Oral Systemic Connection: An Interview with Tosha Kozloski
Today, I went all the way to Tennessee to pull someone who is just going to bowl you over, Tosh, how are you today?
Tosh
I am so good and I'm thrilled to be with you.
Heather Dawn
I know a little bit about you. But tell us who you are and what you bring to the world.
Tosh
I am a dental hygienist and a full time consultant. I was born and raised in rural North Dakota and a town of 1500 people.
There is only one grocery store and one pharmacy. We were lucky enough to have the local dentist, so people came from miles around.
When I was about 10 years old, my mom was asked to be a dental assistant and she was trained on the job.
The local dentist does everything from extractions to orthodontics to all the things.
I was more fun to go to the dentist when my mother became a dental assistant. I was no stranger to the dental chair.
I grew up in a town 20 miles out of town to two parents that had unfortunately terrible teeth.
I didn't realize the hereditary component but also the contagious component of it.
I was no stranger to that dental chair. But once my mom was a dental assistant, she had such a delicate hand and her bedside manner was so good.
I'm sure I was biased because she was my mom, but she was wonderful. I think that ingrained my love for dentistry. I always loved my dental hygienist as well.
From a very young age, I remember always thinking that dentistry was always pulling towards me, and my mom is still a dental assistant to this day.
Heather Dawn
I know that you're a trained dental hygienist. But now you are a hygiene coach focusing on systemic health. How did you make that transition?
Tosh
It wasn't necessarily planned at all. In college, I was just so fascinated by periodontal health and disease and the infection process.
When I graduated, I wanted to work for a periodontist. I wanted to specialize in healing people's gums.
I was lucky enough to find a periodontist that was hiring because I didn't realize how few of them there are when I was in college.
I also worked for a GP practice that had three doctors and 10 hygienists.
I didn't realize how many people had infection and that treating periodontal disease was a hard job.
It felt like I wasn't healing anybody. They were too far gone.
Then at the GP practice, I was just doing bloodied proviz all day long. I’m thinking there's got to be a better way, so I relocated to Tennessee and found a dentist that was as passionate as I was about oral systemic and about doing it differently.
And coincidentally, his father had introduced oral pathogen testing to the bacteria that causes gum infection. He brought that testing to the United States from Germany. So I had the opportunity to work for both father and son.
One is more of a lab setting where I got to look at these pathogen tests to understand what was going on the patients’ mouths and what was causing the bleeding that I had been seeing for years.
But then also clinically, I worked full time for the son being able to treat these patients, and look at infection and see completely different outcomes.
Fast forward, I had the opportunity to co teach alongside of him for about a decade.
We taught hundreds of practices across the United States to look and treat infection.
And then after about a decade, I feel like I'm more evolved past what I was able to do there.
I had a calling and wanted to take this full time and be able to inspire and light up clinicians.
I mean from taking a plaque sample, putting it in under a microscope, and seeing what was in these patients’ mouths and what was causing the infection.
It changed the career from this treadmill hygiene that so many people are experiencing.
Even the assistants as well, they were doing the same thing as the hygienist was doing.
Everyone was an integral part of that entire process. And so, it is one thing led to the next thing lead to the next thing. I kept following my bliss, so to speak, and it kept getting better and better.
Heather Dawn
That is awesome. We never know where we're going to end up. But if we are open to explore, it's amazing what can happen. So, what is the oral systemic health connection and why is it important?
Tosh
It is the connection between our mouth and our body.
The level of health of our mouth directly affects the level of health of our body and vice versa.
We used to look at infection, gum infection, Gingivitis, or periodontal disease, it really doesn't matter.
Periodontal Disease is just gingivitis.
It's been there longer, but we used to look at it as a debris problem. But now, we understand it's more of a host immune response, biofilm and bacteria problem.
So it's the three things put together, which is also why we can have patients that have immaculate homecare, but they bleed all over the place.
Doctor goes to do a crown class to composite, but where's all this blood coming from when his patient does a good job?
So we now understand that there are bacteria causing that and that bacteria making the gum tissue leaky and permeable. The swelling does.
So when we have bacteria sitting there, the biofilm sitting there, it is because the patient maybe is or isn't doing a good enough job of removing it.
But what ends up happening is gum tissue getting swollen, and it becomes leaky and permeable.
It means that the bacteria in the mouth travel to the brain, heart, lungs, gut, and to everything in our body. And that's how it can make the rest of your body sick.
