S4 E04: Sticky Situations: A Little Respect

Strategies for cultivating respectful environments, and handling sticky situations.

Dental Sound Bites Season 4 Episode 4 with Dr. Zerita C. Buchanan

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Episode notes

Sticky Situations: A Little Respect

We’re talking about R-E-S-P-E-C-T: strategies for cultivating respect in work relationships, and handling disrespect professionally

Special Guests: Dr. Zerita Buchanan

“Our goal is to provide care in a quick and easy fashion while it's also the best result for the patient, the best outcome. So that was my sticky situation. I learned a quick little response to kind of stay in my ground and get compensated properly and also explain to the patient, this is something I take very seriously. So I took a lot of time to be trained to do it for you.”

Dental Sound Bites Season 4 Episode 4 with Dr. Zerita C. Buchanan

Dr. Zerita Buchanan

Show Notes

  • In this episode we discuss sticky situations dealing with respect, how to create a positive work atmosphere and confidently cultivate the respect we deserve in interactions with our peers and patients.
  • Our guest for this episode is Dr. Zerita Buchanan, a general dentist practicing in Lithonia, GA. She is a fourth-generation dentist and graduate of UNC Chapel Hill School of Dentistry. And also a nationally recognized healthcare executive, who has established herself as an accomplished cosmetic dentist, public health expert, and top oral health thought leader.
  • A recent ADA Well-Being Survey found that younger dentists reported feeling respected less often than older dentists.
  • Dr. Buchanan shares a couple of sticky situations she has experienced at work- involving having procedure fee conversations with patients, and working with her father. She shares specific anecdotes, and how she was able to navigate the conversations, and manage the situations.
  • Dr. Rachel Jahraus, a dentist practicing in Hilo, HI, shares her sticky situation about working to be perceived as a leader and gain the respect of patients and staff, and the solutions that have worked for her.
  • Dr. Buchanan discusses how showing up authentically at work is a smart strategy for sticky situations, because when you are in the best headspace mentally, you're going to do your best work in the office.
  • Dr. Effie shares sticky situations from her background in academia, and how she managed the situations.
  • Dr. Wright shares a sticky situation from a leadership perspective, and how to navigate difficult conversations.
  • Dr. Sapna Lohiya, an oral-maxillofacial surgeon practicing in West Los Angeles, CA, and 2023 ADA 10 under 10 winner, shares instances when her credentials or abilities were called into question because of appearances, and how her response in those situations helped to change the narrative.
  • In closing, Dr. Buchanan shares three takeaways for what dentists can do to foster a more respectful workplace.


View episode transcript

Wright: [00:00:00] Today we're talking about R E S P E C T, or maybe I should say (sings) R E S P E C T.

Ioannidou: [00:00:07] Oh my I love it!.

Wright: [00:00:08] I'm Dr. ArNelle Wright.

Ioannidou: [00:00:10] You are the star, ArNelle Wright. No, no, no. And I'm the humble Dr. Effie Ioannidou. We are talking about how to create a positive work atmosphere and confidently cultivate the respect we deserve in interactions with our peers and patients. And I think this is so useful in every work environment. Especially in academics

Announcer: [00:00:34] From the American Dental Association, this is Dental Sound Bites. Created for dentists by dentists. Ready? Let's dive right into real talk on dentistry's daily wins and sticky situations.

Wright: [00:00:50] Hi friends. Welcome back to another episode of Dental Sound Bites. Please help us by rating the podcast on Apple podcasts, Spotify, or wherever you are listening.

Ioannidou: [00:01:00] And don't forget to write a review. That will help us continue to support other dentists and our great profession.

Wright: [00:01:07] This episode is always one of our listeners’ favorites. Today, we're going to hear from real dentists in real sticky situations. And this time we're dealing with disrespect in the dental office.

Ioannidou: [00:01:19] You know, I am not surprised at all. It seems like the ADA Well-Being survey found that younger dentists feel less respected by their patients than older dentists. So we wanted to hear your stories and offer ways to maintain professionalism as well as to ensure a very respectful work environment.

Wright: [00:01:40] The real star today is our guest and, as you guys can tell, I'm very excited. I'm geeked. I've been waiting for this episode and for this guest to come on our show. So we have Dr. Zerita Buchanan. Hi, Dr. Buchanan. Can you tell everybody about yourself? And a little bit more about your work.

Buchanan: [00:01:57] Hi, thank you for having me today.

I am also a huge fan, Dr. Wright. So it is great to be on a podcast with you and great to meet you, Dr. Effie. Thank you for having me today. My name is Dr. Zerita Buchanan. I am a general dentist. I've been practicing for the past 10 years. I actually celebrated my 10-year anniversary this year from dental school.

I practice in Lithonia, Georgia, which is about 30 minutes outside of Atlanta. This is where I'm from. I am a proud graduate of Spelman College, which is an HBCU here in Atlanta, and I went on to get my degree from UNC Chapel Hill School of Dentistry. And I am happy to be with you all to talk about sticky situations because I think I've seen them all in private practice.

Ioannidou: [00:02:40] Oh, I bet you did. So let's get things started. Can I call you Zerita?

Buchanan: [00:02:44] Please.

Ioannidou: [00:02:45] Oh, I love it. So Zerita. We hear that you have a story about issues of respect in the dental office, and I'm dying to learn and understand exactly what you guys go through in practice. Then later on, I can share my own experiences in academia.

But tell us exactly what happened and how you responded. I think a lot of our listeners will be learning from your experience and sharing your reaction and how you dealt with it.

Buchanan: [00:03:13] Yeah. So I actually have a pretty interesting dynamic at my practice. I practice with my dad. So when I joined the practice, he had been telling all of our patients, Hey, my daughter's joining us. She's graduating from dental school soon. And they had all been with my dad, like long-term patients. Right. So they were really excited for me to come in. But the dynamic between father and daughter, I think, was picked up by some of my patients.

And so my sticky situation has to do more so with money. And when patients start to question me on how much a procedure costs or why they're paying certain amounts. So one of the things that I noticed really early on, my dad was probably my best teacher when I started in private practice. He taught me kind of the ins and outs of having great bedside manner, how to really, you know, interact with patients and make them feel comfortable.

So when I would present a treatment plan to a patient, I would tell them, Hey, you need a certain procedure. And I would, you know, go over the fees. I like to tell my patients directly kind of what the fees are, and then I'll pass them over to my office manager to collect, and we can get started. One of the things that I noticed early in my career was the fact that some patients would question a fee based on the amount of time it took me to complete that procedure.

Wright: Oh, that's very common. Yeah. 

Buchanan: So, for example, I was doing an extraction. It took me like 10-15 minutes to get the tooth out, and I was like, okay, we're done. And the patient was like, well, why did it cost that much money if it only took you that amount of time? And I politely responded, you know, you're not paying me for the amount of time it took. You're paying me for the amount of time it took me to be trained to do it for you in this short amount of time.

And so that was my sticky situation. You know, a lot of times I feel like patients believe the longer a procedure is, the more costly it should be. But that's not always true in the dental office.

Our goal, you know, is to provide care in a quick and easy fashion while it's also, you know, the best result for the patient, the best outcome. So that was my sticky situation. I learned a quick little response to kind of stay on my ground, get compensated properly, and also explain to the patient, you know, this is something I take very seriously. So I took a lot of time to be trained to do it for you.

