The Art of Selecting New Products and Innovations in Biofilm Removal: A discussion with Emily Boge

You're listening to the Phil Klein Dental Podcast. Certainly one of the most fascinating things about human beings is the uniqueness of each and every one of us. But nevertheless, each of us can still be characterized into a general category, and that category pertains to our personality, behavior, and preferences. For instance, some of us are extremely resistant to change. For many of those people, that can be okay. But if you're a healthcare provider, being too resistant to change may preclude you from implementing products and materials in your practice that have real advantages of what you're currently using. So the question is, if you're willing to try some new dental products, different from what you've been using for years, how do you know which one is best for you, your team members, and your patients? To help us put this all in perspective, we'll be talking with Emily Boge. Emily is a registered dental hygienist, speaker, and writer with a dual doctorate in education and organizational leadership. She's a champion for innovation, influencing manufacturers to prioritize practitioner input into product development. Emily, thanks for joining us on our show. Well, thank you for having me on, Phil. I appreciate it. Yeah. Congratulations to you on all the work you're doing in the industry regarding your patents. You're really coming up with some phenomenally... phenomenally, that's a tough word, innovative products that are so practical, so helpful to our hygiene world, making it more effective and easier for them to scale and root plane and so forth. And it's amazing how many different instrument companies use your products. And I think that's just a fantastic way to use your knowledge to get the whole practical part of clinical dentistry to another level. Talking about products, this is really important, this conversation, I think, because there's so many products out there. And as clinicians and healthcare providers, we certainly want to... the best product for our patient. In addition, most of the manufacturers, as we know, advertise claims stating that their product is the most effective, the most durable, the most reliable, and so forth. So in light of all this, how can we ensure the products we choose and ultimately incorporate into our routine procedures, specifically in the dental hygiene space, are safe and effective for our patients? That's a big question. So the best advice I have when I'm asked this, you know, by students who are getting prepared for entry level or licensees when I talk all over the place, the best advice I have is to slow down. and complete a thorough assessment on every patient. I think that there's so many people out there and they're making assumptions before they really consider what the patient needs. So once you do that assessment and we listen to the patient's concerns and we diagnose what's appropriate for them, I think that's really the first step in choosing the best products. The other side of that, this huge movement toward the concept of personalized medicine that is out there in healthcare today. I think that we learned that way back in school. We all learned that we need to listen to our patients and get out in the real world and choose what's best for them. But I think getting out there and exposing yourself to what armamentarium is available. And so understanding as clinicians that what we might just necessarily arbitrarily put out on our tray. might not be what's best for every patient. And so we have to do our best to educate ourselves. And that education is ongoing. And so getting out to these trade shows and picking things up and getting them in your hands. I think sometimes the manufacturers, when I walk around at trade shows, will just like look at me like, oh gosh, there she is again. Because I am not afraid to walk up to a booth and be like, hey, I'm Emily Boge. What is new? What is new at your company? What can you show me that is different that I haven't seen before? And I go to a lot of trade shows. So sometimes I might ask the same. people over and over again when it's new, but getting out there and getting excited. And I think that's also what is preventing the burnout. And so there's all kinds of things that we can do to ensure that the products we choose are safe and effective, but making sure that we have the assessments done to choose what's right for the patient and couple that with making sure that the companies that are manufacturing things have an evidence base behind them. So it's not just like... at the factory came up with this idea, but, you know, did they listen to a clinician? Did they do their due diligence with product development and make sure that they worked out all the kinks before they just came out with it? So having the evidence-based is so important. No question. Evidence-based is important. But I also, when I practiced endodontics back in the day in Philadelphia and new products came out, like a rotary handpiece was relatively new. It was a reciprocating handpiece. It was a... new concept of doing instrumentation, taking it away from the manual tediousness of hand files into more mechanical files. I asked KOLs, key opinion leaders that were speaking in those days, and I happen to have good relationships with some of them even back in the day. And they gave me their opinion and said, well, this company is spending tons of money advertising it. So it's got a big hype, but there's an issue with the product. This company is