11. Her Dental Patient's Bone Grew Back. Here's How. With Sarah Wright, RDH

It's Not a Buildup Problem, It's a Bacteria Problem

You did everything right. You scaled thoroughly, you educated your patient, you believed them when they said they were flossing at home. And six weeks later, they're bleeding again, and you're left wondering what you missed.

Sarah Wright, RDH, spent 15 years in that exact spot before one course completely changed how she saw periodontal disease. In this episode, she and Tosha walk through two real case studies that reveal why bleeding gums persist even in patients doing everything they're told, and what actually happens when you stop treating it as a buildup problem and start treating it as a bacteria problem.

Why this episode matters

If you've ever felt like a good clinician who somehow can't get certain patients healthy, this episode gives you the missing piece. Sarah didn't have expensive equipment or a biologic dream practice when she started applying this. She was working in a Medicaid setting with a microscope and a salivary test, and the results still spoke for themselves.

What you'll learn

The diabetes and periodontal connection, in real numbers. A 32 year old patient with an A1C of 12 dropped to 10 in just eight weeks after targeted periodontal therapy, and her own doctor asked what she'd changed.

Why bone regeneration doesn't require lasers. A 29 year old with a nine millimeter pocket and active bone loss regenerated bone using non-surgical therapy and a water flosser at home, no surgery involved.

What a plaque sample under the microscope actually reveals. Sarah describes seeing a slide "wall to wall" with white blood cells, a sign the immune system was actively fighting an infection that hadn't shown up clinically yet.

Why "everybody bleeds" was never true. Tosha and Sarah both admit to believing this early in their careers, and unpack why that belief kept them from finding the real cause for years.

The three Ps practitioners often forget to ask about. Parents, partners, and pets can all be sources of reinfection, and Sarah explains why that matters for long-term case success.

Key moments

Sarah's "Red Pill Day," the course that reignited her perio passion and changed her clinical approach for good
 The diabetic patient case study, from A1C of 12 down to 10 in eight weeks
 The 29 year old's bone regeneration case, including exact pocket depth measurements
 The cobweb and force field analogy for biofilm disruption
 Why immune system differences mean two people with similar bacteria can have very different outcomes

Tosha's take

This episode is proof that the shift toward oral-systemic care isn't reserved for high-end biologic practices. Sarah did this work in a Medicaid office. The tools matter, but the mindset shift, seeing bacteria as the actual disease, is what changes outcomes.

Connect and take the next step

Ready to bring this into your own hygiene chair? Book a call with Tosha at tosh.care, or grab the Bleeding Gums Script to start the diabetes and gum disease conversation with your own patients. 

Ready for healthier home care?
Grab the free 6-Minute Mouth Reset guide at mouthymatters.com

Connect with Tosha:
tosh.care | @toshardh | mouthymatters.com

Stay Awesome!
-Tosha, RDH

Disclaimer: This podcast is for educational purposes only.  Information discussed is not intended for diagnosis, curing, or prevention of any disease and is not intended to replace advice given by a licensed healthcare practitioner.  Opinions from guests are their own.  This podcast and its guests may have direct or indirect financial interests associated with products mentioned.

Transcript

Welcome And Sarah’s Path

Tosha Kozloski 0:00

Hello everyone and welcome to the Moffie Matters Podcast, where today we have the wonderful Sarah Wright. She has been in the dental industry for nearly 30 years and a practicing dental hygienist for about two decades now, I believe, maybe a little bit more than two decades. I might be getting that wrong. But Sarah is an absolute wealth of knowledge. If we lived in the same town, she would most certainly be my dental hygienist. And I'm just so excited that you're here, Sarah. Thank you, Tasha. I'm glad to be here. Well, first, I want to find out a little bit more about your story. So 30 years ago, you joined dentistry and then you decided to make the pivot into hygiene. Where did it all start? Tell me where you're how did you become interested in dentistry?