Ioannidou: [00:05:28] Well, that's a very smart reaction to the kind of Inappropriate comment from the patient's perspective, right? But I wanted to ask, I'm curious to know if you have any sticky situations to share related to the fact of the dynamic between father-daughter.

Do you think that at the beginning of your practice, people would question the fact that you are so much younger and maybe assume that you are so much more inexperienced? So did you experience situations like this?

Buchanan: [00:05:57] I did. You know, a lot of people would ask me, you know, are you old enough to be a doctor? And I, you know, I was flattered by that. Anytime somebody would question your age. But I didn't take it personally. I kind of anticipated that. Also, a lot of these patients I had grown up around, so they weren't used to me being in a different position where I was providing them care. They're used to seeing me, you know, at my high school graduation or like, you know, they’re family friends. So being in a position of authority was interesting for some of my patients, that dynamic. But my dad did a really good job of kind of introducing me to the practice before I even got there.

But one of the funny little things that has happened to us more than once, new patients sometimes ask us if we're married. And I'm like, no, no, no, that's my dad. Like, can't you see the age discrepancy here? I get that a lot because we have the same last name. And so they're like, is that your husband that you practice with? And I'm like, No, that's my dad. But thank you for the compliment, I guess. Yeah. 

Wright: [00:06:58] Aww. That's so good.

You know what? You said something that, like, made me, like, strike a chord, actually, with me, or it resonated, about discussing fees. So, like, I have been practicing now for seven years. This is my seventh year, right? And I always was, like, afraid to discuss fees, but now I feel, like, with more experience, I've become so much more comfortable with that.

And I feel like there are some things that should come from the doctor. And I know that, you know, our listeners, they may disagree or whatever, but I love the fact that you, you shared that tidbit, because I think that's going to help some of our doctors out there, like the more you practice, there are some things that I do think that we should talk about and then do that handoff.

Buchanan: 00:07:40] Absolutely. And I think, you know, you're kind of taught not to talk about it. I think that is like the general understanding. But for me, I was like, this is my own lane. Like, I am in a private practice. I felt very comfortable discussing money. And so the ins and outs of insurance, I leave that up to my staff, right?

But I've noticed – and it's not fair – but I noticed that a lot of patients take information from me differently than they'll take it from my office manager. And, you know, I don't like that. I have to be honest. I don't like that because I feel like it's a little bit of a respect issue.

They feel like, oh, I'm the doctor, so they're going to treat me with a certain level of respect, but then they'll treat my staff differently. And so anytime I hear anything inappropriate or if anyone's being rude, I definitely step in. I stick up for my staff members because we are a family. You know, we're together all the time. But I do feel comfortable discussing money.

Especially when it's larger cases, because if you want a patient to buy in, you want them to know, hey, you know the ins and outs of this entire package that you're presenting to them. And I found that my case acceptance goes up when I do that. Especially if they're, like, uneasy about the fee, I can reinforce why it's so important for us to do these steps.

Wright: [00:08:56] Yep. Ooh, I love it so much. I love it so much. Okay. So full disclosure, the ideas that were sparked in this episode, they do come from recent conversations that our producers had with a group of dentists. These dentists, they helped us pick some of the topics for this episode. And we heard Dr. Rachel Jahraus tell us something that we think would resonate with many. So we're going to take a quick moment and hear from Dr. Jahraus.

Jahraus: [00:09:25] Hello, my name is Rachel Jahraus and I'm a general dentist in Hilo, Hawaii. I did a two year AEGD residency after I graduated in 2020 and I've been an associate in a private practice for about two years now.

The sticky situation that I wanted to share is just trying to be perceived as a leader and to gain both the respect of my patients and my staff post graduation. I certainly try, you know, to not wear pink or pattern scrub, nothing too cutesy. I always introduce myself as Dr. Jahraus. And then with the staff, I've been very fortunate that a lot of the time I've had staff who are my age or older, so they've got some experience, which is great.

But at the same time, when you're trying to and needing to give clinical direction as a resident or as an associate, you may get more pushback because that's not how their previous dentist did things. So that's been an interesting challenge to try to address.

And I know I had one of my co-residents when I was in residency had a very apt remark. She was like, as a resident, and I feel like as well as an associate, it's not a question of being like the high or the low person on the totem pole within the organization. You're kind of like the weird arm sticking off to the side since you don't have that hiring and firing power and you're not quite as integrated within the organizational structure.

So there's a few different things that I've tried to kind of address these challenges. One, when dealing with the staff, I realized that as an introvert, my personality might mesh well with the introverts on the team, but possibly not so much the extroverts. So I've been doing a lot of reading on personality traits, personality types, to try to better understand and relate to those more extroverted members of the team.

And then for the patients, you know, I've come to realize that I'm not going to be able to single handedly change some people's perception of what a dentist should be like. I also have to be true to myself, my personality, my practice philosophy, and that is going to resonate with a lot of people and maybe some people not so much, and that's okay.

But I have been trying to, certainly, find mentors, you know, particularly female mentors, who have gone through some of these same issues before to kind of give me their life experience, help me learn from their mistakes, hopefully. I will say that that's a little bit harder to do in my small community just because, you know, looking at the generation above mine, there were not as many female dentists. And I've joined study clubs and other organizations to try to find those potential mentors, but like a study club meeting I was at yesterday, there were 26 or 27 people there, and I would say six of them were women, and two of us were about the same age, younger dentists, not a lot of experience, so there's just sometimes not that pool of potential mentors to choose from.

That's my sticky situation.

Wright: [00:12:21] Okay, what was the first thing for you guys.

Buchanan: [00:12:24] The pink stuck out to me as I have pink on. My heart kind of broke for her a little bit because I want us to be able to show up authentically wherever we show up and not worry about how people judge us based on how we dress, and the color of scrubs should never be an indication of someone's ability to be a great clinician.

Ioannidou: [00:12:45] I have so many thoughts in my mind. You are absolutely right. Zerita, you're absolutely right. But I also, it makes me think and go back as she was talking, I was trying to go back to kind of replay the story of my life. I remember the time that back in the 90s when scrubs were coming in one size, all scrubs were cut on the male body.

Right. So I remember I was wearing those light green hospital scrubs that were so, the pants were so loose on me. And there was this huge string that you had to pull to tie it around your waist. And the top was, like, loose. And thank God now we have all these options for scrubs and the colors that you, you know, you want to show your preference in pink. Good for you. 

You know, you can call it Barbie, you can call it whatever you want, but it's what you choose and you, we have to celebrate your choice, right? ArNelle, she wears the nice aqua, very unusual top, not the classic v neck. I mean, I'm not working for the fashion industry for sure, no, but I want to show that we have so many options to express our taste and our femininity and our choices in how we present ourself.

And we should be proud of that. Free to do this. This judgment is, I mean, to the patients to put you in this position to defend your style is not very nice.

Wright: [00:14:07] You know what I think about too? It's like our career and the profession of dentistry is difficult enough. So performing procedures, we go through so many barriers. And I think about this all the time in my day to day, that if I had to think about my scrubs, man, I, and I'm like, I'm always wanting to wear pink. I'm like the total opposite. So like every Friday for me, it's a pink day, you know what I mean? But it's definitely one of my favorite colors. So I'm just like, I, my heart also kind of sank a little bit too.

I was like, ah, man, I don't want us to go through that. But I'm glad that we were definitely able to hear that story, you know, and I'm interested and curious about what our listeners, you know, comments that they're going to leave or maybe even discussions that may bud from hearing that scenario.

