Communicate better about periodontal disease Interview with Katrina Sanders, RDH

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Full transcript provided by Riverside AI (please have patience with any grammar or spelling errors)

Dayna (00:02.945)
Welcome everyone to the high performing dental team. I’m Dayna Johnson, your host and I have the most amazing guest on for today. This quarter of content is all revolving around the hygiene department, hygienists, and I invited Katrina Sanders, RDH to be a guest on my podcast, AKA the Dental WINEgenist

Katrina M Sanders RDH @TheDentalWINEgenist (00:29.344)
Hahaha.

Dayna (00:30.625)
So thank you, Katrina, for accepting my invite to be a guest on my podcast. I’m super excited.

Katrina M Sanders RDH @TheDentalWINEgenist (00:36.448)
Are you kidding? Thank you for spending your happy hour with me. It’s so awesome. Cheers. Yes, yes.

Dayna (00:42.305)
Cheers, I know. It is happy hour where I am. And so Katrina and I have, you know, we’ve known of each other in the dental industry, but kind of lately we’ve been bumping into each other a lot at dental meetings. And last year we both attended Jerry Gottlieb’s Leading Ladies Retreat down in Palm Springs, which was such a great time for us to really kind of get to know each other.

Katrina M Sanders RDH @TheDentalWINEgenist (01:11.872)
Yeah, Jerry’s amazing. She really is. She’s such an advocate for women, women in dentistry. It is just incredible. So I loved that we all poured wine. We all talked. We all did the thing. It was amazing.

Dayna (01:14.369)
I know.

Dayna (01:24.481)
Yes.

It was, it was. And I do love wine, just like you. And you are also a sommelier. And so my question is, you know, I don’t even know the answer. Did you become a sommelier before you became a hygienist or after?

Katrina M Sanders RDH @TheDentalWINEgenist (01:34.305)
Yes.

Katrina M Sanders RDH @TheDentalWINEgenist (01:42.656)
So I love this question. I actually started studying for my SOM exam. I had been practicing as a dental hygienist for several years, but I did this while I was also going to grad school and getting my master’s degree in educational leadership. The cool thing about becoming a SOM alongside going to grad school is that you have to drink a lot of wine in order to study. So it just worked out really well. They paired well, shall I say.

Dayna (02:08.033)
Oh, yeah, like, oh darn, I have to drink a lot of wine. I know. Yeah, I know. I just love that because it gives you something to connect with other than dental hygiene. You know, you can have these events that revolve around hygiene and wine. I mean, two amazing topics.

Katrina M Sanders RDH @TheDentalWINEgenist (02:11.872)
Exactly. High class problem.

Katrina M Sanders RDH @TheDentalWINEgenist (02:27.968)
That’s right. What’s not to love? What’s not to love?

Dayna (02:29.409)
I know, I agree, I agree. And then Katrina and I have also seen each other a lot more at dental meetings. We have the time to connect in Chicago and then at Hinman recently. So it’s just been really fun to just see you and always say hi and connect and see where are you at, all of that. So it’s just been.

Katrina M Sanders RDH @TheDentalWINEgenist (02:39.36)
Mm -hmm.

Katrina M Sanders RDH @TheDentalWINEgenist (02:53.376)
Yeah, absolutely. You know, it’s so funny. I just giving our listeners a little bit of a behind the kimono about what it’s like for speakers and podcasters when we all connect with each other at these networking events. We do talk shop, but we talk high level thought leadership. And I think that’s one of the things I really appreciate about you is every time I bump into you, we’ve got something really amazing that at the end of, you know, our happy hour time together, I’m like, well, this should have been a podcast. So I’m excited for this convo today.

Dayna (02:59.105)
Hahaha.

Dayna (03:20.641)
I know. I know. I agree because, because I love to connect with people that are going to give my listeners and give me personally some really high value education. So in the next 15 minutes, we’re going to have some really great juicy content that you can take back to your dental team and, um, and really improve the, either the productivity or the.

Katrina M Sanders RDH @TheDentalWINEgenist (03:33.28)
Yeah, yes.

