17. How The TOSH Method Creates Dental Microscopy Results with Dr. Vane

Dr. Nicole Vane spent years avoiding the microscope. Every mentor she trusted had one in their practice, and every time, she found a reason to skip it. Too much setup. Too much learning curve. The ozone would take care of it anyway, right?

Then she went through The TOSH Method, and it changed everything, for her, for her team, and for the way her patients understand what is actually happening in their mouths.

In this episode, Dr. Vane shares what it was really like to be the reluctant one. Not the early adopter. Not the tech enthusiast. Just a busy, high-level biologic dentist who had already built a successful practice and genuinely did not think she needed one more thing to learn. She talks about the moment her hygienist found spirochetes on an eleven year old's slide, the term she now uses with patients called a medical grade cleaning, and why her entire team feels more connected to their work since making the shift.

This conversation also opens up into something bigger than one practice. Dr. Vane and Tosha talk honestly about the hygiene shortage happening right now, why it is tied directly to the insurance-driven treadmill model, and what it would mean if hygiene programs taught this kind of care from day one.

What you will learn in this episode:

•  Why resistance to new clinical tools is normal, and what it actually takes to move past it
•  How a simple language shift, calling it a medical grade cleaning, changes the entire patient conversation
•  What it looks like when a hygiene team stops feeling like salespeople and starts feeling like clinicians
•  Why chairside, real-time results build trust in a way that lab-based testing alone cannot
•  How the current hygiene shortage connects directly to the insurance-driven treadmill, and what could change that

Tosha's take: This episode is proof that you do not have to be the person who loves new technology to benefit from it. Dr. Vane's honesty about her own resistance is exactly why this conversation matters. If she could get past it, so can you.

Ready to see what your own slides could show you and your team? Schedule a call with Tosha at tosh.care.

Want the verbiage that changed how Dr. Vane's team talks to patients? DM SCRIPT to @toshardh on Instagram for the Bleeding Gums Script.

Meet Dr. Vane:
Dr. Nicole Vane on Instagram, @nicolevanedentist

 Moonlight Beach Dental, Encinitas, California

 Dr. Nicole Vane is a biologic dentist and founder of Moonlight Beach Dental in Encinitas, California. After practicing traditionally since 2003, she transitioned to biologic dentistry starting in 2011 and opened her own fully biologic practice in 2014.

Ready to change the way your patients see their own infection?
Get the Bleeding Gums Script. DM SCRIPT to @toshardh on Instagram.

Ready to bring microscopy into your practice?
Schedule a call with Tosha at tosh.care.

Listen to Mouthy Matters:
Available on Apple Podcasts, Spotify, and YouTube

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

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Welcome And Guest Introduction

Tosha Kozlowski 0:00

All right, today, guys, we have Dr. Nicole Vane. She is a fabulous biological dentist. Hello, Dr. Vane. Thank you so much for being here. Hi, Tasha. How are you? So good that I get to talk to you. Tell me about your practice. Tell our listeners about the type of practice that you have built

Building A Biologic Dental Practice

Tosha Kozlowski 0:17

for yourself.

SPEAKER_01 0:17

Okay. Well, I am a traditionally trained dentist who became biologic starting in about 2011. So I've been practicing since 2003 in San Diego, California. And then I opened my own biologic practice in 2014 because I just felt I could no longer practice in an environment that wasn't supportive of biologic principles. So I did a from scratch startup build out, bought all the lasers, the cone beam, everything else. And it's been great ever since to introduce that to my community up here.

Tosha Kozlowski 0:54

And I'm and I'm certain people want it all over the place. I mean, it's biological dentistry is just really exploding. I mean, people want that functional approach to their mouth.

SPEAKER_01 1:04

They do. It goes in line with uh the med spas, the peptides, the IV therapy, the lasers for your face.

