Dying from Dirty Teeth - functionaloralhealth.com · qualified health care professional for any questions you may have regarding a medical or dental condition. Bonnie: ˘ ˇ ˘ ˆ

Dying from Dirty Teeth

Speaker:

The information provided in this presentation is for educational and

informational purposes only. It is not a substitute for

professional medical and/or

condition. Always seek the advice

qualified health care professional for any questions you may have regarding

a medical or dental condition.

Bonnie: Hi! This is Bonnie Benjamin of Healthy Mouth MediaAngie Stone, author of the critically acclaimed Amazon bestselling book, From Dirty Teeth: Why the Lack of Proper Oral Care Is Killing Nursing Home

Residents and How to Prevent It.

from the back of her book. Angie is a 30serving patients as a dental assistant and clinical hygienisttragedies in her own life prompted her to, not only write this book, but to also do

original research that was published in Integrative Journal. Angie speaks at dental conferences around the world educating dental clinicians on the topic of elder dental care.

Today is the first time Angie is sharing her personal story, knowledge research with a consumer audience, and we are absolutely thrilled to have her here. She'll be sharing a wealth of good actionable information, much of which

you may be hearing for the first time. Now, let me ask you a question. Do you have a family member who is in a nursing home or at risk of being admitted to one? According to the Surgeon General's Report of 2000, nursing home residents suffer from the worst oral health of any population. This puts them at high risk

for, among other health issues, aspkiller of nursing home residents.

If you are a caregiver for anyone who has trouble brushing their own teeth or have an elderly relative who might be at risk for needing a nurse a home, you owe it to yourself andthe lack of dental care provided in this setting. She will share with you the

realities of nursing home care, what actions you and your love ones can take now to protect yourselves, and how to preveAngie's mission and her passion. So let's move into my conversation with Angie and get a closer look at how this passion got started. Angie, why has this

become a passion for you?

Dying from Dirty Teeth

Speaker: Angie Stone, RDH


informational purposes only. It is not a substitute for – nor does it provide

professional medical and/or dental advice to diagnosis or treatment any

condition. Always seek the advice of your physician, dentist or other


a medical or dental condition.

Hi! This is Bonnie Benjamin of Healthy Mouth Media. Today, I'm talking with Angie Stone, author of the critically acclaimed Amazon bestselling book, From Dirty Teeth: Why the Lack of Proper Oral Care Is Killing Nursing Home

Residents and How to Prevent It. Let me read you just a little bit about Angiefrom the back of her book. Angie is a 30-year veteran of the dental profession serving patients as a dental assistant and clinical hygienist. Two personal tragedies in her own life prompted her to, not only write this book, but to also do

h that was published in Integrative Medicine: A Clinician's

. Angie speaks at dental conferences around the world educating dental clinicians on the topic of elder dental care.

Today is the first time Angie is sharing her personal story, knowledge research with a consumer audience, and we are absolutely thrilled to have her here. She'll be sharing a wealth of good actionable information, much of which

you may be hearing for the first time. Now, let me ask you a question. Do you ber who is in a nursing home or at risk of being admitted to

one? According to the Surgeon General's Report of 2000, nursing home residents suffer from the worst oral health of any population. This puts them at high risk

for, among other health issues, aspiration pneumonia which is the number one killer of nursing home residents.

If you are a caregiver for anyone who has trouble brushing their own teeth or have an elderly relative who might be at risk for needing a nurse a home, you

to yourself and to them to learn what Angie found out the hard way about the lack of dental care provided in this setting. She will share with you the

realities of nursing home care, what actions you and your love ones can take now to protect yourselves, and how to prevent a tragedy like hers. This is Angie's mission and her passion. So let's move into my conversation with Angie and get a closer look at how this passion got started. Angie, why has this

become a passion for you?


nor does it provide -

advice to diagnosis or treatment any

of your physician, dentist or other


Today, I'm talking with Angie Stone, author of the critically acclaimed Amazon bestselling book, Dying

From Dirty Teeth: Why the Lack of Proper Oral Care Is Killing Nursing Home

Let me read you just a little bit about Angie year veteran of the dental profession

o personal tragedies in her own life prompted her to, not only write this book, but to also do

Clinician's

. Angie speaks at dental conferences around the world educating dental

Today is the first time Angie is sharing her personal story, knowledge and research with a consumer audience, and we are absolutely thrilled to have her here. She'll be sharing a wealth of good actionable information, much of which

you may be hearing for the first time. Now, let me ask you a question. Do you ber who is in a nursing home or at risk of being admitted to

one? According to the Surgeon General's Report of 2000, nursing home residents suffer from the worst oral health of any population. This puts them at high risk

iration pneumonia which is the number one

If you are a caregiver for anyone who has trouble brushing their own teeth or have an elderly relative who might be at risk for needing a nurse a home, you

to them to learn what Angie found out the hard way about the lack of dental care provided in this setting. She will share with you the

realities of nursing home care, what actions you and your love ones can take nt a tragedy like hers. This is

Angie's mission and her passion. So let's move into my conversation with Angie and get a closer look at how this passion got started. Angie, why has this

©2017 Healthy Mouth Media for the Functional Oral Health Summit

Angie: Bonnie, thank you for asking that question. I think that our passions are developed, aren't they? We end up doing things that we never thought we would

be doing and that's shaped by your experiences. That's absolutely what happened to me. At the end of the lives of a few of my family members, they were experiencing all of this dental disease. In my mind, as a dental hygienist, these people as they age should not be dealing with dental disease−especially

not rampant dental disease. That's what I was experiencing. When I had those experiences and I lost these loved ones, I brought it upon myself to help the situation so other people don't have to go through what we did as a family.

Bonnie: This was a nursing home situation, correct? Angie: Yes. Both of my experiences were with loved ones in nursing homes. What I

understand now is that, not only happens in nursing homes, but other care community types, as well: memory care centers and assisted living centers. I think that the defining thing isn't so much where they lived. The defining thing is their ability to take care of their own oral health. Once that diminishes and ones

that ability to perform their own daily oral hygiene, once that task is given to someone else, that's when we have the troubles because with the someone else's, oral care and oral health is not at the top of their lists. They have other

things that they're trying to take care of that appear to be bigger fish than brushing someone's teeth.

