Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
How to perform dentistry faster, easier, higher in quality and lower in cost.
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1200 Kerry Maguire DDS, MSPH, Director, ForsythKids, Chair, Options for Children in Zambia : Dentistry Uncensored with Howard Farran

1200 Kerry Maguire DDS, MSPH, Director, ForsythKids, Chair, Options for Children in Zambia : Dentistry Uncensored with Howard Farran

5/31/2019 9:39:46 AM   |   Comments: 0   |   Views: 95

Kerry Maguire, DDS, MSPH is Associate Clinical Investigator and Vice President for Clinical Operations at the Forsyth Institute in Cambridge, MA. She serves as the Director of ForsythKids, a community-based prevention program serving over 2500 children in sixty sites throughout Massachusetts. Dr. Maguire holds adjunct faculty positions at Harvard School of Dental Medicine and the University of Washington School of Dentistry. She is also co-founder and chair of the non-profit Options for Children in Zambia.

VIDEO - DUwHF #1200 - Kerry Maguire


AUDIO - DUwHF #1200 - Kerry Maguire

Dr. Maguire is the general dentist representative on the American Academy of Pediatric Dentistry Board of Trustees (2014-2020). She serves as chair of the Better Oral Health for Massachusetts Coalition and is a gubernatorial appointee to the board of The Children’s Trust, the Commonwealth’s private-public partnership to stop child abuse. She is active in the American Association of Public Health Dentistry and other national and international organizations dedicated to oral health and health access. Her professional career has focused on oral health access for vulnerable children and other populations, applied interventions, community advocacy, workforce innovations and sustainable systems promoting oral and overall health.

Howard:  It's just a huge honor for me today to be podcast interviewing Carey McGuire DDS MS pH associate clinical investigator and vice president for clinical operations at the Forsyth Institute in Cambridge Massachusetts she serves as a director of four sites kids a community-based prevention program serving over 2,500 children in 60 sites throughout Massachusetts dr. McGuire holds adjunct faculty positions at Harvard School of Dental Medicine and the University of Washington School of Dentistry she's also co-founder and chair of the nonprofit options for children in Zambia at options for children org dr. McGuire completed her dental degree at the University of Colorado School of Dentistry in 1988 and earned a certificate and advanced education general dentistry the following year in 93 she received a Masters of Science in public health from the University of Colorado School of Medicine she has experience in dental education in industry having previously held positions at the University of Colorado School of Dentistry Colgate oral pharmaceuticals Tufts University School of Dentistry tom's of Maine she is a general dentist representative on the American Academy of pediatric dentistry Board of Trustees she serves as chair of the better oral health for Massachusetts coalition and is a gubernatorial toe appointee to the board of Children's Trust the Commonwealth's private public partnership to stop child abuse she's an active in the American Association of public health dentistry and other national and international organizations dedicated to oral health and success her professional career has focused on oral health access for vulnerable children and other populations applied interventions community advocacy workforce innovations and sustainable systems promoting oral health you have more on your resume than me and all my listeners combined it is just a huge honor to podcast you today my first question has got to be are you related to that Jerry Maguire guy I saw the movie well I wish I was I think 

Dr.  Maguire :   I would be Richard I did have a very good run in having both my first name and my last name spelled correctly while Jerry Maguire was Mike 

Howard: So where does all this ambition come from I mean I mean is I mean you ever left any stone unturned where you just not Sleeper what is the how do you do everything that you did

Dr. Maguire I don't know I think dentistry is people like you like me who are passionate about what they do and find a lot of different ways to do it well 

Howard: I'm gonna blame all your success on my favorite teacher at UMKC was Denise Caston Baum who is now the Dean of where you went to dental school so I'm gonna blame all of your success on Denise Kassebaum can I just say that for the record 

Dr. Maguire:well you can say that and actually Denise gave me some very good advice because she came as an assistant professor when I was a senior dog student and I was considering that perhaps full-time private practice was not really what I wanted to do I was interested in research and I was also answers interested in teaching and she said to me that's okay you know you the sort of mantra throughout dental school is that you are going to graduate you're gonna go into practice and you're going to have you know a busy and successful community practice for the rest of your life your professional life and certainly that I think it's a very noble ambition but it wasn't the ambition that she had for herself and she made me feel comfortable about the fact that I might want to play my career out in a different way as well

Howard:  she was so she was so cerebral UMKC I mean you can ask an instructor a lot of times and get a joke you asked her you got an answer with footnotes she was a very intense genius person um you know the ADA just recognize another especially so we have 10 now and it seems like in dentistry all the all the specialists like oral surgery and implants and all these things get all the attention but public health dentistry is a specialty and I always felt it gets the least amount attention it's like a mom and dad of Dentistry had ten kids and the one that didn't get any you know I guess it was the middle child but why do you think public health is not talked about as much as ortho endo peri opido on and on and on white waves public health not just the focus I mean we're trying to manage eight billion humans living on the surface of a rock and you got a first you got to look at it as the whole herd but people start running into oh well this one needs a root canal this one needs a crown this one needs a filling and how do you see public health in your mind