Dayna (03:48.193)
profitability or the workflow of your practice. That’s what I always want to bring to my team. So let’s, all right, so let’s dive in. Okay, so as a hygienist, we are going to talk about hygiene. And I want to kind of kickstart it by kind of giving you a little preview of what I love to do when I work with teams.

Katrina M Sanders RDH @TheDentalWINEgenist (03:55.072)
Absolutely. Absolutely.

Dayna (04:13.985)
One of the first things that I always do when I’m going to work with a dental practice is I look at numbers. You know, I’m a data geek. I love numbers. They are numbers tell a story. They’re very objective and they give us lots of information. And one of the numbers I always look at is what is the perio percentage in the practice I’m about to go into. And, you know, as you know,

Katrina M Sanders RDH @TheDentalWINEgenist (04:31.968)
Mm -hmm.

Dayna (04:43.041)
probably more than 50 % of adult Americans have some version of periodontal disease. And so I would expect to see perio percentages upwards of 30, 40, 50%. That’s what you would expect with the national average being that. Well, what I typically see is I see perio percentages in dental practices less than 10%. And so I wanted to get an idea of what

What are you seeing in the dental industry? And let’s start the conversation of what we can do to improve that number.

Katrina M Sanders RDH @TheDentalWINEgenist (05:22.88)
Yeah, I think we have to go back to the origin story on this. And the origin story really is that dentistry is not prepared for the amount of periodontal disease that is currently occurring in our patient populations across the United States. I hate to overuse this word, but we are in unprecedented times. Patients are living longer. For the first time ever, they are living longer with their natural teeth. So the populations of patients that we’re treating now are boomers and beyond.

they are not full denture cases at the same rate that previous generations were. So one of the challenges that we’ve seen is, and one of my favorite statistics is, from 1990 to 2010, we saw a 57 % increase in the prevalence of periodontitis. However, we have not been well accustomed to having that dialogue in a dental practice. I will share the provocative statement time and again. I think it’s a lot easier for a dental hygienist.

diagnose a brand new patient who came into the office, especially if that patient says, oh my gosh, it’s been five years, it’s been 10 years. What is the patient saying? I know we need to play catch up. That’s an easy patient, right? What about your patients who’ve been coming in every three, four or six months and oh, cringy. Now you’re a little bit responsible because you just did their prophy on them six months ago, right? You are a little bit responsible for some of the

Dayna (06:23.201)
Yes.

Dayna (06:33.409)
Yes.

Dayna (06:46.049)
Yes.

Katrina M Sanders RDH @TheDentalWINEgenist (06:49.248)
complications that could occur. And I say this facetiously, you are not responsible for what’s happening. I think it’s important for us to recognize that when this disease is occurring, this is something that we’ve taken accountability and responsibility for. However, I think it’s important to acknowledge there are so many other contributory risk factors. And because we’ve been so fearful of explaining to patients that things like

their genetic history, their systemic health, the list of medications they’re on, the, I don’t know, fact that they don’t brush and floss the way we recommend them to are all contributory factors inside of this development of disease. And for whatever reason, we feel really uncomfortable as hygienists confronting that. It shows up in our numbers, to your point. And so that’s where that periop percentage shows up. I will tell you, hygienists do not love those numbers. It makes us feel cringy, but…

Dayna (07:37.953)
Exactly.

Katrina M Sanders RDH @TheDentalWINEgenist (07:46.56)
It is a reflection. It’s a reflection of what we’re doing and rather our efficacy inside of appropriately diagnosing and treatment planning appropriate perio cases.

Dayna (07:59.617)
Yeah, yeah, I agree. That is a staggering statistic, that increase in periodontitis over that timeframe. And I agree with you 100 % that a new patient coming in is easy to diagnose, you know, because you haven’t been seeing them every six months and billing out a pro fee and they’ve been getting maybe 100 % coverage on their insurance. And so those are the patients that we really want.

Katrina M Sanders RDH @TheDentalWINEgenist (08:08.224)
Mm -hmm.

Dayna (08:28.545)
to talk about is when you are going to now in your practice, you’re going to really make this effort to really start not only diagnosing, but also billing it correctly. Because I think that’s another thing that happens in our practices is the hygienist is diagnosing it and putting it on the treatment plan. But then when it ends up at the front desk or at the treatment coordinator position,

Katrina M Sanders RDH @TheDentalWINEgenist (08:30.336)
Right.