Bonnie: Really, that is true of many people just in ordinary life. How many people don't

brush and floss every single day? Then you take that into the elder population where they're dependent on other people, and it just makes it that much worse. So that is really a great thing to share. Why do you feel these things happened to your loved ones?

Angie: There are a lot of reasons and as a newer dental hygienist with my first

experience with my mother-in-law, Gladys, I didn't understand what was really

happening. It took me a while to really get my head around all of this. We can point at several different things. A lot of people are looking at what is the education of the caregivers that are tasked with giving care to these folks and a lot of people are trying to address this issue by providing education to the care

teams. There's a research to show that while education is great, it really doesn't lead to

an improvement in the oral health of the people they're taking care of. I think there are two reasons that education doesn't work. While we're trying to remove the barrier of no education−and we can do that very well−we have not been successful in removing the barrier of lack of time. These people are

understaffed, they're overworked, and the last thing on their lists is oral care. We also haven't been able to remove the barrier of the care teams not really wanting to do oral care. They get bitten and spit at. They don't know what they're looking at in the mouth. So even if they're brushing and flossing

someone's teeth, they don't know what to look at in the mouth. They don't know how to get in to the mouth, and when you have people that are resisting that care, it's really easy to say, "Oh, I'm out of time. I can't do that."

Bonnie: I can see where that could be a real problem. Angie: It is definitely a problem, Bonnie. Then couple that with not having access to


dental care. So now, we have people that can't take care of themselves. We have people trying to take care of them who don't understand how to take care

of the mouth and how even to get into someone else's mouth, and then we have dentistry not even visible in these care communities on a large scale. There are some organizations who are doing in-home dental carebut again, this cohort of people isn't the best people to be doing dentistry on. They have serious

complications with their medical histories. They often times can't sit in a dental chair. They often times have behaviors that won't allow them to even have dental treatment. I think that's the reason that dentistry isn't visible in these places, because this is a hard population to work on. So in my mind, this all

have to go back to prevention, because we know that dentistry is necessary when prevention fails.

Bonnie: Right. Just from my personal experience, both my grandmother and my mother were in nursing homes. My grandmother, for almost three years because she was diabetic; and my mother ,just for a very short period of time because she'd been diagnosed with pancreatic cancer but just from that experience, I know

personally that dentistry is essentially invisible in most nursing homes. They do not have a dental office. The closest thing most can offer to a dental chair is the beauty salon. Think about when you go to have your hair done, leaning back in

that chair with the washbasin or something. That's how they're trying to do dentistry within nursing homes. Obviously, not the best way of handling it. I know from personal experience.

Angie, you're talking about a very personal story that you had with a loved one. Can you go into some more detail talking about what happened to your grandmother? I just mentioned my grandmother in a nursing home,and you had the same situation but you were a trained dental hygienist when it happened, so

that puts you in a little different category of realizing what was going on. So please share some of that story with us.

Angie: Absolutely. Yes. Probably being a dental hygienist and having this happened to my own grandmother is what haunts me. She went into the nursing home when she was 90 years old. Between the ages of 90 and 92, she lost 60 percent of her teeth while residing in the nursing home. I could not believe that this had

happened to her. She was really good at taking care of her own teeth−brushing her own teeth. What was happening is she was eating candy because she had dry mouth and everybody keep on bringing her candy. I wasn't on top of things.

I thought she's brushing her teeth well.There was a dentist on board who came in and did exams, and he had just been there to do an exam. Three months later, I get a call from my aunt saying that Gram has a toothache. I said, "Gram can't have a toothache. She just saw the dentist and everything was fine." We

don't know what's going on, so I went up there to the nursing home. I could visibly see with my own eyes that there was decay at almost every tooth.

Bonnie: Wow!

Angie: When I discussed this with the dental team that was on board, I was told that I

had to understand that dentistry in nursing homes is different than dentistry in

private offices. I said, "Well, what does that mean? I mean, I understand that it's different. You can't get them out, etc." They basically told me that if there's no pain, then they don't take care of anything. So what's happening is as she had pain, a tooth was being removed. She ended up with 60 percent of her teeth


lost that she had kept in her mouth for 90 years and going through all of this agony with these teeth. Why? Why, why, why don't we have a professional on

board at these care facilities, whether it's a nursing home, assisted living or memory care? Why don't we have a dental prevention specialist on board that we can prevent this stuff from happening?

Bonnie: Well, that’s just an amazing story and tragic. Absolutely tragic. I'm sure that is a commons story for many, many nursing home residents who don't even have family members advocating for them and checking on these things. I know in nursing homes, many people don't have people checking on them regularly. If

you go to visit Grandma, Aunt Sadie or whatever, you're not looking in their mouth. You're not looking to see if they're getting oral care, if they have decay or anything. By the time there is pain involved, it's too late and disease has

really, really progressed. So absolutely, I'm totally onboard with the whole prevention aspect. So your approach is just right on, and I know you have some great ideas to share with our listeners.

Angie, you had touched a little bit on Gladys and her health challenges at the end of her life and that this was what started you on your journey. Could you just talk a little bit more about that?

Angie: Well, Gladys is actually the start of this journey handsdown. She was the first

experience of a loved one as I was an adult with the care community. My grandparents had been in nursing homes, but I was young. When you're

younger, you don't have the same perspective and when you're younger, often times, you're not the main caregiver, right. So as Gladys's health declined-- She has COPD, a long-time smoker and had periodontal disease, which as a dental hygienist, I was able to manage when she lived in her own apartment, and I

could get her to the dental office, and I was managing her periodontal disease. Then lo and behold, she couldn't take care of herself anymore. She could barely

walk because she couldn't breathe. So here she is like suffocating. She's at the nursing home, and I have been a dental hygienist for about three years. I was new to the nursing home environment, and we hadn't really learned a whole lot about that in dental hygiene schools. So I knew that I wasn't able to get Gladys

over to my office for her periodontal therapy. I watched her have lung infection after lung infection. The medical community would give her antibiotics which would take careof her for a little while, and then lo and behold, it would be

back.We know that people with COPD have a 60 percent more chance of developing periodontal disease, and there is a vice versa relationship. So here is what I like to call baby hygienist, Angie, watching all of this stuff and then thinking,"This is her mouth. This is her mouth." In my brain, I'm like this is her

mouth that keeps getting her lung sick. I didn't know what to do and at that time, I couldn't do anything without a dentist. That had been drilled into our heads at dental hygiene school that the laws in the state was a hygienist can do nothing without a dentist, and there was no dentist there. There was no dentist

in the community that would come and see her. So I watched her die from lung infections, which I know some were from her

mouth. Could I have saved her life? No. I mean this disease was beyond cleaning her teeth and saving her life for that, right. What I know is that I could have reduced the infections, and I could have maybe extended her life and given her a better quality of life. But instead, I stood by and watched it happen. When


she died−and this was in 2003−I vowed to her that I was going to do something, and I had no idea what. So here we are in 2017 now, and I have a

system. The people we work with are absolutely not experiencing what Gladys or my grandmother did.