Dr Maguire: I do believe that public health all public health not just Donald public health has kind of an image problem and the reason why is that if you're doing it right it's invisible so you know clean water right turn on the tap the safe clean water comes out you don't stop to think unless you've recently visited you know Africa or some places in South America or other developing countries that this is not the norm and  I think that public health done right kind of disappears into the background we have to we have to keep putting it forward in order to keep it in the front of people's minds I also feel like you have to do both you have to treat the individual as well as the population and so when we talk about you know the orthodontic procedure that needs to be done or the tooth that needs to be extracted we're talking about what an individual patient needs and that needs to be taken care of at the same time this parallel path of prevention and Public Health have to be running alongside so I do you think you know it's because it tends to be more immediate what the what the patient needs and what the specialty is there to provide but I feel strongly that obviously public health needs to be right there alongside 

Howard:  what would you say that we're doing what do you think we're doing right now or have done that's the best in public health and where do you think what's our strength and what do you think were weakest what did we do that was right was the most right

Dr Maguire:.  what we are  doing right now that's the most wrong what do you think we should be focusing well community water fluoridation we have done right nest I would say I'm disappointed that we have kind of run up against a wall in the implementation around the country and of course so it varies a lot state to state I think that's where we missed an opportunity and that was I think a little bit before my time but if there had been a little more push right there at the sort of at the beginning I think we would be in better shape now and we you know we use up a lot of time and energy other resources and kind of battling the arguments around community water fluoridation and I you know I have to think to a lot of the folks who are who find that controversial are also folks who are not accepting of other major public health achievements like vaccinations so it's that's a tough one you know it we've we got we got off to us great start and then we kind of hit the wall I also feel like and this is what takes me back to what I do every day is that providing care for children early in life and making sure that they are looped into the dental delivery system it's important a very important move and I think that there are new avenues for doing that including partnering more closely with our pediatrician and other medical writer friends and colleagues and but you know once they get to school the importance of actually placing sealants that's still a wildly underutilized preventive procedure that is I think overlooked in many ways.

Howard:  I love your genius correlation that the water fluoridation is the same with the vaccinations and it's just a loss of trust I mean everybody's feeling it on from social media to their family we had family get-together on Sunday and there's you know I have people in my own family that think vaccinations is a plot the Centers for Disease Control is a shill for the pharmaceutical industry and there's just there's just a huge lack of trust and I have to say it you know I'm 56 years old four kids five grandkids and I  think the biggest observation I've made in my life is that Trust has been slowly drifting down trust in our institutions and I don't know what it's all about her if it'll swing back but like the eye fluoridated Phoenix I was on the team doing that here in 89 then 20 years later and one in four people from Arizona they completely thought that you know it was so toxic there was nowhere you could put it so the government bribes the politicians because they poured into the water supply because it's so toxic I couldn't go anywhere else and you're just like dude this sounds like a Disney movie or Halloween three are you I mean it's a cognitive dissonance from reality to think that someone like you who goes to all these fancy schools up by Cambridge and Foresight's and all that stuff knows less than their 15-minute Google search I mean it's just it's just a bizarre deal so yeah and I just read that study that came out today that when they  iodized salt to get rid of godor and now those populations are all showing significantly higher IQs so it's showing that a vaccine you know nutrition to prevent goider obviously that nutrition affected the brain because they're their populations are better and how you know gosh it's just so it's so frustrating to watch i'm who do you think are our most vulnerable dental patients in America

Dr Maguire. - well I've always felt that children are kind of at the end of a very long game of practice and it comes to who they have to rely upon to help get them into medical and dental and the worse that Kids program I mean we know that children who live in low-income communities and communities of color tend to have a higher risk and rate of dental disease particularly caries we look for communities that have over fifty percent free and reduced lunch rate we know that those are the folks that we want to that we want to connect with as quickly as possible have an over 50 percent what free and reduced lunch rate so you're looking for populations of kids that get half their lunch subsidized yes and what does that talk and what does that tell you about those kids that they're getting half are all their lunch subsidized they're coming that they're probably from a low-income family and you know that they're one of the social determinants of world health is  your family's economic status so getting to those kids and getting to them as early as possible is  one of the goals we have now for side kids started as a school-based program like many programs to 20 years ago but we also know that it just to sit down and look in a kindergartners mouth and see a mouth full of cavities it's like we're here for years too late folks so making sure that we also partner with early childhood education centers infant toddler programs you know even to work with WIC and some of the other parent baby programs that's where we really need to be by the time they get to school it's good that they have I think the backup of a school-based program there but we're really gonna lay the groundwork for good oral health before they get to school 