What A Medical Grade Cleaning Means

SPEAKER_01 1:12

I mean, it is getting so much attention. And the fact of the matter is, most people don't know that this is even being offered. So I actually stole a term from someone I heard online, and it's called a medical grade cleaning. And so, yes, so that's going to be how I'm coining it to my patients because it really is. We're getting a full diagnostic and it's opening up a pathway for more diagnostics if someone is really sick that will really help us uncover the root cause. And a regular cleaning doesn't do that.

Tosha Kozlowski 1:45

No, it misses so much. It misses so much. Well, that ties right into, you know, when I mean, I know you've gotten amazing results after going through my program and you had amazing results before because you're so high level. But what was it about adding a microscope and really just taking this part of the practice to the next level with everything else? What interested you?

Why Chairside Microscopy Changes Care

Tosha Kozlowski 2:05

What kind of made you go, hmm, what's that microscope deal all about? And I want that.

SPEAKER_01 2:09

Well, I will say first, what didn't interest me that has now totally changed my mindset. So when I first started doing a lot of these advanced like trainings, I I go to, I have quite a few mentors. All of them had microscopes in their practice. And I was like, there's no way I want to do that. Too much work. I mean, I've always used ozone. I was like, oh, but the ozone will just kill it anyway. So who cares? We're so good at cleaning and we're so thorough that who cares? And so I really had that mindset for a while. And then I looked online after one course at getting like a microscope off eBay. And I'm like, that's this is gonna be too much work to set it up. What if it comes in the box and I don't know how to do all that? This again is too much work. I don't want to do it. And so then I tried doing salibree diagnostics, like, here, spit in this tube, and then we'll get it back. But not having that in-person interaction and having a delay leads to a misperception. And what happens is people are like, it's not like, oh, we're gonna do some lab work and then we'll get it back and we'll find out if you have high cholesterol and low vitamin D. This is like, okay, so you're not gonna clean my teeth today? No. Yeah. No, then what's going on? Yeah, it looks bad. And they're like, okay, well, no one's told me this before, or you've never told me this before, or you have in a different way, but you still clean my teeth. So then there's that lack of service thing. Then you wait for the results. Then you have to call them. Then you might recommend something like, well, you're gonna need an antibiotic. And they're like, what the heck is all of this? Now you're upselling me on all this stuff, or do I really need that? You know what? I'm just gonna go somewhere else and get my teeth cleaned because you're lacking that in person. Then you're leaning on a team member. Did they call back? Did they follow up? So then some of them fell through the cracks. Now they're back for their in another three months. Like, I still didn't get my cleaning. We're like, well, you're overdue and your mouth still looks bad. Let's go over the results. And then it was even more confusing to them. Well, if it was that bad, then why well can't you just clean my teeth today? So, anyway, those things, those disruptions led to team frustration because the patients were getting scheduled. The hygienists weren't on board because they felt like, hey, this is taking too much time and effort, and I could have just cleaned their teeth by now. And also, everyone wants to be liked. So, like had not having the authority, it feels like you're doing something either disingenuous or not of service. So it led me to exploring this, but I still I've always been open-minded, but I still didn't try it until uh Dr. Carrie Le Brit was like, and Dr. Laura Mock were like, this is just gonna change everything for you. It's so fun. And this is my year of yes. So I was like, you know what? Maybe that's what's missing. Let's just, let's just try it. But this time I'm gonna do all the training myself. I'm gonna sit in on every meeting. I'm not gonna miss a single one. I'm gonna listen to everything in the portal multiple times. Instead of having the mindset, I'm the doctor, I know all of this, I do all of that, I've been doing this all along. Because I will say I had that mindset years ago. But what happened is my eyes were opened and I just felt, after a period of burnout, so invigorated because it was so much fun. I kid you not, I never ever would have thought that. And now, guess who's posting you slides when I found that parasite in someone's mouth? And we've had so many active slides, it's mind-blowing. So having you help me with the threshold on the microscope. I think you and the microscope guy who you've connected me with were very annoyed by the number of questions I asked. Is it worth it? The pricing, are you sure? I don't know. That seems like a lot. And now it is very, very worthwhile because we're seeing so many things. And you actually, the whole team's invigorating because we really feel like we're helping people and it's making us feel more connected to patients because we're actually in real time showing them something that they had no idea about. And we're able to step into our clinical authority, like, we got you. This is how we're gonna help you. I'm actually using antibiotics less because right now, initially, a lot of people want to try and start with something. Can you do some laser today and ozone and then do this, and then we're gonna reevaluate, or we'll put them through the full periodontal therapy, which you can go into how you you tier and train it all. But and then a lot of them want to wait, be retested. But again, since it's all chair side, we can very easily monitor progress, or we can have a patient who's been healthy, been on normal recare, and then hard stop. You look different. We need we need to do something. And so that's just been really transformational. And then because my hygienists are so excited now, and because it isn't taking all the time that they thought it would, they thought it's gonna make them run behind. You're like, it just takes a few minutes. I'm like, there's no way.