Ioannidou: [00:14:51] But can I ask a question to Zerita? What do you feel about, as we hear her perception about the workforce in Hawaii, in her small community, in the study club, what's your reaction to this? And how do you feel in your community as a woman dentist?

Buchanan: [00:15:08] Yeah, you know, I'm honestly surrounded by a tribe of female dentists.

I have some really close friends, even from undergrad that went into dentistry. And so to me, I think I have a great perspective on the future of dentistry and how it's changing. Because if we look at the data now, dental school classes are predominantly female. And I think, you know, that says something about how the profession is growing and changing.

We still have a lot of work to do when it comes to diversifying the workforce. But as a woman, I feel very confident in my role as a dentist. I feel like I provide great care. I feel like my bedside manner is enhanced because I am a woman. I feel like I have a lot of compassion for my patients.

There was one thing though that I wanted to touch on after hearing the previous clip. What you wear is something that does come to mind, right? When you go into the office, you want people to take you seriously. But another thing that I think sometimes certain practitioners have to think about is how their hair is presented. I think about it all the time. Will my patients take me less seriously, say, if I have braids in my hair or say if my hair is in a bun? Will my patients think I'm less professional and that's something I had to grow out of because I recognized your skill is never determined by how you show up appearance-wise. Your skill is your skill and you can enhance your skill every day.

But if you let the world tell you this is the mold of what a dentist looks like, a dentist has to be a male who wears black scrubs, who, you know, shows up every day, you know, with their hair neatly trimmed, then you're going to confine yourselves to these unrealistic expectations. And like you said, Dr. Wright, dentistry is challenging. It's stressful. And if you have the weight of the world on your back about appearance, it can cause you to, you know, become unsettled and resent the profession as a whole. So I encourage all of our listeners to show up as you are, you know, show up authentically, because if you are in the best head space mentally, you're going to do your best work in the office.

Ioannidou: [00:17:18] It's true. That's a very good point. Authenticity is really important. And I think at the end, as you said, patients receive this. And understand it and appreciate it. And this is what helps you develop this honest relationship. So I think it's a great suggestion.

So I keep referring to the academic life and there are so many stories and ArNelle has heard me saying so many things about weird situations in academia, especially when you enter as very junior. And I, you know, I have shared a situation where I was asked in my junior years to keep the minutes assuming that, you know, if I'm the only woman in the conference, I should naturally be the one that keeps the minutes because that's the woman's job, right? To have the secretarial job. 

But I never had any bad experiences with patients really. Like the lack of civility and the lack of polite and professional behavior would come mainly from colleagues and mainly from male colleagues. So this is what, these are the memories that I have, you know, in my professional life.

I remember as a junior faculty once in a thesis defense, I was asked by, you know, as the resident was presenting their data, whatever. I was asked by a female senior faculty at the time, if I can follow up and if I can follow through this presentation. And if I do have the knowledge to, do I really, do I know these things?

And this was asked in front of the students. Shocking stuff. Now, I think things have improved a lot because people are more aware and people react as you do when you defend yourself. But weird situations. Very weird. Very sticky.

Buchanan: [00:19:21] Yeah, that is sticky. You know, last year, I moved to Boston to do a fellowship at Harvard T.H. Chan School of Public Health. And my fellowship director, Dr. Joan Reed, is phenomenal. She's like my super mentor. And she said, you know, when people ask you questions that are off-putting or make you feel uncomfortable. A simple response usually will have them correct their course. And she said, just ask them, Can you repeat the question? Or I beg your pardon? Say that again for me.

And when they have to repeat that ludicrous statement out loud, to the world or whoever's in the room, they will, you know, take a moment to see how silly they sound. And, you know, you don't have to go toe to toe with people who disrespect you publicly, but you can just simply ask them, I beg your pardon, can you repeat that for me?

And it'll usually make them aware that what they said was insulting, and maybe they shouldn't repeat it..

Ioannidou: [00:20:17] Yeah. Yeah, yeah, very, very good point.

Wright: [00:20:20] And you know what? We talked about age because, you know, patients, they ask us our age sometimes, well, more often than not, actually. And I used to be like, Oh, how old do you think I am?

You know what I mean? I would say things like that. But now I'll just, I kind of move past it. I want to, I want to get you guys' reaction on this actually. Cause I moved past it and I'm just like, Oh, thank you. And I just keep on moving. I'm like, okay, so and so tells me that you're here for this. So is that like just skipping past it? Or is that, is that a good approach? What do y'all think?

Buchanan: [00:20:51] I usually tell them my age. I'm not a, I will always tell them my age and then wait and let them respond. I graduated dental school when I was 26 and I'm 36 now. So that, you know. Ask, ask and I'll tell, I don't care.

Wright: [00:21:07] You graduated pretty young.

Buchanan: [00:21:09] I went straight through, yes.

Ioannidou: [00:21:10] Wow.

Wright: [00:21:11] I know, she's a rockstar. You're a rockstar. Right?

Ioannidou: [00:21:14] You're a rockstar and you're 10 Under 10, right? Yes. You are really a rockstar.

Buchanan: [00:21:19] I'm honored to participate in the ADA 10 Under 10 this year. I'm super excited about SmileCon. I hope all the listeners are going. It's going to be great.

New Orleans is one of my favorite cities. So I am, you know, I'm honored to be able to share some of the work that I'm doing with the nonprofit that I work with on this platform, because we know the ADA has the largest platform in organized industry. So I'm very excited and humbled to be a part of this group.

Ioannidou: [00:21:45] This is, I mean, yeah, yeah, this is great. This is a great achievement. And I'm so proud of you that you have been selected. You know, there, it's a huge, huge population to be selected from, right? So that's big.

Buchanan: [00:21:59] Thank you.

Ioannidou: [00:22:00] We will be right back.

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Wright: [00:22:54] Welcome back to Dental Sound Bites. We're talking about sticky situations and fostering respect in the workplace with Dr. Zerita Buchanan.

Okay, I guess it's my turn now, right, to share a story. I'm interested to see y'all's reactions. Alright, so mine is actually not with patients and to my surprise, Effie, I'm so surprised you haven't had any, like, strange reactions, you know, with patients or whatever. But the sticky situation that I was gonna share was from a leadership perspective in the dental office. Like with the dental team when I first started practicing. 

So it's a very short story. I was just trying to give some instructions to my team. Cause you guys know, like for the most part, I'm like Miss Leadership as it relates to the dental office. I really believe that the dentist should lead and marshal things going on in the practice, of course, being collaborative with, you know, auxiliary staff, lab, DAs. Yada, yada. But there was this one time in my, I think, second or third year. I got a new manager and it was another female and we were both, you know, fairly young. And so, I was giving some explanations. I was like, Hey, I actually would like it if you did X, Y, and Z this way. And in front of the staff, it was like a morning huddle. And the manager was like, I'm not doing this with you. Like, Nope. I'm, like, shut me down in front of the staff. Like, Nope, we're not doing this. Like, almost kind of like it's their show as opposed to – and I don't feel like it's a my show versus your show actually – but in that moment, I was just like, Oh, I was not prepared and I wasn't ready.

And so, I did keep composed. I kind of had to take a breather. And then later on, we talked about it and it was just like, all right, we're new to each other. We don't even know each other. We're just kind of going down this road together. I'm a new dentist. I'm like, I'm just trying to get quick on my procedures, trying to be accurate, but I also have a way in which things should be done.

