married, that your partner will have great oral hygiene because it's important to you, and you guys will stay healthy."

Howard:  Well, that's still even more insane, I mean, after the AIDS epidemic, the entire planet got religion on STD's and they all went after.  The only country who thought it was voodoo and crazy and all that was South Africa.  So almost every other country has less than 1% HIV infection rate but South Africa has a 25% HIV positive rate because they wouldn’t let in any of the World Health Organisation.  And those guys, I mean, that was literally a holocaust down there.  I mean, those government decisions will end up killing as many people as the holocaust.  But the whole world now, now South Africa, now they understand it.  They have new administration now.  The whole world gets it but then when you go, that's the outdoor, when you go to the indoor you still see dentists and hygienists seeing grandma every 3 months for her Perial maintenance cleaning and they've never seen grandpa.  

Vicki:  Yeah.

Howard:  And then he shows up one day with a toothache and he's got 9mm pockets, he's got bombed out teeth and it's like, do you not get that grandma and grandpa are trading microorganisms all day long?  I mean, they're sharing utensils.  Grandpa’s, their old and senile.  Half the time they go into the bathroom and use grandma's toothbrush anyway...

Vicki:  Exactly!

Howard:  Ryan thought that was funny. But it's true.  I mean, it's absolutely true.  I've heard grandmas tell me that she has to keep her toothbrush in the drawer or grandpa will use it.  So, I mean, how do you, if you had an STD back in the day and you're HIV positive, they tried to get a list of your partners and track them down and try and work it like a detective.  

Vicki:  Yeah.

Howard:  I just pulled that, Ryan just sent me a link for Gardasil 9.  So, the website g-a-r-d-a-s-i-l 9, Human Papillomavirus... That's a hard one to say.  Human Papilloma virus 9 valiant vaccine helps protects girls/women aged 9 to 26 against cervical, vaginal, valvular and anal cancers and general works caused by 9 types of HPV's.  Gardasil 9 helps protect boys and men aged 9 to 26 against anal cancer and general warts caused by those same HPV types.  Gardasil 9 may not fully protect everyone nor will it protect against diseases caused by other HPV types or against diseases not caused by HPV.  Gardasil does not prevent all types of cervical cancers, so support for women to get routine cervical cancer screenings which their insurance will pay for because it's below the naval.  If it's above the naval.  Gardasil 9 is a shot that is usually given in the arm muscle.  Gardasil may be given as 2 or 3 shots for persons 9 through 14 years of age.  Gardasil 9 can be given.  I mean, I think that the main forefront of dentistry needs to be flu shots and HPV vaccines.

Vicki:  Yeah!  Yeah, I mean, it will save lives and people need to understand you're talking cancer prevention and healthcare, not sex.

Howard:  Yeah.

Vicki:  We know that oral sex is happening.  We know that children are having oral sex at younger ages because they think it's not really truly having sex.  Well, okay, whatever they want to believe!  But, they're giving each other HPV.  

Howard:  And in the religious communities, they really need to open their eyes.  I went to an all Catholic grade school, grammar school, high school and I went to Creighton College.  And my graduation class from high school in 1980, 10% of the girls were pregnant at graduation.  So, if 10% of the girls are actually showing at graduation, what percent of the boys and girls in that class you think had sex before they graduated.

Vicki:  Oh, yeah!  Just a few, huh?

Howard:  I mean, if 10% of the girls are showing, you've got to figure at least what?  What would you say?  Half the class?

Vicki:  Oh, yeah!  I mean, they're all experimenting throughout high school and obviously those that didn’t in high school, did in college and…

Howard:  Oh, yeah, I went to Crayton and it was literally, it was seriously a joke because each class was 1 000 people or more, and that was the first time all those kids no longer lived under the thumb of their parents.

Vicki:  Exactly!

Howard:  And so the first semester was just a drunken, alcoholic sex rage and all their parents are probably the same ones that think that their daughter didn’t need an HPV shot when she was 12 because she's not that kind of girl.

Vicki:  Right!

Howard:  It's like, that kind of girl right now is throwing up in a toilet while her friend’s holding her hair back.  I mean.  So, yeah, and doctors should not be judgemental, I mean, when you show up to the doctor, and I’m not supposed to care about race, religion, sex, orientation, anything.  I’m there to help you and I just cannot believe that they won’t have an HPV conversation with a mom and a dad when their kids are under 9.

Vicki: See!  And I have those conversations and I think sometimes, when I’m in my clinical practice, my doctor, who's a good friend of mine, cringes a little when he hears the conversations we have, but the patients say thank you for the education and it's like we're going to prevent cancer.  Don’t you want to prevent your child from having certain kinds of cancer?  

Howard:  Yeah.

Vicki:  And what parent or grandparent is going to say, "oh, no, they can get cancer.  It'll be fine!"?  No, they're going to say, "yes, let’s prevent cancer from my child."