So the mouth is critical in overall body health. A gum infection can trigger a heart attack or a stroke, but most of us don't understand that critical connection.
Heather Dawn
Yes, that is so true. I feel that if we could get the word out, it would make such a difference for so many people because it's doesn't take heart surgery to correct it. It's not that involved, and there are some basic things that can make a significant difference.
So why is it important for a dental assistant to understand the oral systemic health connection?
You're speaking from the experience of a dental hygienist, but dental assistants have helped us put that puzzle together.
My listeners who are primarily dental assistants can understand their role and what they bring to the table.
Tosh
I love this question.
Our dental assistants are an integral part of each patient's oral wellness team. They are spending a lot more time with that patient than the doctor is.
They have a huge opportunity to educate the patient, because they're seeing the same thing that the doctor has seen.
But the doctor often doesn't have enough time to sit and spend with that patient about what they saw.
They have to go do hygiene checks. They have another patient or two waiting in the next room. They have all the other parts of running a practice.
Dental assistants also get a lot more questions than the dentist does.
I found that patients will ask the assistant way more than they'll ask the dentist.
So when the dental assistant has that elevated level of understanding they can provide, they can provide such amazing information for that patient.
So if they don't understand these integral pieces of the puzzle, the whole practice loses those important pieces.
Those assistants work their booties off and they are truly the connectors.
Heather-Dawn
I like to refer to them as the glue. They form the relationships that will allow people to have confidence in the office.
Lisa has all the answers. Lisa is so good at explaining. She's interested in my grandson and his basketball game from last week and the fact that I'm going on a girl’s trip.
They build relationships. They build trust.
We can underscore that our dental assistants play a critical role in making our patients feel at home enough to listen and to hear and to convince them that what we're saying is well worth doing.
So what are some ways that they can stress the importance of a healthy foundation to our patients? Most people are not alarmed when they see a little bleeding because it doesn’t come with pain?
Tosh
Keep the conversation simple, using language that the patient already understands, not necessarily dental terminology.
So I am really against dental terminology personally.
For example, a lot of patients think like, once they get a crown, it's indestructible, and they'll have it forever.
Whereas if that patient has gingivitis or any type of inflammation, they're actually decreasing the life of that crown because the margins are bathing in bacteria and inflammation.
I would suggest to a dental assistant to educate the patient by saying something simple like Mr. Smith, the best way to get the most mileage out of that new crown of yours is to just ensure that your mouth is clean.
We understand now that if plaque lingers around the gums, it means that bacteria also linger, and it causes swelling.
Bacteria love swollen gums, and that swelling is going to decrease the miles out of that crown.
Brush your teeth and gums twice a day. Use a Waterpik to bring it up another notch. And I'm going to go ahead and show you what that great technique is.
So just keeping it simple and helping the patient understand that the investment made isn’t going to last forever if they don’t put in the work.
Because seeing your hygienist again twice a year to get your teeth cleaned, it’s like working out twice a year, but it’s not going to do that much good even if I’m the best clinician there ever was.
The same is true for all restorative patients, who spend their hard money on that restorative.
If the foundation is full of termites, it's not going to last as long. So keeping it simple and helping the patient understand how they can invest further by their home care.
Heather-Dawn
You made so many good points! I'm going to take them one by one.
- Use dental terminology among yourselves. Use basic language to speak to the patient because you’re not going to be effective if you’re speaking above them. Although using those terms may sound intelligent, they are not helpful at all if the patients don’t understand them.
- Make the patient understand how they invested a significant amount of money in a crown and how it will last long if they put in the work and keep the foundation healthy.
- Give them tips on how to use the proper technique in brushing, using a soft bristle brush, and angling it. So the bristles get below the gum line and getting that floss in between, or using the floss plus threader to get under the bridge. They can also use a mirror and feel comfortable cleaning their teeth.
Tosh
As dental professionals, we take for granted how good our dexterity is, we are working in it in little miles all day long, but even if it's a big mouth, it's still a small space.
We get so overconfident in what we do because we've been doing it for so long, and it’s much easier. It’s not the same for patients, so we show them how to do it. It's like going back to basics really?
Heather Dawn
The kiss rule - Keep it simple, stupid. What is one thing that you wish that all dental offices would do as it relates to the oral systemic health of a patient?
Tosh
So I think a large problem in dentistry is that we've normalized bleeding. And for the most part, we've been taught that gingivitis, periodontal disease, or another is a debris problem.
I wish every practice would incorporate using a microscope chairside. A hygienist can do it, and assistant can do it.