And you know, the manager was like, Nope, Nope, Nope. And, so anyway, we ended up kind of like working it out and it's fine. We chat even now, we kind of laugh about it now, years later. But, that was one of the sticky situations as it relates to staff, because I'm one of those leaders, and I'll be quick about it, I'm one of those leaders where I ask a lot of questions because I want to be clear on my expectations. I'm very communicative with my staff and sometimes in dentistry, we're not like that. And so when you find a doctor that is very, like, involved or hands on, it can be like, Whoa, this is too much, you know what I'm saying?

And so I'm interested to hear what you all thoughts are about that.

Buchanan: [00:25:31] Dr. Effie, I'll let you go first.

Ioannidou: [00:25:32] No, you go, you go.

Buchanan: [00:25:35] I would be shocked and appalled if someone said that to me in front of my staff.

Wright: [00:25:41] I had no idea what to do. I just had to keep it together in that moment. Cause I was like, Ooh, the staff is watching. This could go down and be bad.

Buchanan: [00:25:47] Yeah, you do have to, you know, keep your composure. I'm glad you stood up for yourself because that was inappropriate for her to say in that manner. When it comes to leadership at my office, I've always had the understanding that if you tell someone to do it, they need to be able to see you do it as well.

So, I never have a problem really, you know, reminding my staff, Hey, we need to take out the trash today. Or, hey, can someone go and Windex the mirrors in the bathroom? Because I would do it myself, and they've seen me do it. So, if someone has seen you do the work, they usually will feel more motivated to do the work behind you because they know this isn't a hierarchy structure. Now at the end of the day, it is a little bit of a hierarchy because you are the dentist and they are the staff team member, but I feel like if people see your work ethic and they see how you lead, they'll be willing to follow.

And so I'm sure your staff when they saw that situation, they knew your character and knew that you weren't just saying something to be rude, but you were saying something because it was important to the betterment of the practice. And that, you know, probably is a testament to your leadership skills. So I'm sorry that happened to you, but I'm sure you navigated it properly.

Wright: [00:27:08] Yeah, navigate. I feel good about it because now it's, it's like a thing that we were just like, Oh, got off to a little bad start there. You know what I mean?

Ioannidou: [00:27:16] I really like what you just said about the dynamic in the practice and the relationships and the way they should be built. And I also have a little bit of an allergic reaction to the word hierarchy.

And I know that implies, you know, this differential that many times poisons relationships, right? But I think that the alternative view of this would be, you know, we like it, we don't like it. The way we, you have a team in the practice, but some people report to some other people, right? So there is this kind of a reporting dynamic and a relationship that is built with respect, but yet, you know, you're the boss. Yeah. How else can I say it? Right. So it's really important when these relationships are built with respect, because if you abuse this dynamic and this differential, then it becomes a problem, in my opinion. So I like the way that you describe it and the work ethic that we all have to portray it as we keep these relationships. You shouldn't expect the people that report to you should be doing things for you.

Wright: [00:28:26] It's alongside.

Ioannidou: [00:28:27] Yeah, exactly.

Wright: [00:28:28] Yeah. Perfect. I was gonna say, I think it should be, like, alongside one another. I don't really like to show up as like, Oh, like some people say, like, throw your weight around. Y'all have heard that, right? Like I don't necessarily show up that way in practice. And so it was an interesting interaction, but I'm glad that, you know, we're past that.

Ioannidou: [00:28:47] And because I'm a little bit older than you and I never play this card of being the older, I still feel that, you know, we are all learning in every phase of our lives.

But my observation is that more frequently women are placed in this situation of wondering where am I? What's my position? How should I do this? How should I deal with, you know, I find that many times I find, and I see now junior men, junior dentists, go into the room and they own the room. They don't have to think about these things. How am I going to portray myself? What am I going to answer? What if they say that I wear gray versus I wear navy blue versus I wear pink? I mean, yeah, pink in this society may be criticized. But in the European society, no, it will be very natural. Everybody wears color.

But, you know, we women kind of second guess ourselves. And like, should I walk in like this? Like that? How am I going to get more respect? So tough life.

Wright: [00:29:45] Hard, hard, hard. Okay. Next up, Dr. Sapna Lohiya shares her story with us. So we're interested to hear another sticky situation.

Lohiya: [00:29:53] Hi, thank you so much for having me.

My name is Dr. Sapna Lohiya and I am an oral and maxillofacial surgeon practicing in West Los Angeles. As a young female clinician, I can speak to many sticky situations or instances when my credentials or abilities were called into question because of the way that I look. For example, I have had patients tell me that I look as young as their daughter and I come to find out later that their daughter is just about to graduate high school.

I've had patients ask me if I was strong enough to take out their tooth. And question the way that I looked to be able to do that. By peers, I've been told that women don't belong in surgical specialties and that having a desire to start a family could affect my job prospects. The way that I typically respond to these situations are, I find that there is a small majority of people who aren't going to respect or trust you as a provider because of their preconceived notions. And for those patients, I reiterate how important trust and respect is in a doctor-patient relationship. So sometimes I will offer for them to see my partners or to seek care elsewhere if I don't think that I will be able to achieve that level of trust and respect that is so necessary for patient care. 

For the vast majority of patients or people who are just speaking from a place of nervousness or anxiety or from their previous experiences with what their doctors have looked like, I speak to them in a way that shows my competence and speaking confidently so that I can help change the narrative. For example, for patients who tell me that I look as young as their daughter, I receive that as a compliment and I tell them thank you.

I have now changed that narrative from one of, you know, questioning my training and the time that I have spent training into receiving it as a compliment. And now we can move forward to the issue at hand, which is treating that patient for the reason that they came into my office. For patients who have questioned my strength of doing a particular procedure, I tend to tell them that fortunately, you know, dentistry and taking out teeth is not as much about sheer strength as it is about technique and skill. And I find that that reassures patients and helps to regain that trust. So that is typically how I handle those sticky situations.

Wright: [00:32:38] I picked up a lot from there. So like one thing that I love and that I wrote down, I love how she reframed her new response or changed the narrative, as she said. What are y’alls’ thoughts?

Buchanan: [00:32:48] That was a very interesting clip. She touched on a lot of points. What stood out to me was the advice that your potential jobs will be affected by if you decide to start a family. And, you know, when I went back to Harvard, I got my MPH, but it was  specialized in health policy. And so one of the things that I really thought about a lot of my female classmates who are, you know, physicians and dentists, we went straight through school.

We put a lot of time into our career and it's interesting to me that different institutions do not support family planning for residents and interns through insurance. For example, when you are in graduate school, if you want to freeze your eggs per se, there's not financial support for that. And so that, you know, kind of stops a lot of women from starting a family later in life. It may eliminate the option for them. And I hate that that's even part of our discussion. Like, why do we even have to think about that? That is not something that our male colleagues have to think about.

So when we think about policy initiatives, one of the things that we're going to talk, all this talk about, hey, we need more women in the workforce. We need more women in these fields. Well, we need to support them when it comes to family planning. If they decide that they want to have children in residency, they should not feel like their job is in jeopardy. And if they decide they want to wait, they should have the financial support of the institution to go through any type of procedure that will allow them to have children at a later date.

So I sympathize with our colleague because I know what it feels like for someone to say, Hey, think about that, how it's going to impact your career before you make that decision.

Ioannidou: [00:34:33] Both of our colleagues brought this up as several issues related to this inequity. And I'm glad that you had this exposure at Harvard and you looked at policy. And I mean, this is really very useful. The comments were right on point.

