Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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962 Mentoring Hygienists with Katrina Sanders, RDH, BSDH, M.Ed, RF : Dentistry Uncensored with Howard Farran

962 Mentoring Hygienists with Katrina Sanders, RDH, BSDH, M.Ed, RF : Dentistry Uncensored with Howard Farran

3/3/2018 7:38:17 AM   |   Comments: 0   |   Views: 594
962 Mentoring Hygienists with Katrina Sanders, RDH, BSDH, M.Ed, RF : Dentistry Uncensored with Howard Farran

Katrina M Sanders is a graduate and recipient of countless awards from the University of Minnesota’s School of Dentistry Division of Dental Hygiene.  She is proud to currently serve on the alumni society for one of the most prestigious dental schools in the country. 

Upon moving to Phoenix, Arizona, Katrina sought opportunities to extend patient awareness beyond her operatory by exploring and performing non-traditional clinical roles such as developing outreach programs to further educate targeted populations.  Katrina coordinated and implemented educational programs through participating schools and their districts as well as holistic grocery stores.

Katrina’s professional career emerged as an educator when she attained full-time employment with a career college in Phoenix, Arizona. During her time in these capacities, Katrina spearheaded curriculum design, redesigned program objectives and created policy manuals.  A physical manifestation of Katrina’s commitment to her profession is in the development of her textbook, Introduction to the Dental Hygiene Profession.  Katrina has also been contracted to create curriculum for Bachelor’s degree completion and nationally recognized continuing education coursework in local anesthesia.

Katrina proudly received her Master’s Degree in Educational Leadership with distinction through Northern Arizona University as a Phi Kappa Phi Honor Society distinguished member.  Her graduate degree led her to founding Sanders Board Preparatory in which she has developed and implemented a 100% pass-rate National Board Preparatory course offered to the dental hygiene students preparing for their National Boards. 

Currently, Katrina is a distinguished speaker with Dental Hygiene Culture as she lectures nationally in a variety of dental hygiene continuing education content.  She also speaks internationally with Smiles At Sea, and spoke as a finalist in Dentistry’s Got Talent 2017. She has also been a featured speaker with Dental Hygiene study clubs throughout the state of Arizona.  Katrina is a content writer for Dentaltown Magazine and Today’s RDH, and serves on the editorial board of, a website dedicated to helping the dental hygiene community flourish and succeed.

Katrina still enjoys clinical dental hygiene practice in Phoenix, Arizona and spends her free time at her Jazzercise gym, snuggling with her rescue dogs and proudly received her level I wine sommelier certification in early 2018.  She hopes to begin her PhD studies in 2019. @MsSandersRDH

VIDEO - DUwHF #962 - Katrina Sanders

AUDIO - DUwHF #962 - Katrina Sanders

Howard: It is just a huge honor for me today to be podcast interviewing Katrina M. Sanders, RDH BSDH, MEDRF, amazing. She is a graduate recipient of countless awards from the University Of Minnesota School Of Dentistry, division of dental hygiene. She is proud to currently serve on the alumni- society for one of the most prestigious dental schools in the country. Upon moving to Phoenix, Arizona, Katrina's saw opportunities to extend patient awareness beyond her operatory by exploring and performing nontraditional clinical roles such as developing outreach programs to further educate targeted populations. Katrina coordinated and implemented educational programs through participating schools and their districts as well as holistic grocery stores. Katrina's professional career emerged as an educator when she attained full-time employment with a career college in Phoenix, Arizona. During her time in these capacities, Katrina spearheaded curriculum design, redesign program objectives, and created policy manuals. A physical manifestation of Katrina’s commitment to her profession is in the development of her textbook, Introduction to the Dental Hygiene Profession. Katrina has also been contacted to create a curriculum for a Bachelor's Degree completion and nationally recognized continued education, coursework in local anesthesia. Katrina properly received her Master's Degree in educational leadership with distinction through northern Arizona University where three of my boys went.

Katrina: Awesome.

Howard: And then the fourth one went to ASU. As a Phi Kappa Phi Honor Society distinguished member, her graduate degree led her to founding Sanders Board Preparatory in which she has developed and implemented a 100% pass rate National Board Preparatory course offered to the dental hygiene students preparing for their national boards. Currently, Katrina is a distinguished speaker with dental hygiene culture as she lectures nationally in a variety of dental hygiene continued education content. She also speaks internationally with Smiles at Sea and spoke as a finalist in Dentistry's Got Talent 20 17. She has also been a featured speaker with dental hygiene study clubs throughout the state of Arizona. Katrina is a content writer for Dentaltown magazine and Today's RDH and serves on the editorial board of Modern Hygienists, a website dedicated to helping the dental hygienist community flourish and succeed. Katrina still enjoys clinical dental hygiene practice in Phoenix, Arizona and spends her free time at her Jazzercise Gym, snuggling with her rescue dogs and proudly received her level one Wine Sommelier Certification in 2018. She hopes to begin her Ph.D. Studies in 2019, damn. So you were born in Milwaukee.

Katrina: Yeah.

Howard: Went to hygiene school in Minneapolis, St Paul.

Katrina: In Minneapolis, yeah.

Howard: And then what made you move to Phoenix? Was it the climate?

Katrina: Have you been to Minneapolis in the winter time?

Howard: Actually, so have you heard Lake Elmo?

Katrina: Yes, of course.

Howard: My two oldest sisters when they left high school they went straight into the nunnery.

Katrina: Oh okay.

Howard: And one of them into the [inaudible 00:03:00] Monastery in Lake Elmo.

Katrina: Oh awesome.

Howard: So I always visit her all the time. I have left Phoenix and got to her place and lost 100 degrees temperature.

Katrina: Yeah, that sounds about right.

Howard: Like four or five times and people say, "No dude it wasn't a hundred degrees." I'm like, "Dude, it was a hundred degrees."

Katrina: It is.

Howard: I left here it was like seventy-eight. You get there and it's below zero.

Katrina: Well, you know what's so funny about the University of Minnesota campus? I believe it is the second largest campus as far as size in the United States and so even though I lived, I'm going to put in quotes "on campus", it was still a two-mile walk from my apartment to the dental school in [Louis 00:03:34] Tower. So you're walking that in I mean literally negative twenty, negative thirty-degree weather and after four years of that you're just over it. You need to move on.

Howard: My kids don't even believe this because they don't get it being born in Phoenix.

Katrina: Yes, of course, you wouldn’t.

Howard: But so I went to Undergrad at Creighton in Omaha.

Katrina: Okay.

Howard: And then I went to dental school in Kansas City and so I didn't have a car...

Katrina: Yeah.

Howard: During undergrad or the first three years of dental school I didn't have a car. And in dental school me and a couple other dental students like Georgia we lived eight blocks away and when we had to write with our tests, we used to walk the eight blocks and get there at least twenty minutes early because your hands will be so frozen...

Katrina: Yeah, had to let it defrost.

Howard: You'll be trying to do your tests and you needed to write an essay so you'd be shaking your hands and warm it up so you could write as fast as you can for an hour SA test.

Katrina: Absolutely and you don't even realize our clinics were set up so that our patients could take off the seventeen layers and their boots and all that stuff. It's a big deal. It really changes the way that they set up the structure of that campus so, yeah.

Howard: So I call this dentistry uncensored, so I don't like to talk about anything that everybody agrees on. But some of the more controversial things, you have a registered dental hygienist, a Bachelor of Science and Hygiene, Master's in Education, but RF stands for?

Katrina: Restorative Functions.

Howard: Restorative Function. And Arizona just past expanded duty function. Is that what RF is? Expanded duty function?

Katrina: Similar concept. Every state has their own interpretation of what it is and one of the fun things about this RF was that I was the very first class at the University of Minnesota to train dental hygienists to perform the restorative functions duties. So we are certified to deliver composites, glass atomizers, amalgams and stainless steel crowns on a primary dentition and one of the amazing things...

Howard: Now could you prep for them or...?

Katrina: We can't prep.

Howard: You couldn't prep, just restored. So the dentist numbed and prepped.

Katrina: Hygiene would anesthetize, the doctor would come in and cut the prep and then leave and the hygienist would finish it. And we can do all the finishing on that. So the nice thing about this was we would go into these really rural areas and we would be able to provide care, so much more care to the populations there because the hygienists were able to supplement, do a lot more work instead of having one doctor and an assistant kind of running around from operatory to operatory. So speaking of this being kind of controversial this was incredibly controversial at the University of Minnesota at the time because you had the dental hygiene program and then you had the dental folk who were very much feeling threatened by the fact that hygienists were now beginning to do this. So there was a study that was conducted where they took my cohorts work that was done. We had to place for competency composites, glass atomizers, stainless steel crowns, amalgams and they had compared our typodonts to that of grad completed third-year dental students. And they had a rubric that was filled with integrity and anatomy, contour all of the beautiful things that you have to think about when you're delivering a restoration of this type and they compared the dental hygiene students to the dental students, and this was in a blind study, and the dental hygiene students made remarkably better materials than the dental students. And this of course was published in the DM magazine and it kind of changed the way that people began to look at how hygienists deliver these fillings. So the unfortunate thing is since I moved down here to Arizona I've not been able to use it in Arizona, but when I go down to Mexico, Puerto Penasco and I do humanitarian work down there, I'm able to utilize those skills, which is a really amazing ...