SPEAKER_00 0:44

That's an interesting question. I actually thought in high school that I wanted to be an orthodontist. I thought making perfect smiles for a living sounded like a really cool job. Um, so I asked my orthodontist about it. And looking back, I think he might have been going through a midlife crisis because he was like, no, girl, you don't want to do this. And I was like, What? You're supposed to encourage me. And he's like, No, you should go to hygiene school. And I was like, ew, why? He goes, Because it's not 12 years of school. And I just challenge you to ask any hygienist you ever meet if they like what they do. And so I did that. And I asked probably five or six of them over the next couple of years, and every single one of them said, I love what I do. School sucked, but I love what I do. And now that's true on on both fronts. But I'm glad you told me that because it it made me ask the questions before, like, well, let me see what I think eight years into school. So I started to assist to see I wanted to get my feet wet and see if this was something I wanted to do. So I started my assisting career in 1998.

Tosha Kozloski 1:52

And then you were like, hey, I want to run my own operatory. Let me go back to school.

SPEAKER_00 1:58

Well, and the kicker was I was really having fun with doing some expanded functions things and toying with the idea of going to dental school. But the hygiene part, it got to the point where my chemistry courses that I took for prerequisites were going to expire if I didn't apply. And that's really what kicked me into gear and said, you need to do this now or you have to redo organic chem. So I went to hygiene school.

Why Patients Still Bleed

Tosha Kozloski 2:23

So once you were out and you were practicing and you were you were in it for, you know, 10 to 15 years, was it everything that you hoped it would be?

SPEAKER_00 2:30

Yes and no. From school, I I loved period then. I loved the class, I loved the treatment planning part of it. And the idea of taking a patient who might be really fearful or had been kind of neglecting their home care and their self-care and bringing them into a place of health. And I got to be part of that was really cool. But what I started to see, like I was always wanting to get more and more information on how can I do this better. But what was happening was 15 years in, my patients weren't necessarily getting better. And so I'm like, there's got there's something missing here. Cause even on the the patients that I did the best job, I knew how to, and I actually believed them when they said that they did what I asked them to do at home. Six weeks later they were bleeding, and I could not figure out why. So it was bumming me out because I'm like, there has to be something.

Tosha Kozloski 3:24

Gosh, I can so relate to that so much. Like wanting so badly to work in a period office, specializing in getting people's gum health better and just saving people's teeth and getting them healthy, and that's all I wanted. And the same thing, the bleeding was everywhere. And I knew, just like you knew, you did a great job. You did everything that you were trained to do, and yet there were still bleeding. I mean, I don't know about you, but I remember a couple years in telling my mom, who's a dental assistant, I was like, everybody bleeds. When you clean their teeth, everybody bleeds. And she looked at me and she was like, I don't think so, Tasha. And I said, No, seriously, everyone bleeds. They just about do. And I I thought it, and I knew in my heart and my gut that it wasn't normal, but I also saw it so much that it was kind of like, well, if I'm seeing it this often, and I know so many of my patients are coming in regularly, they're doing everything that I'm asking them to do. They're not, they don't have filthy teeth, they don't have filthy mouths. Well, why are they still bleeding then? And so it's like a conundrum. So what what changed that for you? Were you like, well, I guess, I guess this is it. This is just gonna be a, I guess, you know, working in bloody mouth is my future.