Katrina M Sanders RDH @TheDentalWINEgenist (08:48.224)
Mm -hmm.

Mm -hmm.

Dayna (08:58.433)
then they also have this anxiety or this, they get, you know, start sweating about, oh my gosh, I have to talk to this patient about money. And the patient just thinks they’re getting their teeth cleaned, you know? And so I also feel like we have to talk about that as well.

Katrina M Sanders RDH @TheDentalWINEgenist (09:09.184)
Mm -hmm. That’s right.

Katrina M Sanders RDH @TheDentalWINEgenist (09:15.968)
Yeah, you’re spot on with that. The challenge with our every three, four or six month patients is they come in with a different expectation and oftentimes they come in a perceived state of health. We forget that periodontal disease in its earlier stages. Now I’ll back up a little bit. I’m a periodontal hygienist. I work in a periopractice, a large group, periosurgical practice. I work in the surgical suite. So I’m seeing patients with such advanced disease that they are having their tissues flapped back, pusses pouring out, sorry to get graphic but…

pus is pouring out, we’re scaling, we’re doing all the things, we’re sewing everything back down, and oftentimes those patients aren’t in pain either. So it’s a challenge. We’re talking about a disease process that isn’t really asymptomatic. I mean, people bleed, but for whatever reason, the general public thinks it’s normal to bleed from the mouth. So now we have to convince patients they have a disease process they don’t necessarily believe they have. And that’s on the clinician side. On the administrator side,

Dayna (09:44.737)
That’s okay.

Dayna (09:53.665)
Right.

Dayna (10:09.473)
Mm -hmm.

Katrina M Sanders RDH @TheDentalWINEgenist (10:14.176)
Now the challenge is, oh gosh, the patient thought they were getting their free cleaning, their insurance covers, and now I have to give them an advanced treatment plan. And depending on how skilled that clinician was in the back about explaining this to the patient, I’m either going to get a patient who’s crossing the arms reticent, right? Oh, I don’t know, or taking that treatment plan and going, okay, I’m going to go home and talk to my wife about this. And that…

Dayna (10:32.353)
Yes, yes.

Dayna (10:39.457)
Right.

Katrina M Sanders RDH @TheDentalWINEgenist (10:41.312)
unfortunately waivers the level of confidence that we have when we’re educating our patients. Instead of coming in with that confidence and saying, Mr. Jones, you have stage two periodontitis and your dental hygienist is concerned. Here’s the treatment plan to address that stage two periodontitis before it gets advanced into stage three and beyond. It will never be easier, more pain -free or cheaper to treat than it is right now.

Dayna (10:49.729)
Yes, I can see.

Dayna (11:05.761)
Yes.

Dayna (11:11.105)
Yes. And so I’m going to kind of like add onto that just a little bit. Now you work in a periopractice in the surgical suite. So you’re very accustomed to talking to patients about periodontal disease, but our GPs, our general practitioners, our dentists that are treating general patients, the hygienists and the admin team members are not necessarily as

Katrina M Sanders RDH @TheDentalWINEgenist (11:18.592)
Mm -hmm.

Katrina M Sanders RDH @TheDentalWINEgenist (11:24.416)
Yeah.

Dayna (11:39.457)
fluent in the verbal skills. And so if you were, let’s say I work in a general practice, if I was going to have you come in, and I’m going to kind of put you on the spot a little bit, but I know you can handle it. If I was to have you come into like a little lunch and learn from my practice, what would be like, where would we start? Like where would you have a practice start if their perio percentage is at 5 %?

Katrina M Sanders RDH @TheDentalWINEgenist (11:52.16)
Okay?

Dayna (12:08.001)
and they really want to, they wanna do this. They wanna treat patients better. They wanna diagnose better. They wanna do the coding correctly. Where would they start?