It will allow patients to see what was swimming in their plaque, the pathogenic bacteria that don’t belong in our mouth and should never be there.
I don't think we would just say, go home and floss more Mr. And Mrs. Patient. I think we would have a much better understanding of it.
“Seeing is believing” in so many ways.
How many of us would like to explain what a failing amalgam looks like versus showing them a photo of that failing amalgam?
And so any, any area that we can show a patient versus tell them is going to be of huge benefit because dentistry isn't just tooth care, but also health care.
Every day, all of us have the opportunity to save lives because we understand that gum infections can trigger a heart attack or a stroke.
Simply by teaching a patient how to do better with brushing, flossing, or using a Waterpik is critical.
We have to almost slow down and go back to what feels old fashioned and simple to a lot of us because people understand that there's some kind of connection there.
But that connection is difficult to understand.
And I've found that because of seeing is believing, I've really gotten behind, like using microscope chairside. We had those abilities in the 80s to use a face dress microscope.
When I can show a patient, bacteria keep swimming around in their mouth
This explains the changes I was seeing in your gums today.
They're asking, what are you going to do about it?
Let's work on this together versus one to three millimeter pockets is normal.
Heather Dawn
Making it real is the key. They can see it because let's face it, Tosha.
If I do not feel pain, no matter what I'm seeing, I naturally minimize what it could be because if it was bad, it would hurt. And since it doesn't hurt, it can't be that bad. And we know that a lot of damage can occur before a patient even has a clue that something is going wrong.
Tosh
Absolutely! So much of the mouth is silent until it's almost too far gone. In some cases, it's completely silent. And it makes sense because we have to eat to stay alive. And you know, high blood pressure doesn't hurt either, but it would be far gone before someone knows it.
Heather Dawn
I always say to my patients something that can really be serious can be silent for a long time. And that thing is high blood pressure.
And most people know if somebody dies of a heart attack or stroke, it may have something to do with the blood pressure being high.
So then I say, something similar can happen in your mouth, and it can make your teeth loose and you can lose your teeth prematurely, without even recognizing that something was going south because you don't necessarily feel any pain.
So we're on the same page, we try to make connections that people can relate to, and understand.
Tosh
It's so important. I know, I always tell my patients with high blood pressure, and they’d be “it’s only high when I’m here.”
I'd say no and that actually over 65% of the time white coat syndrome turns into hypertension.
And it's like driving down the road 70 miles an hour in third gear, how long is that clutch going to last? Not very long.
Heather Dawn
The truth is that there are some people who will hear what you have to say the first time, and they'll adjust.
Then, there are people who we have to be prepared to mention it every time because what I find is that human nature is I've told her about it five times, and she hasn't done anything about it. So I'm just not going to bother to mention it. And that is the opposite of what we should do doing.
This has been such a fruitful conversation. I feel like we could stay and chat for a long time. But we have limitations.
However, I always ask my guests if there is a quote that they'd like to share because it's just such a wonderful way to end the conversation. Do you have a quote that you'd like to share with us today?
Tosh
I do, and it's from Maya Angelou.
"Do the best you can until you know better. Then when you know better, do better."
Heather Dawn
Everybody can relate to that. Do the best you can until you can do better.
One more thing if my listeners would like to connect with you. What are the best ways to find you?
Tosh
Yes, they can find me on Instagram, which is at Tosh.care (https://www.instagram.com/tosh.care/) or on Facebook at Tosha Kozloski, RDH. and my website is www dot Tosh dot care (https://www.tosh.care/)
Heather Dawn
All right, Miss Tosh. This was a pleasure. You had to promise me one thing. That you'll come back another time and share with us.
Tosh
Oh, I would love to this. It has been so much fun.
Heather Dawn
Thank you!
This connection between our mouth and our body, otherwise known as the oral systemic connection is important for our patients to understand.
They need to understand that bacteria in our mouth can travel to other parts of the body and cause harm like heart attacks and strokes.
Why do dental assistants need to know these things? Because they often have the opportunity to sit with the patients and chat more with them than the dentist and other health care providers would have.
The more the dental assistant can share, the better for each one of our patients.
Remember to keep the conversation simple and use simple terms so that everybody understand, and nobody feels as if you're speaking over their head.
Finally, remind our patients that the investment that they make in our crowns and implants can only last with a healthy foundation. Bleeding is never normal.
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This is Episode 22 of my Irreplaceable Dental Assistant podcast.
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