SPEAKER_00 4:34

I mean, I had accepted that as kind of a like, yes, but there should be a point in this in this journey where we get to the not bleeding part. And that's where the ones that were hard for me were the ones that were immaculate. Like there's nothing clinically that I can see or feel that should be causing this bleeding. What is this? And it was just this big abyss of I don't know. And that bugged me. So well then, okay, so we were 15 years in, and being that I I loved Perio, that means I was like, I was doing a lot of scaling, which meant my body was hurting. So I kind of came to this crossroads where I'm like, I don't know how long I can do this because between my neck, my back, my thumb, both my joints were are and so even just rinsing a patient or using the air water syringe was painful. So I thought, well, it was it was an easy way for me to think maybe I should find something else to do because I've I've maxed out what I think I can do here. And that bummed me out because I love this this profession, but it hurt. So I had a an instance where I I found an office that I thought was wonderful. I found a doctor that I thought was actually like supportive and he was, you know, all about continuing education. And then um, and then we lost him. So that was hard. And I decided that's it. And I went completely to the dark side and went to culinary school. I like I no longer was the floss fairy. I went and was the sugar fairy, and I was like, you know what, I I can't. So I went the completely opposite direction. Took a little hiatus, you know, but that doesn't pay quite the same. And I mean, I did it for several years, but then just the way the family situation was going, and my husband was having surgeries, and like I need to get back into clinic. So I accepted a tempting position for a doctor who had just bought a practice, and I was only supposed to work for her two days a week for about a month, and then she kept me for about four

The Course That Changed Everything

SPEAKER_00 6:40

years. But that was the that was the job that was the doctor who sent me to a periol course. And I thought, I mean, all right, I'll buy. I like period courses. She made a comment, like, I'm gonna send you to a course where they're gonna teach you about how bone can grow back. And I said, shut up, you cannot. She's like, Yes, but it can. So I was intrigued because I thought that sounds crazy, because that's not what we were taught. Once it's gone, it's gone. So yeah, that's that's how I met you. It's been 10 years. Amazing.

Tosha Kozloski 7:12

And at that course, what was it that you saw or that you heard that changed maybe everything after that and how you practiced and how you felt and how your body felt. And man.

SPEAKER_00 7:25

Well, I I found I felt like I had my my periopassion reignited that day. My now we were new colleagues, we'd known each other about a month. She's still my bestie 10 years later. But we sat in that in that room with all those other hygienists, and we call it red pill day now, because it was like, actually, this is what's going on. And it was like the veil of I don't know lifted. So what struck me first was periotherapy that was monitored not just by the pocket depth numbers, but the fact that the bone actually regenerated. And I was like, that can't be, but it was. And then just the correlation between looking at the bacteria and that's what we're after. It was not a degree problem. It wasn't too much buildup. It was, it was, I mean, it was too much bacteria and too much of the bad stuff, you know, because there's a lot of good stuff in there too. But I'm like, well, how do we how do you differentiate? But then we learned about salivary diagnostics and well, who do you how do you know when to test for that? If everybody bleeds, does everybody need to be tested? Well, yeah, probably. But then probably. But then we learned about taking a look at their plaque sample under the microscope and being able to see in real time what was going on because everything I feel like for treatment planning has been plain catch-up. Like we waited and watched it until the bones started to go away and then went, what, row? We need to do something. This felt proactive. This felt meaningful. And so I was texting my doctor furiously during this thing, going, Oh my gosh, what is this? And she's like, Told you. So little did I know, she sent me a picture of my op and she was setting up back in the day. We used a dual select. It had two different bottles of like Medigamas that we could use. She had bought them and was setting our rooms up. And I could not wait to get home and go to work on Monday because I was gonna change the world and test everybody.

Tosha Kozloski 9:24

And for those of you that don't know what a dual select is, uh third alert here for us hygienists, it is machine that when we use a fluid in somebody's mouth, we can actually put medicine in there. We can put different types of medicine that the bad, unhealthy bacteria do not like. So we can get rid of those bad guys to allow the good guys to flourish and balance their mouth again, balance their oral microbiome.

SPEAKER_00 9:47

Exactly. To have a doctor that was like, I'm gonna send you here and then I'm gonna give you the tools to do the things. Yes. That was huge. I love that. I love that so much.

Tosha Kozloski 9:58

So you have so many incredible case studies, and I personally love to live vicariously through you and hear about your case studies because they just they just warm my heart seriously so much.