Howard:  I always find it I mean I love my country and but I've lectured to Dennis in 50 countries it's so amazing how these things are so obvious to like the 20 most developed countries on earth and yet America it's still so controversial and emotional and I mean it's just like I'm it's just even amongst the dentist with 9 years 10 years of college out there you know doing it all day every day they still just don't see I mean it was Winston Churchill that said if all your people are uneducated and sick how you gonna build a great country might when I go into these prisons and talk to my Arizona prison dentist buddies they say everybody in prison has three things in common they grew up below the poverty line they didn't finish 12th grade and they're abusing some substance and it's like those are all fixable things and you'd rather just fix it by throwing them in a cage for 30 to $50,000 a year I mean who  would think that was a good idea so the biggest thing now that's the most controversial about children on dental town I didn't think I'd live long enough to see a controversy with pediatric dentists you know most of the controversies are at occlusion or MJ or something else the pediatric dentists are very emotional about silver diamine fluoride and the how do you view silver diamine fluoride is that is that a trigger word for you do you like it where do you think that's going and

Dr.Maguire: you know sort of a joke around portable within portable and  mobile dental provider circles is you know you've seen one portable dental program you've seen one portable dental program here in Massachusetts we have a number of institutions like stuff sent you and also this the state has a sealant program as well as for said kids we were the rather large institutional school and community-based programs but we also have public health dental hygienists who are licensed to practice independently in high-need areas primarily schools and nursing homes so everybody approaches it a little differently it's very I would say we're very persnickety about we how we approach the care of our children we actually see our kids three or four times a year and two of those visits at the beginning of at the end of the school year involve a demo a dentist examining the child so we have a full team including a dentist dental hygienists and dental assistants we very much take our  role as  preventive providers especially when it comes to sealants and the application of fluoride varnish seriously and but we also we're not a we're not a screen and release program we when we see a child who has active decay we are very aggressive about making sure that that child gets into a dental home for more comprehensive care and I think that silver diamond fluoride buys you some time between when you have them there in the chair in the school and when they can actually get into the office and we all know there can be a great deal of variability in how quickly you know the system the parents the clinic all those pieces like I said that the game of crack the whip you know it has to work in to the benefit of the child and it doesn't always happen as quickly as possible I think silver diamine fluoride buys you that time I think where it's misunderstood is that and I'm not saying that my pediatric dentist colleagues are the ones who are  doing that but it's not a restorative procedure it doesn't restore function so you can't just paint it on and forget about it that's it is a it is an interim stuff and I think it is one that can be used to dish' Slee but you don't just paint it on and let the kid go you know

Howard:   you actually are from the Forsyth instead I mean it's one of the most prestigious independent not-for-profit institutions founded in 1910 but the Forsyth family made their money and in vulcanized rubber and that is what turned dentures around George Washington had several sets made he left the country when he was the president trying to get a fitting denture but it was actually the vulcanized rubber where they started they would they had this pot and they would vulcanization so you'd go make your horrible ill-fitting dentures are made out of wood or ivory or whatever and then they'd heat up that vulcanized rubber and they'd set it and then it cooled and it was the first successful denture and did you is there any of that vulcanized rubber denture connection to Forsyth since they made their money in rubber or do you know

Dr.  Maguire:  well I haven't seen any you know antique dentures being around the office that's what you mean but no we're very  proud and grateful to the Forsyth family you know there were four brothers and a sister and they there were two brothers who wanted to honor a brother who just passed and that's how they one of them was speaking to his dentist and the dentist said you know you really want to make a difference in the world in here in the City of Boston you know we need um we need an institution that will care for these children than this epidemic of dental disease that we that we have and so you know they open the  Institute and a few years literary of the second dental hygiene school in the United States open I mean the connection to prevention and also to systemic health was there right from the beginning so in some ways you know of course I've not only I think defined much of Dentistry in the 20th century you know we're sort of on the forefront in the 21st century - its we're coming full circle in in terms of that systemic connection.