Howard: Puerto Penasco’s Rocky Point.

Katrina: Right.

Howard: That's how they say it in Spanish, Puerto.

Katrina: Yeah, but you see Puerto Penasco it makes it sound more like you're giving back to the community. They're like, "Oh yeah, I party at Rocky Point." And then sometimes [inaudible 00:07:23]

Howard: Well, it's funny because one of the advantages of living half a century is you keep seeing the same rodeo over and over.

Katrina: Sure.

Howard: The first time you see it you might be emotionally or shocked or upset or happy. By the time you see it a second or third time it’s just it is what it is.

Katrina: Yeah.

Howard: And so dentistry went through this just creating your career.

Katrina: Absolutely.

Howard: The dentists were completely threatened. You are not going to train someone to do, that's what we do. Well, now that hygienists are out there nobody would say get rid of them.

Katrina: I want to clean teeth, yeah. I want to do prophy’s all day.

Howard: And then the expanded duty function, which just got passed Arizona last year.

Katrina: Yeah just last year.

Howard: And my office is thirty years old and I know what you're thinking. I don't even look like I'm thirty, so how can I have a practice that's thirty years old.

Katrina: You don't, I know. Yeah, you a Doogie Howser or something?

Howard: And for thirty years I grew up in Kansas, so all my friends there had that expanded duty function and they loved it. They would have one or two room’s hygiene and one or two rooms ... I know one dentist had four rooms of expanded duty so he would numb, numb, numb, numb, drill, drill, drill, drill and they go back in his office for half an hour and read the newspaper.

Katrina: Yeah, finish some coffee, hang out.

Howard: And of course the expanded duty functions do them better than dentists because they sit down and take the time to do it right.

Katrina: Yeah.

Howard: The dentist is trying to do two fillings in room two, while he's got a crown going in room three.

Katrina: Yeah, an exam over here.

Howard: And he's running around and every dentist I know with expanded duty function says well they do it far better because they're not under this stress storm of running around three or four rooms. And so now you have the most controversial thing on Dentaltown, which is, I don't know if it's DSO's or dental therapists, but in the States that I've seen the dental therapists, the dentists love it. They go, “I got two people in the first two rooms doing hygiene and then the next two rooms I have dental therapists doing all the fillings. So now all I get to do is root canals and crowns."

Katrina: Right.

Howard: And they're like, "How cool is that?"

Katrina: Yeah, exactly, yeah.

Howard: And the dentists from Dentaltown is like the end of the world. The sky is falling ... so what's your thoughts on dental therapist?

Katrina: Well...

Howard: And is that going to come to Arizona?

Katrina: I think it should come to Arizona and...

Howard: But do you think it politically will come to Arizona?

Katrina: I don't know and I think a lot of that stems from the education that we are providing. So for example, in Minnesota the bar or the standard is established by the University of Minnesota and we've got the Mayo Clinic right there and so that drives a lot of the concept about outreach and going into rural areas, and so there's a huge need for that. The problem is so many people stay here in Phoenix and are not interested in going out into some of the rural areas and being able to deliver a care for that type of a population and that's where the need is. So is it productive here in the city of Phoenix? Absolutely. However, the idea behind establishing this in a state like Minnesota really is to provide access to care for populations outside of the city. Having said that, you need to then decide, so are these going to be hygienists that received their associate's degree that maybe take a certification class and now all of a sudden they're able to perform these procedures that you've had to go to dental school for. There has to be such a planned idea when it comes to the certification process and how this is implemented. So when you're talking about dental therapists I think what you're talking about are hygienist who can maybe do simple extractions even and can cut their own preps and things like that which are being done in other states, and that's a Master's Degree program. So I would say do we have the ability to do that? Absolutely. Are the dental hygiene programs willing to take that on and wanting to implement programs like this? Absolutely. Do we have hygienists out there who, I'm going to do a shout out to Jasmin Haley who does Beyond the Prophy and Elijah Desmond who does Trapped in the Up. Are there hygienists who are ready to move beyond doing scaling and root planning, prophy’s and fluorides all day? Absolutely. So I think there's a need, there's a want for it, but of course, we've got all of those other barriers and as you mentioned earlier a lot of it is dentists who don't see that this can really be an excellent opportunity for them.

Howard: And dentistry in dollars has always been 5% of the total healthcare budget and the MD's, there's a million MD's there's only two hundred thousand dentists. The million MD's have physician assistants.

Katrina: Right.

Howard: They have something halfway between a four-year registered nurse.

Katrina: Right.

Howard: And an eight-year MD and it's a six-year PA, right?

Katrina: Umm.

Howard: And they couldn't call it a dentist assistant like the physicians is because the market already knows the PA.

Katrina: Right.

Howard: And I ask people and I hear them, they're great with the PA for I got a cold, I got a flu. I need a tetanus shot, all this stuff like that, but they don't want a PA to do a quadruple bypass.

Katrina: Of course, yes.

Howard: I mean they get it. I love the PA's because when I grew up with the four boys an emergency room visit was always a three-hour wait. Now I just take them to Walgreen's.

Katrina: Right.

Howard: And they got a twenty-four hour Walgreens. They got that medical clinic in there. It's all PA's. Love it. So which states have dental therapist? I know Maine has a hundred. Alaska has...

Katrina: Maine, Alaska, yeah, and Washington has and I'm not quite sure they might have just changed because I know they were talking. There's been a lot of legislative work because I know that they are heavy in the restorative function hygiene, but I don't know what their dental therapists is. In Minnesota, they've got dental therapists and advanced dental therapists that have different levels of care that they provide as well so...

Howard: It's almost like I'm afraid to get on my own website Dentaltown and tell people I'm pro dental therapist. I mean I’d rather tell them I was a gay, homosexual stripper.

Katrina: Yeah, you might want to relocate. Yeah.

Howard: Yeah, I'd rather tell them I was a gay stripper in Scottsdale.

Katrina: You don't want to tell them the truth.

Howard: Because for instance when hygienists enter independent practice.

Katrina: Yeah.

Howard: I mean they're ready to take up arms over that. I mean they'd really get an M16...

Katrina: Yes.

Howard: And a thousand rounds of ammo. Yet when I go to Colorado states [inaudible 00:13:48] every dentist I know loves it because every one of them, I think there's only seven or eight, is in a small town of a thousand.

Katrina: Yes.

Howard: She did what I did for [inaudible 00:13:56] she took out our dining-room table. The reason we converted our dining room into a podcast studio is because being a bachelor since we had never cooked on it one time in almost a decade we thought it was just a museum. And so that's what the hygienist did.

Katrina: Function, absolutely.

Howard: She didn't go buy land and building on that she took her front room, got rid of the table, the China closet and put in a dental chair. And then if she sees something she writes a referral to the dentist an hour into town and the dentist loves it.

Katrina: Absolutely. You've got a thriving business.

Howard: Because he's got a phone call I just got my teeth cleaned by Katrina.

Katrina: Right.

Howard: And she says she wants you to check something and he says obviously there's something wrong and they all love it. And you said [inaudible 00:14:35] Mayo clinic, they saved a dentist friend of mine's dad who's a dentist, life. That was amazing.

Katrina: Wow.

Katrina: I got to tell you the Mayo story because it's really important because it shows you there's always a market for the best. So they moved to this small town, Saint Joe and he got sick and sick and sick. And she took him to the doctor. They couldn't find anything wrong. And then he started to get really sick so the wife thought well, the doctors in Saint Joe aren't as good in Kansas City. So she put him in their Jaguar, drove him all the way to Kansas City. Went in there and Kansas City they couldn't find anything. He's just sicker and sicker and finally, the Kansas City doctor says, "We don't know what's wrong, but he's definitely dying. He's going to shut down and die."

Katrina: Wow.

Howard: So she ordered an airplane ambulance and I didn't know they have such a thing.

Katrina: Yeah.

Howard: So she called an airplane ambulance. The ambulance took him to the airport. They flew him all the way to Mayo Clinic. Mayo clinic walked in there and said, "Look, the doctors in Saint Joe and Kansas City they're highly educated. I'm sure they ran everything that you should run.

Katrina: Right.

Howard: So we're going to work backward and we're going to run exactly what they wouldn't have tested for. The most illogical stuff.

Katrina: Yeah.

Howard: And within, I think it was within two hours guess what he had?

Katrina: I don't know.

Howard: A yeast infection.

Katrina: Holy cow.

Howard: But you only check girls for yeast infection. They only check girls for breast cancer.

Katrina: Right.

Howard: The 1% of breast cancers, yeast infection and sure enough his wife had had a yeast infection.

Katrina: Oh gosh.

Katrina: So almost died and there's always that market for the high-end and we've got a Mayo Clinic out here.