Diabetes Case Study And A1C Drop

Tosha Kozloski 10:10

So diabetes and periodontal disease are highly correlated. We know that somebody that has bleeding gums can actually have higher sugar levels and be very, and even if they're not diabetic, um, we can actually get diabetes from chronic periodontal disease, so chronic bleeding of the gums. And you had a fascinating patient that had diabetes and that had a really high A1C and an incredible outcome. So I would love for you to share her story.

SPEAKER_00 10:37

Sure. So when I met this patient, I had just started at like a community health type of a setting. And um, I'd invested in some technology after having, you know, followed your recommendations and tutelage for several years. I'm like, this is how I want to practice. And I had the leeway to do that. So I I'd gotten a microscope so that I could look at things and I had been doing the salivary testing for a while. But when this patient came into my op as a new patient, we're going over her health history, all the normal things, taking x-rays and asking if she had any major concerns. And she said, Yes. I, this area, and she indicated her lower left was really painful. Her gums seemed to be moving down her tooth, and she bled every single time she brushed her teeth. And then she said something that clicked in my head. She goes, I think that my diabetes is affecting my teeth. And I thought, well, that's one battle I don't have to fight. Yes, you're exactly right. That is what's happening. And I just was kind of impressed or or just kind of taken aback by the fact that she put that together. Um, I'm like, okay, well, tell me more about that. What's going on with your diabetes? And she said, Well, I was diagnosed in 2012. I have an insulin pump and I've kind of been neglecting myself. And now that, you know, I'm in my, she's 32 at this point, and I've got two kids. I feel like I need to, I know. And she'd been diabetic since early 20s. So it had been a minute. But both of her parents, come to find out, were diabetic. And I asked if they still had their teeth, and she said, no, not all of them. She'd watched them battle with tooth loss and that kind of thing. And that's probably why she knew about the correlation. But um, I asked her if she'd seen her doctor. She said, Yep. My last A1C was 12, which is quite high. Um, above six, it's typically when like six, six point oh, six point five is when they technically diagnosed she was diabetic. So she was double that with an insulin pump. So we were sick. So my brain was going crazy, and I thought, I want to throw the kitchen sink at this. I asked her if she would be willing to be a case study for me, and I explained what that looked like, like lots of pictures and the end all being that I would use her case to help teach other people how to how to do this and what's possible. I had no idea what was possible, but that's how I phrased it. She said, absolutely, I just want to feel better. Um, I did her, I took a sample and I looked at it under the microscope, and it was wall-to-wall white blood cells. So, I mean, we know that those guys are our immune um cells and they help fight infection, but they don't live in the mouth. They have to be summoned. And she had a lot of them. So there her immune system was on and working. And I thought, well, that's not that's not great. Even if I didn't know what I was looking at, looking at her slide, there was a lot of busy, a lot of movement, a lot of bad guys. So we proceeded to um to do some pictures, some before and afters of her tissue. And it just makes you squint to look at it because it's so red. And I did a salivary diagnostic. And so what that showed me was all 11 of the periodontal pathogens we were testing for, five of those 11 affected diabetes. And she had nine out of the 11 all over threshold, and those five affecting diabetes were off the charts, too. So that gave me something measurable to say, okay, we'll call up her doctor and say this is what I found. Umber recommending that we do some medication for this. Like you were saying about being diabetic, they don't heal as well. They don't, they don't get better very quickly, and that's because their blood vessels thicken. So it doesn't let the good stuff in or the bad stuff out. Well, we already know that that gum disease is systemic. So in her case, I thought the antibiotics were going to be warranted. And she was willing to do those. So we did her uh we did her therapy and did a couple things, did some laser, did some really intensive biofilm disruption, showed her how to use her water flosser therapeutically. And I tested her again about eight weeks later. And I called her to tell her, oh my gosh, your test results came back in and they were amazing. All of her really bad bugs were completely gone, and everything else was under the threshold line. So we were definitely trending in the right direction. And um, she said, I just left my my doctor's office and I have my A1C done again. And it was 10. So it had dropped from 12 to 10 in two months. And her doctor said, What are you doing? What have you been doing? And she said, I'm going to the dentist a lot. She's like, Okay, fine, we'll keep doing that. So I was thrilled at her at her how far she'd come in eight weeks.