Tosha Kozlowski 7:12

This is gonna be a experience. Like, I promise it will give you time. You do not have to explain the pockets and the radiographic bone loss or the lack thereof.

SPEAKER_01 7:24

I will say, seeing is believing. I did not believe that. I don't think they believed it. So a lot of times we'll

Real-Time Slides Build Patient Trust

SPEAKER_01 7:30

run over to the slide, and I remember just just this week, my one of my hygienists was taking a sample on an 11-year-old. And I was like, what are you doing? Why? Who cares? And she had sparrow keys all over. And she's like, I just figured she looked a little inflamed, and I just thought, I why not? And I'm like, why not? And so they're teaching me that the consistency, because it doesn't take much time, because we're not trying to sell anything, because our true goal is just making our patients so healthy and uncovering these conversations that lead to heart disease, dementia, colon cancer, which is the highest on the rise in the population under 50, which is correlated to the biome, which comes from the mouth for one big tube. It's just all coming together in such a way where we can be in service of our patients with good conversations and not a salesmanship. How did I do with explaining that?

Tosha Kozlowski 8:26

I don't perfect. 100% perfect. I just love it. I just love it. Yeah. Do you feel like the patients really understand what they're seeing? Like, oh my goodness, there's there's a there's an infection problem here versus, I mean, for me as a hygienist in my early days before I had a microscope, I was trying to explain an infection, but I think I was doing a better job at explaining to them that they had a dirty mouth problem, which actually wasn't the case for most of those people. And they felt like it was a fault issue. And so when I started using the microscope, it completely changed the conversation. And I needed to see the slide as much as my patients needed to see the slide because I was really surprised sometimes.

SPEAKER_01 9:03

You know, and it's um I've I've taken a lot from you on verbiage. You're very skilled with that. I think the whole team has. And you're also really good at shifting the ownership because one of my hygienists is she's so caring that it leads to anxiety. Did I do something wrong? Yeah. Are their teeth not clean? What why would they look like this? They must not be doing the work then. But then what if they blame me for that? She now, because of the verbiage and having the slides that tell the story and having to see how they're responding to therapy, are you taking this? Are you taking the zinc? Are you doing the oral probiotics? Are you doing maybe we should try the biocyanin? We're constantly mixing things in, trying the iodine mouthwash. We're we're we're using a lot of things to see what works for them specifically, because we're all unique. But having that uh confidence that comes from, I'm doing everything for you, but let's get a real diagnosis and let's create a treatment plan for you is what is making all of us feel more successful with our communication. Patients are receiving it differently. One, energy is everything. So them leaning on our authority, being able to be like, I'm not showing everyone the slide. Some of them I'll ask, do you want to see it? And they're like, Yes. So we bring them over, and then I'm really enjoying filming some of these really active ones because they are surprising. That one I sent you recently, that was on a 22-year-old. A 22-year-old.