Katrina M Sanders RDH @TheDentalWINEgenist (12:18.656)
Yeah, I love this. I’m going to go back to something that you said earlier when you said, I love the numbers, the numbers are so important to me. And you love the numbers because that is allowing you to inspect what is expected, right? So we have to start at the beginning. One of the key issues that we see when it comes to diagnostics is the fact that the vast majority of patient dental charts across the United States,

do not contain sufficient enough information to even capture an appropriate diagnosis. And I will share this lovingly because part of the work that I do as a periodontal hygienist, but also a perio consultant is I do remote chart audit. So I go in through kind of the back door into the practice management system and I look at the charts ahead saying, okay, for these hygiene patients next week, here are the things that I’m seeing and it is concerning the things that we are missing.

Dayna (12:49.217)
Mm -hmm.

Katrina M Sanders RDH @TheDentalWINEgenist (13:13.408)
the radiographs that are not being taken with appropriate approximation of those bone levels. It is concerning the number of horizontal bite wings that are being captured, not vertical bite wings. So we’re missing alveolar bone. We are not capturing things like recession, gingival enlargement, frication involvements, mobility. I mean, all of these things are important because they tell a narrative about the level of disease. So we have to start at the beginning. If you are not assessing,

appropriately. Not only can you not gather an appropriate diagnosis, but you will never have the data, the complete data that a third party payer needs to capture. That’s where you start, always, every time. And I think that gives you the opportunity with your three, four, six months or six month or patients to then do what I call a comparative analysis between baseline. This is what you looked like when you first came in and this is what you look like today.

Dayna (13:51.841)
Mm -hmm.

Oh, I agree. Oh my gosh, 100%.

Katrina M Sanders RDH @TheDentalWINEgenist (14:14.016)
to show patients the fact that periodontal disease is actually a chronic and progressive disease. It is the frog in boiling water, right? You don’t notice it’s happening until it happens. And so that I think is the educational piece. Patients now are experiential learners. They want to learn alongside you.

Dayna (14:26.401)
Yes.

Katrina M Sanders RDH @TheDentalWINEgenist (14:37.824)
They want to understand. They want to look at their very first chart when they first came in to what they look like today and go, oh gosh, something is not right. They want to discover that alongside you. And so those numbers become exponentially more critical.

Dayna (14:38.241)
Mm -hmm.

Dayna (14:47.041)
Yes.

Dayna (14:53.025)
I agree with you 100%. I do feel that patients want to be involved with their healthcare, you know, the health of their body. I think people are more in tune with the health of their body than they ever have been. I mean, patients are sicker now than they ever have been. We’re taking more medications. We are sicker now than we ever have been. And I do feel that they are more in tune with…

Katrina M Sanders RDH @TheDentalWINEgenist (14:58.432)
Yes.

Katrina M Sanders RDH @TheDentalWINEgenist (15:08.16)
Yes.

Yes. Yep.

Dayna (15:21.185)
with medications and how it affects their oral health.

Katrina M Sanders RDH @TheDentalWINEgenist (15:25.696)
You hear it when they come in, they’ll say, oh, I’m on this blood pressure medication. My doctor says it might make my gums. You hear it. The patients understand. And to your point, COVID really did something. It taught the general public that the mouth is a portal to the rest of the body. During the SARS -CoV -2 pandemic, the general public was told to cover their mouth to protect their body.

Dayna (15:33.857)
Mm -hmm. Mm -hmm.

Dayna (15:43.745)
Yes.

Katrina M Sanders RDH @TheDentalWINEgenist (15:50.528)
And I think there’s value inside of that, that dentistry has not fully captured in how we educate and communicate with our patients.

Dayna (15:58.433)
I agree. I agree with you, definitely. And so you did say that you kind of do this behind the scenes, look at their charting, and then you also go into practices and do some consulting. So what does that look like when you go into a patient? What happens when you have another colleague, another hygienist that is kind of giving you a little bit of pushback?