Howard: well you guys have won that horse race and dental history by several lengths I mean you guys identified going  back ed century guys identified the two most common global infectious diseases dental decay and gum disease identified the protective mechanisms of fluoride name the oral cites for the human microbiome project I mean you guys I mean talk about and I mean I wish would you accepted my invitation to come on the show I figured you must not have ever heard of it or know who you were talking to because I certainly didn't think you were gonna come on the show I mean it's just an amazing on an amazing Institute so um on your historical timeline of all the achievements these are all long term goals where is your where do you where do you see the research going now

Dr. Maguire:  particularly strong the oral microbiome and of course back in you know the heyday of taxidermy around periodontal disease a lot of microbes that are associated with periodontal disease were discovered there at the foresight so I think now you know this the microbiome the human oral microbiome database that we have there is something that is a national treasure really when it comes to science and especially oral science and I do think that the research that's being done in the interaction between micro microbes in the mouth you know the 700 species that live there is really gonna tell us a lot about how we function as humans and of course you know the mouth is one location in this long you know what I heard somebody say oh you know humans are just tubes from guns to bombs you know and but that environment starts right there in the mouth and the ability study yet and ability to kind of rub elbows and with some of the scientists that I get to work with every day is it's pretty impressed it humbles me let me tell you

Howard: and what's so you know humans always focus on what they know but they never stop to pause to think that possibly there's something they don't know and that a hundred or a thousand years we may look silly but I'm reading that they're discovering a new species of life in the mouth about every quarter so for so you when someone says oh this you know this absolutely doesn't do this or does that's like dude they're discovering four species a year in your mouth it's quite possible that when this whole gut microbiome from  your mouth to your gut is gonna change how we view everything everything we believe today .

DR Maguire:. it's entirely possible and so it's very that's very exciting too - like I said to hang out with the folks who are making that happen Dr. Wen she who's our CEO and chief scientific officer and Floyd Dewhurst Gary Morrissey they're so well recognized in their feet adults and it's an honor to work with them

Howard: yeah  so they the gut microbiome I'm is what you're excited about you said you guys are still analyzing the silver diamond fluoride you don't really know where you're gonna stand yet on that

Dr Maguire:.  oh no we're definitely incorporated into our but again we see that you know we see it as an interim step in the journey to care to comprehensive care and that's where you know this is it buys us time it's definitely useful you know so for example probably one of the populations that will benefit the most that we see are young adults and older teenagers who have come here without their parents from the you know Central America primarily so unaccompanied minors and these folks you know often have never they're 16 17 years old they've never seen a dentist before you know when we sit down with them we're just trying to buy them some time until we can get them into more comprehensive care so starting with what we've you know what we've got and silver diamine fluoride is certainly one of those things that's a very important place for us to sort of you know arrest what's going on arrest the process while you work with the system to get the care that the child needs

Howard:  you know I'm considering how long you know the four sides in suits I mean I'm how old is it I mean it's over a hundred years right over a hundred years I'm it seems like we're still fighting that that the difference between dentists and MD were people they are not associating dentistry as far to healthcare like so late like it's like look at Medicare doesn't cover dentistry like the mouths not connected you and I both know 50 million school days are lost each year from children that their mouth hurts so bad they can't go to school and in Arizona where I live eight and a half percent of all emergency room visits are odontogenic in origin so  how do you think going forward and that the Medicare Medicaid md community will realize someday that the mouth could be part of the body and  how does it how do how do we drive down that being a tapper son out of every hundred reasons to go up to emergency room how do you how do you approach those problems

Dr. Maguire: I think one way to do that and I think that even some of our colleagues that we've already talked about Denise Kassebaum at the University of Colorado at Harvard School of Dental Medicine I mean but the collaborative education between the dental and the medical students and nursing and PT and pharmacy I think that that you know there was a there was a little blip in that kind of interdisciplinary education and practice back in the early 90s but now I think it's really kind of dug in and I I love that it's happening I. I know that they're very passionate about making sure that the dental and medical providers and professionals work together I think where the challenge comes in is when you get out into practice and the system doesn't support you know that natural bringing together care for the peace that's where you really have to work at it and I think that's you know what  will happen eventually I believe is that professionals will feel this is a great way to take care of patients and we got to find a way to make it happen in real life not just in education.

Howard:  so I'll tell you embarrassing things when I went back to school after his death 10 years get my MBA because I wanted to understand the business better and it was it was just so sad I was in a class of 200 listening to people from hospitals saying well you know we get a hundred thousand dollars for a bypass and we get fifty dollars for an exam so for us to break even we have to do three bypasses a day and I thought to myself how horrible and now here we are in silver diamond fluoride I've heard this conversation a dozen times or kids say I graduated $400,000 student loans a pulpotomy and a chrome steel crown on a child is this much money and painting SDF on it what will I get 15 bucks I wouldn't even be able to pay my student loan indebtedness so money or incentives matter I mean we're not gonna find any economist who says incentives don't matter so I think what are your views on that I mean do you think Medicaid Medicare insurance companies will get smarter in the future knowing that maybe you shouldn't give so much for a bypass and you should give a little more for preventive public health do you think that's the direction we're going

Dr. Maguire:  incentives for prevention are just not as great and  unfortunately there's still plenty to treat right so it's  not like we're ignoring prevention it's that it's not keeping pace with the development of disease I you know I do think it'll ultimately be the payers who light on this and you know the Medicaid the further the states that are responsible for providing care for kids that's the thing I'm most familiar with of course is you know if we can get to them and really show the cost savings there has to be a pinch where there's a shift but if but if we can show that and really you know prove where prevention pays I think we'll get some traction that's a tough one 

