Your Mouth Matters

Welcome to Massachusetts College of Pharmacy and Health Sciences Podcast, the Secret to Living to 200. My name is Jennifer Persons and I'm your host. In each episode of this series, we will explore different aspects of health and the factors that allow us to live longer, healthier lives. With the help of a thought leader from the university this year, MCPHS is celebrating its 200th birthday, and what better way to kick off our bicentennial celebrations than with a podcast about longevity and wellbeing. Joining me today is Dr. Linda Boyd. She is a professor and associate Dean of Graduate Studies in the Forsyth School of Dental Hygiene. Welcome, Linda. Thank you. Before we dive into our conversation, we're going to start with an icebreaker. So my question for you is, if you had a time machine and could travel 200 years into the future or 200 years into the past, which would you pick and why? Probably into the future. That's a little scary to think about what's going to happen in 200 years, but I feel like everything continues to advance and improve and I think it's going to be really exciting to see what the world is like in 200 years. I think that's a very brave answer. So as I mentioned, you are a professor of dental hygiene. As we get started, I just want to learn a little bit about how you became interested in dentistry. Well, it's. Kind of a very strange story. It was not my life's goal to be in dentistry at all. I literally started in high school by accident. A friend told me about a job that was available in a dental office, and I applied and I started working there. I had never even been to the dentist at that point. I was 16 years old, a junior in high school, and so I really didn't have any idea what I was getting into. And so I think maybe that was a good thing because so many people come into dental offices in their younger years and have a lot of dental anxiety. I had no anxiety. I had no idea what I was encountering. And so I loved it. I loved everything about it. I loved working with the patients. The dentist I worked for was just a really gentle kind school. It really resonated with me. And so I changed from what I thought I was going to do was, which was be a teacher, an elementary school teacher. I changed my major to dental hygiene in my senior year and had to take all my science courses that I had been avoiding thinking I was going to be a teacher. And so that's kind of where I got started. So then throughout your career, your first experience working with a dentist, what made you want to continue learning and then eventually transitioned to higher ed? Well, his wife was a dental hygienist. She was in one of the first classes of dental hygiene in the 1970s in Oregon. And I worked at dental hygiene for 20 years. Loved it, loved all my patients, but as I got into the career, I didn't see that I could continue doing it until I was like 65 or 70, and so I needed to look for other options. So then I went back to school to get a bachelor's degree because I had an associate degree in dental hygiene. Went back to get my bachelor's degree and I thought I was leaving dental hygiene. I was, after 20 years in the field, I thought maybe I wanted to do something different. Nutrition was something really interested me. So I got my bachelor's degree in nutrition, and then I went on to get my master's degree in nutrition at Tufts University. But I also realized that I couldn't leave dentistry. I really loved it, and so I was really blessed for my very first rotation. When I got to Tufts University, I got to rotate into the Tufts Dental School with one of the dieticians there, and she taught dental students how to counsel their patients on nutrition, oral health and reducing risk of cavities and periodontal disease. And so I kind of had a vision at that point of where I could take my oral health, my dental hygiene background and my nutrition background that I was receiving and kind of combine them together. And that's kind of where my journey started. And then when I graduated my master's degree, I started teaching at the dental school in Oregon. I taught nutrition and preventive services and the dental hygiene aspects of care to the dental students and realized I needed to get a doctorate education because I didn't know how to be an educator. I felt very out of my element trying to teach dental students. And so I went back to school and got my doctorate while I was teaching in the dental school. And that was the beginning of my education journey, which has been almost 25 years now. You've seen a lot of different disciplines and healthcare. As you mentioned, you delved into nutrition a bit and got an understanding about how different providers play a role in that field. So when you came back to dental hygiene, did you have a better sense of how our oral health can affect the rest of our body and the other things that are going on? That was one of the really fascinating aspects of doing my dietetic internship at Tufts University and New England Medical Center, as I did rotate into all the different disciplines in the hospital from oncology, I worked with transplant patients, I worked with cardiovascular disease, I worked in the pediatric piece where we looked at children that had failure to thrive, and I worked at Joslyn Diabetes Center. So I got a really good broad range of how the systemic aspects affect oral health and vice versa. And that was something I didn't have as a dental hygienist. I felt like every dental professional needed to have a better understanding of all those different systemic issues and the medications these people taking, all the side effects that they have from their condition and the medications and the other challenges that they might be facing. They need to understand that because it impacts their oral health and how we provide care for them. And so I still try to bring all that information that I learned back to my dental hygiene and dental students when I was teaching them to try and help them to see the bigger picture, that it's not just about a mouth. I mean the head is connected to the body. It's not just a mouth. I mean, everything comes together and the oral infection in your mouth impacts all of your health system. It's related to preterm low birth weight babies and pregnant women, cardiovascular system, heart disease and diabetes. It impacts their blood sugar control. So there's so many things that we need to know as dental professionals that we really