Tosha Kozloski 15:29

I mean, two points on A1C is crazy pants. I mean, we know based on studies that when we get people healthy, especially those who have diabetes, most often we do see when we arrest that infection, their A1C drops immediately. And I I didn't learn anything about that in school. I don't know about you. I mean, we knew that there was a correlation between diabetes and gum disease, but I really after I graduated, I had no idea how to tell my patient that or how to talk about it. Didn't know anything about a neither did I.

SPEAKER_00 15:59

Neither did I. So, and I I'm not entirely I must have gotten that information from from you and from Jennifer because same thing. I think we probably graduated around the same time. I knew diabetes was all overboard. I know that there were a ton of questions about it, but if it reflected, you know, what to expect if your AONC is this and you do treatment, should it do? I had no idea. Not then. I love that. So her story just keeps getting better though. It does. She she signed on to to get better and to get healthy. And she wanted to do this if she put in the work at home. So I saw her every three months or so for about two, two and a half years. And at that two and a half year mark, she had had, she got healthy enough to have the gastric bypass procedure that she wanted to have done. She'd lost about 65 pounds and was able to do that. And on top of that, she was able to have a third healthy pregnancy, which is huge for a type 1 diabetic. So I was thrilled for her. Baby was healthy, she was healthy, she looked amazing. I asked her about how's her A1C doing because you're just put your body through a lot. Her A1C was 5.6. I think that's better than mine, but it was it was 5.6. And I was so happy for her. And I could tell after I was freaking out in celebration about that, there was one more thing she had to tell me. She looked down at the at the car seat carrier with her little one in it, and she said, I've got one more month until I go back to um my doctor to check some things. But she said, the way I was trending, I may be able to get rid of this insulin pump. And okay, nobody told me that in school either. That right there is worth that's why I get up in the morning.

Tosha Kozloski 17:43

Yes.

SPEAKER_00 17:43

That was huge, life-changing for her, just because I'd gone to a course that lit me up years before, and she's doing great.

Contagious Oral Bacteria At Home

Tosha Kozloski 17:53

I love that so much. I think about her three children that very likely will not go through what she went through or that her parents went through, because we see that so often now when we know what to look for in dentistry, that we end up going through the same thing that our parents and our grandparents, because not only from a genetic standpoint, when we used to think heavier on that, but because these bacteria are so stinking contagious. I mean, we're just passing them around, living in the same household, eating and drinking after each other, and we don't realize that we're kissing on our babies with our mouths of potential unhealthy bacteria, whether that be from bacteria that causes your gums to bleed and causes gingivitis and gum disease or causes cavities or any of those things. Like it's all so contagious.

SPEAKER_00 18:41

It is. I feel like some of those commercials that they do around winter time for RSV where they're like, please don't kiss the babies if you have this going on. I was thrilled. I was like, right? That's what I'm talking about. Stop kissing other people's babies. Just wish them well, or I don't know, path or diaper, but don't kiss the babies. But that's exactly what we're up against. And we always that was the other thing that stuck with me that first course that I went to was a a case study of yours where the parents were in their early 40s and both had been treated for quite some time with active periodontal disease. And we looked at their test results and then tested their 12-year-old. And it was exactly the same, the same bugs that stuck.