Katrina: Yes, yes.

Howard: And I cannot tell you some of them are very famous dentists and I didn't want to say it, but there's some really famous dentists have some miracle stories...

Katrina: Absolutely.

Howard: Of where they were in another major city and they finally got frustrated and said, screw it, I'm going out of the insurance. I'm going out of network and usually, when you're about to die of some disease it's probably going to run you a hundred grand, but they run in there. Here's what happens in your town. You go to the doctor, they find a lump. So they schedule you for a biopsy that's two/three weeks away. Then do the biopsy. Then they're now going to read it and figure out what it is.

Katrina: Right, right.

Howard: So you go back three weeks and then they say okay, it's cancer. So now you're going to see hematologists. Well, that's another three or four weeks and then the hematologist says okay, you need to have a surgery. So by the time you're even getting going, you've already wasted four, five, six months.

Katrina: Right.

Howard: Mayo Clinic, everything I just said would be done in twelve hours.

Katrina: Yeah.

Howard: And so they have their own labs, they have everything. They do a biopsy. There's a pathologist in the basement, everything's done.

Katrina: Absolutely.

Howard: And then they come back and tell you these are your only three options.

Katrina: Right.

Howard: And then you say okay, this is the option. And then they do it. I mean it's just amazing.

Katrina: Very seamless.

Howard: And I always found that interesting that in healthcare people always know Mayo Clinic, John Hopkins.

Katrina: Cleveland Clinic.

Howard: Cleveland Clinic. The Scripts in San Diego, but none of the DSO's took that position.

Katrina: Right.

Howard: All the DSO's are just faster, cheaper, easier.

Katrina: Right.

Howard: Which is a great market. I mean obviously the McDonald's market is hundred times bigger than the Ruth Chris Steakhouse market.

Katrina: Of course.

Howard: Nobody's really identified themselves. If someone needs it. It needs to be a very big group like Mayo and it could be just in one city. Mayo's in what, three cities? What is it?

Katrina: I believe it's three. I can't recall where the other one is, but...

Howard: Florida.

Katrina: Okay, Florida, yeah.

Howard: Florida somewhere. That's where every person over eighty in New York and New Jersey that's worth a million now lives in Florida.

Katrina: Yeah, there you go.

Howard: The last I heard on the expanded functions that the state Board of Dental Examiners told the dental schools and the hygiene schools okay this is legal now, but we're not going to certify anybody until someone makes a program.

Katrina: Somebody's got to build a program. So I know that Midwestern has a program and I know that Phoenix College has a program and I know that Phoenix College's program is completely booked up for a long time. I mean there's a big interest.

Howard: Have they graduated a class yet?

Katrina: I don't think they have.

Howard: Okay.

Katrina: I think they're starting their first, I believe it's right around this time that they're starting their first-course offering of it. They had to build it. And the way that the law works here in the state of Arizona is if an assistant can do it, then a hygienist can do it and so there was a big push to have it be EFDA, which now means hygienists can step in and do it. So right now you're seeing a huge influx of assistants doing it and I wonder if hygienists will start to get on board. The certification isn't inexpensive. It's a couple thousand dollars, but I'll be interested to see what kind of platform is now built when it comes to entering a private practice and saying these are the certifications I have. And I'm also interested in seeing what patients have to say about it because I've been practicing for eleven years, but I still go in and when I'm going to numb up a patient, they look at me like I'm twelve and like, "You know how to do this?" You're like, "Yeah."

Howard: Well, you look seventeen.

Katrina: Thank you. That's so sweet. Your check's in the mail.

Howard: So, you don't look twelve.

Katrina: No, but I mean and when I graduated I was twenty-two-years-old and I really...

Howard: You have awesome, amazing great teeth. Is that au natural or is that...?

Katrina: Thank you. They are, yeah, they're all...

Howard: Were there no braces?

Katrina: Oh, I did have braces twice.

Howard: Oh okay.

Katrina: Yeah, I thought you were asking if they were veneers.

Howard: No, okay.

Katrina: Braces twice because I didn't wear my retainer the first time. 

Howard: Another thing I think would help accessibility is I feel so sorry for all my dentist homies in NYU in their foreign grad programs because they're already a dentist from an accredited school around the world...

Katrina: Yes.

Howard: But they can't even get ... I think they should lower their degree one for economic purposes.

Katrina: Yes.

Howard: Like if you're a dentist you should be able to be a registered hygienist. If you're a cardiovascular surgeon you should at least be able to be a ... if you're a cardiovascular surgeon in New Delhi you should at least be able to be a physician's assistant.

Katrina: Yeah.

Howard: I mean because they need a job while they're going through these programs that cost bank.

Katrina: Well, you're absolutely right. And it's interesting because the University of Minnesota does have a program like that. It's a one-year residency for people who are dentists in another country. So they're trained. They're already [inaudible 00:20:55]

Howard: Is this a one year program?

Katrina: I believe it's a one-year residency and they come in and they can get their DDS from the University of Minnesota. And I find it interesting because when I was faculty here in town, I taught a student who was a dentist in another country and I can't recall where she practiced, but she was coming here to get her associates in dental hygiene. And I felt kind of silly because I had to teach her injections, and it’s like, "You know how to do these. Why am I teaching them to you?"

Howard: Yeah.

Katrina: But she still appreciated it and she was fantastic. And now she just graduated and is starting to practice, but you're absolutely right. It is interesting because in other countries they're already performing these duties and now they're having to go through the rigmarole here when there are other ways that we can streamline that in education.

Howard: The single greatest economic, well they say never talk about politics, religion, sex or violence so I'll skirt the issue, but when I got my MBA issue, the thing that perplexed the mind of all my PHE instructors, myself included, and all my idols and mentors, like Milton Friedman, was the fact that if you ask anybody what made America the greatest country on earth? And they just say, "Ellis Island."

Katrina: Yeah.

Howard: The people who vote with their feet, leave their country and come here they're twice as ambitious. They've got more passion.

Katrina: Absolutely.

Howard: I mean it's like building their esteem. And then you look at, well when did the stagnation start, is when they've had the department of immigration and you sit there and say okay, I'm Irish, you're what, German?”

Katrina: German, Austrian.

Howard: And Austrian and even the Native American Indians came from India and Mongolia. I mean everybody came from somewhere.

Katrina: Right.

Howard: So you say well, to just get this country going great again let's just get rid of the Department of Immigration and open up Ellis Island and let them march with their feet and it'll be the greatest brain drain of the world. They're like no, hell no.

Katrina: Yeah.

Howard: Build a wall. And you're, oh, my God.

Katrina: Wow.

Howard: Yeah, so it's funny.

Katrina: You should run for the presidency.

Howard: Oh, my God. I would, but I don't lie, cheat and steal. I'd have to be a crook first.

Katrina: You would, you would.

Howard: Do you have a program on how to be a crook in a year? The rural versus urban deal. I have to take issue with the rural versus urban because when I talk to the Dean, hell, just doing a thousand podcast ... if you accept kids from LA and Phoenix and put them in dental school, hygiene school wherever, they go back to LA and Phoenix. The only kid that goes back to the town of five thousand is a kid you accepted at a school from a town of five thousand. And to tell somebody who grew up in a town of a million that he's going to live in Eloy, a town of four thousand.

Katrina: Sure.

Howard: He's thinking he's in solitary confinement and shoot me now. And if they want to solve the rural issue they have to just sit there and say no more kids from the urban. We're only going to accept rural because the dentist center against dental therapists are very correct in saying when they graduate they're not going to go to these rural areas.

Katrina: Absolutely, there's the challenge.

Howard: They're going to get a job for a rich dentist like me so that I cannot do my restorative.

Katrina: Right.

Howard: And they're exactly right, but the nuance is the only kids that go rural have come from the rural.

Katrina: Umm.

Howard: So they on Friday night were going to a rodeo and hanging out in the Walmart parking lot. You were at the Diamondbacks and the Sons and The Plaza and the shops and the … it's just two different people.

Katrina: Yeah.

Howard: And, my gosh, that was one of the dumbest things I ever did, Ryan, your mom was from Colwich, [inaudible 00:24:29] Kansas. My God, the minute she got here she told me she hated this town, but it's three point eight million.

Katrina: Yeah, it's a change.

Howard: And one of the first thing she did after we divorced, went back to ... how many people live in that town [inaudible 00:24:47] five thousand.

Ryan: Yeah, I was going to say less than twelve [inaudible 00:24:49]

Katrina: Wow.

Howard: I know and that's where she was from and you can't take a city boy and make him a country boy.

Katrina: Yeah.

Howard: You can't take a city girl and make her a country girl.

Katrina: Absolutely.

Howard: And so if they want to solve the urban to rural, what the government planners think if you double the class size, you double the number of graduates, you'll push them into the rural and you don't see that. You see buildings in downtown San Francisco on 457th Street that has a hundred and sixty dentists in a high-rise.

Katrina: Right.

Howard: None of them would even consider. What has got you passionate now? What are you most passionate about?