Bonnie: It's funny how people can start from the most unexpected places on a journey

and windup where you never would have dreamed you would wind up. Now, you teach and lecture all over the world, primarily to dental professionals though. Correct? So this is pretty much your first time talking to a consumer audience. That's one of the reasons that Scott and I really, really wanted to have you on

as an interview, because it is one thing educating dentist and hygienist who should already know a lot of this stuff. But the consumer doesn't hear this from anybody. They really, really don't. Unless they somehow trip across your book or

it's recommended to them, they don't know the challenges that they are going to be facing if they become a caregiver or if a love one winds up in a nursing home. By the time it happens, it can be too late.So I really, really appreciate all of this information that you have been sharing with us. I think it's fantastically

interesting and just so, so useful, hopefully, to thousands of people who are listening to this.

Angie: Bonnie, I want to add just a little bit to that. It is the family members that are coming to the HyLife Oral Health Alliance and hiring us to take care of their love ones. Right now, it's not the dental community, nursing home, assisted living or memory care facility. It's the loved ones of these people who are suffering. Just

like you said, once they know and they're in the situation, they absolutely want the best for their loved one that they can. Then there's also another outside person coming in once a week who is medically trained and where our eyes are on those peopleand we spend time with them. The relationships that are

developed between these oral care specialists and our clients and the families are so awesome. So that's another aspect of this I never saw it coming.

Bonnie: That can be so important for the patient because I know again, from my own experience with nursing homes and my mother and grandmother or particularly, my mother who is much more recent about 10 years ago, the staff are so overworked that they do not have a lot of time to really spend quality time with

the patients and really get to know them. It's get in and clean them up, change the sheets, "Can I help you to the bathroom?" and then they're on to the next patient.

So what you described is doubly important. It is not just the oral care and

another set of trained eyes; it's the emotional support too, which is so important in nursing home facilities where there's a lot of loneliness. If you don't have

family visiting on a regular basis, it really, really helps to have an emotional connection to other people. So that's terrific too. Angie, you turned up some interesting figures from the Surgeon General's Report. Could you share those please?

Angie: Absolutely. This was to me all telling about what is going on in our country.

Actually, if we look at other countries, it's happening in other countries as well

that nursing home residents have the worst oral health of any population. I don't understand why that statistic is okay. If we came out and made a statement that children have the worst oral health of any population, do you know what? People would be all over that, wouldn't they? I mean, it wouldn't be okay. But for some


reason, the Surgeon General just flips it out there. "Oh, this population has the worst oral health population." It's like, "Oh, well. That's okay." It's not okay.

These people have spent their lives working and contributing to society. Now, because they can't take care of themselves and they're in a care community that doesn't focus on oral health, which by the way we haven't even gotten to this point yet−we know that oral health is directly correlated to our overall

health−and that's just okay. To me, it's not okay. We need to be working to get that statistic gone.

Bonnie: Absolutely. You make a very good point again on what we're talking about here,

the whole oral systemic connection, that the health of the mouth is intimately tied to virtually every other system in the body. If we ignore the health of the mouth, we do it at our own peril because so many other things can very quickly

become involved. Would more education of nursing home assistants help with this issue?

Angie: Well, I touched on that just a little bit earlier and mentioned that there are many

groups that are trying to do just that. They're trying to make the certified nursing assistants into oral care providers. While education is always a good thing, it doesn't mean that what we know about, are we going to put into

practice? So let's back up to what the certified nursing assistants, if they go through a program say, at a technical college, in their education, they get 30 minutes of oral care instruction hands-on and 30 minutes of lecture. So in 120-hour program, they get one hour that's dedicated to oral care. They practice on

each other, and the students don't even have the same kind of oral situations that the residents do. So they don't teach them what to look for. They tell them, "If the gums are bleeding, contact the nurse. If there's a foul odor, contact the nurse."

The next thing is the nurses aren't even the experts in oral care. I like to tell my

dental people when I'm lecturing to them because we're like, "Well, those

nursing assistants should be better at oral care." I asked them, "How good are you at changing a catheter?" I mean, we all have our things. The oral care of this particular population-- While the aides can offer basic oral care: "Okay, here you go, Wilma. Brush your teeth," they can offer the support and could do a

basic brushing if there's no resistance. This population though needs a higher level of oral care than what a typical person would be. Just like the nursing assistants, they do a little bit of physical therapy. They'll get someone up and

walk them, but they still had a physical therapist coming in to do the actual real therapy that the person needs. Nursing assistants also wash hair, but they don't do the hair. They don't blow it dry, curl or perm it. They need a higher level of care than what the aide can provide, and it's the same thing with oral care.

Bonnie: I like that so people can understand the different levels of care that really are

needed. Besides writing your bestselling book, Dying from Dirty Teeth, Angie, you also started a company to really try and make this happen. All the things

that you were talking about improving oral health for this population, could you share just a little bit about what you are doing and your mission with this company?