Howard:  And you know what, it makes so much sense because I remember clear as a day, freshman year of dental school, that would've been ‘84, talking about cancer and at that time I was smoking and drinking, all that.  I remember raising my hand saying to the guy, it was Dunlap.  Dunlap and Bargender, they're all passed.  I said, "if I took a room full of rabbits and just filled it up with beer and cigarettes and smoke, it seems like they would all just die but that cancer looks like it's been given fertilizer.  I mean, dividing every 20 minutes and won’t stop.”  I said it just doesn’t make any sense?  And now it turns out that it didn’t make any sense.  Something got into the nucleus, something hijacked the DNA and turned on "keep dividing" and that, I mean, I seriously think that almost all these cancers, when they finally find out what's caused all of, it's going to be viral related.  So, if you're taking an HPV vaccine, I mean, it might give other benefits to other cancers that they haven’t even figured out the connection yet.

Vicki:  Yeah, because the HPV turns off the tumour suppressor cells.  So, PR, P53 and PRV get turned off and then those tumours things go nutso.

Howard:  It's not some random, you drink a coolers light and now you have some cell doing crazy activity.  Something very specific is going on.

Vicki:  Yeah!  The DNA gets changed and those tumours suppress themselves, get turned off and then the cancer is off to the races.

Howard:  So, tell us about  If my homies went to, what are they going to find there?  What's that all about?

Vicki:  Well, the OCF, Brian Hill started.  He's an oral cancer survivor and decided that he needed to do something to help other oral cancer survivors, so he started the OCF.

Howard:  What is his name?

Vicki:  Brian Hill.

Howard:  And he's not a dentist or a hygienist?

Vicki:  No.

Howard:  And how old is he?

Vicki:  Brian is less than 50, I believe.

Howard:  Less than 50?  And how long has he been a survivor?

Vicki:  Gosh, I’m not sure.

Howard:  Was it a brutal ordeal for him?

Vicki:  It was pretty brutal but he's an amazing guy, and so we have all these oral cancer awareness events all across the country.  So, here in Washington I do a walk, because the city we're holding a walk in is Kirkland and we're down along the North end of Lake Washington.  It's a really beautiful park they let us use but we're not allowed to run on the city sidewalks in Kirkland without hiring police officers to cordon off the lanes of traffic, and that just costs more money than we're willing to spend.  You're raising money for awareness and, to help oral cancer survivors and to fund research.  You don’t want to be throwing $1,000.00 at police officers when we can just say, "okay, just walk.  Don’t run, walk and we'll raise our $30,000.00.  So, we have probably 250 people who showed up this year.  We have some pretty amazing sponsors and the oral cancer walk has become a pretty good-sized event here in Washington.  

Howard:  Yeah, and I think it's amazing.  And so, your chapter's all across America?

Vicki:  There's not a walk in all 50 states yet but we're working on it.

Howard:  How many states are you up to now?

Vicki:  I think there's like 15.  15 to 20 that are doing events.

Howard:  So, if one of my homies listening wants to bring this walk to their state, what do they do?

Vicki:  They contact the Oral Cancer Foundation, they can go to the website and there are places on there that you can click around and find out how to start a walk in your area.

Howard:  Nice!  Okay, others get involved.

Vicki:  Yeah.

Howard:  Get involved.  They got a really nice site.

Vicki:  They do.  Brian's put a lot of time and effort into that.  He's got some good people and the rest of us are all volunteers that put on the walks, so.

Howard:  Well, tell him, next time you see him, tell him to come on the show. 

Vicki:  I will do that.

Howard:  Tell us his story.  So, you said Kirkland?  You mentioned Kirkland just a second ago.

Vicki:  That’s right, Kirkland, Washington is where our walk is, down at Juanita beach.

Howard:  Is that where all the... When you go to Casco’s, it seems like every tenth item is made by Kirkland.  Is that in Kirkland?

Vicki:  Yes.  Costco’s home base is in Washington and Kirkland brand is Costco's house brand.

Howard:  So Casco is based in Seattle?

Vicki:  Yes.

Howard:  I did not know that.  I never thought of that.

Vicki:  Their headquarters is in Issaquah.

Howard:  What’s that?

Vicki:  Their headquarters is in Issaquah.

Howard:  So they’re in Issaquah.  Is that a suburb of Seattle?

Vicki:  Yes.

Howard:  And they’re probably going to get beat up by Amazon quite a bit, which is also in Seattle.

Vicki:  There's a little competition in town, yeah!

Howard:  And where's Kirkland?  Is Kirkland in Kirkland, Washington?

Vicki:  Yes.

Howard:  And that's the house brand for Casco which is in Isaac?

Vicki:  Issaquah.

Howard:  Issaquah.  That sounds like an Indian name.

Vicki:  We have a lot of Indian names up here in Washington state.

Howard:  Yeah?  Well, I mean, they came over the Bering straits so their first entry point was Alaska and then Washington would've been probably the first entry into the lower 48, right?

Vicki:  Yes.