Katrina: Gosh, I'm passionate about a lot, but I'm here to talk about dentistry I think. The things I'm passionate about with dentistry, right? So I left education last year but did not leave teaching. So I now work for myself. I have my own LLC and I deliver continuing education to dental professionals as well as through my board preparatory course, so I'm going to start with my board preparatory course. This was kind of started in an organic fashion. I had left education and my previous students had contacted me and said, can you help us? We're getting ready to take on national board’s exam and we'd like your help.

Howard: Okay now which website [inaudible 00:26:01] because you got a couple of websites. Which one is the one you're talking about now to help them pass their national board exam?

Katrina: So it’s...

Howard: Is that katrina...

Katrina: katrinamsandersrdh and then you just click on the...

Howard: That's the board one.

Katrina: And you click on the tab Sanders board preparatory.

Howard: What part of town do you live in?

Katrina: I live on 32nd Street in [Shea? 00:26:18] so I'm pretty centrally located.

Howard: 32nd Street in [Shea? 00:26:21]. Is that Phoenix or Scottsdale?

Katrina: It's Phoenix.

Howard: In Phoenix.

Katrina: It's on the border of Phoenix and Paradise Valley.

Howard: Have you ever been to Hygiene Town? Have you ever been to the building Hygiene Town?

Katrina: I haven't.

Howard: Because you've [inaudible 00:26:32]. Hell, it's right in your backyard.

Katrina: Yeah.

Howard: You're the most prestigious hygienists in Arizona.

Katrina: Oh, start.

Howard: No, I'm serious. You got the whole team ... I mean just consider them your bitches.

Katrina: I love that. Are you recording this?

Howard: Yeah, I’m serious because I’m a big fan. I called you, you didn't call me. In fact, when I called you, you said, "Who the hell was this? You got to the wrong number." And then you hung up on me. 

Katrina: Yeah.

Howard: I think we have fifty-seven thousand hygienists registered in the Hygiene Town.

Katrina: Yeah.

Howard: And we do an email blast to every one of those hygienists I think every, I don't know...

Ryan: [inaudible 00:27:11]

Howard: We do a hundred thousand dentists twice a night. In fact, my only claim to fame...

Katrina: Your only claim to fame.

Howard: I am the greatest spammer in all of dentistry. I email all the dentists twice a night and I think all the hygienists every other day, but anyway.

Katrina: That's great.

Howard: But things like this I’m talking about you should tell them to put it on your hygiene...

Katrina: I will, I will I'll do it.

Howard: On your email blast or magazines or whatever.

Katrina: Yeah, so...

Howard: But anyway so if you go to katrinamsandersrdh, now they'll remember that better if they know what the M stands for.

Katrina: M is for Marie.

Howard: Marie.

Katrina: Yeah, and marvelous. I mean you could put marvelous.

Howard: And marvelous. 

Katrina: Marvelous. You could also do that.

Howard: Okay.

Katrina: And then so I've got tabs in there. My...

Howard: Tabs? That's the hamburger thing.

Katrina: Yeah, click the hamburger.

Howard: Now to me it looks like a Big Mac, but it's not.

Katrina: Okay, hit the big Mac.

Howard: It's a Big Mac.

Katrina: And then you click Sanders board prep.

Howard: Sanders board prep.

Katrina: And then you'll find my board preparatory page. Do you see my logo there?

Howard: Yeah.

Katrina: Isn't it cute? Do you like it?

Howard: Oh my God, a skull, and an apple.

Katrina: And my Mac book. That's my Mac Book.

Howard: I have to say something incredibly racist about skulls, but living in Arizona.

Katrina: Okay.

Howard: So I was born and raised in Kansas, right. Came out here where Arizona's a quarter hygienist.

Katrina: Yeah.

Howard: Land wise it's quarter American Indian. I swear all the Hispanic girls love the color black, skulls and crosses.

Katrina: They do, yeah.

Howard: Every one that's ever worked for me had [inaudible 00:28:35] because she's got a skull logo on her website.

Katrina: I'm not Hispanic.

Howard: Well, your middle name's Marie.

Katrina: It is. That's true, yeah.

Howard: That's the most common girl name in the state Arizona. It really is.

Katrina: I put the skull on there...

Howard: In fact, the biggest joke in Arizona is that when your patient walks in, she's a female Hispanic. You say, "Maria." It's either going to say, "Oh, you remember my name." Or she’s going to say, "Oh no, no, no. That's my sister." It's the most common name in Arizona. So you're Marie, you have a skull.

Katrina: Oh my gosh, you crack me up.

Howard: You should tell them on Hygiene town to put that tab on their website.

Katrina: I know, I will because it's fantastic. So my spring course is coming up soon. I'm very excited about. It's going to be a three-day course. Just an intensive of dental hygiene program and one of the things that I am passionate about because we're kind of making a circle here what I'm passionate about, is I think it's important if we're going to be talking about dental hygienists going into expanded functions, going and doing additional duties when it comes to treating our patients, is that we need to be on the education side, preparing these providers to assume those roles. So this program that I offer is not just, "I'm here to help you prep for your national boards." It's, "I'm here to help you prep for your dental hygiene careers. I'm here to ensure that you instill that passion, that joy, that love that you have for providing care to your patients, but doing so with immense excellence." So when you walk into a practice, because I do agree, I understand where these doctors are coming from. Like, "Ooh, I don't know if I'd want my hygienists doing fillings." Because there are a lot of hygienists out there and because we're on uncensored, I can be completely uncensored, right?

Howard: Absolutely.

Katrina: There are a lot of hygienists out there that I'm like are you serious? Some of the stuff they post on Facebook like the other day a hygienist was I thought I wanted LDL's and I thought the HDL's were the bad ones. And you're a hygienist and do you not remember that from nutrition. A hygienist just this morning posted on Facebook, "So I'm thirty-five. Can I get fluorosis if I take a lot of ...?" You're hygienist you don't understand that fluorosis is from the systemic acquisition of fluoride and you're thirty-five, so you're not ... you know what I mean, hello. And so there's no wonder why these dentists are going, "Ooh, I don't know." Do you know what I mean?

Howard: I do.

Katrina: Because hygienists need to get it together and so that starts in the education realm. That starts with me going, listen, you're not walking into private practice going, "Oh, I don't know." You should be the one with the answer. You should be providing that solution to the doctor and going, “Doctor, I have a patient who has a liver disease. I need to deliver anesthesia. I would like to use articaine because it's metabolized in the plasma [colonastories? 00:31:17] instead of through the liver.” Boom. You should be prepared for that because then when we start getting these additional expanded functions we are ready to step into those roles and our doctors believe us. Does that make sense?

Howard: It really does.

Katrina: Because I believe in that and I think that we need to get it together and I will always be an advocate for hygienists, but not if we're just going to sit back and be prophy queens. So I'm not interested in that.

Howard: Well, a lot of the dentists have the same...

Katrina: Yeah, preps.

Howard: A lot of the dentists say funny things. Take the amalgam issue.

Katrina: Yeah.

Howard: It's half mercury and it's bond to the other half silver, copper, tin, and it's an insoluble salt. If you triturate amalgam and swallow it the next day, ding there is it.

Katrina: Yeah.

Howard: Just swallow it and wait every day for a year and it's all there but the absorbable mercury from burning coal that's taken the ocean from one part per million mercury in 1950 to four-part per million in 1918 and that mercury goes to the bottom, is eaten by things on the bottom like shrimp and lobster and shellfish.

Katrina: Right, the bottom feeders.

Howard: So that when you eat shrimp it's absorbable. Ethyl mercury, methylmercury goes completely in your bloodstream.

Katrina: Yes.

Howard: And UFA, I know you're NAU and I'm ASU and the only thing we agree on is we hate UFA. That guy has done so much research on it so all this mercury in the brain is from seafood and the CDC has wanted to put banning, pregnant mothers not eat tuna and things like that.

Katrina: Right.

Howard: And you'll have these dentists who think mercury's toxic, taking out all these amalgams and they're telling you about it at dinner while they're eating six shrimp and cocktail sauce...

Katrina: Absolutely, they're enjoying their sushi. Sure.

Howard: And they're eating a big piece of tuna and I mean it's, wow.

Katrina: They don't get it.

Howard: Really? You're a doctor of dental surgery and you don't see the complete insanity of this.

Katrina: Absolutely.

Howard: And if you're going to take people's mercury fillings out because you're a holistic all natural dentist, well then you better tell them all quit eating seafood, including yourself.

Katrina: Right. No, I agree and it's interesting that you bring that up. I just delivered a very provocative lecture two or three nights ago on fluoride and the title of the course was called "What the Fluoride" and it was...

Howard: What the Fluoride.