Angie: Absolutely! So I've developed the HyLife Oral Health Alliance. What that

company does is it provides oral care into these facilities by dental hygienists. Dental hygienists are the best people on the face of the planet to be trying to


get into people's mouth and prevent disease, right. So this is a no-brainer for me. We're not doing dental hygiene procedures; we are doing oral care. So we

are visiting those residents on a routine basis, usually once a week, and we are brushing and cleaning between the teeth with over-the-counter items like floss, interdental brushes or things like that. So what we're doing is we are controlling the bacteria because we know that, "Oh, my goodness! That's what causes the

dental disease is the bacteria in the mouth is going uncontrolled. So there's research that shows that when a professional brushes people's teeth

on a weekly basis for 12 weeks and then continues that once a week care, we

can reduce the risk of aspiration pneumonia by having a professional brush teeth on a weekly basis. We also know that weekly brushing will turn around for oral health, because again we're getting in there to control those bacteria. Our

program also uses Xylitol to control those bacteria numbers in between our visits. So we're using gum, candies, mints or gel that are sweetened 100 percent with Xylitol and the care team gives the resident these products. How easy is that, rather than trying to get someone to get a toothbrush in someone's mouth

three times a day, which is virtually impossible? That's what they're taught they have to do and they're taught to floss everybody's teeth once a day. But then,when they get to the care facilities, they're taught never to put their fingers

in someone's mouth. So how can they floss, that's what they're taught in school, but then they get out in the real world and they're taught never to put their fingers in someone's mouth. So the oral care is not happening.

I want to just make sure that you understand is we are controlling the bacteria also on a daily basis with the utilization of the Xylitol. That's what the HyLife Oral Health Alliance does. I have my own published research in a peer-reviewed medical journal about using Xylitol with the elder community. I have another

research project, which remains unpublished at this point, where we ran this protocol with 45 residents. We saw great results, and that then was the beginning of the company.

Bonnie: Well, that's great. Is this something that is available nationwide or are there

places that people can call? Are you limited to a geographical region right now? What is the future plan?

Angie: Well, right now we have 18 oral care specialists and I believe it's the seventh

states. So we're a startup, and we are serving several clients. Obviously, we

want to serve more because there are so many people that need help in this arena. So the goal is to get as many hygienists on board being oral care specialists. They go through a program where they become certified caregivers. So when we go in, we are caregivers. We're not doing dental hygiene, although

we bring dental hygiene eyes. So if we see something, we can say something and get them an appropriate referral for help, if the family and the resident decide that's what they'd like to do. So we're hoping to grow this thing. The family members that are coming to us are super excited by the service that

we're able to offer. Bonnie: That sounds really terrific. I'm so glad that you are able to offer this. I'm sure

that there are probably thousands of people who would like to have something like this available to them that it may not be in their area. it may not be available.Although, I'm sure they can check around and perhaps ask around. Just briefly visiting Xylitol, I think it is worth mentioning that Xylitol products are


available over-the-counter. This is not something that is prescription. This is something where if you have someone-- I'm going to throw out here, even kids,

teenagers or anybody who has a sweet tooth like I personally, a sweet tooth, it is much, much healthier to suck on that hard candy with Xylitol than something with sugar, because the sugar is going to really destroy your teeth. I think most people realize that sugar is the culprit and Xylitol can be the answer. There's not

a whole lot of conversation about that, so we'll visit that just a little bit later here on our talk.

Angie, I'd like to read something− and this is right out of your book−and maybe

you can comment a little bit more on this because so far, we haven't talked about the cost for all of this. Nursing homes are expensive. This much, I know. You're looking at $3000 to $5,000 a month typically. A lot of insurance does not

cover it .Medicare covers some for a limited time. Medicaid, you get some coverage but it's really not good. So people are falling through the cracks from an insurance and a cost standpoint that the family could be faced with a choice between okay, paying extra to have something done or watching their love one

slowly die of dirty teeth, aspiration pneumonia, heart problems and all of these other issues.

So let me just read a study here talking about aspiration pneumonia and maybe, when you talk about this you can explain what aspiration pneumonia is for people who are not familiar. "A study that looked at 102,842 nursing home residents in New York, Mississippi and Maine--" Over 100,000 residents. This is a

big study. "--for a year, reported that three percent of those residents experienced the case of pneumonia during the year. Each case of aspiration pneumonia costs an average of $30,000 in care. While the cause of the pneumonia was not tracked, if one-third of those cases were caused by

oropharyngeal bacteria(that's bacteria from the mouth) the cost to care for these 1028 cases of pneumonia would be estimated at $30.84 million. If these numbers are extrapolated to reflect the nation's reported 1.5 million nursing

home residents, the cost of poor oral care related to just aspiration pneumonia would reach $450 million." That is a huge, huge number and here, you were just talking about once a week cleaning the teeth could improve oral health dramatically and drop these numbers.

"Diabetes is another medical condition that cost Medicaid an enormous amount

of money. Consider these facts. The number of residents with diabetes was

362,000 or 24 percent of nursing home residents, in a 2004 National Nursing Home survey, which is the most recent one available. People with diagnosed diabetes incur average medical expenses of almost $14,000 per year of which about 8,000 are attributed to diabetes. The total number of people with diabetes

is projected to rise for 171 million in 2000 to 366 million in 2030." We have a diabetes epidemic, and I think people are starting to wake up to that reality. "In 2013, Medicaid was the primary payer for over 63 percent of nursing facility residents.

An analysis of these numbers can conclude that Medicaid is spending approximately (I think I'm reading this right) $1801.674 (That's one million

with almost two billion, would it be?) in direct medical cost as a result of diabetes and another $1.3 billion in downline medical cost to care for residents with diabetes. This is a total of over $3 billion. If effective oral care procedures were put in place and reduced diabetes cause by a mere three percent, Medicaid


would save approximately $94 million. When the savings of pneumonia care and diabetes care alone are combined, Medicare could potentially saveapproximately

$544 million." Those numbers are absolutely astounding. We're all dealing with the problem of

healthcare costs rising every year and nursing homes are even worse because of

the Medicaid situation. What you're offering is an inexpensive solution that could save literally billions of dollars in healthcare so I think this is a really, really important message that you are sharing with people.

Angie: The numbers are staggering, Bonnie. If you take a look at it like you just read in my book, it just makes sense, doesn't it?