Tosha Kozloski 19:25

Yeah. I mean, he was suffering from bleeding gums, gingivitis, which I think it's so easy to think of a 12-year-old, young, you know, tweens, a little bit younger, a little bit older, and think like, oh, they're not brushing their teeth well enough. You know, as a parent, I'm too old to get in there and brush their teeth. I just tell them all the time and they don't do a good job. And then they come in to get their teeth cleaned, and we say, you know, little Johnny, you better brush more. Let me teach you how to floss again. And we just keep thinking that it's poor home care. When what does the parents' mouth look like? What does their primary caregiver's mouth look like? If you have a pet at home, they, you know, plain fetch and you know, think think of I mean, I think of that with my dog plain fetch and that slimy slob I won't let my dog kiss my mouth, but I know darn well that I'm whatever bacteria is probably flying up in my face. And so I keep him on protected. And so it's also contagious. It's all so contagious.

SPEAKER_00 20:23

There's so much that we did learn that makes sense now. Microbiology ruined me in so many other ways before hygiene school, but now to be able to see that day-to-day practically and in clinic, especially the patients that look like I look in their mouth and they look pretty healthy. And then I ask them about their their background or the how their stress has been. Stress is huge. And take a slide, and their slide is crazy. And uh it doesn't look like that in their mouth yet because their immune system's working. But what happens? So that part is is weird, but it's cool to me because maybe we can get in front of this instead of waiting for it to blow up.

Tosha Kozloski 21:04

Yep. Yep. Well, it it yeah, I I think the microscope, I mean, it changed my life forever. I mean, when when I implemented that, because it was so great to just be able to take a little piece of plaque and show the patient, do you have healthy guys in there or do you have unhealthy guys in there? And if their tissue was looking really good, it was like, okay, you have all the ingredients for a really bad storm. These are the things that you can do. So you have a lot of stress in your life. Like, what do you think, Mr. and Mrs. Patient, that you can do to mitigate that? Can can you get a little bit more sleep at night? Are you not wearing your CPAP? You know, maybe you should start wearing wearing that. What do you think? You know, just offering different ideas because ultimately we can't necessarily change our patients' behavior, but we can certainly investigate with them and figure out what they do. And seeing as believing, you see those creepy crawlies on the microscope, and it's pretty motivational. I mean, I've had some nasty buggers on mine before, and let me tell you, I was very motivated to do even more than I was doing.

SPEAKER_00 21:57

You know, too much. I've seen some pretty interesting ones. Uh and I I always laugh or if I'm teaching um case studies, I'll bring up if a picture's worth a thousand words, well, how much is it worth if it's moving? What you're looking at on the screen, the big flat screen, is your bacteria and it's going crazy. Are we motivated to get rid of that? How do we how do we do that? So it's it's very, it's the best tool ever.

Tosha Kozloski 22:27

It so is. It's so

Bone Regrowth Without Surgery

Tosha Kozloski 22:29

good. Well, I want to talk about one more case study, jumping back to that bone regrowth and how you went to the course and saw that bone can, in fact, regrow something that in in hygiene school we are taught it is not possible. But now we know even without lasers, it is actually possible. We know that there's special lasers out there that dentists can use that are specifically made to regrow bone. But we don't necessarily always need that. That is a great tool. That is a great tool. The lasers are absolutely incredible. But some people, their infection is more that earlier stages, or not all their mouth is in pretty dire straits. And so with non-surgical periodontal therapy, arresting and stopping the infection, we can regrow bone. And your case, I think, is just such a such a great example and classic example. So I would love for you to share how that patient presented to you.