Katrina: What the Fluoride. I thought it was important because as a hygienist, as a dental provider, people assume that we're always going to defend fluoride. That fluoride is everything when it comes to remineralization therapy and the reality is one, it's not the only product that we use on the market for remineralization. Second of all, I do think that so many times we don't realize that our patients have access to so much information. The amount of information that people get over Twitter, the amount of information we get over Facebook, we can go onto Wikipedia, Web MD. There is information out there and if you go and you search fluoride on the internet you can get information about how fluoride causes Alzheimer's because of aluminum buildup in the brain and you can get information about how some guy did a study that fluoride causes down syndrome in mid-western communities. And so if I'm a parent and I'm not, I have three dogs who are absolutely adorable by the way and a tortoise who's hibernating right now, but he says hello. But if I were a parent and I'm getting ready to take my kid to the dentist and I have a hygienist who's now annoyed with me because I'm saying I researched fluoride and I don't want you to give it to my kids, and now I'm getting this attitude from the hygienist like she's annoyed. Like I'm an inconvenience. What are we doing in the dental industry then? Do you know what I mean? So I delivered a very provocative lecture that went over okay, let's crack open these cases. Let's look at these communities where they stopped fluoridating their water. Where did their decay risk go? Why was there decay risk still declining even though they had removed fluoride from the water? Iceland's a great example. Iceland removed fluoride from their water and they said we're continuing to see a pretty steady decline in dental decay. Well, if you look at the PH of their water it's anywhere between eight point four and ten So we know that the strep mutans have to live at what, five point five critical PH, even to just bite through enamel. So we know if, if people in Iceland are drinking incredibly alkalized water, they're not even at an elevated risk for decay. Why would you be fluoridating these people? And so I had this just really intense conversation in a room full of thirty some odd hygienists and by the end of it, it was, wow, fluoride is great. There's no question about it. I grew up in a fluoridated community. I use fluoridated toothpaste. I put fluoride varnish on my dog's teeth after I do their cleanings, but the reality is if I have patients that come in and aren't interested in having fluoride, at least now those thirty hygienists who hung out with me are preparing to have a conversation or to ask the question, what kind of remineralization therapy would work for you? And I think that's where we need to be going in dentistry. Customizing that care for our patients and not just saying well, fluoride is fine and then taking personal offense to it when a patient doesn't want to have fluoride. Because that's I think where a lot of dental providers go.

Howard: Talking down, condescending,

Katrina: Yeah, absolutely really...

Howard: Making the patient feel bad.

Katrina: Absolutely.

Howard: And then they're not getting to part with their money.

Katrina: Right.

Howard: But the amazing thing that I've seen in all the amazing minds is that people don't realize that when they're born in a country, that country gave them their religion, their food preferences, their language. They drank all the purple Kool-Aid...

Katrina: Yes.

Howard: And you'll never have an original thought in your own country, but it's going around the countries to Iceland. The greatest luxury I ever got, which I didn't know would have when I started lecturing was not lecturing in fifty countries and when you go to Iceland. Singapore and Japan are amazing where Singapore, totalitarian, authoritarian government forced fluoride in the water. Tokyo, one of the biggest cities took it out.

Katrina: Right.

Howard: Both of their decay from 1950 to 2018 it went down the exact same rate. So then you talk to their dentists and their dental schools and they studied the hell out of that and they said they linked it to change in behavior. Their studies showed that the child did whatever hygiene the mother did and not the father. Like the Mona Lisa, the reason she looks so bizarre is because she shaved her eyebrows. So all through times sometimes they shave their eyebrows, their underarms, their legs. Lots of countries now, today, girls don't shave their legs.

Katrina: Yeah, that's a choice isn't it?

Howard: So when the mom started brushing and flossing the baby will. If the Mom brushes but doesn't floss, the baby won't. If the mom uses mouthwash the baby will. It's like whatever the mom does, but by having dental schools and programs, commercials raising the dental IQ of all the moms making babies that all their home-care took up and so in those two cities water fluoridation is a non-variable.

Katrina: Right and I do find that very interesting because it does go back to that theory or that concept that because of what we were taught in school and I took a poll of the people who attended my fluoride course. Why do you recommend fluoride? 55% of the hygienists in the room said I recommend it because it's what I was taught in school. And the reality is we know water fluoridation is just one piece. In fact, we're taught in dental hygiene school that the number one decay risk factor is frequency of fermentable carbohydrate intake. We know that. So when we see somebody who's got high [cario-genic? 00:38:58] tendencies and we're going, "Well you should be doing fluoride." Why are we not having a nutritional counseling conversation with those patients? Because and I think fluoride is thirty-five/$40 application for our patients so that's going to be a lot more profitable for the practice. So now we kind of go into this conversation about patients walk in the door thinking that we're trying to sell them something and we want them to believe that we do have their best interests at heart and we do care. But then I'm going to make this recommendation for a fluoride treatment when really what I should be starting with is a conversation about your nutrition and that is going to be that comprehensive total body wellness care that we should be providing to patients if we want to have a seat at that oral systemic table.

Howard: And the other thing that annoys me about all these dentists that are against silver fillings or water fluoridation. They're always having this conversation with me with this, their bottled water?

Katrina: Yeah.

Howard: Their water is a dollar a bottle all day long and the one reason I was so involved with it in 1989 the first time I got the Arizona Award from the Arizona State Dental Association.

Katrina: Congratulation.

Howard: And then we got it again twenty years later is because all the middle class and the rich, they don't drink the water.

Katrina: Right.

Howard: They drink bottled water. This is reverse osmosis, this doesn't have squat in it.

Katrina: No, yeah.

Howard: It's the poor of the poor. When I grew up my mom and dad had seven kids in three days and we were drinking out of the garden hose.

Katrina: Yeah, of course.

Howard: And we didn't know that in the rich part of town had water fountains and all these fancy things. But when I'm in Phoenix, Arizona and when you go to the areas, my dental office across street's Guadalupe.

Katrina: Okay.

Howard: And I had been to Guadalupe a hundred times and when I go into my patient's house or friend's house, whatever, half of those floors are dirt floors. They're not drinking bottled water.

Katrina: Yeah.

Howard: Their dads working a lawn mower or a weed-eater or hammering nails for cash on the side because he's an illegal and the water fluoridation helps the poorest of the poor. There was another thing I was going to say on that, but anyway.

Katrina: Yeah, what you bring up is actually a really interesting idea because one of the major arguments that anti-fluoridation do have is about the fact that even though they implement high fluoride levels, one point two parts per million, let's say into lower socioeconomic status income communities, they're still seeing high rates of decay. But in cities like Scottsdale where the water is not fluoridated, there a lot of wells and so there's no fluoridation happening. They're not seeing the high levels of decay. So they're trying to find a statistically significant piece to wrap everything up with a little bow saying, "Hey, we're fluoridating the water in these lower income communities and we're still seeing high rates of decay." When again the reality is coming back around, it starts with water fluoridation, but that's not the end of it. The lack of education in nutrition, the lack of funding the money that they have because it's a heck of a lot cheaper to buy a bag of Cheetos than it is to buy fresh fruits and vegetables. And that's a sad reality that we had.

Howard: I'm going to tell you about another four thousand pound elephant in the room so we're both from Arizona and we know that a pediatric practice just had their second child die there.

Katrina: Yes, yes.

Howard: Had a two-year-old die I think it was right before Christmas.

Katrina: Yeah.

Howard: And then they had another same office, died three years ago. So if you're here in Arizona, you know that that guy is a board-certified pediatric guy, one of the greatest guys, protocol. I mean he's just the best. In fact, if my granddaughter needed a cavity I'd send her to him tomorrow, but you know what I think is bizarre is he's always the bad guy. And I'm sure it'll take an autopsy, it'll take a lot of Science to figure out because obviously, something was wrong with this little kid [inaudible 00:42:57]. But they never address issue, "Hey mom, why did your two-year-old need so many root canals and pulpotomy’s and crowns that no dentist in Arizona would touch her. So you had to take her to this now new bad guy, this pediatric board-certified guy and then he couldn't even do it in his office. He had to take her to a damn place and put her completely under.

Katrina: Absolutely.

Howard: And thirty years of looking at this I know what we know, but we don't know we don't know.

Katrina: We don't know what we don't know, yeah.

Howard: Everybody that looks out at space they say okay they say, they don't even know what it is. They call it black energy. Something is throwing the universe apart. It's expanding faster and they don't know what that is. They don't know what dark matter is. Well, there's a lot of things I don't understand in dentistry thirty years watching it, but I swear to God, we know below the belt that you transmit a lot of diseases. Gonorrhea, syphilis, HIV, all the things like that, but...

Katrina: HPV, Herpes and umm.

Howard: When I see these two-year-old kids that need eight cavities. Mom's got a bombed out mouth. Dad's got a bombed out mouth. They're all kissing her. I mean you see them at Walmart hugging and kissing.

Katrina: Yep, absolutely.

Howard: People you probably kiss your dogs.

Katrina: I do, right on the mouth. Yeah, I do.

Howard: So this two-year-old at the delivery room if you would have put her in an isolation cell by herself and fed her these fermentable [inaudible 00:44:19] or the average American diet. I still don't think she'd have a bombed out mouth.

Katrina: Of course not.

Howard: It's the parents and they don't realize that and here's how they feed them. They warm it up in the microwave. Then they take a spoon, then they check it, then they blow on it.