Bonnie: Yes. Angie: It makes sense to put people in these positions to prevent all of this disease. It's

not going to cost nearly the amount of money that it can save. For me, even

bigger than that, I know the bottom line is always money, I had a college professor that told me and he told every class, "The bottom line is always the dollar." While I understand that, how can we let these people suffer from these

things like diabetes and aspiration pneumonia simply because of the condition of their mouth? For me, it's a human thing. It isn't right that when someone can't take care of themselves, we don't help them. We help them in every other aspect of their life. There's no one there specifically to help them with their

dental needs on a routine basis. Bonnie: Hopefully, people listening to this will realize what kind of an issue this is

because I'd be willing to bet most people listening to this interview either have

someone in their immediate family or they know someone who is in a nursing home or at risk for going into a nursing home, and they may not be aware of any of this. So in your book, you talked about some proactive steps that people

can take to make sure that before they get to a potential nursing home stage-- I'm certainly not saying that everybody is going to wind up in a nursing home, because that's not true. But when you have older people who are more likely to be at risk, maybe they already have health issues and their family looks at them

and thinks, "Well, it's a matter of time, and Uncle Joe is probably going to wind up in a nursing home." What can family members do proactively before Uncle Joe is admitted and starts having problems? What can people do? Is there a

checklist or something that people can look at proactively to better prepare for a potential nursing home experience?

Angie: Well, I don't have a checklist per se; however, you can bet I'm going to. That's a

great idea. That's a great idea, Bonnie, to have that on our website. The basic thing is that we always want to go into a situation as healthy as possible. So as we start to decline after we retire, a lot of times we don't see a dental professional because we don't have our insurance or anything like that. So a lot

of times, people can enter these care communities already with dental disease. It becomes important to keep up that dental health and make sure you're the best you can be before that starts to decline.

So I think the best people that can help with that are the dental team. My goal is to educate the dental team about what can theydo to help these patients be prepared for the loss of these instrumental activities of daily living. We, as


dental professionals, can see that if we know what we're looking for. We can start to give them things like Xylitol so that we can get the bacteria in the mouth

good and not bacteria in the mouth that's causing decay and disease. So if we start them on the products like Xylitol, products that keep their mouth

moist so that they don't have the dry mouth and products that are not wearing

the gum tissues away by using hard bristled brushes.Those things should all start sooner. I think the consumer can gain a lot of information from the dental professionals as how to prepare for this next coming of transitioning out of adulthood and into elderhood. It's a definite shift between those two phrases.

We don't often times hear of elderhood. That can be another whole topic. We talk about childhood, adolescence and adulthood. Well, there is this next phase called "elderhood" that we need to be prepared for. That's what I would

recommend. Bonnie: Okay, great. Thank you. For people who do not have a medical or dental

background, can you please explain what aspiration pneumonia is?

Angie: Yes. Aspiration pneumonia is when something foreign gets into the lungs and

then we get an infection in the lungs. There are many people as they age who

start to have some swallowing difficulties. What happens is they can aspirate or swallow into the lungs right. We're not supposed to swallow into the lungs. It's supposed to go into our stomach and digestive system. What can happen is the bacteria that are growing in the mouth, if we allow it to overpopulate, we can

aspirate those bacteria into the lungs. We can also aspirate food that's been left in the mouth that's not starting to break down and it's laden with bacteria. We aspirate those things, and they get into the lungs. Almost all aspiration pneumonia comes from what is residing in our mouths.

Aspiration pneumonia is the leading cause of death in elders that are in care

communities. So this is a serious thing. How would you like your loved one to die

from the bacteria that was in their mouth that got into their lungs, and you can keep the bacteria out of their mouth. Everybody's like, "Well, Angie, you know they have to die of something." I'm like, "Okay, I get it but really, dirty teeth? That's what you want them dying from?" I don't think that that's very cool.

Bonnie: I'm sure our listeners would agree with you. I certainly do. I cannot think of a

more frustrating, useless way to go. If someone is seriously ill with a heart

disease or something like that, that's one thing. But something that is so easily treatable and preventable, there shouldn't be any excuse. As you said before, it shouldn't just be about the dollars. We shouldn't be trading human life and quality of life for dollars. That should not be the only determining factor. That's

something that's up to society and duh, maybe our interview here will change a few people's minds and get a few people motivated to talk about it and start conversations in their communities and with their families. Maybe, we can start changing that.

Angie, one of the things that you mentioned just in passing that I'd like to delve

into a little bit more because it's very common really, which unless you have it

you probably don't realize it, but dry mouth. So can you talk a little bit about that and the impact of that on oral health?

Angie: Well, Bonnie, saliva is nature's miracle. Saliva has got all of these things that it


does in the mouth that we never realize. Some hygienist like to say, "Spit is it" because it is so important. When we eat, the saliva levels increase and so we

have more saliva in our mouth. That's actually done on purpose by design because the saliva has enzymes in it that start to break down our food and help us to pack the food into a bolus of food so that when we start the swallowing process, that food is prepared to be further broken down. In the absence of

saliva, our digestion doesn't start properly. That's one thing that the saliva does.

Another thing that the saliva does is it actually flushes the teeth to keep the bacteria from sticking to the teeth. So now, if we have a reduced salivary flow,

we're not starting our digestive process very well and we're allowing the bacteria and the plaque to sit on the teeth. The other thing that the saliva does that's way cool is keeps the pH or the acid level in the mouth. They keep the mouth a

neutral environment. So what we know is that when we don't have enough saliva, our mouth is acidic too long and that is actually what causes the tooth decay− having the acidic mouth and having the bacteria not be exposed to the saliva.

Sodry mouth can lead to a whole bunch of dental issues, not to mention not

being able to talk. If you and I didn't have any saliva going on, Bonnie, we

wouldn't be able to talk together here today because our lips and our cheeks will be sticking to our teeth and our tongue doesn't slide well enough to be able to create our words. So that's another big issue. People with dry mouth don't sleep through the night. They have to wake up and take sips of water. That's usually

what they're doing. Water isn't the best agent used. You can't eat as well. Women's lipstick sticks to their teeth. That's a telltale sign that if you are having your lipstick stick to your teeth that you have a dry mouth.

Bonnie: Wow, interesting! I did not know that. Yes. Angie: Who would know? If you're sitting with someone whom you love that has like

two or three different things to drink every meal or if they're always asking for gravy or sauce, that is a telltale sign too that they're experiencing dry mouth. Now, the fascinating thing is that as humans, we will really adjust to things. So as we lose our saliva, we don't really recognize it until we've lost about 60

percent of our saliva flow. Again, that's when a dental professional can notice these things well before the

patient. So we're looking at people's mouths like oh, you have dry mouth, Mister? "Oh, no."But we know they do, and we can do some testing to help diagnose that for sure. So, dry mouth is huge. Particular people who have had cancer treatments, chemotherapy or radiation,especially head and neck

radiation, the salivary glands are not good anymore. Medications are probably the number one cause of dry mouth and our people over age 65 are typically taking three or more meds that have that side effect. It becomes the big problem. So keeping our mouth hydrated and keeping that pH up so that we're

not getting tooth decay and we can process our food properly is really, really helpful on a bunch of levels.