SPEAKER_00 23:17

Absolutely. And you're right, this was one of those patients where the whole mouth wasn't on fire, that it was sick everywhere. So he had some deep pockets and some bleeding kind of all over. But what brought him in was the discomfort that he was having on the lower right. So he had a swollen lymph node under his jaw. He had some sensitivity back there, but he couldn't really figure out it's not really hot sensitive, it's not really cold sensitive, but something's going on. And he had all that swelling going on in the lymph nodes. So we did the things, we took some some x-rays and we did some measurements, and that's the first time I got to get a look at what was going on. So on one of his molars on the lower right side, he had what looked like a ski slope. So we've been watching Olympics, right? It looked like one of those from the snowboarders. It was straight down. It was a really, it's really steep. It was on its way to making it impossible for him to keep that tooth. And he's 29 years old, and he was not excited at all about losing teeth. So we kind of did the same thing. I asked him if he was willing to throw the kitchen sink at this with me, and he said, Yep, I am. I don't want to lose teeth. So I remembered from that course when I met you that the doctor said bone can regenerate everywhere else in the body. Why can't it do it in the mouth? Well, it can regenerate in the mouth, but it cannot do it in the presence of infection. And so that goes back to it's not a buildup problem. It's not because you had too much tartar on that tooth or under the gums. It was the bacteria had gone crazy over there. So we did the things. We took a salivary test, and so we'd have something measurable, and everything was, he had something similar, nine of those 11. He had a lot of bad bugs, and a lot of them were really out of control. So that's what we did. We just um cleaned everything really well. We did some therapeutic stuff underneath the gums, which sounds scary, but really wasn't. We were just meticulous. And I think the biggest part of this success story was the fact that he did what I asked him to do. I couldn't have done this by myself. And all he did was get a water flasser and diluted peroxide. And that's how we did this. He just kept slowly keeping keeping all of those bacteria. Yeah, just keeping it flushed out, keeping it clean, trying to even the playing field for the bacteria.

Tosha Kozloski 25:42

For a clinical audience, because we're talking about bone regrowth, do you remember how deep that pocket was and how much bone he had lost?

SPEAKER_00 25:48

I do. On one side, on the outside, it was nine millimeters and healthy is three. And then on the tongue side, it was seven millimeters.

Tosha Kozloski 25:57

Wow.

SPEAKER_00 25:57

And where did it where did two? We got probing depth back to four and five millimeters there. What was really remarkable though is that the bone, we've had that happen where the pocket can reduce, but it's kind of just the tissue, so it can go back to being a nine really quickly. In this case, it had gotten healthy enough that the bone was like, actually, I'm supposed to be here. And so it regenerated and filled in. And that was, it blew my mind. I knew it was possible because I've seen your cases, but this was something. I mean, I'm working in a Medicaid office. I didn't have all the bougie things that I that I do now in my biologic office. But the the idea was my brain's still the same, my motivation's still the same. And he he met me where I was at, and I met him where he was at. And together we just went in and kept at it. And it just got better and better. So I was really proud.

Tosha Kozloski 26:52

I love that so much. It's uh it was it's always been surprising to me when young patients come in, I mean, their 20s and in their 30s, and they'll have like one or two teeth that just have incredible bone loss. I mean, their jawbone has literally dissolved away around just a couple of teeth. And in traditional methods, we were trained to just treat those teeth like it was a debris problem around those teeth. And now that I know that, I think, how from a common sense standpoint would that ever work? It's like, well, Sarah, you know, your finger is starting to dissolve away. So I'm just gonna clean it a little bit around there, that fingernail, and hope that all is well. It's like, no, folks, like we have to flush out the entire mouth. We have to use antimicrobials, we have to disrupt the bacteria that we can't see with the naked eye. We have to just know that it's everywhere and we have to disrupt all of it, not just with our hand instruments. We need to use an ultrasonic, we need to blast that stuff off of there and then ensure that our patient knows to do the exact same things at home because these bugs, like they live on our palate, they live on our tongue, they live in our cheeks. You have tonsils, get those tonsils clean.

SPEAKER_00 28:09

You guys, I can't with the tonsils. But honestly, they are everywhere, they're absolutely everywhere. So, giving them the tools, and I feel like if they can see what things look like on the microscope or on the screen, imagine that 3D, like a great big cobweb on your front porch, and if you hit it with the hose and knock it down, it has to start over. It's kind of that concept. So being able to disrupt all that stuff because it's really sticky, and it has like a really gooey force field over top of it, and you have to be able to bust open the force field to get at the bad stuff. So you can't go, can't go home.