Howard:so you in your mind is the big players in public health I mean is that the fhq is that a big part of it I mean when you think of big public health dental government institutions providing care who comes to your mind first is it FQHC FQHCs the community health centers

Howard: they're the safety net we do we all we know that that's inadequate they don't they don't have the capacity to care for all the patients who need them and you know you have your foot on the rheostat 24/7 and it still wouldn't you know you wouldn't be able to plow through all the disease that's  out there so I think that they're an important part of the system 

Dr. Maguire: I think that they're they are understaffed and kind of under built and so that's one thing you know I think about the  Medicaid providers or the insurers around the country Donna Quest comes to mind they have a lot of spread they have on they have a declared passion for preventive dentistry I would I hope that that will make a difference because I do think that they have the they have the clout to actually make a change and make a difference so that you know that's not maybe your traditional public health institution that comes to mind but it's part of this that is very important to providing care for Medicaid populations

Howard:  and do you think this um do you think public health who do you think it needs more public health do you think it's more urban or rural

Dr. Maguire: well I mean rural health was like my that was my first love which when I dental school you know I worked in the migrant health program in Colorado and that has always been you know a passion of mine certainly the concentration of people point at that points to urban centers but I think girl you know rural health is a huge  issue and I I've always thought that you know the challenges of providing care spread out I mean we for example you know there  are many places in the US where the concentration of dental providers is quite adequate you know but we know that there are vast areas in the United States that are basically considered dental deserts 

Howard: how do you even that out it's a tough one and do you think moving forward do you think mobile dentistry you  mentioned it earlier when we start trying do you think mobile dentistry is going to be more of a thing is a bigger part of the solution or not really

Dr Maguire:  I do think it can be I think what the solution that we really need to be looking for or that is the multiple access points and sort of entry into the system whether that's a mobile program to get you started kind of us you know a hub-and-spoke network that where the simplest most useful procedure preventive procedures are excellent example I think they don't have to be provided in an operatory you know why would you use up to your time for something that you can do in a bus or in a gym and so again kind of redistributing the care and at the same time increasing the access points that patients have and Families have to the system I think then you sort of feed up into the more complex procedures if needed and the more expensive facilities and the higher also you know professionals who are really working at their highest level of competency and legal status

Howard:  we just had last Friday fifty-six dental schools just kicked about 6,000 kids at a dental kindergarten school and they're all a 25 they're all bright-eyed and bushy-tailed and they're all excited what would you say to one of them right now if she's listening you thinking well what do you think about me going into public health dentistry what do you think of that especially I I'm thinking about maybe a pediatric dentist and orthodontist what would you say to someone who's thinking about a career in public all dentistry 

Dr. Maguire :  twenty percent of your students are already public health practitioners they don't need any convincing you know and 20 percent are interested at all you know they don't even understand that like making mouth guards for their kids soccer team is public health that's public health I think it is it's the sixty percent in the middle who are up for grabs and so that you know making sure that they understand public health dental public health is I think a challenge with in adult education within dental education because again it tends to be marginalized I think a bit and if done right it's hard to see I used to have my students when I was teaching at Tufts  I had them in their first semester of their education and I would have them write a letter to themselves how they were planning to practice public health after they graduate my collectible letters and I would hand them out at graduation you know as kind of a reminder of you know you were that bright eyeed optimstic gonna change the world professional that's what you want it to be and here you are you know and your intent is in your hands you know go for it

Howard: so um do you consider tell the dentistry a big part we talk about mobile dentistry do you think tella dentistry is  be a big part of public health

Dr. Maguire:   I do I think tella dentistry is gonna be a big I think tell anything telehealth is gonna be a big part of it should be a big part of our system indeed I mean the our dental system in particular is really set up for the you know for the maximum efficiency of the dentist it's not necessarily set up around what the patient needs and I'm not saying that the you know that that's wrong but we have to look at the system for what it does now the folks you can get into the traditional dental delivery system are well served the folks that are for whatever reason marginalized or poor face barriers to that to that system they just don't get there and you know when I know that many dental professionals feel that school-based programs undermine care I don't necessarily agree with that but I always say you know a school-based program like Forsyth kids is not a dull home we're a dental sidewalk so we have an opportunity to get the child into the system some families and some patients are gonna need a sidewalk before they can climb up the front porch steps 