Bonnie: Well, that's great! I learned some things just listening to you talk. That's wonderful. Angie, we've been talking about nursing homes, assisted living facilities and that sort of thing, but there are a lot of people in this country who are caring for an elderly relative at home. This is something they need to be


aware of too because they may or may not be watching how well that relative is brushing their teeth, flossing or using an interdental brush.

By the way, I don't know if anybody knows what an interdental brush is. It's like a toothpick with little brush on the end that goes actually between your teeth and gums. I use that all the time. I actually use that instead of floss personally,

and it works great for me and has worked for years. Just a little personal side there. But when you have someone at home, an elderly relative or even someone who has physical problems (It doesn't even have to be elderly), someone who's maybe had a stroke or multiple sclerosis, some other physical

problem where they have trouble taking care of themselves, what would you say to these caregivers as helpful hints of what they need to watch for in the mouth and what they can do about it to help these people that they are caring for?

Angie: That's a great question. I like,Bonnie, that you made that connection

between.it's not only old people that have these issues. People come to us all the time like, "Oh, what about this person that had stroke? What about this

person that has Alzheimer's? What about this group that's maybe had head trauma?" I mean, there are all of these people. The basic connector here is people that can't take care of their own oral health. Because my experiences

were with my elder loved one, that's my passion and where this is all starting. But absolutely, this idea can absolutely span across all dependent people. So thank you for making that connection there, Bonnie.

As a person who is tasked with caring for someone else, the biggest thing I would say to pay attention to is a foul odor coming from the mouth. If you can't get close enough to that person to give them a kiss on the cheek or hug them because of the odor, something is not right. So that's going to be your telltale

sign. The other telltale sign is if you're able to get a toothbrush in their mouth and you are helping them to brush their teeth, if the gums are bleeding something is not right. As a dental hygienist and hygienist across the country,

we see people all day everyday that come in and "Oh, yeah. Well, our gums always bleed." Bleeding gums are not okay. What I like to tell my patients is okay,well if you came in to me, I just bumped your arm and your arm was bleeding, would you tell me, "Oh, my arms just always bleeds." You would know

that something is not right. Blood is the literal red flag. It should not be coming out of your mouth, unless you've just had some surgery or something.

That is telling us that there's some infection in the gum tissues, and so you're going to want to do what you can to get that under control. Again, by controlling the bacteria by more brushing and more interdental cleaning-- it's really hard to floss someone else's teeth unless you're a dental hygienist. The interdental

brushes, Bonnie, that you're talking about that have a longer handle really are easier for people to get between someone else's teeth. So I would absolutely recommend that. If you can't get a toothbrush in there, if they don't try to bite you and like cooperative, you can always put a washcloth. You can buy really

thin washcloths and get some warm water on the washcloth, put the washcloth on your finger. Go in with a washcloth, and use the washcloth as a toothbrush. That feels good with the gum tissues as well.

Also if you're having troubles, I would recommend you reach out to your dental

professional, to the HyLife Oral Health Alliance for some tips on how to provide care at home for those folks, because we don't want them dying from dirty


teeth.

Bonnie: Those are all great tips. I have been doing research and working on the importance of oral health with pregnancy, newborns and that sort of thing. One of the things that people are not aware of is that you should start really cleaning your baby's teeth as soon as the first tooth comes in and you can massage their

gums. There are a number of products out there that fit over your fingertip, very much like you described the washcloth. But for babies, and I'm thinking those could be just as well used for an adult, teenager or whoever where the caregiver has to get into the mouth and for whatever reason, "Can I get a brush in there?"

Would you comment on that? Angie: Absolutely again, Bonnie, you are right on with that. Right on.There are these

things and you can go to your local store and go to the dental aisle. They'll have all of these apparatuses and you can take look at them. But yes, it's just kind of like a finger cot but it's thicker.and it just goes on your finger and then you use your finger as a toothbrush with a brush on it. They are popular for babies, but

you could absolutely use them with whatever population can benefit by them when they can't use a toothbrush.

Bonnie: Okay, great. We were just talking about an interdental brush, and I have one here. I'm going to put it against my shirt here so maybe, you can see it a little bit better rather than against the white background. This is a little tiny, tiny brush on the end that fits between your teeth up with the gum line, and as Angie

said, this is a fairly long handle. So if you're working on someone else's mouth, it's pretty easy to get in there and clean between the teeth, assuming that they're not fighting you on it. I just wanted people to be able to see what this actually looks like. So that is an interdental brush. There are a number of

brands, and you could find them in any drugstore in the dental aisle, and they're quite inexpensive and very easy to use.

The services that you offer or that might be available on other parts of the country for outside dental care, whether it's a dentally trained caregiver coming into a nursing home or some of the facility or actual dental care getting to a dentist, how does this tie into insurance, Medicare or Medicaid? Is this

something that is an out-of-pocket expense? Because I know people are going to be concerned about costs.

Angie: Of course, they are and they should be because things are very expensive. So let's visit the Medicare. So Medicare is the national funding source, so to speak and they don't have any provisions for dental care, whatsoever. So then it comes down to each state's Medicaid system. Most state's Medicaid systems do

not have much of a dental benefit. I think they're starting to get a little bit better. It's not great. It's not high on a totem pole, if you will. The other thing that we run into with Medicare or Medicaid is that when a dentist sees a patient that has Medicaid for the pay source, they are paid, I think literally pennies on

the dollar. So what happens then is the dentist isn't really able to see a lot of those patients because they can't cover their costs with the reimbursement rates of the Medicaid. So traditionally, what happens is because they can't find a

dentist that's going to take care of their troubles, they go without. That's another piece of this whole puzzle that we didn't even talk about−why

does this happen? Likewise, Medicaid and Medicare are not onboard yet with a


prevention program, which really isn't surprising to many of us. I don't think that they're interested in preventing much of anything. So our oral care services,

which are provided by the HyLife Oral Health Alliance are private pay. So what we try to do is we try to keep those costs as low as what we can so that the families or the individual can afford the prevention which will end up costing them much less than losing 60 percent of their teeth in the last two years of

their life that they have to figure out how to pay for when they don't have any money.