Wright: [00:34:47] So I feel like we've covered a lot of scenarios in our episode today. We've covered everything from office staff, respect with patients, peers. This is a good time for us to do some big takeaways from today's episode.

So Dr. Buchanan, you can start by sharing three takeaways, maybe that we can do to foster a more respectful workplace from your perspective.

Buchanan: [00:35:09] So the number one thing I think is to show up authentically. When you are happy with yourself, you interact with people differently. So you'll interact with your patients and your team members in a positive manner when you take care of yourself and you're happy to walk in the door every day and practice dentistry.

The second takeaway, I think, for new dentists who are listening, a lot of the things we touched on today will come with time. Don't beat yourself up if you are, you know, in year one to five and you feel very uncomfortable talking about money with your patients. Keep going. Keep trying. It will get easier. 

And I think the last thing to think about is for, you know, our male colleagues who may be listening, speaking up when you hear something is so important. If you hear your colleague being disrespected, your female colleague being disrespected, please do not feel afraid to speak up in the moment because allyship is so important as we, you know, progress in our careers there's going to be a time where we all need each other, especially if you're in group practice. So if you hear, you know, a patient or a team member is treating you differently than they're treating a female dentist, take a moment to say something. We all need support in different arenas. And I think that is, you know, something that would really be appreciated by your, your team member.

Wright: [00:36:37] That was phenomenal.

Ioannidou: [00:36:37] That's really important. And it's really true that we need to count on allies. It's really important, like silence will not protect you, as I say.

Buchanan: [00:36:47] That is the realest quote I've ever heard. Silence will not protect you.

Ioannidou: [00:36:52] Right.

Announcer: [00:36:54] On the next Dental Sound Bites.

Wright: [00:36:56] We're talking about cultivating a leadership mindset to create change at work, at home and in your community.

Ioannidou: [00:37:04] This was such a great conversation. I love it. Thank you so much for joining us. Thank you so much for sharing your wisdom. I'm impressed.

And I'm really, I have hope for the profession because when I met ArNelle, that was like, huh? I love this. I love this gal. This is that. This is our future. And now when I see people like you, Zerita, in our profession and, and you guys have such wisdom developed at such a young age, I'm like, I salute you.

Respect for sure. Respect. Respect. Mic drop.

Buchanan: [00:37:39] Thank you. Thank you.

Wright: [00:37:41] Well, before we go, we really want to say thank you again so much for being on the show with us, Dr. Buchanan. Can you tell our listeners how they can find out more about you and where to follow you online.

Buchanan: [00:37:51] Yeah, you can follow me on Instagram.

My Instagram is just my first name, Zerita, Z E R I T A and the initial B, so ZeritaB on Instagram. I am also going to do just a little shameless plug to learn more about some of the work that I'm doing. When I was asked to be a part of the ADA 10 Under 10, they highlighted some of the mentorship programs work that I'm doing to diversify the dental workforce. And the nonprofit I work with is called IDID Pipeline, Increasing Diversity in Dentistry Pipeline Program. We're a 501c3 and our mission is to eliminate the racial disparity in the dental workforce. So if you go to ididpipeline.org, you can learn more about our 501c3 and you can help to support students who are interested in entering the field.

Ioannidou: [00:38:40] Oh, that's so great.

Wright: [00:38:41] Yeah. And we need this. We're so glad for the work that you're doing.

Ioannidou: [00:38:45] We definitely need this.

Buchanan: [00:38:46] Thank you. Thank you all for, you know, allowing me to share on this platform. I appreciate the work that you all are doing. Thanks.

Ioannidou: [00:38:53] Thank you. Thank you. Thank you. Thank you. And if you guys like this episode, share it with your friends, then be sure to subscribe to this podcast wherever you're listening. So you can get the latest episodes, people.

Wright: [00:39:05] Yep. You can also rate it. You can write a review and follow us on social media.

Ioannidou: [00:39:10] And don't forget the conversation continues on the ADA member app. Catch all the bonus content. And we have a lot of this, everything you did not hear on the episode.

Announcer: [00:39:22] Thank you for joining us. Dental Sound Bites is an American Dental Association podcast. You can also find this show's resources and more on the ADA member app and online at ada.org/podcast.do if you have a patient in a dental chair who is obviously high? I'm Dr. ArNelle Wright.

Ioannidou: [00:00:06] And I'm Dr. Effie Ioannidou and today we are having a really great conversation about cannabis and our patients.

Announcer:: [00:00:19] From the American Dental Association, this is Dental Sound Bites. Created for dentists by dentists. Ready? Let's dive right into real talk on Dentistry's daily wins and sticky situations.

Ioannidou: [00:00:34] Before we dive into the episode, if you have enjoyed Dental Sound Bites, please help us by rating the podcast on Apple Podcasts, Spotify, or wherever you're listening.

Wright: [00:00:45] Yes, yes, please leave us a review. That's going to help us continue to support other dentists and our great profession.

Ioannidou: [00:00:53] Yeah, absolutely, ArNelle. Thank you, guys. 

Okay, let's talk about cannabis. All right. There was an ADA news story about this, right? Some years ago, that said that many dentists have had a patient that was high during a dental visit. I have never experienced this, but I'm sure many people have, right?

Wright: [00:01:12] Crazy. Yeah. It surprises me that you haven't had a patient that was high in your chair.

Ioannidou: [00:01:18] Or not that I know of.

Wright: [00:01:20] Oh. Okay. Okay. So maybe today during our conversation, you may learn some things to look for because I'm sure somebody has been high up in your chair. I'm sure.

Ioannidou: [00:01:33] That's right. That's right.

Wright: [00:01:35] And in 2023, the ADA Dentist’s Trend Report survey found that 46 percent of the 500 respondents reported seeing more patients under the influence than in the previous year. And that made us want to know, what should you do in that situation? How does it affect your treatment plan? And why are some patients coming in high?

Ioannidou: [00:01:56] And also this finding tells you that it's not that rare, right? So it's exactly what we were saying, like maybe either I'm not that observant.

Wright: [00:02:05] No, I doubt it.

Ioannidou: [00:02:06] Or I don't know the signs.

Wright: [00:02:08] Effie, do not do that to yourself. No, we know you're observant. Come on, we know you're Queen Bee. You're observant.

Ioannidou: [00:02:15] So actually, that's why we have the right guest today to help us get some answers on this topic. We have invited an expert, Dr. Barry Taylor, to join us today. So hi, Dr. Taylor. Nice meeting you. And tell us a little bit about yourself.

Taylor: [00:02:31] The introduction conversation has been great. A lot of comments I would love to make. Which all lead to why I got into this as the expert, so to say. But I'm a general dentist. I no longer practice clinically now, but I did practice clinically up until 2020 and I still have an active dental license, a general dentist.

I went to Oregon Health Science University School of Dentistry. But I think related to this, before I started dental school, I did two years of research as a research assistant. And the lab I was in, we actually were looking at the dopamine receptor. And at that time, there were two dopamine receptors. I think now they recognize four or six, I'm not sure.

But at the time, there was the D1 and the D2 receptors. I just kind of had that in my background and went to dental school, graduated from dental school. And then what happened was, about 2016, I read an article in a well respected dental magazine. It wasn't a peer review, but it was just kind of an article about what you should do if you have a patient in your chair that is high.