Howard:  yeah I mean I mean the what the last generation left us I always think is  you know public health I mean when I was born I make the interstates they were already there I mean I had there was already clean water I already had a sewage and so many these people they just slightly do something and they think they're entitled to everything and they don't realize it that none of this would have been available if they were born on about 80% of the rest of the planet I mean we you know we all need to help it get back now when I think of public health dentistry or someone listening things public all dentistry does that also I mean we talked about an FQHC federally qualified health center but is it also in your mind include like the Indian Public Health Service or prison dentistry is that public health demonstrating you are not really 

Dr. Maguire:   one way is to practice as a provider within a system like the federally qualified health centers I think another way to practice public health is you know through the you know through policy and advocacy you know Boston Public Health Commission better oral health for Massachusetts coalition that's also a practice of Public Health and I also do feel that you know I used to say to my dental students look you if you're gonna be a general dentist you're probably gonna do a little ortho you're probably gonna do a little endo and you're probably gonna do some public health and don't don't limit your definition of public health to you know I have to take a trip to Zambia you know that the public health can happen every day within your practice and I do believe that involvement in the community and the leadership that many dentists and other adult professionals show in their communities is a form of public health

Howard:   you just mentioned Africa you're very involved in Africa with your options for children in Zambia take you see a journey how did you in Zambia 

Dr. Maguire:  well it started with a dental student project and like so many things do and so back in 2004 took a trip there and was had a connection to physician who was practicing there he had noticed that in the orphanages that he where he was seeing children there were there was a lot of dental disease you know wouldn't it be great if you came over and he handed out toothbrushes or something like that you know sort of the again like a lot of volunteer projects I think we had a very that we had a very typical beginning that way I and practice the public health of course means that you have to listen to what the community wants and so as we got more involved in in what was going on in Zambia it was clear that probably you know coming in even to the same places even to once a year was not necessarily the best way to build infrastructure and I think over time our philosophy there has really shifted away from organizing volunteer trips to in fact trying to build capacity within the system that they have and so we're very active with the dental training school there they have Dell therapists program dental assistants and also laboratory tax they do have a newish dental school that has just started in the northern part of the country we haven't been as involved with them frankly I think that the you know the backbone system that they have of dental therapists in whorls am BIA is quite good and could be strengthened I think to the benefit of the of the country and the in the Zambian people 

Howard:  you know um I I've always told myself I am want to write me a book and I'm gonna call it a the giggle factor the one thing that always blew my I've lectured to dentist in 50 countries and  this on this august of nineteen it was I started August 4 1990 so I'm coming up on next year August 4th I'll be my 30 year anniversary and I always thought it was bizarre I called the giggle fighter in the poorest places I've been in several places in you know Africa ages they're all happy and giggling and then you go to some of the most advanced societies in the world like New York subway Tokyo subway Koreans Seoul Korea so and they don't seem nearly as happy I mean some of the happiest people I've ever seen in my life were playing in the street and Kathmandu Nepal Tanzania I'm I mean it's like have you ever when you're spending your time in Zambia do you ever sit there have you ever thought about that like these people are really you did you ever think they were happier than the average person in Cambridge Massachusetts

Dr. Maguire:   it's hard to be hungry right and it's hard to have to walk a long way for clean water those are the things that I never want to minimize the real hardship associated with it at the same time you know there's a Zambian saying that Zambians will always be carrying a smile and it's true that they are a very joyous and I think loving  and deeply grateful for everything and I love that sense of appreciation and joy about life that that they I think they have more collectively then sometimes we do hear especially in our big cities.

Howard: yeah I I just my gosh I I thought they were so much happier my ice yeah I I noticed it all the time even going down to Mexico going down to the place we go down there I mean there just incredibly happy people I think I think of a lot of people and these highly advanced countries do not realize how many balls are juggling how stressed they are and for me what I love the most about these missionary dentistry trips is when you just unplug out of the United States and run and you get rid of your cell phone and then just go unplug and get back down with the people I mean it's  just a my gosh I think it's so good you should do missionary dentistry for your own self not to mention all the good you're doing over there and you're doing a ton of good over there do you think student loan forgiveness is going to be a big part of public health data stream moving forward

Dr. Maguire.-   I just I just paint amount of our poor young colleagues are graduating with and I don't know I mean I do think it will have an effect on public health unless we can find a way to for student loan forgiveness and wrap that into practice in rural settings you know in high-need settings otherwise just the absolute need to pursue a more profitable practice this has to be there you know if it really worked I think we're limiting our young colleagues choices because of the cost of their education makes me very sad

Howard:  and what do you looking back what do you think caused the increase in price were you what do you think this come from

Dr. Maguire:  well I mean dental education has never been cheap but I'm not exactly sure tell you the truth there's certainly not because of the big salaries that they're paying the dental educators but my you know my my experience sort of within I was very active in ADEA and you know the dental education groups when I was teaching but since I've been away from that now for 15 years or so I'm not as looped in it really did seem to sort of take off though in terms of the cost you know in the last 15 or 10 10 years you