Katrina: Yeah.

Howard: And then give this and then grandma comes over, she's got an upper denture, lower partial. Hasn't seen a dentist in ten years, where she kisses the baby?

Katrina: Yeah, right in the mouth.

Howard: Me and my five sisters used to have this long discussions. It's a three-hour drive from Wichita to Parsons, Kansas to see both grandmas where mom and dad were both from. And we'd all talk about the fact that we like dad's mom, Grandma [inaudible 00:45:02] the most because she always kiss on the forehead and she’d give us a hug. But Grandma Mary, oh my God...

Katrina: Yeah, went in, yeah.

Howard: Yeah, she was all kissy.

Katrina: Get that lipstick over here, yeah.

Howard: Oh my God. You had to take your shirt, it’s like, "Can I have a towel?" How many millions and billions of microorganisms did she put in her mouth. So I see this icy, I don't know what to call this family, but when everybody in the family hasn't seen a dentist in ten years and you're in there making babies, that's the two-year-old that ends up having to be put under and no one talks about that. The media always just talks about like, "Well there's going to be an investigation of that dentist, that bad guy." They never sit there and get some mom to say, "What the hell's going on in here."

Katrina: Absolutely.

Howard: And I have to have a license to drive a car in Arizona, but I don't need a license to make a baby.

Katrina: To have a baby, absolutely. Yeah. No, I agree. And I think a lot of times because I do work in a Medicare Medicaid practice on the weekends and we do see a lot of those cases of just absolute rampant decay and you get into, is this child abuse. You really have to think especially when you see because there's a QT right next door to this practice and so everybody comes in and they've got their giant big gulps and their hot talkies and you know what you're doing. You have to know at some level that this is not healthy for your three-year-old kid to be drinking a red bull right now and they're completely bombed out. And so I completely agree you do tow the line of, is this child abuse and now we're going to be putting this on a provider because they took the responsibility for caring for this poor patient. So and it's interesting to I was just reading an article the other day they found strains of HPV on the back of tonsils.

Howard: Yeah.

Katrina: So we're starting to see this trend now where we're going what's being inhaled? You see people at an airport all the time wearing surgical masks, right? Because they're afraid of the bugs. They're afraid of the viruses they're going to be contracting, but somehow people are still not making that connection when they walk in the door and they get their FNX taken and they're having their work completed.

Howard: It's actually western world versus eastern world.

Katrina: Yeah.

Howard: Western world people wear masks so they don't catch anything. In the eastern world like in China, if I'm sick I will wear a mask in South Korea because I'm to get on a train. I don't want to infect you.

Katrina: You don't want to infect, yes.

Howard: Isn't it sweet over there?

Katrina: It's amazing that they do that.

Howard: Yeah.

Katrina: Yeah.

Howard: So who's this on your website?

Katrina: That is Dr. Jackie Matthews. She is one of my faculty from my board preparatory course.

Howard: Is she a dentist in town?

Katrina: She's a dentist in town. She is faculty with Midwestern University and she will be teaching radiology and pathology for my board prep course. Underneath her Miss Kathleen Lavoy, she is a faculty member with Phoenix College and she'll be teaching community oral health. And then underneath her, you'll see Dr. Clark Chen who teaches for [Asdel? 00:48:09] He is teaching my biomaterials coursework, dental materials, and bio-materials.

Howard: Well tell those three to come, you've got my address, tell them to come on the show.

Katrina: Absolutely.

Howard: We do a daily show. That would be an amazing show. Also...

Katrina: They’re fantastic.

Howard: We started online CE courses and we've put up four hundred one hour courses and they're coming up on a million views.

Karina: Oh my gosh, that's awesome.

Howard: Yeah and they're free for all dental students and...

Katrina: Yeah, these guys would just rock it. They're fantastic.

Howard: But yeah, network with the team. When you left you got off an Alec Road?

Katrina: Yes.

Howard: So the first light was 31st Street.

Katrina: Yeah.

Howard: The second one is 48 Street.

Katrina: Yeah.

Howard: So my dental office was on the south side.

Katrina: Oh, okay.

Howard: That’s Today's Dental and Dentaltown is down the other side.

Katrina: Oh very cool.

Howard: So local anesthesia, out of fifty states how many states can the hygienist numb up?

Katrina: It's a great question. I think the most recent research is like forty-seven or something, forty-six or forty-seven. There's only a handful of states where hygienists can't. I was very fortunate to get my training from the University of Minnesota. They were allowed in 1975 to be able to deliver anesthesia I believe.

Howard: In Minnesota?

Katrina: Yeah.

Howard: In what year?

Katrina: I believe in 1975. I'm trying to picture [inaudible 00:49:36]...

Howard: So why do you think some states are more ahead. Are they...

Katrina: Well, they're more progressive.

Howard: Progressive.

Katrina: Yeah, of course. Yeah.

Howard: Are they?

Katrina: They're definitely more progressive. Again, having that Mayo Clinic there really is a hub for healthcare and so it forces that advancement, the provision of patient care and so I think that that plays a major role in that. And I'll be the first to say I work in a practice where I deliver all the anesthesia for the doctor. The doctor does not grab a syringe and...

Howard: In Arizona?

Katrina: Yeah. In the event that I...

Howard: Who do you work for?

Katrina: Oh I work all over the place.

Howard: Oh okay.

Katrina: For North Scottsdale Dental on Monday. Tuesday, Wednesday, Thursday I went with Dr. Brett Damaran. Fridays I'm with Dr. John Koerperick with Rain Tree Dental and then Saturdays I'm at Dental Depot.

Howard: Damn.

Katrina: And then Sundays I'm here hanging out with you.

Howard: Are you a workaholic?

Katrina: Well, I am, yeah, I think so. So I deliver all the anesthesia for the doctor and because of that I think now there's become this culture with the patients where they do expect the hygienists to come in and do the anesthesia. And I know that in the time that I was faculty with one of the local dental hygiene programs here that we worked very hard to make sure that hygienists had the appropriate technique. They knew the safety provisions of these anesthetic techniques. So it was really important for us to make sure that hygienists continue to maintain an integrity and a quality when it came to delivery of anesthesia. So one of the things that I am very passionate about when it comes to anesthesia is the use of alternative injections. Specifically the fact that there are a lot of injections that we are taught in school that we go on to private practice and deliver that are oftentimes incredibly unsuccessful. And I would say most providers and I deliver CE coursework on local anesthesia.

Howard: On your website?

Katrina: On my website, I also do live CE courses as well. I have a course that I teach on local anesthesia techniques, trends and troubleshooting and I would say, I mean even when I'm standing in front of a group of dental providers and I say, "What's the most frustrating injection?" Without hesitation, everybody says the IA nerve block. It's the most frustrating injection and there's so many reasons why and so my favorite is throughout the course I take them through why this injection is so horrible. Now do people have success with it? Absolutely. But for the most part, there are so many things that are against us as providers when attempting to deliver this injection and what most patients don't realize, I was just talking to a patient yesterday. I said, "We can't see your nerves, Susan." We can't. We don't have a map that tells us, oh, we're getting close or anything like we don't. We don't have a spinal column where we can go well the cords probably in here. We have to approximate and guess and there are so many other muscles and blood vessels and nerves that can get in the way of what we're doing. There's a lot to be calculating as a provider when we're delivering anesthesia. So I'm very passionate about a lot of the other alternative injection techniques that we have available because A, they're more successful. A lot of times you're doing less needle penetrations, which is always a benefit for the patient, right. They're a lot happier with that. Time saved for us, plus they're more successful. So you're not having to deal with that embarrassment of having to re-inject again because you weren't successful the first time. So I do teach about that coursework and I've done clinical coursework as well.

Howard: So what's your favorite? Is it like the wand or...?

Katrina: No, my favorite is to do the Gow Gates.

Howard: The Gow Gates?

Katrina: Lower block, yeah. Hands down I would say.

Howard: You know that's my favorite time on a clock is 6:30, hands down.

Katrina: Hands down, there we go.

Howard: Those hands are down at 6:30. [Inaudible 00:53:25]

Katrina: Those hands are down 6:30, yeah.

Howard: So you like the Gow Gates better than [inaudible 00:53:29]

Katrina: Gow Gates, absolutely. Confession, I have not delivered an IA nerve block since I took my anesthesia injection back in 2007 for western regional. Now have I delivered an IA to demonstrate to students behind me in a classroom setting? Yes. But in the actual delivery of patient care, I have not delivered an IA nerve block since 2007.

Howard: Out of nowhere, we're talking about they found HPV on the back of the tonsils.

Katrina: Umm.

Howard: Big shout out to Tennessee.

Katrina: Yeah.

Howard: And by the way, you're the only ten I see.

Katrina: Oh you're ... [inaudible 00:54:04]

Howard: Two bad jokes in a row. But shout out Tennessee. I've always found it highly insulting that after you know I went to college for nine years and I can't give a flu shot and right now in Arizona or in the United States this flu season might be worse than 2009. So every year in the United States between eight thousand and thirty-eight thousand die and they're saying it's going to be a bit high, close in the thirties. This might even be a forty.