And in that article, it made reference to the fact that if that patient has used marijuana, like within the past seven days or something like that, you should not treat that patient. If they're a risk of infection, you shouldn't treat that patient. And I read that and having grown up in Oregon, having gone to undergraduate in Oregon, having gone to dental school in Oregon, I'm sure the first patients I treated that were under the influence that probably started in dental school. And I read that article and at that same time was when Colorado, Washington, California had already legalized it for medical reasons. Oregon was coming on board legalizing it for recreational reasons. And I just really wanted to develop a program of educating dentists, dental hygienists, dental assistants, anyone in the oral health profession, that they would feel comfortable talking to their patients about marijuana use, cannabis use, but have it come from a scientific evidence-based background.

And going back to that article that I read when I was reading something about, you know, you shouldn't treat a patient for seven days, I just, there were just some ridiculous statements.I really wanted to educate oral health professionals so that they would feel comfortable treating patients and be as comfortable talking to their patients about marijuana use and cannabis use as they are about tobacco use or alcohol use or opioid pain, you know, any of the other medications, substances, that our patients are under the influence of.

Wright: [00:04:59] I love that. Can I just chime in really quickly? I'm so glad that you said you wanted to develop an education program, because I don't know if y'all saw my face about when you said you shouldn't treat anybody, like when you read that article, I was like, because I'm like, Oh, well, more than likely, I probably have done that on a very, very regular basis. And, hopefully, you know, the authorities won't come and get me. But still, is that still a recommendation?

Taylor: [00:05:22] No, absolutely not. Absolutely not. No, not at all.

Wright: [00:05:26] Update us.

Taylor: [00:05:27] You know, when we talk about recommendations, and there's kind of two different issues because either A, and I would say it's somewhat similar to how do you treat patients who have used alcohol?

Wright: [00:05:37] Right.

Taylor: [00:05:38] You know, if it's four o'clock in the afternoon and your patient tells you that they had brunch and had a mimosa or a Bloody Mary with their friend at breakfast at 9 a.m., are you still going to treat them that afternoon? There's two things, you know, for consent and whatnot, you're going to use your professional judgment to make a judgment call as to are they coherent with me? Can I have an intelligent conversation with them? Are they answering questions? So on and so forth. 

And then the second factor is you're going to take vital signs. And I think that's, with cannabis, I always go back to the importance of taking the vital signs. And then also that gets into a discussion of the difference of asking questions. And this is where I want the doctors and hygienists and assistants, everyone to be comfortable asking the questions. You know, did you smoke it? Did you take an edible? Is it a, 3 o'clock afternoon patient and they wake and bake, so to say, and he's a 25-year-old who does that every single solitary morning, but they did that in the morning and now it's an afternoon patient? Or did they take an edible in the parking lot at noon because they want to be relaxed for the dental appointment at 1 o'clock or 2 o'clock?

Wright: [00:06:38] Yeah, I always say, how did you consume it? That’s how I ask.

Taylor: [00:06:41] That's a critical thing. That's a critical thing. Because when we smoke it, a quick onset of action of about 30 minutes, peak action at about 30 minutes to 45 minutes. And then on average, a duration of action of about two hours. You know, we're talking averages here and it affects everyone differently. But when you start talking about an edible, and all of a sudden you're talking about a range of onset of action, which could be anywhere from one hour to three hours where that peak action is for the patient is much, much more variable. It could be at two hours, it could be out at three or four hours.

And then I think really the concern with an edible is a duration of action that can be as long as six or eight hours. So asking the patient when they took it, I think almost more importantly is what form did you take that in? Did you take it as an edible or did you smoke it? Because you're going to have very much different dynamics for how it's affecting the patient.

Ioannidou: [00:07:37] But I think what you said was very right. It's how we train practitioners and staff to feel comfortable asking these questions, right? There is this kind of a, it's the stigma, the taboo of, you know, I know that's not my business. I don't want to go into this for several reasons. Like we are not trained for this. We don't, maybe we feel, you know, we don't want to touch any legal liability thing. It’s so complicated.

Wright: [00:08:03] Dr. Taylor, is cannabis use from your experience and expertise, is it increasing overall? And if so, could you just let us into a little bit more why that is?

Taylor: [00:08:15] It is. As it becomes legal in more states, and I think now we have 23 or 24 states, District Columbia, however we're going to count them, where it is legal for recreational use. You have, I think, 36, 37 states where it is legal for medicinal reasons. And you really only have, I think, three states where there is absolutely no use of marijuana or cannabis in any manner.

The other thing that's interesting when we're talking about it, is that it's not an increase in use among teenagers and whatnot. That actually hasn't increased in the manner that you would maybe, you think it would as it became legal in states. The greatest rate of increase of use of a marijuana for THC is actually in the older population over the age of 55.

Wright: [00:09:00] Huh. I can believe that actually.

Taylor: [00:09:02] Yeah. And people will sometimes say, like, Oh, well, of course, you know, those are all the hippies in the sixties. Well, actually, no, those people are actually in their seventies and eighties. It's, the reason why is, hypothetically, is that more and more people are using it for a perceived medicinal reason and not for a recreational reason.

Ioannidou: [00:09:18] Interesting.

Wright: [00:09:19] I can believe that.

Ioannidou: [00:09:19] Yeah. I'm 55 and I can tell you I'm no hippie of the 60s. I was born in 69. So these people that say the hippies of the 60s don't do simple math.

Wright: [00:09:29] I hope that, I hope it wasn't offensive for me to say I can believe that. I think I was thinking, I'm just saying it from an experience.

Ioannidou: [00:09:34] No, no, no, no. You were absolutely right.

Wright: [00:09:36] I was just going to say from an experience perspective, seeing some of my patients, like, they talk about, like, anxiety and they're just, like, medicinal users. Exactly to your point, what you said. So, like, and I feel like it's just becoming less taboo. It's almost like stigmas around, you know, mental health things. People are just being more open and talking about it on a regular basis now. So, I really love this conversation we're having.

Taylor: [00:09:58] I think the stigma is a good word. I mean, I'm talking about the scientific terms of, you know, reduced rate of safety and how people view it. But yeah, it's the stigma. That's the word that sums it all up.

Ioannidou: [00:10:08] Yeah. I mean, I really want to go back to what you said about the, if you will, the least increase that we see in the teenager, young adults, probably because, you know, I mean, I don't know about teenagers and I would, I would predict that with the vaping and everything, perhaps they use, they're combining those two, but for young adults, we always know that four years in college, if you don't experience this, then you're not considered cool. Right? So it has been in common use for ever and ever and ever for decades now, right?

Taylor: [00:10:42] Very much so. Yeah. And I think going back to kind of the original question, everything is, because this is about patient education and communication with patients, is the reason why I like to talk about that older population using it, is that when a patient is sitting in your chair and yes, statistically, the highest heavy consumers are, you know, age 20-25, 16-20, you know, the young male that is your classic. True. But having said that, you need to ask every patient, because it's your older patients can, not as likely, but they very commonly can be using it.

Wright: [00:11:11] I feel like my older patients, they just come outright and say it. Like it's no hiding it. They're like, it's on Front Street, right? Yeah. And I feel like when we have conversations about it, it make it less, it makes it less, like, weird to talk about it.

Taylor: Yeah, you're right.

Ioannidou: [00:11:25] So if I suspect that someone on my dental chair is high, what's the first thing that I need to do? And what's the right way to approach this patient?

Taylor: [00:11:34] Well, the first question is to say, you know, Hey, I noticed you have dilated eyes or, you know, I can smell cannabis on you, but if they've used an edible, you're not going to have that aroma.