Howard:  That is amazing.  I always thought Casco was down around LA but I saw a story of their wine.  I guess they sell more wine than anybody in the world.  Did you know that?  

Vicki:  No, I didn’t know that.  There's a lot of wine when you walk into Casco, and Washington wine industry is growing, too.  We have a lot of great wineries up here.

Howard:  Well, it's not very price elastic.  People just pay huge amounts of money for wine.  It's huge!  Like when you go into a restaurant, if you ordered a steak and salad, baked potato, they might not even make 10% on that.  But you order a drink and they'll make 80% on that.

Vicki:  Exactly!

Howard:  What I always think the funniest thing is whenever you see all those wine tasting events, they've always got all these grey-haired men and women in tuxedos and dresses, and being a dentist, okay, when you have grey hair, probably 90% of all your taste buds don’t even work.  I mean, if you really wanted to have a genius taste winder, he'd be a 10-year-old little boy and girl.  

Vicki:  Yeah, their taste buds are really healthy.

Howard:  Only a 10-year-old could tell you if it tastes good.  That’s why all the seniors, when you go to dinner with them, they're always pouring Tabasco sauce and salt and pepper.  They're always throwing anything on there because they can’t taste their eggs and toast.  So, I mean, you've done so many things.  You're also in the Smiles for Veterans, and the guy who started Oral Cancer Foundation, he went to Vietnam, any relationship between his military service and Smiles for Veterans?

Vicki:  No.  I was asked to volunteer at a Veteran stand-down down in Seattle and I went down there and a bunch of hygienists had volunteered to do oral cancer screenings, and we're doing visual oral cancer screenings and I was frustrated because I'm standing there with itchy palms going, "why can’t I get in here and get rid of this calculus on these people?  We are granted an oral cancer screening is very important but I want to do more."  And so, I wandered around and talked to some people that were involved in it and they separate the men and the women at the stand downs for the very services that they're offered, and so I was with the men for a while and then went over to the women and said, "I've got to do something about this."  So, I started asking questions and went to the Dean of the University of Washington School of Dentistry and said, "hey, this is my idea, what do you think?"  And he said, yeah, it's a great idea.  And then he passed me off to some suit people who ended up finding 110 reasons why we couldn’t do it.  So, I found another location and I got a lot of volunteers and we started and we’re, we've been doing it for 5 years and I now use the Pema Dental Hygiene Clinic in the Northgate area of North Seattle.  They have an 18-chair clinic, they've just expanded.   

Howard:  We have a Pema Clinic, too.

Vicki:  Yeah.

Howard:  That must be a very common Indian name?

Vicki:  Yeah.

Howard:  I mean, really, you have Pema Washington and we have the Pema Hygiene School here.

Vicki:  They have 3 in the country.

Howard:  Oh, are they related to the one out here?

Vicki:  Yes.

Howard:  Oh, they are?

Vicki:  Yeah.

Howard:  I did not know that.  So, Pema is in Washington, Arizona and where else?

Vicki:  I would say Texas.

Howard:  Really?  I had no idea.

Vicki:  Yeah.  They're gracious enough to open their clinic up to us one day a year, and so we have a lot of doctors that will come and volunteer, and we get the medical teams International van to show up.  So, any of the oral surgery that needs to happen goes out to the van and we keep the hygiene and the restorative, and its simple restorative.  We're talking fillings.  We're not doing root canals or crowns, we don’t have that capability yet.

Howard:  Yeah, and the number one cause of failure in 60 months after a molar root canal which is 5 years, 10% are extracted if a dentist does them, 5% extracted if an endodontist does them and the number one reason they’re extracted is because they didn’t go in for the final restoration.  So, it's still leaking and that's another pet peeve endodontists.  I wish all endodontists would do the final build-up and seal, but a lot of their referring doctors say, "no, I want to do that, I want to get it", so they can bill for the build-up and everything, and then between the Endodontist doing the root canal and having to send it back to the general dentist, I mean, that could be weeks.  Weeks while they’re sitting in there.  And I love your picture on there, on your website.

Vicki:  Oh, thank you.

Howard:  Well, there's something really obvious going on and that is, you’re going to so many dental offices and the dentist is wearing loupes but the hygienists and the assistant isn’t, and anybody with their hands in the mouth can be, I mean, the easiest way to increase the quality of your dentistry is magnification.  That’s a no brainer.  And then you'll hear the dentist get mad because the assistant didn’t clean off the cement right or whatever and he's wearing 3.8 loupes, and the assistant's got naked eyes going on and it’s like, anybody who's working in the mouth...  I mean, you go into any jewellery shop and they're all wearing magnification and then you go across the street from the jewellery shop into the dental office, and the assistants and the hygienists aren’t wearing magnification.  What percent of hygienists in the United States do you think use magnification?

Vicki:  A lot more!  We're pushing probably 50% now because here in Washington, the schools require the students to buy loupes.  That's part of their issue.