Katrina: Yes.

Howard: This might even be a forty. In fact, a dentist died.

Katrina: Yes, yes I saw that.

Howard: A healthy young dentist in Alabama died.

Katrina: A twenty-four-year-old girl just died two days ago. Twenty-four-year-old second-grade teacher.

Howard: And I can't give a flu shot.

Katrina: Yeah.

Howard: My hygienist can’t give a flu shot.

Katrina: Right.

Howard: But you're in the hospital with a four-year degree registered nurse can’t. The six degree PA can’t. And then I go to Walgreen and CBS and a pharm tech, not a pharmacist, not six years of college, a pharm tech can you give me a flu shot and a HPV tech and I can't. And good old Tennessee finally passed a law that the dentist and the hygienist can. Because the bottom line is when you're treating a grandma and you're a prophy queen, one of the top three reasons you might not see her for a six-month recall, is that she died of the flu.

Katrina: Yeah.

Howard: So we're going to get a [00:55:30] oral-systemic link, but that's got to be on your top ten list. And I think the United States now we're over thirty flu deaths under the age of two.

Katrina: And I think that’s...

Howard: So how many pediatric dentists in Arizona said, "I'm going to give your two-year-old a flu shot.”

Katrina: I would say perhaps the scariest part about all of that is the fact that these are young and healthy people that are dying. When you think about the immunocompromised populations that should be getting these flu shots, you're thinking the elderly, pregnant women, healthcare workers, people that are going to be exposed to it. And now you've got a dentist, you've got a second-grade teacher, she was literally twenty-four years old, passed away from the flu.

Howard: Wow.

Katrina: And it is unnerving and it kind of opens up this can of worms, this concept of people having injections, vaccines, inoculations and the perception that is surrounding all of that. Of course, the concern being so many of the things that we are vaccinated against we do not see in this country. So now that we're starting to see this influx of deaths from young, healthy people because of the flu virus, I think there will be a resurgence in people protecting themselves. But then going back to what you were saying in some Asian countries where people protect for others. They're the ones that are sick and they're taking those necessary precautions. What does it take in a dental practice for a dental hygienist or a dentist to say, "You know what, I think I need to call in sick today because I'm not feeling well." And how many times do we get patients, I get them every day in my private practice where they're saying, "Oh I'm just getting over the flu and here I am.” Thanks,” you know what I mean? They think that it's perfectly okay to show up to their dental appointment and potentially infect other people. So there needs to be a resurgent and we saw that with H1N1, right. We saw this resurgence of now there are hand sanitizers everywhere and there are masks available in airport bathrooms and things like that. There was a huge resurgence in awareness of how easy it is to spread something through droplet form and I think we're just stepping back into that again in our developed countries sometimes we lack an awareness of what that really is.

Howard: [inaudible 00:57:51] from Minnesota 3M, one of the most amazing thing about 3M is 30% percent of their revenue last year was some products that didn't exist five years ago.

Katrina: Wow.

Howard: But their biggest growth category is all this respiratory sanitary stuff in China. Because they're burning coal. You go to China, I don't know if you guys have been there, but you don't ever see the sun. You just see kind of...

Katrina: The smog covered.

Howard: You know kind of where it is. I mean the smog. China, they're just making bank on their masks, their gloves, all the respiratory products, all that stuff. My gosh, I can't believe we went over an hour. That was the fastest hour ever.

Katrina: I love it.

Howard: But I got to keep your little overtime. So a lot of dentists don't believe, I mean they say it on Dentaltown, a lot of dentists don't believe that decay and gum disease is contagious and you're dude, "If you walked out your backyard and you saw a giraffe, don't you think it had to come from somewhere?" How does this little two-year-old kid get strep [cocc? 00:58:54] mutan, [inaudible 00:58:54], herpes simplex one? I mean just what, fairly dust and picture dust.

Katrina: Yeah.

Howard: And a lot of them don't believe in the oral [inaudible 00:59:06]. I mean so many times in our post society first five comments. That's correlation. This morning the sun came up, I made coffee, looked out my window the sun came up. Me making coffee in the morning...

Katrina: Doesn't mean...

Howard: Did not cause the sun to come up. They just say correlation, correlation, correlation. Do you think there's an oral systemic link?

Katrina: I think there's an oral systemic link, absolutely. And I think here's the reason why we are not as aware of it as we should be. I would say dentistry is, and I'd have to think a little bit more about it, but dentistry has to be perhaps one of the only medical professions where we do not take a survey of what's actually going on with our patients. So let me give you an example. When I have a new patient coming to the practice, I take enough FMX. I probed my patient. I observe the bleeding tendency of their gum tissues. I talk about fibrosis, edema, all that bolony and then I come to an assumption about my patient's periodontal health. I can give you an idea of probably what microflora looks like sub-gingivally. I can probably tell you your red complex bacteria are going to be hanging out in there. Probably P-gingivalis. I got a pregnant patient, [audible 01:00:19] inter-media is going to be present, [t-dentical? 01:00:21] whatever. I can probably tell you what's going on there, but I don't know for sure. Let's take it a step farther. My dog Darby is an eleven-year-old Pug-Beagle mix and he's got these big floppy ears, which means he gets ear infections very frequently here in Arizona. When I take the Darby to the vet and I say he's got an ear infection. You know what the vet says, "I need to take a sample of his ear to find out what's actually going on. Is it yeast, is it bacteria, is it viral, and if it is bacteria what kind of bacteria?” So it's amazing that we treat Darby's ear infection with more care and conscientiousness than we do a disease process that's happening in our patient's mouths that we're trying to sell for quads, [inaudible 01:01:08] and root planning with laser therapy and chlorhexidine and irrigation, right? So none of us actually know what's going on unless we are delivering some kind of oral DNA survey. We're taking a sample, we're sending it off to a lab and we're saying, guess what, these are the type of bacteria that are living in your mouth. Now, interestingly enough we're starting to find specific bacteria that are directly linked to other disease processes. So one of the most interesting ones right now is Fusobacterium nucleatum which we know is an intermediate colonizer in the plaque bio-film development, right? It's got main attachment apparatus, it's a facultative anaerobic bacteria, and we know that it is perhaps the most major player when it comes to the transition from plaque-induced gingivitis into periodontal disease. We know this is one of the most, the largest markers. We're starting to find Fusobacterium nucleatum in high quantities in the oral pharyngeal component of patients who have oral pharyngeal cancers. As well as in the colons of patients who are currently suffering with colorectal cancers. So we're starting to find that this strain of bacteria is not only found in the mouth but it’s found in these other areas and when they're found in these other areas, we know that this bacteria is playing a major role in our patients development of these life-threatening diseases. So you're absolutely right. Can you ignore the fact? I mean can you ignore the fact that f-nucleatum is heavily populated in the mouth of diseased patients and if this patient didn't have periodontal disease they probably would not have that intermediate colonizer. If we were able to manage their oral micro-flora, would that bacteria have entered their blood circulation? Would it have entered the entire digestive tract? Would it have circulated through the digestive tract? We know because of its anaerobic qualities, because of its protective qualities that these bacteria can survive hydrochloric acid in the stomach. They’re built for those things and the more that we turn a blind eye to what these correlations are I think the more that as dental providers were being negligent to the comprehensive care that we are required to be providing for our patients.

Howard: So you're saying the vet is more scientific with your dog’s ear than we are as a dental office.

Katrina: Absolutely I am, absolutely.

Howard: And you know what's really unnerving? A root canal.

Katrina: Yeah.

Howard: Get it, unnerving.

Katrina: I got it.

Howard: But you know what’s really, really, really insane. Something no one ever talks about is in the United States, two hundred thousand Americans die in the healthcare system each year that had nothing to do with their disease and so right here in Chandler when I go get a tour of the Intel plant, you got to know someone in there because it's a lot of proprietary secrets. You take off all your clothes, you take a shower. You go to the next room, you put on a white coat, you put into breathing [gill? 0104:01].The air is filtered at one part per billion because when they're making a chip your little skin cell whatever falls on that chip that could make the chip go bad. So yeah, the sterilization is unbelievable.

Katrina: Yeah.

Howard: Then you go across the street to the Chandler Regional Hospital and here comes the surgeon and the nurses and they get out of the car wearing Nike tennis shoes and they walk through bird shit, dog shit. They walk all the way in there and they change. They leave their shoes on and...

Katrina: Bring their coffee in and...

Howard: Yeah, and then they go they do this religious ceremonial, fifteen minute scrub of their forearm. What is that about?

Katrina: Yeah, yeah.

Howard: The air is just filled with fungi, viruses.

Katrina: Yes.

Howard: Microorganisms, yeast I mean...

Katrina: Absolutely.

Howard: The place is just as filthy as it was a hundred years ago in a sanitarium.

Katrina: Absolutely.

Howard: So America treats your dog's ear more scientifically at the vet.