Tosha Kozlowski 10:33

That to a microbiologist because was that the one with the with the tapeworm?

SPEAKER_01 10:37

No, that was an another one that was literally, you said that's the your response was, wow, that's a really sick mouth. But when you look at the patient, this beautiful blonde girl who is young, healthy, and then you look at her medical history, which is benign. She was referred to me by a naturopath who's her cousin. And we're like, let's just do it. And I think the if she went anywhere else that didn't have this mindset, it would be, sweetie, you just gotta start flossing and let me get you a prescription for some fluoride mouthwash and some chlorohexidine. And that's gonna make you right as rain, sweetheart. That's all you need. That's not what they need.

Biome-Safe Treatment And Product Choices

SPEAKER_01 11:20

Yeah. So it's been interesting. And then also, having practiced for 25 years, I had a couple patients who had a surgery and they brought in their chlorohexidine. And I'm texting the surgeons, what are you doing? Have you read the literature on chlorohexidine and it kills fibroblasts and it's super toxic? Here are the products that really work in service of our patients with healing with surgery. One of them being, for instance, Stella Life Rinse. There's great studies on it. So it's really, really nice to be able to fully take care of them. So people are healing optimally without pain. We don't have patients, although we still hear it. I heard one this week when they had deep cleaning before it was so painful and it was horrible. Or they end up with the periodontis and then they're talked to about surgery, and these surgeries are so expensive, and then they just get lost in the weeds. Yeah. And then they go somewhere else that's like, let's just do an all-on X. You'll probably lose these someday if you keep up with this. And I just don't like that whole pathway for dentistry. I really want to help people help themselves. And some of the things that we can implement are so easy and they're not medication driven. And then now with Ozempic mouth and these other issues, we're gonna have a whole new slew of stuff that we've never seen before. And this is how we can help them because it all shows up in the mouth first. So I'm I'm to steal from McDonald's. I'm loving it.

Tosha Kozlowski 12:46

I mean, it's incredible to have dentists like you, Dr. Vane, that really look at the patient from a whole health perspective and the ways that we can make them and keep them well, help people to get well, versus the old-fashioned way of thinking about medicine in general is just like nuke a bomb on it, throw an antibiotic at it, like kill everything. And we're not really thinking about, well, our body has a lot of mostly really, really great bacteria, and we want to keep all that stuff really great so that we can fight off unhealthy stuff that comes our way. And if we don't, then we get sick. And so, yeah, I think having being able to show people exactly what's going on with the comb beam, the three X, the three-dimensional X-ray that you mentioned, and having the microscope right there. And then in the beginning, you kind of mentioned like salivary diagnostics. It's like how how helping a person understand why we want to do a test in the first place. Well, let's take a look. What's on your microscope slide? Are there healthy bacteria or unhealthy bacteria? If there's a lot of unhealthy bacteria, maybe we want, maybe we need to take that one step further with a lab test. But that conversation is so much easier. The why, why to that conversation? Because without the creepy crawly bug swimming around the microscope, it can be difficult for just any old person to be like, well, why do I need that again? Because I felt just fine before you started, you know, poking around in my gums.

SPEAKER_01 14:03

I think also with so much going on, I think COVID was a good initiator for people. The no-swabbing. And then even now I have a friend whose dad just got COVID and he's been sick for a week. And that that whole mindset of just swabbing, testing, let's see, let's see, let's see, versus oh, well, you have the sniffles, you have the cold, you know, people were like, I want to know what it is. Is it that? Is it that? I think that that's really shifted people's mindset about things. But also now, if I had someone who came in and was like, sorry, I canceled my cleaning, I had uh COVID last week, those things can shift their entire mouth. And sometimes they don't shift back for a long time. It could it it could be two years, they could get the explosive parasitic diarrhea and the constant throwing up, dehydration, and parasites can shift again your flora, and what that'll show up as is spirochetes on the slide a lot of times. Yeah. So it's just really interesting for me to be able to connect the parts for for the patients. Yeah.