Howard:  um I call this Dentistry uncensored cuz I don't like to talk about anything everybody agrees on you know I like to talk about that tough things and I'm down here in Arizona by the border and there's no bigger controversy than migrants but you're interested international health began in 1988 when you're working with the Colorado migrant health program what did you what was your experience with that like and how did that change your how did that affect your thinking with migrants and oral health 

Dr. Maguire: well I was posted in Pueblo Colorado I think there is still a very successful program is that the children of the migrant workers were enrolled in school so you had six weeks to sort of give them everything that they could possibly get and sometimes that was the only school that they had all year long depending on how their family was traveling so in addition to the you know the normal topics that you would include we tried to give them everything that we could in terms of the medical and dental care i exams hearing we look we just loaded him up but they also had a lot of fun which was great it was really a terrific experience in that community in pueblo many of the families have been coming back to the same farms year after year and I could really see in the chill that I treated the prevention that had started right from the beginning with the kids you know was now paying off ten years later in the fact that they were still healthy you know compare that to their parents who didn't have the same benefit and you know one night a week we would hold the adult clinic and it was basically you know they would they wanted everything out you'd say we'll pick one you know we don't have time to do everything it was you know the contrast was just amazing so that really drove home the  message of prevention for me at that point I was headed into private practice and I do remember I had this moment where I was sort of sitting with a child and really you know was just having a great time helping them feel comfortable and really getting into it and I thought you know if I don't go into private practice nobody is probably gonna miss me so there'll be somebody else will be there it's a successful practice there's room for you know somebody who wants to be in that particular situation maybe this would be more fun instead and so that I kind of discovered that I had a public I had a public health had all along actually talked asthma sea Nemo who was my pediatric dal instructor at the University of Colorado before he went to Ohio State I always like to remind my Ohio State colleagues that he did actually teach other places before he went to Ohio State so I was lucky enough to have him as an instructor and he took me out on my first school-based clinic we went to some that he you know rounded up me and a couple of my classmates and we went off to a school and urban Denver and did a school screening and I had a blast and so it's come back around to me through my connection with him in the in the AAPD and of course what I do every single day it just makes me laugh that that was that was how I got launched 

Howard:  um you're on a search for your name pulls up many articles you know on dental town because you know it's a searchable database but I mean you you're in the news quite often just recently you were in the news five for good for sites kids offers preventive dental care in school thousands of children benefit from free dental care throughout the Commonwealth is that mostly on charity or government I mean who's who's financing preventive dental care in schools is mostly government through state Medicaid is it more donations from the four sites ensues where does that money come from 

Dr. Maguire: MassHealth Medicaid reimbursement takes care of a portion of it we actually received state funding for a portion of it Forsyth raises the remainder and that goes back to our original mission you know to care for children that it and 

Howard: you're also you're so innovative on your on your website are the 

you're also raising money by handcrafted sweater creations PeaceWorks Zambia is that is that tight indeed that's you funding that the options for children is that am

Dr. Maguire:   I putting it together right well you are putting it together right although I have to say I don't have quite the same amount of time to piece those sweaters together as I used to that that it's a fun thing it basically the approach is kind of a sweater chop shop so I studied with someone who is a fabric artist years ago you can buy thrift store sweaters you wash them in the washing machine put them in the dryer you essentially felt them and then you can cut them up and reassemble them so that's what piecework Zambia really came from I can say that it ever generated a ton of money for our Torres Sambia project but it was certainly a lot of fun to do and it was a great way to you know I kind of got it kind of gets my creative juices going

Howard:  it shows you're an artist at heart I'm you know we just had the IDF meeting in Cologne Germany and it's the biggest meeting in dentistry in Cologne Germany every other year and I always can't get over how different it is than America like in America no one would want to hear from a CEO of like Colgate or tom's of Maine or any of these companies that you worked in the past because they're selling something for a profit so they always want to listen from a dentist he doesn't know half of what this company is about their product but then when you go to the ideas meeting in cologne all the nice air that they want to talk to the owner of the company if you're like well hey I'm us I'm a speaker I'm an I'm the middleman intermediary of information I mean like when I go to 3m I have to go to 3m in Minnesota all the time because my sister is in a nunnery up the street in Lake Elmo so I have to go somewhere for four hours in one minute to make it a taxes offense and you would talk to all these PhDs in organic chemistry and then I would tell them what you know T people were saying on the lecture circuit and they would just they didn't know if they wanted to cry or throw up I mean it was just so stressful the misinformation but I'm Denist I say well those guys are making money it's like well what are you a volunteer I mean some lady comes off the street you tell her you got four cavities how she's supposed to know if that's true or not and she's trusting you and so why your patients have to trust you because they would know a cavity from root canal and the dentists in Europe trust dental manufacturers and they want to talk to the top dog you've worked with these companies that are for-profit Colgate Tom's of main I love working with the value chain I mean I've never gone to a dental company like like Colgate who's the Greek a guy photogoh I mean the guy's got two doctorates I mean if you spent an hour eating lunch with him at Colgate if you'll raise your IQ three points what advice would you have to these young kids coming out of dental garden when you know and interacting with these big companies well as your experience been with them 