Katrina: Yes.

Howard: Than the dentists and hygienists and periodontists does across the street from him and Intel and Microsoft take infection control for an iPhone and a computer chip, a thousand times more and when two hundred thousand Americans die, Americans well that's about it.

Katrina: They say yes, that’s' fine.

Howard: The funniest thing now is they're doing, Phoenix was the test market for the driver-less cars for Uber and Google.

Katrina: Yes. I have a friend that's working with Uber and doing that right now.

Howard: And I see them all around I'll tell you every patient I talked to said, "Well, I wouldn't trust driverless cars." It's like monkey forty thousand Americans die each year in a car.

Katrina: Yeah.

Howard: How could they be worse than that?

Katrina: Right, right.

Howard: I mean I bet if everybody went driverless tomorrow the worst case would be four thousand. In fact, I read another deal that these cruise missiles I mean they have to fly like ten million miles before they have an accident.

Katrina: Yeah.

Howard: The American pilot, guess who's more reliable, a driver-less cruise missile or...

Katrina: A machine or a human?

Howard: A monkey. Like that last time in San Francisco, the pilot with thirty years’ experience decided the last second to take another lap and a cruise missile wouldn't have done that.

Katrina: Yeah, absolutely.

Howard: So it would probably save at least one hundred thousand Americans lives every year if the hospitals would just clean up.

Katrina: Absolutely.

Howard: And I keep seeing people or patients like grandma had a hip transplant, so the daughter goes and visits her with her two year old.

Katrina: Yeah.

Howard: And the two-year-old's on the floor crawling around. Now has MRSA all over her legs.

Katrina: Yeah, of course

Howard: And why would you take a ... so all the sickest people in town go to one box...

Katrina: One building, yeah.

Howard: And you decide to go visit grandma and take your two year old.

Katrina: Right.

Howard: And if you pass a law that said only sick people can come in here, I'm sorry if you want to talk to your mom, there's face-time.

Katrina: Yeah.

Howard: Or get the hell out of here. Then they'd call you a death panel.

Katrina: People lose their minds.

Howard: Yeah, they'd lose their minds. But just crazy.

Katrina: Yeah, absolutely. Yeah, I think bottom line, I think that if we want to continue that trajectory of dentistry having a seat at that oral systemic table, being able to provide comprehensive care to our patients and being knowledgeable about our research and really implementing the things that are in our research into private practice, we need to be mindful of the steps that we can be taking as providers to ensure that we are really being comprehensive with our patient’s needs.

Howard: Final question. You're so sweet. It was an hour show. You're already ten minutes over time.

Howard: I always do that. I always do that.

Katrina: Final question. It's real with dentists and hygienists, I've been doing it thirty years. A lot of my homies are burned out.

Katrina: Yeah.

Howard: They say I've been doing this for ten years, twenty years, thirty years. Do you see burnout?

Katrina: Hygiene burnout all the time.

Howard: And what's your thoughts on burnout? What advice do you have for burnout?

Katrina: That's a really, really great question. For me, I always find that when I start to get tired or burnt out of hygiene, it's for a couple of reasons. One, I'm working too many days a week, which happens. I mean there's hygienists that work five days a week and feel burnt out or four days a week and feel burnout and those are the times when you need to take a day off and have a personal day. And we in dentistry we don't really condone that. If I call my doctor tomorrow and said, "Hi, can you get me a temp because I'm just going to take a personal day and go get my nails done." The doctor would probably lose his mind, but I think that we need to be mindful of that. We learned in dental school, hygiene school about Maslow’s hierarchy of needs that we do have our own needs as humans and if we can't take care of ourselves we can't effectively take care of others. So I think that step one is knowing when you need to take a step back and go, okay I need just like a day trip. I need to go and get a massage or something and really take care of me. And the other part of it and this is kind of a little bit of a shameless plug, but the other part of it I think is continuing education, but the right kind of continuing education. There are a lot of CE courses out there that just drone on about the same crap that we've heard about for forever. Like if I have to hear another CE course where somebody's talking about HPV 16. We get it, it's HPV 16 you know what I mean? So finding new fresh, continuing education courses that helped to really enforce what it is that we get to do because it is a beautiful privilege. Every day to wake up, suit up and have patients implicitly trust us. It's amazing and I think a lot of times because we get so wrapped up in it, we don't realize how incredible it is that patients open up and trust. They trust when they review their health histories. A lot of times they'll go over things that are going on with their families. They'll talk to me about their horrible divorces or things that are going on with their kids. I mean they trust us and it's a beautiful thing and I think if we can go and take continuing education coursework that helps to reinvigorate that, revitalize that, and ignite that flame, that passion that we have for dentistry. I think that's another excellent piece that helps to address burnout. And then the final piece of advice I can give is if you're working for a doctor who doesn't appreciate you. If you're working for somebody who makes you feel less than, doesn't honor your skills. Always negates your clinical decisions, "Well, they've got radio-graphic calculus and bleeding six-millimeter pockets." "Oh no, I think we can prophy them today. And if you have somebody who's constantly dismissing your clinical skills, that's not the place for you. I think that's really important to make sure that where you are delivering your dental care is in a place that appreciates, respects and supports you.

Howard: I tell you what 95% of prostitutes are drug addicts and it's because they hate their job. And I always tell it's not worth the money, you don't trade your soul and your self-esteem and a lot of people and I had a hard time believing this when I was little when I was a freshman year in college and Dr. Betty Dawl was talking about how in psychology 101 that verbal abuse and mental abuse was worse than physical abuse.

Katrina: Absolutely.

Howard: And I was no, no I'd rather you call me fat ass than punch me and it took me years to realize she was absolutely right.

Katrina: Yeah.

Howard: And doctors do it all time I tell them never have someone on the payroll who you don't want to play in the sandbox with.

Katrina: Yeah.

Howard: And you should be driving to work and when I walk into work I'm like Yoni, Valerie. I mean...

Katrina: Yeah.

Howard: They're my homies and I’m...

Katrina: Yeah, it's so awesome.

Howard: I want to see them.

Katrina: Yeah.

Howard: And I'm driving to work and I mean when I see Yoni I light up like a Christmas tree. And there's other dentists that when they see each they say, "Oh my God and they go hide in the breakroom.

Katrina: Yeah.

Howard: And never ... I mean you're playing in the sandbox and another thing for burnout is toys.

Katrina: Yeah.

Howard: You don't ever need a laser or a cad cam. You don't need any of that shit, but if it makes you run twenty red lights on the way to work because you want to go play.

Katrina: Yeah.

Howard: That's your our little Tonka toy in the sandbox.

Katrina: Yeah, then do it.

Howard: My four boys if I want them to stay in the bathtub I had to throw boats, cars, balls. The more shit I throw into that bath-tub because I want them to stay until their skin got all crinkling.

Katrina: [inaudible 001:12:29] yeah.

Howard: So I recommend technology.

Katrina: Yeah.

Howard: If it lights you up, but man don't ever stay in a relationship with someone who makes you feel bad. Don't ever work with someone that makes you feel bad. A huge part of burnout is not your job because like you said, it's a privilege to do your job.

Katrina: Yes, it is.

Howard: And the same thing with the patient's, fire patients.

Katrina: Yeah, get rid of them. The pain in the butt ones, why?

Howard: And I had to fire my best friend.

Katrina: Well, sometimes they are the worst ones, your friends. I have a friend...

Howard: Oh my gosh, I had no problem with him, but the rest of the staff absolutely hated him.

Katrina: Yeah.

Howard: He was loud, obnoxious, foul-mouthed, told dirty jokes.

Katrina: They are. Friends and family are sometimes are the worst ones to see. Where did you learn that?

Howard: But it was, I saw it during the morning huddle and I’m, “Oh my god, look, he's at 10:00.”

Katrina: Yeah, that’s when you know.

Howard: And I'm yay and they’re like I know he's your friend. And, but then I realize so I just called, I had his phone number, I just called him and said, “Dude, you’re fired. Nobody wants to see you today.” And he starts losing and it’s like John, that that's why they don't want to see you because you losing on them.

Katrina: Yeah.

Howard: I mean, they tell you your portion of the payment you start dropping that bomb. And what's weird about that? Here's another thing what’s weird about that. He's one of the richest dudes in town.

Katrina: Just get over it. Just pay for your dentistry.

Howard: I know he's like one of the richest dudes in town and then it's like when you treat rich people, rich people are rich because they don't part with their money. You give a dollar to a poor man they'll part with it like that. But hey, thank you for all that you do for dentistry.

Katrina: Thank you.

Howard: I can't believe you came over here on a Sunday and then went into overtime, but thank you for all you do. I hope. And remember we got Hygiene Town, we’ve got Dentaltown.

Katrina: Yes.

Howard: Anything you want to do with our media company. It's a privilege to have worked with you.

Katrina: Thank you so much for having me. I really appreciate it. It’s been a pleasure.

Howard: And you have a rocking good day thing.

Katrina: Thank you. You too.

Howard: Sorry I was sneezing through the whole thing.


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