Tosha Kozlowski 15:11

Yeah. And it gives it gives them a reason. It's like that's what's going on in there. That's why my stomach has been feeling icky. That's why, you know, all the different things. That's so awesome. Yeah.

SPEAKER_01 15:21

And then the other thing too is is following up with patients where they were looking better and then now they're looking worse again, it just opens up more conversation. Are you still using these supplements? Are you doing this? They're like, No, I thought I didn't need that anymore. You said I was better. And you're like, Well, I I think you do. If you're still looking great, then we would not need it. But but they're like, Well, oh, I ran out, and so I went to the store and I got some pro health because things are very well marketed that are toxic, toxic to our biome, Listerine being the example. I tell people, you know, save it, use it to clean your toilet, but don't use it in your mouth because you don't want to destroy everything and have alcohol and have that burn. Like healing doesn't mean pain. Healing doesn't mean, like you said, nuking everything and then seeing what if it worked, because that's also not healing. Healing to get you better is not to have a huge setback, it's to help promote healing so that your body can maintain it. So I I just love that about biologic

Training That Makes Microscopy Simple

SPEAKER_01 16:30

dentistry in general and then also having a medical grade cleaning. So well said. I love that.

Tosha Kozlowski 16:36

So, was there if anyone's considering a program like this, getting a microscope, what would you what would you share with them? I mean, I'm always like, don't nobody go out and buy a microscope. Please, please, please. They are not all equal. You can get some for a couple hundred dollars on Amazon. That is not what you need. That is to look at, you know, pond water and you know, bumblebees. Um, we need a very specific one. But from a microscope, the program that we did together, what would you share with people about the program or just any any heads up or tidbits that you have? Okay, so many things, but I'll break it down.

SPEAKER_01 17:11

And and also, we're you, as you know, you have not paid me to say this. I am just such a true believer that I want to tell people first, I am not technologic. It took us longer than normal to log on to this call because I was having issues clicking on it. So having a platform that is remote, that is guided, structured, and for me, I like listening to podcasts. So I had my earbud and I would listen to your training program over and over and over again with my phone propped up while I was like even putting on makeup, while I was doing something, I'm like, I'll just revisit this. Oh, I really like that. I got another tidbit out of it. So it's very digestible. If you had sent me a program, like when I did my IV recertification, I had to sit down for eight hours in front of the with with these big manuals. And that feels a lot more like a block, like it's gonna, oh, that's gonna be too hard. I don't know how I'd roll that out to the team. So I will say, because I could follow it easily, they can follow it easily, right? You have a patient cancellation, pop back on and listen to that one again. So it's structured and easy. And then the second part is with the microscope, as I mentioned, I was dreading the setup, what happens if something goes wrong, because you know, uh, I already have a lot of technology in the office that was quite draining and a huge learning curve. Huge learning curve with some of my lasers and stuff. But for this, I was thinking it'd be the same. It's not. But I I will say if I had gone rogue and tried to set it up on my own, or I bought one off a friend, and then the lens went wrong, that it would not have gone as seamlessly. So the the visibility on this one is so good and it's so easy. I didn't buy one for every operatory. I had a nice little bay that happened to be in between all my ops where it's super easy to walk out and walk back in and bring the patient there. So it wasn't even a huge investment where I needed to buy one for every room. It's just we have one stationary one. There's never a long, long line waiting for it. So it was very easy to bring on and easy to be able to recoup the investment. Awesome. Awesome.

Tosha Kozlowski 19:15

Well, I am so glad that you had a great time through my program. I definitely work really hard to keep it digestible because we're busy clinicians. I mean, we're busy in our practices, we're taking care of patients and and we need a lot of extra continued education. But man, the type of continuing education that we take, it has to be digestible. We have, I mean, to me, it's like I wanna, if I'm gonna learn something, I want to be able to implement it right away versus just, oh, that was cool. I want to be able to implement it to help my patients.