Bonnie: Yes. I know our whole healthcare system really revolves around sickness and

disease. It does not revolve around prevention, which would save us all so much money if we looked at prevention, rather than just treatment of when things go bad at the end and are so much more expensive. Angie, I know you touched on

a lot of nursing homes do not have certainly a dentist on staff, that I'm not sure any do, or even on call, but how many nursing homes even have some kind of facility where a dentist comes in once a week, once a month, or on a regular basis that even if it's a self-pay, the patients can make appointments to see a

dentist? How big a percentage of nursing homes even offer this? Angie: That's a great question. I don't have a percentage in my brain. What I do know

is there are companies who are attempting to do this. It's very expensive. I mean, just think of the equipment that they have to haul around. You mentioned that typically, they're setup in the beauty parlor. That is absolutely the truth. They don't have a dental office really that's permanently there. I mean, if we're

talking about nursing homes and other care communities that actually have a dental office within the structure that isn't like mobile, that is slim to none. So you either have to get that person out to go to the dentist or we have to rely on a company that comes in to provide the dental care.

Again, sometimes, if a person is Medicaid, they will bill the Medicaid for what

they do. I don't know that the care that they're able to provide is the same type

of a very routine basis, like you get your cleanings every six months orget your exams every six months. If you have something to do, you get it done. I don't think that the biggest share of these companies that that's the way they're able to operate. There are so many people to take care of. There are not enough

people that travel around to do this. This work is hard work. God bless the people that are attempting to make this happen.

Bonnie: If an older patient has significant health issues that might put them at risk for eventually being in a nursing home, how likely is it that when they visit their physician, the physician is going to recommend that they see a dentist and get their dental work optimized?

Angie: I'd like to really be optimistic and say that that's happening. My knee jerk

reaction to that is that it's not really happening. In fact, this is crazy that you asked this. I just had a conversation with a colleague who had her mom at her

medical appointment−older mother. The doctor looks at her eyes and says, "Hey, when has she been to the eye doctor last?" My friend has it all written down because that's how she rolls. She's like, "Oh, her eye exam this date." He

looks in her ears and says, "Okay, so when's the last time that she saw the audiologist?" The woman knew when her mom had been there. He looked at her toes, and "When has she seen the podiatrist last?" She had that information. He told her to open her mouth, stick out her tongue and say "Ah" which she did and


he moved on.

Bonnie: End of discussion. Angie: She called him out. She said, "So hmm, aren't you going to ask me when she

went to the dentist last?" He's like, "Oh! Oh, I guess that--" Yes, that would be a

good question, wouldn't it?" But it's like, so they're looking at the throat. I don't even know what they're trying to look for, actually. But it's an afterthought. So really being your own advocate or an advocate for your loved one, which goodness knows I'm getting more experienced than I ever thought that I would

in advocating for people's health. You have to be an advocate for all parts of the body, including the mouth which actually is I think systemically, it's more important to have our mouths checked and cleaned then it is to have our eyes

and our ears. Okay, so I know we want to see, I know we want to hear. I get that. Our eyes and our ears aren't typically going to cost a stomach infection and give us a heart attack or a stroke, right. So the mouth is vitally important and so overlooked because no one really sees in it.

Bonnie: For a couple of centuries, dentistry has been separated from medical health

care. Dentists have always been kind of the poor stepchildren in healthcare,

which is crazy, because if you go back far enough in history, dentistry and people looking in the mouth, that was part of what a physician would do. Now, I'm not talking when dentists were also barbers and pull teeth. That was much later, but if you go back before that, a few hundred years and people realize that

dental care, just looking at the mouth and what kind of condition are the teeth in, that told you about the health of the whole person. I know when I talk to people, one of the first things I will say is, "Okay now, think back to the last time you went to the doctor for general check-up or for women, your Ob-Gyn. Did

they ask you about your oral health care, the last time you went to the dentist, or do you have any problems in your mouth? Do your gums bleed?" They look at you like, "No. Nobody ever asked me that." Well, we have a lot to talk about,

and this is part of the education on the whole oral systemic connections. So yeah, we're both out there advocating for the same thing.

Angie: I think Bonnie, in the big picture, it's a dentist's responsibility as well to ask

when they had their last physical. We update med histories. We've looked at the medications that people are taking so that we kind of know maybe what things we'll see going on in the mouth, because of the medications like maybe dry

mouth and things like that. In Angie's mind, which can be a scary place, my husband tells me, not enough people are taking blood pressures in the dental office. I have referred to date, 10 people that had high blood pressure, two of which were admitted to the hospital and they didn't even know they have had

high blood pressure. So we can't expect medicine to be telling people to come to us and then we're not telling people to go to the medical, because we know this is an oral systemic link. So we need to work together and not be in our own little silos which we all liked to be.

Bonnie: Yes, very true. Healthcare certainly is siloed. That's a research insider term, but

for the people listening, that just means if you think about silos on a farm, these

big tall individual structures housing usually grain, each one is completely separate from the other. They don't communicate. They're not interconnected and that's what's happening with health care now that you have these silos of here's your primary care, your cardiologist, your dentist, your audiologist and


people are just barely starting to realize we can't chop people into little pieces, and say, "Okay. Well, you know there's something wrong with your toe. Go over

here." Well, what's causing the problem with the toe? We're one whole body, and we need to get back to that realization. The mouth is a huge integral part of that whole body.

Okay, Angie. You talked a little bit earlier about Xylitol. First of all, what is Xylitol? Is it a chemical? Is it a natural substance? What is it, and the history of it maybe? Where did it come from? When did we first know about it and started using it? How is it available today and how does it really help, other than

substituting for sugar which of course is great, but how else does it really help in terms of oral health and oral treatment?

Angie: Oh, my gosh. Xylitol is like the most fascinating thing that I think I've learned about in the last 10 years. So Xylitol is a natural occurring. I said,"natural occurring." It's not a chemical. The word Xylitol sounds like a chemical.