a smaller company. They don't have the budget for huge advertising. But try this. This is really, really good. So it's not always the bigger is better. And you see these things in, I used to say the magazines. Now it's not, the magazines are not really the big thing anymore. Internet is really where a lot of the products are being advertised and marketed and so forth. But do you find that's really the case where your colleagues, your cohort? Absolutely. I get so frustrated. when people are telling me that they've been using the same products for decades and they haven't looked at anything else. Because first of all, that tells me they're not getting out there to see what the new science is uncovering. But secondly, this feeling that sometimes we get in dentistry that one company can make the very best of everything. And just because one company might have more money, like you put it, than another company doesn't mean that this little tiny company can't make things that are really, really good. And I've found that as I've been working in the instrumentation design sector, that, you know, one company doesn't make the best of everything. They might make something that you really, really like, but once you get out there and you get new things in your hands, you're going to find they might be the little guy on the block, but their stuff is really, really cool and it's really high quality. And so you have to... That brand recognition, yes, it's important to a certain extent, but it's not the only thing you should be looking at. And when you go to continuing educational lectures, you hear some of the speakers talk about their different techniques they're using to do whatever they're doing in, let's say, indirect dentistry, CAD CAM, and they have this one little tool that they use or one little device or one little, you know, great little product that they use that saves them five minutes every time. And, you know, then you can try it. See if it works for you. And it's a process. It's really a process. My ministry isn't one size fits all. That's what also frustrates me. So those people who are listening to this and they know me, they know I'm not a small human. I mean, I'm 6'1". I'm big framed. When I started hygiene, I was entering into a world of hygiene where I really think that they thought everyone was between 5'3 and 5'6 and weighed 100 pounds. And it just isn't the case. And so what feels good in my hand might not feel good in some of my more petite friends' hands. And so recognizing that if you keep looking, there's someone out there that's going to make something that's going to feel good for you. And if there's not, then talk to somebody because they're going to be super excited to develop it for you. Yeah, or do what you did. If it wasn't out there, you went ahead and designed it and built it and sold it to the instrument companies with patents, which is very, very exciting. So in dentistry specifically, specifically the dental hygiene world, we all know how important it is to do whatever we can to remove the biofilm. We hear about biofilm all the time. We got to get rid of it. It's got to come off the teeth. That's the goal, at least in the beginning. And part of that process is not only focus on good technique, but also to utilize products and materials that are clinically effective and will help us achieve our goals of removing that biofilm. So the question is, what should we be thinking about? when deciding what products are best for our patients when it comes to the removal of biofilm. So I know that I just stated that there are so many things that can't be standardized when it comes to patient care. And I just said that you should customize your care to the patient. But I'm going to contradict myself just this once. There's certain products that clinicians can standardize. And I think that one of them in the dental hygiene chair is the prophy angle you use. Now, I'm not saying you should start with one prophy angle and use it for your whole career. What I'm saying here is that there's a lot of science being put into the design and the manufacturing of prophy angles now. And I recently found one from Premier. And it's a disposable latex-free profi angle, but it articulates. So it makes movements kind of like your wrist and your fingers would as you polish. It's called the ProFlare. And so it's really compact in profile and much more compact than a traditional angle. I don't remember the percentages of how much smaller it is offhand, but it pivots from side to side. So in addition to flaring out, like we've been seeing the profi angles. able to do for the last couple of decades, it flares and it pivots to fit the shape of the tooth. And so all of these actions together, they decrease the ergonomic stress that the clinician feels because the clinician is not having to. make all those smaller movements with their hand because the prophy cup is doing it for them. And so it minimizes a lot of the unnecessary flexion and extension of the wrists and fingers. And a couple of weeks ago, I just had hand surgery. And so, yeah, I appreciate things like that. We know, you mentioned biofilm. Biofilm is encapsulated. And I lecture a lot on that. And I think that knowledge has been around a long time. But to really wrap your brain around that concept that those really bad guy germs are encapsulated in that protective slimy matrix. So what this angle does is it seeks to disrupt that matrix and get inside and remove the biofilm. And it's done through a few different ways. But when a prophy cup has those extra