The first thing I would just, I'd flat out ask them, and then I think, and I hope, every single solitary dentist, hygienist, oral health provider, well, particularly with hygienists and dentists, that we're taking their vital signs. So that's going to be the other thing. So if you haven't, you take the vital signs. You're asking them in a nice conversation manner, have you used cannabis today?

And then you want to know, going back to our earlier conversation, when did you use it and how did you use it? Hopefully we'll be honest with you. If you're suspicious, they've got dilated eyes, or they seem a little incoherent, then that's a check mark of, okay, this is, I'm not going to proceed with treatment because my professional judgment is picking up that something is off here and I need to know what is off.

But if they are honest with you and they tell you that they, I just took an edible an hour ago, that's what you need to be educated. Like, you know, I'm not too comfortable. Or, you know, maybe like, okay, like how many milligrams did you take? How often do you take it? Oh, it's the first time I've ever used cannabis. My friend suggested it to me and said I should take 10 milligrams because it will help me relax. I've never done this before. Well, no, that'd be a red flag. And I would absolutely be, like, no. You know, have someone drive you home because there is an increased risk of motor vehicle accidents. You're under the influence. I'd be very, very concerned about it.

If it's someone who says, Oh, I took five milligrams every night before I go to sleep. Um, I thought it would help me relax for the dental appointment. I took five milligrams. I take the vitals. I'd be more comfortable treating them. And I think there in the Journal of the American College of Dentists is a 2010, Dr. Peltier, well respected editor for the journal, he wrote a really good article in that issue. And it was about, it's not ethical to have a blanket statement around cannabis use. Like you can't just say like, if you have used cannabis within the past 24 hours, I will not treat you. There's not really evidence to back that up either from an ethical standpoint or from a scientific standpoint.

Wright: [00:13:38] The nature of our job is so hard. Like, we have to shift in between decisions and it's, like, case by case. As much as like, I say this all the time to mentees, as much as I'd like to have, like, blanket statements for certain things, it's like, it depends on the data that's in front of you at that time. Like, I don't know, to your point, I hope that that's, like, adding value to our listeners

Ioannidou: [00:13:59] For sure.

Taylor: [00:14:00] Well said. It's very well said. We, I think we dentists, I mean, I think all providers want those black and white statements of, this is the path to take. And we, Oh yeah. That's why we go to dental school with the professional judgment. We have to make some judgment calls.

Ioannidou: [00:14:14] Absolutely. For sure.

Wright: [00:14:15] Okay. So let's say that my patient admits that they are high. How does that affect my treatment plan? Maybe we can go into a little bit more background about cannabis and all of that, like anything that you have to add.

Taylor: [00:14:29] Yeah. So when we talk about cannabis and marijuana, we tend to use the two terms interchangeably. Cannabis really is referring more to the plant. So the cannabis plant could be very, very high concentrations of CBD and CBD is cannabinoid, which is not psychoactive and has low affinity for the CB1 and CB2 receptor, when we start talking about the endocannabinoid system. 

When we talk about marijuana, we're tending to talk about the cannabis plant, which is high in THC concentration. And so it's like, when we talk about medical use and recreational use and, going down a rabbit hole a little bit, you know, if someone is using cannabis for recreational reasons, they are probably using it with a high THC concentration. If someone is using it for medical reasons, you really need to ask like, Oh, are you using cannabis with a high CBD concentration? Cause that could have zero effect on our dentistry. Or other people are using marijuana, cannabis, with a high THC concentration and saying they're using it for medicinal reasons. Did I take us too far down a rabbit hole? That was a lot.

Ioannidou: [00:15:29] No, no, no, no.

Wright: [00:15:30] That was a lot to wrap my head around, but this was good. I feel like our listeners, they actually need this. Like even me, I was just like, okay, wait, let me just write a few things down here. Let me get some notes. You know.

Taylor: [00:15:40] The bottom line is that if someone says a blanket statement of, yes, I use marijuana or yes, you use cannabis. You, that's why I want to educate. And that's why people listen to the podcast to like, Oh, okay. So like, do you use it for the high THC concentration or do you use it for a CBD concentration? Then you ask more probing questions of, Oh, how often do you use it? And when do you use it? Do you use it as an edible or do you smoke it? So kind of two different paths, but going back to conversation with the patient.

Wright: [00:16:07] We'll be right back.

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Wright: [00:17:02] Welcome back to Dental Sound Bites. We are having a conversation with Dr. Barry Taylor about the impact of cannabis on oral health.

Ioannidou: [00:17:10] So how does cannabis specifically impact oral health? And what do we see with the chronic use of cannabis? And is there a difference between patients who smoke versus consume it as edible?

Taylor: [00:17:24] Taylor: Yeah. All, do you have a few hours? No, all great questions. I think that the quickest and easiest one to explain is that it causes dry mouth. Now we're talking about marijuana, THC. So I may have said this already. CBD has this weak affinity for the CB1 and CB2 receptor. THC has a high affinity for those receptors.

And so, it decreases salivation and it does it through a number of ways. It decreases the signaling within the cells of the salivary glands. It relaxes the muscles around the salivary glands. And it also decreases the innervation and the stimulation of the salivary glands by changing the neurotransmitters at the nerve ends and whatnot.

So, a number of different ways, all those ways, they all cause decreased salivation. I was just lecturing at the dental school today, that's why this is so familiar to me. And it's on a number of the different strains. The number one negative effect is dry mouth. So, getting dry mouth is incredibly common from using THC.

And you're going to get that whether you're smoking it or if you're using an edible. And then we all know xerostomia, of course, is going to cause caries, you know, that's a given. And so then there are a number of studies, the best one is actually out of an adolescent program in Nevada, I think it's the most extensive one, but showing a very significant increase in dental caries.

And then that kind of leads, because of that xerostomia, that leads to the second thing. That is that THC, you get the munchies, right? We all, you know, I'm sure you've heard people joking about getting the munchies when they use THCs. So that is, that's caused by, there is a hormone protein, called leptin, which is released by fat cells. And so the normal process is we eat a meal, leptin is released, leptin tells our brain that we are full. We don't eat anymore. Cannabis inhibits leptin. So the brain doesn't get that message.

And then another thing that THC does is it increases, in certain areas in the brain, it increases the release of dopamine. So now all of a sudden sweeter foods taste, you know, more sweet, salty foods, you know. So you develop this craving for unhealthy foods. There's no message in your brain saying that you're full. So this whole joke about like, Oh, you know, getting high and getting the munchies. And so these high sugary foods, soda pops and whatnot, combined with dry mouth. You have like the recipe for dental caries.

Ioannidou: [00:19:50] Absolutely. It's exactly the recipe. 

Taylor: [00:19:53] The next one is a little bit more, you don't have that same cause and effect, so to say. But when we talk about periodontal disease, so there's a great study out of New Zealand. I mispronounced the name, I think it's the Dunedin Study. But a number, three papers were published in different journals on the Dunedin Study, and this was a large general population study, meaning that they were taking a large cohort of people, and then every four to six years, doing, full health exams on them.

So this wasn't a dental study. This was a study looking at heart disease, lung, everything, just the general health of the population. But we were lucky because they were doing periodontal disease, periodontal probings and measurements in that study. So you're following this population over a number of years.

And now that study, three papers have come out of that showing that the increased prevalence of periodontal disease. And actually kind of the lighthearted thing, that you saw some headlines in popular literature was that periodontal disease was actually the only disease that showed a correlation to smoking THC cannabis.