Katrina M Sanders RDH @TheDentalWINEgenist (16:28.48)
Oh my gosh, this is my favorite. If you haven’t figured it out by now, I love provocative. I love that uncomfortability. That is my favorite part of my job because I will tell you, there is something so empowering when a hygienist comes up to me and says, they won’t even let me update their FMX. There is no way that they’re gonna do a perio treatment or custom perio protect trays or local delivery of animal, whatever it is. And,

we start talking about the important narrative there. How do we change that discussion point? And together, the hygienist and I create a motivational interviewing opportunity. That’s something that the medical industry has done very well and dentistry does not do very well, which is what is that patient’s motivator? Why are you here? What are your dental goals? And that I think allows the opportunity then when I’m working chair side with a colleague of mine,

it allows us to really start to workshop what that communication looks like. You’ve seen it, Dana, you’ve seen it in the role playing. Now I did theater back in high school and college, so I love role playing. It’s like my favorite thing in the whole wide world, because I feel like I’m in a theatrical production of a little shop of horrors or whatever. But adults, we don’t like doing the role playing thing in a…

Dayna (17:40.609)
Yeah.

Dayna (17:51.105)
Hahaha!

Katrina M Sanders RDH @TheDentalWINEgenist (17:55.232)
workshop or in a CE course, but here it’s live, it’s with a patient. And now we can really see the fruit and the eyes that open up when we change the way we’ve been doing it. Because this isn’t the definition of insanity is doing the same thing over and over and over again, saying the same thing to the patient, doing the same stuff and expecting different results.

Dayna (18:20.481)
Yes.

Katrina M Sanders RDH @TheDentalWINEgenist (18:20.512)
So we changed that narrative and I will tell you that that is the most exciting and thrilling part about doing cheer side consulting with clinicians.

Dayna (18:28.545)
Yeah, I agree with you. I love observing the clinical team. You know, I’m not a clinical trained person, but what I have observed and what I have learned is language and verbal skills and how patients will react to different things. And I love observing the hygienist and the clinical team. It’s just so fun. I love it.

Katrina M Sanders RDH @TheDentalWINEgenist (18:33.024)
Yeah.

Katrina M Sanders RDH @TheDentalWINEgenist (18:50.048)
Yeah.

Katrina M Sanders RDH @TheDentalWINEgenist (18:57.952)
It is, and it lets you see it in real time. Again, I do coaching calls where I’ll ask hygienists, this is where the numbers are important. I ask the hygienist, do you talk to patients about this? Well, yeah. Well, then when you see it live and live in color, it’s, okay, here’s the opportunity. You’re talking to the patient about their medical history, but all you’re asking them is any changes since last time. That’s not a medical history review.

Dayna (18:58.753)
Yes.

Mm hmm. Yeah.

Dayna (19:14.081)
Yeah.

Dayna (19:18.145)
Yes.

Dayna (19:24.801)
No, that is my biggest, that is my biggest pet peeve. And if any of my offices that talk to me, it’s like, that is my number one biggest pet peeve. If you say no changes to me, I will, I will probably like scream.

Katrina M Sanders RDH @TheDentalWINEgenist (19:33.376)
Yeah.

Katrina M Sanders RDH @TheDentalWINEgenist (19:37.44)
Uh huh, yeah. Yeah, but it happens all the time. And again, if that’s the question you’re asking, do you review medical history? And the hygienist just says, well, yeah, I do. I mean, are they wrong? You have to see it. You have to see it live and go, okay, here’s where we’re missing the opportunity because there’s so much more, right? You sit down with a patient, you start talking to them about their genetic history of cardiovascular disease and…

Dayna (19:57.121)
Oh yeah, there is.

Katrina M Sanders RDH @TheDentalWINEgenist (20:03.2)
oh gosh, they afford ice granules, which means that they have high cholesterol, but they don’t know it. And oh my gosh, you just took their blood pressure and they have high blood pressure. And before you know it, you start building a profile of cardiovascular disease risk, which means that the inflammation in their mouth has a different narrative for the patient than just a bleeding four millimeter pocket, right? And so that’s where you make it based on the patient’s motivator, not on our motivator, which is I want everybody to be clean and healthy, one, twos and threes, no bleeding. That’s…

That’s our motivator. That’s not the patient’s motivator. So we have to change that narrative.

Dayna (20:35.809)
Right. Yeah. Oh my gosh. I want to climb through this camera and just give you a big hug.