SPEAKER_01 19:42

And having us all sitting together with with my hygienists and myself, it also really connected us. But I would say the greatest takeaway was still the verbiage that you've offered. We would hang up and be like, oh, she is so good at saying that. Or we would wait for our next call. We would each have a list. How would you handle this? How would you handle that? And then it it all starts to stack and come together because it's also affected my verbiage now with how I talk about other procedures in the office, because it's given me a different way of speaking to patients. And I I really appreciate that. I would say that's your greatest strength is not just infusing your passion into others, but being able to give that that verbiage is is so powerful.

Tosha Kozlowski 20:24

Thank you. I I do agree. It is my superpower because I get to work on it every day. And I do feel like communication in life is the most important thing that we do. And the way that I was trained as a fental hygienist wasn't quite cracking the code for my patients. And so I worked really hard to um ensure that what I'm saying really resonates with anyone and that they can understand the why and the what so that they can make the best choice for their health.

SPEAKER_01 20:51

Can I one last thing too? I think it really the hygiene shortage, the hygiene burnout. It's so real, but it's all insurance driven. Get them in, get them out, crank them, crank them out. You have to upsell them on this deep cleaning and then with irrigation and then make them have the fluoride bar,

Hygiene Burnout And Insurance Pressure

SPEAKER_01 21:10

make them have this so that we can charge more. Because insurance, insurance, insurance, but insurance isn't gonna cover this because there's not enough phone loss, and insurance isn't gonna do it, it helps free us from all of that. And it really lets us know what great providers we can be when we are in service of our patients and not in service of just insurance or the traditional mill of let me have someone come in, quick, flosh, polish, fluoride, and then Becky will check them out. It's it changes everything on how we feel as a provider. And I think if this were more integrated from the get-go with hygiene schools, people would see the value and we wouldn't have the shortage we're having now.

Tosha Kozlowski 21:49

Yeah, I think that is a large part of it. It's it's chimes have changed so much. And you mentioned COVID earlier, and that really was the instigator of a lot of this hygiene shortage because many schools closed and a large number of hygienists retired early and just left the field altogether. Um, and so there was a compounding different issues that happened, and now we're, I want to say, like there's like another four to five years potentially of not quite enough hygienists. I'm super happy to say that there are some colleges though that are training some of this stuff. They're using guided biofilm therapy, they're doing microscopy and lasers and they're so they're they're getting a taste of it. And so I'm so excited for those hygienists because I can't imagine how how my life would have been coming right out of school, having all that understanding of what's in that blood.

unknown 22:37

Yeah.

Tosha Kozlowski 22:37

What's calling? Oh my goodness, yes, yes, absolutely. Well, if anyone is happens to be listening in your area, Dr. Vane,

How To Find Dr Nicole Vane

Tosha Kozlowski 22:45

can you share with us how people can find you, how they could become a patient of yours? Yeah.

SPEAKER_01 22:49

So Instagram, my handle is at Nicole Vane Dentist, and our office is called Moonlight Beach Dental. So we're holistic, fully biologic, and yeah, we're in Incinitas, California. And check out our website. We're I'm working on developing a new one that hopefully has a lot of this info in there with really easy to digest videos too. Because I really want to share this with the public because again, I see a parasite on a slide, I mean, that you couldn't see with your eyeball. I literally couldn't see anything on the slide. I wasn't sure I even got a sample of stuff. And so seeing that on there, it was like mind blowing.

Tosha Kozlowski 23:23

These bugs are translucent. We can't see them with our naked eye. So how could our patient? Absolutely. And we'll I'll make put um your links in the show notes as well so people can easily link to them. All right. Well, thank you so much. Awesome. Thank you so much. Thank you so much, Dr. Vane. This has been so much fun, and I look forward to talking to you again sometime. Okay, thank you.