There is no other disease that showed a correlation with increased use of THC. And then a similar study was done in the United States. It's called the NHANES study. Very similar, but the same conclusion after that study was that those people that smoked cannabis increased clinical attachment loss.

So, you know, you have two very large studies, large and showing a prevalence of periodontal disease in those people that use cannabis. And the important thing there,as well was that, that was for people that were smoking marijuana. So we don't know if there's a difference, you know, like between using edibles versus smoking it, and then it comes back to smoke. It’s smoke and smoke is bad, you know, the damage it does to the micro vessels and everything. It comes back to, you can't say so much that maybe it's the THC, the marijuana, causing the periodontal disease, but what it comes back to  is smoke,

Wright: [00:21:50] Right? So good.

Ioannidou: [00:21:51] Oh, for sure. And I'm sure it, perhaps it also goes back to the microbial profiling of these patients. But you know, it's so interesting. Yeah, for sure.

Taylor: [00:22:02] Yeah. And then the three big categories of oral health and the third one is around oral cancer. Yep.

And there are probably equal number of studies showing a positive association between THC use and oral cancer. And there are, I would say, probably even more studies showing no association between THC and oral cancer.

The one exception to that is with laryngeal cancer, positive association with that. But there is a study actually showing that there actually was a decrease in oral tongue cancer from that population that was using THC. But that's hard to study oral cancer because it, you know, I don't know, when I was in dental school, they told us oral cancer was like 3 percent of all cancers. I don't know the exact statistics, but it's a very small population that gets oral cancer. And then of that small population, you have, you know, let's say 10 percent that are using marijuana on a regular basis. So it's such a small population sample. It's hard to study that.

Wright: [00:23:03] Yeah. Well, speaking of studying, like, are there any specific guidelines or recommendations for the use of cannabis in medical or dental patients that our practitioners should be aware of?

Taylor: [00:23:16] I say this a little bit cautiously because this is just Barry Taylor speaking after reading a lot of articles and everything. I think there's something to be said for using edibles versus smoking it. Because we know the damage from smoking it. 

When you smoke it, you also have that increased airway retention. You're inhaling it. You're trying to hold it in. We know all the damage from smoke, whether it's tobacco or cannabis or anything. So I think there's something to be said for using it as an edible and not smoking it. I think a lot of it then is patient communication, you know, your patients may, your college patients or whoever, may think it's kind of funny, the increased appetite and everything. But they may not put the connection between, Oh yeah, I do get cotton mouth, dry mouth every time I use THC.

You know, that's where the education comes in. Like, Oh, yeah, you get that dry mouth. You're also eating a lot of sugary foods and your oral healthcare, you know, increased caries and whatnot. And I think it's all things in moderation, just like alcohol use or a lot of other substances. The person who's using an edible Friday nights, two or three times a month, you know, I'm not the least bit concerned about, I'm concerned about the person who is smoking cannabis on a daily basis.

And then, you know, we haven't talked at all about cannabis use disorder and there is a cause and effect there with dosage and chronic users. It's not a completely safe drug, depending on how you look at it, about 20 to 30 percent of the population will develop some degree of cannabis use disorder. The population that uses cannabis, different ways to measure it, different studies, but I think it's pretty safe to say 20 to 30 percent will develop a degree of cannabis use disorder, you know, anywhere from mild to severe. Centers for Disease Control will say that 10 percent will develop an addiction. So I think it's safe to say that probably 10 percent will develop an addiction, severe problem with it, but as high as 30 percent will develop some degree of a problem with it. And again, the other thing that's important is that we're talking about THC.

Ioannidou: [00:25:09] If we want to think about the key, the bottom line of our conversation, how would you summarize the bullet points for us, Dr. Taylor?

Taylor: [00:25:19] Right. Being comfortable to talk to your patients, finding out, are they smoking it? Are they using it as an edible?

Ioannidou: [00:25:25] That's right.

Taylor: [00:25:25] Clarifying with them, are they using products which have, you know, marijuana, high THC? So are they using it to the degree to get that euphoria, that intoxication? Or are they telling you that they use cannabis and it is just, you know, CBD gummies that they bought on Amazon. So really making sure you understand and clarify, is it CBD or THC? Because two different paths there. 

And I really think at the most basic level, the most common one, you know, is, is the dry mouth and the, and the connection between dry mouth and dental caries. And if they're smoking it, then, you know, how often? Because, it'd be the same conversation you have with a tobacco user about periodontal disease

Ioannidou: [00:26:07] And cancer.

Taylor: [00:26:08] Yeah. Very much so. Exactly.

Ioannidou: [00:26:10] I mean, this was such a useful conversation. I learned so much.

Wright: [00:26:14] So good. I'm over here still writing notes.

[00:26:17] I know

Taylor: [00:26:18] You two are great. You two are great. You two are great.

Ioannidou: [00:26:21] I'm like looking forward to having a patient who's high.

Wright: [00:26:25] Listen, you might not get any work done.

Ioannidou: [00:26:28] I'm ready to go.

Wright: [00:26:28] You might not get any work done.

Taylor: [00:26:31] You know, if it's someone who has smoked I'll, if it's someone who has smoked cannabis and you've taken the vital signs and it's been a couple hours and the vital signs are fine. There's not huge medical emergency risks with someone who has used cannabis.

Ioannidou: [00:26:46] Oh, very good point.

Announcer:: [00:26:48] On the next Dental Sound Bites.

Wright: [00:26:50] We're bringing back one of your favorite topics, sticky situations.

Ioannidou: This time we are focusing on respect. 

Wright: Tune in for strategies for cultivating respect in our work relationships and building a better work environment.

Ioannidou: [00:27:07] Thank you so much, Dr. Taylor. This was meaningful. This was very educational. I'm prepared. I'm prepared. Yeah.

Taylor: [00:27:16] Yeah. Thank you both.

Wright: [00:27:16] Yes. We're so glad that you are here with us. Yeah.

Taylor: [00:27:19] Thank you for the opportunity. It's great.

Ioannidou: [00:27:20] Oh, of course. Now tell us a little bit, where can our listeners find more about you or where can they follow you online if they want to?

Taylor: [00:27:29] Yeah, I don't have any presence online. I'm the executive director for the Oregon Dental Association. Yeah. I'm the, I'm the executive director for the Oregon Dental Association. So I don't have any online presence or anything. I'm going to send you a website. It's called STEM. I think is what it's called, but it's a pretty good website for information on cannabis and it's all evidence based and whatnot.

Ioannidou: [00:27:51] We can share with our listeners so they can have at least the resources to get more educated. That's great.

Taylor: [00:27:56] It's just a good resource for that information.

Ioannidou: [00:27:59] Yeah, that's great.

Wright: [00:28:00] We do want to tell all of our listeners, if you like this episode, please, please share it with a friend. Then be sure to subscribe to this podcast wherever you are listening so that you can get the latest episodes.

Ioannidou: [00:28:12] And don't forget that you can also rate the episode, write a review and follow us on social media.

Wright: [00:28:18] Yes. And last but not least, the conversation does continue in the ADA Member App and on our YouTube channel. Catch all of the bonus episodes and the bonus contents and the moments that you didn't get to hear on the show.

Announcer:: [00:28:34] Thank you for joining us. Dental Sound Bites is an American Dental Association podcast. You can also find this show, resources, and more on the ADA Member App and online at ada.org/podcast.