Howard:  I mean, it's just the most obvious way to get better.  That’s the only thing I like about scanning for impressions is because when I'm on there, figuring, to scan my first impression, I looked at that prep and I thought "Stevie Wonder did the prep” I’m seeing my prep 40 times bigger where you used to only see it a reverse negative in a dark purple EM Program.  I still don’t know why EM Program is purple.  They should make that something more reflective so you could see.

Vicki:  Yeah.

Howard: And the Endodontists, they're all getting microscopes, hanging them on the ceiling looking down those canals.

Vicki: Exactly. So, I wear 4 powered loupes and a head lamp.

Howard: Nice. You look darling in your loupes, by the way.

Vicki: Thank you.

Howard: You look like a fashion statement. I got to take you to schooling though, on you not being on Twitter. You know why you got to be on Twitter?

Vicki: Why?

Howard: Well, first of all, Trump showed us that if you have 50 million followers you can be the president. So, if you ever want to be the mayor, the governor, the president, you've got to be on Twitter. But seriously, what's very powerful about Twitter that people don't realize, that if you have a hundred friends on Facebook, and you post something about your walk, well, your hundred friends aren't all going to see that. I mean, if no one likes it or comments or shares, they might not even push that out, hardly any of them, and if you want a, they'd rather yet you see sponsored ads, anybody paying money is what you're going to see.      

Vicki: Right.

Howard: Whereas Twitter, if you got a hundred followers on Twitter and you send tweet, they all get it instantly. I mean, just like if you text them or email them, they all get it. And furthermore, everybody's always giving money to Facebook to buy ad but nobody gives money to Twitter. I still ain't know how they’re in business. I've never given a penny to Twitter. And I have 300,000 followers on Facebook and only 21,000 on Twitter and I'm telling you, I get a bigger response posting to 21,000 cause they all get it. But if I post it to my 300,000 followers on Facebook, the response is half that unlike on Twitter. Unless, of course, I give them money to boost the post. So, Twitter, and that's everything about LinkedIn. LinkedIn is the same thing, you post on LinkedIn which is bought by Seattle. Microsoft just bought LinkedIn, I don't know what they going to do with that, but I'm sure they plan ways to put lots of bugs in there so that you have to call an IT director, learn how to run it but, yeah. I would, I think if you're going to try to get walks in all 50 states and Smiles for Veterans and all that. You really need to go, if you're low budget, you need to go Twitter and LinkedIn. And the deeper you get in with Facebook, the more money you're going to give them.  Because they, I've absolutely figured out that they know what you've boosted in the past. So, I boost a deal to say Dentaltown, they know that. So, they're not going to push out anything to Dentaltown unless I gave them money. But if I sit there and say I've never given a dime for say Smiles for Veterans boosting that post, then they might let that one sneak out. But they know what means money to you and once they realized this guy values this with money, then they got you. So, I would really.

Vicki: I don't know about that. Thank you.

Howard: I just sold you a Twitter deal. So, what is, I'm Fidalab. Fidalab US. What is Fidalab? Oral HPV detection can prevent HPV associated oral cancer. Tell us about Fidalab.

Vicki: Fidalab is a start-up that was begun by Doctor Quin Feng, she has a PHD from Johns Hopkins and did her post doc stuff at MIT.  So, she's one smart Chinese lady. And then she did 15 years of research at the University of Washington with HPV and cervical cancer. Her husband is a pathologist in the military and she decided, she thought some similarities between HPV and cervical cancer, and HPV and oropharyngeal cancer and decided that she could make a difference. So, she has a…

Howard: What's her name?

Vicki: Quin Feng.

Howard: Q-U-I-N F-A-N-G.

Vicki: F-E-N-G.

Howard: F-E-N-G. Quin Feng.

Vicki: Yeah. And so, we have a little gargle, swish and spit and goes off to the lab and it's very specific, for HPV 16 and 18 only. And it's quantitative as well as qualitative. So, we'll know how much are the viral load is there.

Howard: Wow!

Vicki: Yeah, it's pretty cool.

Howard: So, this is a vaccine?

Vicki: No, it's a test.

Howard: It's a test?

Vicki: Yes. So, it's a screening tool for oral and oropharyngeal cancer.

Howard: So, what is Fidalab US?

Vicki: Yeah, so she, it's a pretty cool HPV test and if somebody has a large viral load of HPV 16, the thought is you send them off to ENT, they can drop that scope and look for precancerous lesions and get rid of them before we have cancer to deal with.

Howard: So, on our side, Fidalab US is learned about easy accurate oral HPV test, we are a CLI certified lab, we utilise the latest technology for oral HPV detection. We only need an oral rinse sample to detect oral HPV infection. We offer patient education as far as the chemo and reducing oral cancer incidents. Our objectives are to provide oral HPV detection to a non-invasive test to provide an oral cancer screening method complementary to visual screening. To educate and raise awareness about oral HPV infection cancer, to help patients adjust to help their lives. Are you friends with her? I mean, do you know her?

Vicki: Yes. She's my employer.