Tosha Kozloski 28:48

Your analogy than anything. Every time I hear you speak, Sarah, I'm always like, an analogy. I wish I had that. Yes, a force field, a cobweb. I'm like, I'm keeping that. Yeah, it does make sense. I love that. Okay. Anything else you want to share about that case before before I ask another question?

SPEAKER_00 29:06

Last time I saw that patient, the bone was stable. It had actually kind of thickened on the edge of it. So that was really promising. However, he had recently acquired a girlfriend. And I thought, so now we have just introduced a complete new oral microbiome to all of this work we've done. I'm like, please bring her to me. I need to do a view now. So we please don't unravel all of that. But hopefully, after three years of being in my chair, he he knew what to do. So I gotta let that go.

Tosha Kozloski 29:39

It's one of those things that I never was trained to ask about parents and partners and things like that. I mean, I I guess I just didn't think of it that way. And now I can't imagine doing treatment on somebody without talking about, you know, my three Ps, parents, partners, and pets, you know, our primary offenders when it comes to these contagious bacteria. And if I have bleeding gums and I like my spouse, then he might have bleeding gums too. And so I need to make sure that his mouth is okay. And it is possible for one person to be sick and bleeding without the other, but it's good to just make sure. Just, I mean, if if we're gonna be working that hard to get somebody healthy and we're that we have this teamwork, let's just mention it to our patients. And, you know, maybe not everybody is ready to get their spouse in there, but we can bring it up.

SPEAKER_00 30:24

Absolutely. And they may have the exact same kind of bugs in there, but what they don't have is the same immune system. So we see that a lot of times where spouse is spouse one is trying to do everything she can do. And listen, being a woman, we already know that how much we take on. We aren't sleeping the same. We've been sleeping with one ear open because we have kids for years and trying to make sure everybody's homework is done and bed and bath and all the things, plus our own job. And spouse two over here is is sleeping soundly. Know what I'm saying? Sleeping soundly without a care in the world. So our immune system, a lot of times, especially in our 40s, when everything is changing yet again for us in our body and our body chemistry and hormones, everything is different, not it not quite the same for our spouses. So we can test, we can look at things, and they can be almost identical, but one of us is losing bone and the other one isn't. Investigatory skills. I love that.

Tosha Kozloski 31:23

I love that so much. All right,

Mouth-Body Connection And Daily Signals

Tosha Kozloski 31:25

Sarah. Lastly, I could talk to you all day, but you know, people got places to go. So if there was one thing that you wish patients would know, people would know before they saw their dental hygienist in regards to their oral health, what might that be?

SPEAKER_00 31:38

Just to lay out the the idea that the mouth is not, in fact, separate from the body. It's really the gateway to the whole show. And so if this is sick, a lot of times, you know, the gut is sick as well. Or it could be the other way around. The gut is not so good, but it's really kind of the same tubing. So sometimes it's chicken or egg. But being able to find the balance is what's important. We don't want to go through and kill everything in there and then leave us susceptible to other infections. We want to try to go for balance as much as we can. And the little things like you were saying, getting enough sleep, hydrating, finding something to help manage stress, those things are all really, really important. I think stress is one of the first things we see in the mouth. And so just helping patients to be mindful of that and teach them that, say, for instance, using their water pick, if they can get that pressure up really high, say eight or nine, and it's going well. And then one day they see bleeding or it feels different, it stings a little bit. That's your body telling you that something's going on. And so now you can add maybe a therapeutic to your water flosser, something like that, just so that you can help mitigate it because it's very silent and very sneaky, just to give them this you have some control over this, over your health. Yeah.

Tosha Kozloski 32:58

That so much, Sarah. This has been so fun. Thank you so much for being a lifelong learner. Uh dang incredible. I just I'm just so proud to be your friend. And so thank you so much for your time. And I am certain that I will ask you to be on here again. All right. I look forward to that. Thank you, Tasha.