Katrina M Sanders RDH @TheDentalWINEgenist (20:39.552)
Oh, but we’ll see each other soon. I can’t wait to hug you then.

Dayna (20:44.385)
I know, I know, oh my gosh. Oh, this has been so eye -opening. Not just for, I mean, if it’s eye -opening for me, I know it’s eye -opening for the listeners and just so validating to hear it from someone that lives it every day. So thank you so much. If there is any, one thing or any last minute.

Katrina M Sanders RDH @TheDentalWINEgenist (21:02.432)
Yeah. Yeah.

Dayna (21:11.073)
tips that you would give any of our listeners. Now’s the time.

Katrina M Sanders RDH @TheDentalWINEgenist (21:14.88)
Yeah. Here’s my one final tip, and it’s something that if you want to integrate something like right away, like, OK, Ginger, you just like threw a lot at us in this like small amount of time. Give us one thing, one thing we can do. Use the word your as many times as you can when you are educating a patient chair side.

your gum tissues are, your x -rays show, your bone level, your medical history, your genetic makeup, your bleeding tendency. Use the word your as many times as you can. It allows the patient to recognize and capture the importance of the onus they should have on their disease. We’re not doing this to them. This is

part of the sequelae of the disease process and we just want to partner with them in helping them through that. That’s all we want to do. So my one little nugget, use the word your as many times as you can when you’re educating your patient.

Dayna (22:23.617)
That was beautiful. Thank you. One last little nugget. And then I will definitely have your contact information in our show notes, but if you would like to shout it out live as they’re listening and they want to write it down, what would that be? How’s the best place to reach you?

Katrina M Sanders RDH @TheDentalWINEgenist (22:24.864)
Thank you.

Katrina M Sanders RDH @TheDentalWINEgenist (22:41.376)
Yeah, for sure. Follow me on Instagram. I am at The Dental WineGenist on Instagram. That’s definitely the easiest way to get a hold of me. I’m always putting on there, you know, new courses I’m presenting. I am putting podcasts on there. I’m putting articles I’ve written. So if you want to interact with free content, you want to get a behind the scenes look at some of the things that I’m doing, definitely connect with me over Instagram.

Dayna (23:11.041)
I agree 100%. I love your, while following your Instagram. You always have not only great nuggets about dentistry and hygiene and lots of new products. And cause you are like love to try out new products, which I love. And, but your Instagram is just phenomenal. And I love following your Instagram. I’m.

Katrina M Sanders RDH @TheDentalWINEgenist (23:25.6)
Mm -hmm.

Katrina M Sanders RDH @TheDentalWINEgenist (23:30.08)
Yes.

Katrina M Sanders RDH @TheDentalWINEgenist (23:36.32)
Thank you.

Dayna (23:38.817)
You know, I almost take, I sometimes take some of your posts and I’m like, I want an Instagram post to look just like that. So I’ll kind of, I’ll kind of copy it a little bit. You know, mine, mine isn’t, mine are never pink, but they’ll always look a little different. But Katrina, thank you so much for spending your evening with me. And this, this has been just eyeopening. And I know that,

Katrina M Sanders RDH @TheDentalWINEgenist (23:44.832)
Yeah.

Katrina M Sanders RDH @TheDentalWINEgenist (23:49.312)
Sure.

Yep, see, there you go.

Sure.

Thank you.

Dayna (24:07.809)
My audience is going to take a lot of your tips and put them into action. And I appreciate you. I appreciate you so much.

Katrina M Sanders RDH @TheDentalWINEgenist (24:14.432)
Awesome.

Oh, likewise. And to all the listeners out there, go and do amazing things. Yes. Cheers. Cheers, my love. Cheers.

Dayna (24:18.977)
Cheers!

Dayna (24:23.169)
Cheers, my friend. Yes, and I appreciate you and I’ll see you very soon.

Katrina M Sanders RDH @TheDentalWINEgenist (24:28.48)
Yes, can’t wait.

Dayna (24:30.465)
Yes. Thank you all. I hope that you found this interview with Katrina Sanders very engaging and informative. If you would like to give us a five -star review, please do that. Share it with your friends and your colleagues. And I look forward to watching your journey of becoming a high -performing dental team.