Howard: She's your employer? Well, tell her to come on the show. We'll do a one-two punch.

Vicki: I will do that.

Howard: So, we'll get your other buddy from Smiles for, your Smiles for Veterans. Will get her from Fialab US and we'll get your buddy oral cancer.

Vicki: Like Bryan Hill.

Howard: Bryan Hill, and basically, and we'll have a week of trying to get these homies to quit being molar mechanics and drilling and filling and billing on rocks all day. And take a step back from that tree.  And realize a forest out there. I mean, it still seems the most amazing, mind blowing research that I did not see coming, 10 years ago was that the human animal cells, Sapien cells are huge. And we're only a trillion cells, but from our mouth to our anus is 10 trillion microorganisms, bacteria, fungi, and parasites. And they are linking it to basically everything, I mean, from mood to depression to obesity. A lot of these people that say there's something wrong with my metabolism, they do something with their thyroid, now they're finding out the gut microbiome, the obese pre-diabetic people are completely different than the person over there with the six-pack.  If all you're eating is processed food, you hardly have any of these diversity of life in your good by him. I was reading a story the other day of that's journalist went to, I think he went to Tanzania, Africa and he lived with the oldest known generation of hunter gatherers. And just started eating, they took his poop and urine sample before he landed, and they took it after a week of just eating what these, they say it's a last true tribe of hunter gatherers and just eating with them for a week. All this blood chemistry got better, everything got, and the diversity of life and his colon completely changed after just a week.

Vicki: If you take all the sugar out your diet, you'll be amazed the difference in inflammation in the body and all kinds of things.

Howard: I tried to do that. But I can't find sugar-free beer.

Vicki: Yeah.

Howard: Are you, have you found that? Can you tell Kirkland that they need to come out with a…

Vicki:  So, you find some, yeah.

Howard: A protein beer that has no sugar on it.

Vicki: Yeah, this is thing called the whole 30 eating process. Where you get rid of breads and sugars and dairy for 30 days, and it makes a huge difference in how your body feels.

Howard: So, I just looked up Pima, a member of either of 2 American Indian peoples. The upper Pima living chiefly along the Healan and Salt River, Southern Arizona and the lower Pima of Central Samoa. The [unclear 38:37] languages of Pima. I did not know that our Pima hygiene school was later related years. So, let me, so let's switch gears, completely forget everything we just talked about and switch gears to, the bottom line is you're talking to a lot of dentists right now and a lot of hygienists. How could they work together? You've been doing this for years. How could they work together better as a team?

Vicki: Talk and respect each other. I, my employer I've known for 20 years, we're personal friends outside the office. But with any doctor I talk with, if there's mutual respect back and forth cause we all come at dentistry with our own personal viewpoints. And if we just put the hierarchy aside and just communicate as people, we'll do a better job. And we need to remember that, that person lying in my chair is a person, they are not a dollar sign, they are person, and they deserve respect. It’s like when my hygienist come and volunteer at Smiles for Veterans, one of my colleagues came in and said, I have an hour? And I said, no, you have as long as it takes to take care of this veteran. And I want you to make that that veteran feel loved and respected. And if they need to sit and talk to you for 15 minutes and share their story, you listen. You're not running people in and out. It's not a money-making machine. This is, I want to take care of you as a person and make sure that you get the best care possible. So, if I run 5 minutes late because I'm doing an oral cancer screening, screw the schedule, the patient gets an oral cancer screening. There are things that are more important than the bottom line of money. If you treat people with love and respect, the money follows. Your office will grow, and people will love to work for you if you treat everybody with respect and if you're honest with people. People don’t want to be sold a bunch of goods.

Howard: Yeah, and wait, I think it's interesting, so many consultants have all been refurnished for years that if, after the dentist presents a game plan and if they leave the room, they leave on a recording device on smart phone and usually the first 6 questions that patients mouth to the hygienist or the dentist or the dental assistant is trust questions. That really have a cavity, do I really need it removed? And then it seems like the more trust questions asked the more the dentist is a controlling freak who won't let the hygienist. Well, hygienists can't diagnose. And I will say, she's in there for an hour and she's an employee and drives a $35000 car, he lived in this big mansion and drive a Mercedes-Benz, who do you think the patient trust more? You're selling the invisible. When you talk about 4 cavities, what are they supposed to do, you can't google, do I have 4 cavities. It's all in trust. And if the hygienist took the x-ray, did the hygienist diagnosed and told them and all what's that. The believability and they asked a hundred times more questions to the assistant, the hygienist, the receptionist, the most never asked anything to the doctor. And…

Vicki: Correct.

Howard: So, if you, but the doctor is, comes back and says, well, if that's illegal and I say, well, so are drugs, they're on every corner of America, and how many hygienists have gone to jail for diagnosing x-rays?