have not embraced as much as we should have over the course of the years. I mean, I think it's getting better in the last decade or so, but I don't think we're still not there because dentistry still is in a silo and we're still very separate from all of the other healthcare providers, and we need to find a better way of coming together and really working interprofessionally with all the other providers. And a lot of progress has been made, but probably still plenty more to be. Made. I think we have made really great strides, but dental schools and dental hygiene programs are still very isolated because everybody else works in a hospital setting or in a clinic setting, and they work together in many ways. And we're one of the disciplines that doesn't do that to any extent. And so we really tend to still be outside the realm of the other healthcare providers. So we need to find a better way of integrating ourself with within that environment so that we can all be interacting on a more regular basis. So would you go so far as to say with, for example, pediatric patients, diabetes patients, cardiovascular patients, is it possible for them to completely heal or get to the root cause of their issue if they're not also taking care of their oral health? Or was it more difficult if they're not? I can't say it's not possible, but I mean, I think that there's a lot of ongoing research and existing research even to the level of systematic reviews, meaning there's been a lot of research that they've kind of pulled together to tell us what is the outcome of that really shows that if your diabetes is not well controlled, your periodontal disease is going to be worse and vice versa. If your periodontal disease is not controlled or gum disease, then the blood sugar is not as well controlled in something with diabetes. So it's definitely a component that needs to be addressed. Some of the other conditions, I don't think we know whether treating it is going to impact the overall health, but it's one thing you can control. So why not get that care and make sure that you're taking care of your whole health and not ignoring your oral health. Think about it. If you don't have a healthy mouth, you can't eat. You have problems speaking, you might be embarrassed by the way you look. I mean, that happens with children that have really severe decay. They miss school days. They are in emergency rooms more often. They can't eat as well, so their nutrition is not as good. And the same with on the other end of the spectrum with the elderly folks. If we look at the research on the elderly folks, there's more malnutrition, the kinds of diets they choose if they don't have teeth or have very few teeth or if they have pain. So oral health is a component, but we don't think about it until it becomes a problem. Obviously preventative care is a huge piece of that. We had different experiences in that you had never been to a dentist and I've gone to a dentist as long as I can remember. So there are obviously issues and barriers getting access to care. So what kind of stuff is being done to break down those barriers to get more people healthy and try and avoid some of these issues, especially later in life? There's. Been ongoing efforts for years. I think it's real challenging for some groups to get access just because of the cost of oral healthcare, lack of insurance around oral healthcare. Even in Medicare, there's not, oral health is not included. Dental care is not included unless you have an emergency situation. It's something that I know the dental organizations are advocating for at the legislative level to try and get some dental benefits included in Medicare. Medicaid doesn't always have benefits for adults. They children usually have coverage now. So that that's been a real improvement over the course of time. But the challenge still is oral health literacy. If you grew up in a family like mine where all the older people had dentures, we didn't go to the dentist. We didn't know what we should be doing. We didn't know that we should have preventive care. We didn't know we should floss. I've never heard of floss. And there's a lot of people out there like that. And so how we get to those people I think is still an ongoing challenge because there just are so many communities that we don't think of that might not have access. And I think when we provide care, we're saying brush and floss, but they might not have access to a new toothbrush. They might not have access to new floss once they use whatever you gave them in the dental office. And so I think that's something all of us as providers need to be thinking more about is making sure that everybody does have access to some of the basic kinds of things. And then continuing to advocate for adults to have access to Medicare dental benefits as well. And many states have included that, but it's not universal. So often all they can get done is an extraction, and that's terrible. If you were in a situation yourself where you didn't have funds for dental care and you were covered by Medicaid maybe for a short period of time and you had a toothache and you just had to have it extracted, well, when you finally do have benefits and you can get something done, it's much more expensive to try and either get an implant put in or put in a bridge to replace the missing tooth. It becomes much more complicated to try and fix what maybe if we had caught it very early on, could have been taken care of much more easily. So that's where that dental literacy and the lowering cost comes in. Yeah, I forgot to mention too is expanding the workforce and fully utilizing the workforce and their scope of practice in every state. And that's been an ongoing issue for dental assistants. Dental hygienists, we have a lot of skills that we are able to use in some states, but not in other states. Interesting. And that limits access as well, because if you can use us fully, like in some states there are public health dental hygienists, they can go out into schools, into nursing homes, into correctional facilities, into elder facilities and provide some preventive care. But that's not true in every state. And in some states, they have to work collaboratively with a dentist. The dentist may not want to do that. And then the other newest for the United States newest is dental therapy. Dental therapists have been around the globe for 50 years. I think they're more than 50. Oh wow. Countries that have dental therapists. But the