Dr. Maguire:  I’m an industry champion I enjoyed working for Colgate I enjoyed working for Thompson main you know Colgate that purchased tom's of Maine I don't know what kind of karma I have about Colgate but obviously I'm still working um but you know both great companies and also the because of the manufacturing standards around the products that they made it was very easy for me to sell what they had I thought that they were both really impeccable in how they approached their quality control and of course they have some help from the government in keeping that quality control up but I you know I'm still I'm a very strong proponent of both of those companies and the and the products that they that they sell I have to tell you we were talking about fluoride earlier when I worked for tom's of Maine you know they make products they make toothpaste without fluoride and they make toothpaste with fluoride and we figured that if we were getting calls and in the customer service center saying you know why the heck are you making toothpaste with fluoride and then you know about the same number of calls saying why the heck are you making toothpaste without fluoride that we were doing it about right

Howard:  yeah so yeah the crazies on both ends are probably the same but you know what I always tell us look if you because I used to um you know I've said this a million times when I was a little kid I had five sisters and a brother and our vacations are go to some big theme park Six Flags over somewhere and then dad always stopped at a place to watch this make something like when we ordered our new family station wagon we drove the Detroit a golf cart pulled us on a deal we got to follow a car from start to end I took us to you know Coors all these different places I just so I always had that love of seeing all the dental manufactures my four boys have been to probably a hundred dental manufacturing plants in 30 different countries love it I used to have one each month introducing your value chain to the dentist and we had to stop it because there is like why do you have these people selling stuff in here and it's like dude you sell stuff why  is it so emotional why is health care emotional why is it dental manufacturing motional I mean sometimes I think I'm the only normal person on the entire planet but Colgate I mean what would a legend in dentistry you go around the world and half the countries don't even have a word for toothpaste it's called Colgate just like you'll say hand me a Kleenex and it wasn't a Kleenex you'll say make me a Xerox copy and they're on a Canon printer I mean I mean Colgate it was so amazing there's not even a word for toothpaste and a half the countries and what I would recommend is that when you're on vacation number one you make it a tax expense I mean if you're there for hours in one minute but if you walk into any of these dental companies and you're a dentist they treat you like royalty but when you get to see feel touch the manufacturing of a bonding agent an impression material to the toothpaste it's it shows you that show touch feels how you educate children I mean it is just I there's so many products I will never think about the same because I actually went in there and then you find out that the people that own the company and the people work they're just as passionate as you are and they all see themselves on the same team fighting oral health decay and every everybody gets it except my homies I mean I just I don't get it so and so I can't believe we went over an hour are there any I mean you could talk forever is there any things that you wish I would have asked that I was too dumb to not ask enjoyed our conversation so 

Dr Maguire:. I you know we could do this for the next 24 hours and we'd still be going at it 

Howard: well you know I would love I'm I mean so I'm actually a dental journalist because I've owned a magazine since 94 I've had a monthly column 94 to 2018 and I you know you get two feet of stuff sent to you every month and you're gonna publish three or four things but if you if you yourself anybody in public health I mean I always tell my editorial team we have way too much stuff on root canals fillings and crowns and public health like I say I started it off with public health it's like the redheaded stepchild of Dentistry I mean it's saying you know she should be she's just it's just it's overlooked anything on public health and then just for selfish reasons for myself you have so many connections with Harvard and foresight and all those fancy universities could I bribe you to get any my five grandchildren into college do you do you have a program that I could I hear it's a new range now to get into these fancy schools I just got to find someone and give up money maybe that should be your new piece works or Zambia you should just start taking bribes to get dentists rich dentists kids into your fancy schools and then just channel all the money to your operation options for children in Zambia well hey um thank you for coming on the show thank you for your love for public health thank you for all that I'm when I read about your career I mean it's just amazing I have to live to be about 690 to do everything that you've done but seriously thank you so much for coming on the show and then I want you to email Denise Kassebaum say oh I went on the show and you're still stalling you're too busy Denise she would be a great follow-up to you but thanks for all you've done dentistry 

Howard: my last question is my last question is what would your advice be to all these kids that just left school last Friday bright-eyed and bushy-tailed what what's your what would you say to them what would you final advice me

Dr. Maguire   I would say you know do find the way to practice dentistry that makes your heart sing and the rest of it is gonna take care of itself 

Howard:  truer words never spoken that is obvious thank you so much for coming on the show.

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