Vicki: Yeah, I mean, we'll learn how to do that. And I wear loupes, I'm not blind and if I see a crackdown the lingual wall of the molar and I get a click over when I run my explorer or scaler over it, I'm going to tell the patient, this is what I found in your mouth. I don't know what doctors going to say. I can guess but I'm not always right. You may need a filling, you may need a crown, he may decide he wants to watch this. One of my former employers called me eagle eye. He was, I love you because you come in and you've got a sticky note here for me with everything you've found. And I know you're thorough and you've gone through everything because you make my exams so easy. So, if doctors would respect the knowledge that their hygienist has, that would be great. And then also back up the hygienist when he or she finds a lesion and want to refer that oral surgeon look at this. We all know that has gone in two weeks, you got to do something.

Howard: I think that the way the football team works is the way they can block so well on the Sea Hawkes is because when that Quarterbacks says give me four seconds, they'll give it all they got for four seconds. And the Quarterback knows at four, the pocket is going to collapse so he'll roll out of it. And so, the Quarterback, so I believe that if everybody keeps saying the same story, the same diagnosis, the same trim plan, I hear my assistants saying it, the hygienist, everybody's have the same wording so I mean, I would even, what my, have to say, I don't know what Howard's going to do. If she said, well, I don't know what doc’s going to do. I feel that's a failure my part, I mean. If I can't sell and explain and educate my assistant and my hygienist, how the hell am I going to educate my patient. And if I say this crown needs to be replaced because it's an open margin. Well, that means, if my hygienist sees one of my crowns I did six months ago on recall was the exact same criteria, then she's to say diagnose, this is open, something happened when they cemented it and we're going to redo that for free. And my hygienist will just say, yeah, we're redoing number thirty for free, something happened in the cementation that didn’t go down all the way. I mean, we're all, just all on the same page.

Vicki: Yeah.

Howard: And I think that helps with the treatment plan acceptance and, it needs to be standardized. Like an iPhone, every phone is exactly the same. And when you have these dentist that, sometimes it's a watch than the exact same size cavity. This one we're going to fill, I mean, it's crazy, they need to be consistent, there needs to be scientific reasons for everything you do.

Vicki: Right. Right. And that's probably, as a hygienist, one of the biggest areas of frustrations in clinical hygiene is being on the same page with the doctor, knowing what the doctor's going to say and what his or her diagnosis is going to be. So, you can actually prep the patient. And so, when the doctor comes in and says, okay, Mrs. Smith, you need a crown on number thirty and Mrs. Smith is like, yeah, Vicki just told me about that tooth, and warned me that it could have a problem. So, yeah, doctor, let's do it.

Howard: And one of the feuds dentist have with hygienists is an independent practitioner and that just proves my point that they're not patient centre, they're dentist centre like, if you ask a dentist or you all about the patient or you about yourself? I'm all that patient. Hey, what are your hours? Monday to Thursday, 8 to 5. Okay, the federal reserve released a study, they release about every ten years, whenever, by the access to care, they're saying somebody got, a hundred and ten million Americans cannot go to the doctor, Monday through Friday, eight to five. And then, and then you go to these resorts, you go on a cruise and you go to resort and you can get a facial, you can get your hair done, you get a mani/pedi and get a massage. I just want to get my teeth clean, but, why can't I? Because the dentist thought the best idea was for me to get my toenails done and not my teeth cleaned. They don't have cleanings on cruise ships, they don't have them in resorts. Because dentists are so concerned about their patients that they think no care is better than any care. It's the same thing with this foreign dentist from Mexico practicing in this all Mexican parts of Phoenix, like Guadalupe where there, and their best idea is to shut them down because God knows those people have no access to anything. So, the dentist believed it's better that they have nothing. And, the fact that you have detectives and police going to work with all the robberies and murders and rapes and all the construction people, they feared their truck every night because they think someone's going to come steal all their tools out of their truck. And what they are doing, they’re going around Guadalupe looking to see if there's some hygienist, and they’re cleaning teeth in their house without a license. It's like, how did that make the top thousand priorities?

Vicki: It's crazy, I mean, there is such an access to care issue nationwide. And we all just need to loosen it up a little bit. And say we got, I became a hygienist to make a difference in the world. I didn't become a hygienist to argue with doctors. So, there's probably some things we all just need to agree to disagree on and move forward, but patient care isn’t one of them. We all need to say, I became oral health care professional because I care about people and I want to make a difference. And yeah, give back more. I think we all could give back more.