United States has just started to develop dental therapy programs and approve legislation for dental therapy. And Minnesota is the first state. They pass legislation for dental therapists and they in communities, and they work in school settings in tribal communities in Minnesota, does amazing work with their mobile dentistry. And so they're a part of the dental team and they can take care of basic restorations while it leaves and it frees up the dentist to do more advanced kinds of procedures. And so it provides another kind of a mid-level provider, like a nurse practitioner. So they're kind of between the dental hygienist and the dentist, and they provide some of the more controlled disease by removing decay, putting in fillings. They can do some extractions. There are some procedures they can do. And it varies by state what will be allowed. And so that's an upcoming, I think, benefit to the community in increasing our workforce. And it's been approved, I think in 14 states now, but only Minnesota has actual education and providers at this point in time. But I do want to say there are also tribal communities that have a dental therapy kind of workers well, and that started in Alaska, and that's now in some of the northwest states, Oregon, Washington, Idaho. And they work in tribal communities providing the same kinds of early restoration, early disease control, early care, removing of decay to prevent the disease from advancing. Switching. Gears a little bit, I'm curious, where do you hope to see the dentistry fields in the next 10 years or. So? I mean, I would like to see not just dental hygiene, but dentistry in general incorporated more into the healthcare system and into the healthcare settings. I mean, there is some early attempts to do some medical dental integration, and I'd love to see that kind of expand. I think it's been mostly for pediatric levels, but I think it needs to be expanded throughout. I think about what I'm just hearing now about mental health professionals. I don't know if everyone's been hearing this on the news, but they're saying they want to co-locate mental health providers in pediatric offices. And I think the same needs to happen for dental hygiene, dental therapists. They need to be co-located in the pediatric offices and they can just get the full circle of care professionals and then referral for any additional care needs to take place. That's what I would love to see is that we just have that whole circle of care for everybody as they come into an office because people know they're supposed to go to someone else and do these things, but referrals don't always work. And I think if we can all come together and work as a team, that we could be much more effective. And do you think by maybe starting that kind of initiative with children that sets up more people for a lifetime caring for their oral health? Absolutely. I think that's why there's been such a focus on the kids, which is great. Starting out those habits early really sets you up for a lifetime of good oral health and general health. But at the same time, we've got to make sure we're taking care of all the people that are here. And that was one of my frustrations with so much emphasis on the children is that there was none for the elders. And once they are no longer working and have no dental insurance, many of these elders do suffer a lot of effects of their oral disease. And so yes, I think we should start as children and hopefully as they age, they would have better oral health, but we also can't forget the people on the other end of that spectrum. Absolutely. So if you were talking to somebody who may not have received regular dental care or is just looking to take care of their teeth a little better, what's the one thing you would recommend they do to improve their oral. Health Prevention is important. You can't do it all yourself, but what we can all do ourselves every single day is thorough removal of the bacteria in our mouth because the bacteria in your mouth is what causes the disease. And so whether that's brushing, it's cleaning between the teeth in some manner. Some people it's floss, some people it's called a little brush that goes in between the teeth. Some people use little floss swords that kind of hold floss and help them to do the flossing. There are some water jet kinds of instruments as well. So I mean, people need to do some form of removal of all the bacteria in their mouth as much as they possibly can because that's where the problems begin. And if you can do that, you can at least have a good baseline, but you do need help from a professional because once the bacteria has been there long enough and starts to harden into calculus, you can't remove it. And then what does that lead to later in life if it goes untreated? I kind. Of think of calculus as like a coral reef. Oh, that's where all the little bacteria live. And if that calculus is on your teeth and and it's just housing all that bacteria, it holds it right against your gum tissue and your teeth and causes decay and gum disease. So. The message is get that coral reef off. Clean your teeth as much as you can. Yeah. Yeah, do as much as you can to minimize that bacteria in your mouth. Linda, thank you so much. We've come to the part of our show called Red's Rapid Fire, so I'm going to ask you a short series of questions, and the goal is to answer them as quickly as possible. Are you ready? I'll. Try. What is your favorite season fall? If you weren't a professor, what would your job be? I. Don't know. I, I've been in dentistry for 50 years, so it's hard to think outside the box. Sweet or savory? Oh. My gosh, both. What is your dream? Vacation? I think being with family wherever that is. Cats or dogs. Dogs. What is one thing you could talk about all day? Probably food. Would you ever go to space? No. Who is your role model? Oh my gosh, there's so many role models. I'll tell you, my role model right now is a 70-year-old woman that completed the half marathon that I was running in. She passed me at mile 11, just like zooming along. And that 70-year-old woman is my. Idol. And my last question is, what is one piece of advice that you would give your younger self? I think to be unafraid, to attack things that you've never done before and to not doubt yourself. That's wonderful. Thanks again, Linda. And thank you for listening to this episode of The Secret to Living to 200. We hope you'll join us next time. And as always, stay curious Cardinals.