cuts. or those extra grooves on both the outside and the inside, it does a couple different things. First of all, it retains the prophy paste inside the cup itself, and it helps to reduce splatter and the motion and the way that the prophy paste flows away from the cup. But secondly, those little ridges help to dig inside that slimy matrix and really work to mechanically work its way off. Working to make when you can standardize processes, like such as the cup that you take out and you use for every single patient for their appointment, it does make us more efficient. It makes us more effective. That's one supply decision that does become a little bit easier when you're talking about, yes, I want to provide personalized, customized patient care, but I want to be able to take one thing out of my drawer for my setups that I can just have out and know it's reliable and know it's effective and know it's back by science. Yeah. Now you did mention better ergonomics with the design of that. And that's an example of a product that was developed so that the operator would require less wrist motion. So the decrease in wrist motion is actually a benefit to the actual operator. So when we were talking about products that are safe and effective for our patients, what are your thoughts about also taking in consideration the ergonomic factor of those products for the actual? user, which is the hygienist, because we certainly want to extend their careers as long as we can. So how does each one play into each other when selecting a good product? As providers, we know we're in the service industry. We know we're thinking about our patients, putting our patients first every time, but also we need to think about ourselves. And that's an interesting balance at the school that I see. I tell the students, you don't want to injure yourself or give yourself... some type of musculoskeletal disorder before you have the ability to even practice and so we are going to do everything at the school that we can to put the right tools in your hands we're going to give you ergonomic wrist fitted gloves we are going to use ergonomic instruments we're going to teach you about sharpen free technology we're going to put you in the right saddle chair so you're not hunched over we're going to give you loops in a headlamp so this is just another one of those considerations because when you look at ergonomics it's all about layering those ergonomics tools to decrease your risk factor. I always think about it as a stack of books and learning. The more books I put on my stack, the smarter I get. The more interventions I can provide myself. As a taller person, I bought myself a saddle chair. The cylinder wasn't long enough. I called the company. I said, can you get me an extended cylinder? Absolutely. We'll send you one out. I got myself an ergonomic chair that was tall enough for myself. And as the more innovative loops and headlamps have been coming out, I've been improving those as I'm able. And, you know, nobody likes to say it, but as my old eyes get older, I've had to increase my magnification too. But yes, we always want to put our patients first. I'm not saying that by any means, but, you know, we got to put ourselves first too, especially in the economy we're in, where we're all going to have to be working a little bit later in life, or hopefully we have the ability to. Yeah. So when it comes to prophy procedure, how much risk? motion is someone using with a regular profi cup, just the run of the mill profi cup that they buy in bulk versus this pro flare where it has that articulating cup. Is it something that's significant and worth looking into? I think it's significant. I couldn't apply a percentage to it off my head, but it is significant. And the other thing to remember is having a light cordless profi system. is also really important so if you can if you have the ability or you can afford the technology to go cordless that that cord drag and all of that should be factored in as well but if you only have the ability um in your practice to change one thing changing that disposable cup yeah you might you might spend a few extra cents on it per patient but you're going to save yourself time you're going to save yourself ergonomic strain you're going to be more efficient and the other really cool thing about Um, this profi angle, I was just referring to that pro flare, it is more compact. So if you think as you're polishing along, you want to get, make sure you're getting every surface, all the stain, make your patient happy. It's smaller. So you're not having to contort your body to be able to get the tongue out of the way to fit something that's even larger in a smaller space. So when you think, you know, I'm polishing the distal of number 31. It's going to be smaller. It's going to get back there easier. And when you think that's not such a significant difference in the short term, you add that up for all the patients you see all day, all week, all year. That's when you're going to get that ergonomic kickback or benefit. You're going to decrease your risk on a more consistent basis. Yeah. And I do want to tell the audience that. Emily did not invent this product. It's not one of her patents. She does have a bunch of patents, but they're on instruments. And I asked her before the podcast because I wanted to know whether there was a connection financially. ProFlare, but there's not. So she's actually giving us advice on products that are beneficial to the patient on biofilm removal and also beneficial to the operator in the ergonomic way. So