Howard: You know Google and Apple and Steve Jobs and (00:48:08 unclear) they always say whenever you get to a fork in the road and you are confused, you just got to be the customer. What is the best thing for the customer? And I think independent practice, it's not about the dentist and the hygienist, we know that availability is a, availability and affordability are two key issues and these dentists will say, well, Phoenix has got too many dentists. Why did they build a dental school?  It’s like dude, there's not one dental office in Phoenix open on a Sunday. On Sunday, you better make sure that if you're going to have something break, it better not be your tooth, it better be your arm or your leg. Because you can call the ambulance, they'll pick you up, they're working on Sunday. They'll take you to hospital, they're fully going. And you say we have too many dentists, if there were too many dentists, you think someone would work on Sunday. There must. And now I want to ask you about the most controversial thing and I know it's a big controversy in Seattle. And Seattle water fluoridation, I mean, we fluoridated the water in Phoenix in ‘89 and then it expired after twenty years, we just have to do it again. We still have, one in every four people in Arizona think it's toxic, it's a communist plot, it's big government, it's everything in the world, and then here's fluoride, it's the thirteenth most common element of it in there. And it shows up in the ocean at one point four part per million naturally, and I don't know why naturally is such a good word. People will say, was it natural? HPV is natural, tornadoes and hurricanes are natural. When yellow stone explodes and kills everybody west the Mississippi river, that will be natural, too. But here it is showing up in the ocean one point four, part of a million, we put in things what are half that amount. At point seven and I swear my boys, they were too little the first time they saw me in this campaign but the second time you're on TV and you're on debates, you're in a paper and they keep showing me the comments on my post on Google+ and there's a lot of really violent comments. I mean, so what's your take on water fluoridation? Are you ready to throw in a towel at the insane asylums, take over the, the …?

Vicki: No.

Howard: The prison, what's your view?  

Vicki: Fluoride is a good thing. I stand a hundred and ten percent behind water fluoridation. I grew up with well water. My mom put fluoride drops in our juice growing up. To make sure we had good teeth and in the year 2000 when I was present on the Washington State Dental Hygienist’s Association, I spoke in the capital rotunda at the fluoride rally. And that day I spoke I stood there and I said, I'm not talking to you, cause I'm talking to the choir there. I was surrounded by dental people. I said I'm coming to as a single mom, I'm not coming to you as a hygienist. My kids have grown up with fluoridated water and they have no cavities. At thirty five and thirty, my son has had two cavities and he's thirty years old, my daughter at thirty five has never had a filling. I believe in water fluoridation.

Howard: But Seattle's seems that the more of the natural, all nature.

Vicki: Yeah, we have a lot of tree huggers and a lot of granola, what I call granola type people. Most in the State of Washington has fluoridated water except the Olympia area which is our State capital. That county fights it all the time.

Howard: Did you know Utah is the most un-fluoridated state in America?

Vicki: No, I didn't know that.

Howard: And you know what, when I go to, I mean, I get, I mean, I love my Mormon dentist friends. I love their, their, they have a year’s supply of food in their basement and their …

Vicki: Correct.

Howard: Most of my Mormon dentist friends have a years supply of food, a lot of them have big five gallons of honey, cause remember the honey is the longest preserving food. The honey they found in the pyramid are still good. And they usually have a few automatic weapons and 4,000 around Obama. But they’re just not into the big government. I understand that but the middle class doesn't drink water out of the hose like we did. The middle classes is buying this, it's like so you're not drinking the water out of your sink anyway. Who's drinking the water out of the sink, the poor people. And these poor people have horrible teeth, they don't have money to go to the dental office anyway. So, would you rather pay about 20 cents a year to prevent a cavity or do you want to raise taxes and try to go do a $100 filling and I know when I talk on my dentist friends up in Utah, they say that they’re against water fluoridation for the fact that they don't want government, they don't like government period, along and putting something in their water supply. It's more an anti-government thing than it is a health issue. They just don't like the government. And I totally get that, I mean I, words like every election. I think it's so funny, everybody says they patriotic for America. So, every four years you get two people to pick from, both of them are completely lying liars, sociopath that will always let you down and lie. It's like a, it's a whole lot of noise. And then you think every four years we be picking between Batman and Robin or Superman and Wonder Woman. It's always two completely insane lying sociopaths but I get that no friend of the government. But I still just can't believe that almost thirty percent of Americans still don't drink water fluoridation when they've known it's a fact that since 1945 right after Michigan, in January 20th.

Vicki: Yeah, I mean, it's a proven fact then why people are opposed to is beyond me.

Howard: I think they still move of the water fluoridation. I still, they got school started. Did you ever hear that story when they fluoridate in Grand Rapids?

Vicki: Yeah.

Howard: But have they delayed the turning it on? The guy knew the crazies we're all going to come out. So, they announced that it was going to start Monday morning at 8 o'clock and then of course the crazies that called an ambulance showing up in the hospital rashes couldn't breathe, they all freaked out and he kept coming back to the health director, wanting him to respond but he wouldn't respond. So finally, after the pressure is completely amount where even the government say you need to say up and address this. It comes down says, yeah, we never turned it on. We knew that's going to happen. We'll turn it on tomorrow. So, everybody that went to the emergency room and has rashes, can’t breathe. I mean, that was the best chest play in the history.

Vicki: All that out.

Howard: Of all time.

Vicki: That was perfect.

Howard: My God, it’s a great story. So, you just had, this is the, I only get you for two more minutes. It's July 7th, you just had a bunch of high dentist just graduate. This in the last two weeks. They just got out of the dental hygiene school. You're given their commencement speech, you've given their advice. What advice you have for all of newly minted dental hygienist entering the workforce?