Bonnie: It does. Angie: It's a natural occurring sugar substitute. It's found in our plants, fruits and

vegetables. So if you're eating those things, you're eating Xylitol every day. As it turns out, the Xylitol is also created in our liver every day. Who knew? It turns out we need it for metabolization. Xylitol was discovered in the late 1800s. Yes, it's only a couple days old.

Bonnie: Well, I had no idea. Angie: Yes. It was discovered by Mr. Emil Fischer. He has discovered it in the plants in

his lab. So it's been around for a really long time. Many, many countries have been utilizing Xylitol for dental health for decades. The United States, we always think that we're all that and a bag of chips when it comes to medicine and

dentistry. In the Xylitol realm, we're really bringing up the rear. So the way that the Xylitol works is fascinating. First of all, I'm just going to give you a little tidbit of what typically happens in the mouth when we eat. As humans, and as things that are alive, we have bacteria in our mouth. That's just the way it is−

bacteria in the mouth. When we eat, the bacteria in our mouthseat because they're alive and need food

to live. So they gobble up the stuff that we're eating and because they're alive, they have to metabolize or digest what they eat. We know that after what…, follow this train a minute. We're going to get there.After we digest stuff, everything living has to have secretions. The bacteria in the mouth eat the food

we eat, they digest it and they secrete it. So literally, they go to the bathroom. That's the acid in the mouth is from−for lack of a better term−and this is for our consumers, that's the poop of the bacteria. So that acid and the stickiness, that's the building blocks for the plaque. The plaque is what causes the trouble.

So when I'm seeing a patient as a dental hygienist, that's what I tell my

patients. Anybody that's listening or watching, take your tongue and rub it on

the outside of your upper teeth or your front teeth, you might feel it feels kind of fuzzy. That's plaque. That's the poop of the bacteria. That's why you want to get it off your teeth with your toothbrush. You don't want that stuff in there. So Xylitol changes up that system, that series of events. We eat the Xylitol, the


bacteria now eats the Xylitol; they cannot digest the Xylitol. So without digestion, there are no secretions. So there's no poop. It kind of constipates the

bacteria, and then they can't live either. Think about if we always were eating but we could never get rid of anything. We would die. That's what happens to those bad bacteria. The Xylitol supports the good bacteria. So now we're making the environment of the mouth healthier with less acid and less bacteria that

cause decay and gingivitis. Does that make sense? Bonnie: Absolutely. That is terrific information. Again, I have learned something from

you. Thank you. I never really knew the full history of Xylitol. I know it's

certainly a good thing to use, and I know the chemical reactions but-- I think it's very important to again emphasize to people who are listening to this Xylitol is a natural product. It is not a chemical. So it is plant derived, because I know that's

important to a lot of people. It certainly would be to me. Well, thank you for sharing that. That's fascinating. Xylitol is available in drugstores and supermarkets in a lot of different forms. You have mentioned gums and hard candies. What other kinds of things can we find Xylitol in?

Angie: So we have companies that are putting Xylitol in toothpaste, mouthwash, gum,

candies, mints and tooth gel. You can also get it in sprinkle form. Another

interesting thing about Xylitol is that the glycemic index of sugar is 83; the glycemic index of Xylitol is just 7.

Bonnie: Wow.

Angie: I know, right. Xylitol is amazing for our diabetic population because it won't do

anything to the blood glucose levels. You can cook with it just like you do sugar. So if you're making a recipe that calls for a cup of sugar, you can simply use a

cup of Xylitol instead. So there's no fancy measuring that needs to be done either. The only thing that you need to be cautious of is if you're baking with it. Our cakes and things rise because the yeast in the recipe eats the sugar and

gives off a gas. That's what gives our things to rise; however, the yeast cannot metabolize the Xylitol. So it's good for yeast infections also.

Bonnie: Okay. An extra little tidbit there.Now, how does Xylitol compare to other natural

sweeteners like say, a Stevia? Angie: Well, I'm not a Stevia expert. I want to just give a little bit of a disclaimer here.

I was the lead Xylitol educator in the country for five years for the leading manufacturer of Xylitol products in the country. So that's how I know a lot about Xylitol. I spent a lot of time researching Xylitol with the elders and using with elders, but I'm not a Stevia expert. What I know though is that there's one other

sugar that's up and coming in the dental world and that's called Erythritol which is showing some promise for dental health. So the other sweeteners, they don't really have that whole dental health aspect where it works on the bacteria so they don't cause the troubles.

Bonnie: Okay. So what really separates Xylitol out and perhaps, this new Erythritol that

you mentioned is that it has a very beneficial effect in the mouth that even

natural sweeteners do not have. Angie: Correct.


Bonnie: It's more than just a sweetener. It actually has a therapeutic value to it as well which makes it, in my opinion anyway, that much more valuable as a product

that you want to seek out and probably start using. So that's great. Okay, just to wrap up here, Angie. One more time, I'm going to show your book

here, Dying From Dirty Teeth. Why don't you give our listeners your contact

information, maybe a website where they can reach you, and if they have more questions, how they can contact you?

Angie: Absolutely. So our website is www.hylifeoha.com. I can be reached at

[email protected]. Our office phone number and stuff are listed on the website as well. You can see our providers in the areas that we're providing care on our website. You can get some more information from there about the topics

that we spent the last little bit here talking about. If there isn't an oral care specialist in your area and you want services, we're definitely open to finding a dental hygienist that would love to become an oral care specialist and help you out.

Bonnie: Thank you, Angie. I appreciate you taking all this time to spend with us and to

educate our listeners. I think I can safely say that they have learned a lot. I

know I certainly have. You have had some wonderful information to share that I think is going to be very, very valuable for anawful lot of people out there who are facing different challenges as caregivers and thinking about their own oral health and the health of others. So thank you very, very much. I appreciate you

taking the time, and it was wonderful talking to you. Angie: Bonnie, thank you so much for having me. This hasbeen a treat for me to be

able to spend this time with you and to hopefully help our consumers and other

peopleever to get the message of dental health and how vitally important to this. So thank you very much.

Bonnie: Okay. Thank you.

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Dying from Dirty Teeth - functionaloralhealth.com · qualified health care professional for any questions you may have regarding a medical or dental condition. Bonnie: ˘ ˇ ˘ ˆ