Vicki: I would tell them to be respectful of the employer, be an outside-the-box thinker, always do an oral cancer screening even if it makes you run late and explain to your patient exactly why are you doing it. And to make sure your instruments are always sharp.

Howard: Nice! And also, if you’re looking for job, Dentaltown has said free class since 1990. There's usually less, let's say 6,000 class for the ad and lot of hygienists sometimes are having a hard time planning a job or they want to move in somewhere else, where you can post looking for a job, there's a lot of jobs on there right now for, basically the categories are selling a practice, buying a practice, looking for a job, hiring, looking for an employee and so that's a great way, any other tips on how they can find employment?

Vicki: I always think it's good to, when you're considering an office, to temp in the office for at least a week. Because the first day or two everybody's very nice and after that the foot drops, the honeymoon’s over and you really see what the office atmosphere's like. So, I think you should work it on and off at least a week before you make decision on whether or not it's a good fit.

Howard: And the biggest red flag is employee turnovers, so by the time the average dentist gets the 5000 charge, 4000 of them are gone and went out of the backdoor. So, they have the eight percent of their own customers don't even come back. So when you walk into your interview between two different dental offices and one has a bunch of girls in there that have worked their ten, twenty, thirty years and then the other office, no one’s been there two years and that is the red flag and that's a problem with …

Vicki: Exactly.

Howard: Corporate and the patients that come to me from corporate are saying that every time I go there, it's a different dentist. Every time I got my teeth cleaned, they've got a different hygienist. I called, I said I wanted my same hygienist I had last time, she's no longer with us. And then they actually go to Facebook and find out where her new home is. So, I think the single biggest red flag on treat plan acceptance is staff turnover. Single biggest flag on for working editions where no one else would stay here for two years. Why the hell do you think it's in a work for you?

Vicki: Right. And another red flag for me is if the spouse, or I think another involved in the office and to what degree.

Howard: Yeah. And it's either awesome or a disaster and it all comes down to, is there an org chart. If you go in there and there's two presidents, it's back shitting the same. But if there's, they, there's got to be a pope, a bishop, a priest, an altar boy, if you go in there and there's two people and no one knows, no, that sounds crazy. Well, Vicki, I just think you are such a wonderful person. All your volunteers and, I mean, my God, you are just a very amazing, special, you're just unbelievably cool. And I just want to thank you so much for coming on my show today and talking on my homies, and I hope you deliver those other two people because I want, I really want my grandchildren, when they go the dentist someday, that someone's talking to them about oral cancer giving him a HPV vaccine, I hope that when I'm old and senile and have dementia and don't know my name, that someone’s given me a flu shot when they're taking me in from my cleaning, you know what I mean?

Vicki: Yeah.

Howard: We need to be more oral systemic called. We're not just working on a molar, we're working on a human.

Vicki: Exactly.

Howard: And, okay, Vicki. Vicki Munday, thank you so much for coming on the show today.

Vicki: Thank you, it's my honour. And I will get Brian and Quin Feng in touch with you.

Howard: One last thing, one last over time question. I forgot it. We're both friends of Trisha O'Hehir. You also graduated from O'Hehir University in 2014, for the hygienists listening, tell them what O'Hehir University is?

Vicki: O'Hehir University is this wonderful degree completion program where you can also get your master’s degree... O'Hehir University is amazing. She's Trisha's, I think she's in Venice, Italy right now, actually. But O'Hehir University is the perfect place to do degree completion.

Howard: And Trisha's right here in Phoenix, I started an online, Dentaltown online because we both watch Phoenix University is from Phoenix. And it just exploded. I mean I'm in, one mobile building popped up and next I went there, there were two or three and now it's like an entire mile long corridor. So online education is just so much easier faster than driving.

Vicki: It was.

Howard: Or sitting in a brick building. There's just no reason you need to be sitting inside a classroom.

Vicki: No.

Howard: To hear the instructor any more than if you're listening to this on iTunes while you’re driving your car, I mean, this works. You don't need to sit in a bricks and mortar building.

Vicki:  It does, we do our best.  

Howard: So, a better choice for O'Hehir University. Who all is involved with that besides Trisha, there's a couple people.

Vicki: Tim is, gosh, I don't remember Tim's last name. Susan Windrow is involved. There, she's got several people that have courses going at all times.

Howard: Nice. Alright, Vicki Munday, you're sure. Is it Vicki Munday or Vicki Tuesday?

Vicki: It's Friday. It's Friday today, so I could be Vicki Friday.

Howard: Vicki Friday, thank you so much for coming on the show. You have a rocking hot weekend.

Vicki: Thank you. You, too.

Howard: And remember, whenever the Sea Hawkes play with the Cardinals, you must vote and rock and cheer for Arizona Cardinals.

Vicki: Yes. Sorry, that's not going to happen.

Howard: Alright, have a good day.   

Category: pathology
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