let me ask you this, Emily, with your experience, what's the best way to collaborate amongst the entire dental team so that everybody's on the same page with the kind of products that should be used in that practice? I really think that has to start at the top down. Meaning that the leadership can't just say, okay, guys, we're going to collaborate on this decision. They have to believe it. They have to live and breathe that communication. And I've seen it work really well, and I've seen it work not so well. Because if you're going to walk the walk, or you're going to talk the talk, you got to walk the walk. And I was very fortunate to start out in private practice for 12 years with a dental group that was phenomenal at that. Getting on the same page, having consistency. We had seven hygienists and four dentists. And it was very, very important because you might not see the same hygienist every time. You might not see the dentist every time. And if one person's telling you one thing and another person's telling you another thing, you're not going to have very much confidence and trust in those who are providing your care. And so in my experience, in both private practice and academia, the best outcomes stem from good communication. And so a lot of offices see a really high number of patients, let's say, with. enamel caries or incipient lesions or watch areas or whatever you want to call them. If I was a clinician at an office that didn't have a caries assessment and risk program and didn't have one established, didn't have any system established for remineralization, I would approach my leader and I would say, we need to devise this. I want to make up a team that includes one of the dentists, one of the hygienists, one of the assistants, one of the people from the front office team. Then I would make sure that All the symptoms and the assessments and all of that was considered. So when we talk to a patient that might need, I don't know, some kind of product like enamel on, some kind of protective treatment gel to restrengthen any of these watch areas, everybody would be on the same page. Everyone would know which products we offer in office for dispensing or what we plan on using for prescriptions per patient. I'm not saying use the same thing for everybody, but I'm saying it doesn't make sense to have inconsistency in the practice. And oftentimes, in addition to... know, when you're recommending something for one problem, like I gave the example remineralization, it's going to help them with many other things. And it's important for the whole team to understand all the benefits of this product. And so if the patient comes in an emergency on a Friday when one doctor is on vacation and the other one. can see this patient that has the emergency and they see that the patient is taking that on the chart, they're going to be like, oh yeah, that's what we all talked about, that we all valued. And you can have your autonomy as a clinician and use the products that you individually believe in. But I really believe that everyone from the front desk, pardon me, front office team member, to the dental hygienist, to the assistants, to the doctor, everybody, that message needs to be consistent. Because ultimately, if we all have the same mission and the same end goal for the patient, we need to show them that we're all willing to do the homework that we need to do to get on the same page. Yeah. And that collaboration is established, I guess, with weekly meetings or a monthly meeting. So it's more maintaining consistency in the culture and the ideology of the office as far as whether it's a preventative office, heavy in prevention. Is it very heavy in the oral systemic link as far as overall health for the patient? Is it tooth dentistry where it's emergency dentistry where they just treat people where they're coming in and most of these patients never come back? So the whole culture of the office has to be established. And then from there, you then establish what products are best to fulfill that culture. Does that make sense? And I feel like, oh, absolutely. We're thinking on the same level. I think another integral part of that is, like you said, having those meetings. I was talking to a dentist once at a trade show. And he was telling me about how he couldn't afford to have team meetings. He couldn't afford to have monthly team meetings. And he didn't understand how people could integrate that because he couldn't afford to pay his team for an extra hour. And I said, how can you not? I said the name of the game that we're in is trust. If our patients don't trust us, then what do we got, right? They're going to go to the guy down the street if they don't trust us. And so part of building that trust is being cohesive and being on the same page where I would rather have, I don't want to say a disagreement, but a difference in opinion with a supervising dentist that I have. I would rather have that in a team meeting. where we can talk it out and we can have all the providers together to give input then ahead of a patient where the doctor brings up something that maybe philosophically i don't necessarily agree with as a hygienist then all of a sudden we have a patient in the middle and are we going to have this conversation now or i mean if it's something wackadoodle like i don't i shouldn't give any examples of wackadoodle but like i had a patient once that wanted to mix bleach and baking soda and brush their teeth with it and And it was one of those things where fortunately the dentist and I looked at each other like, what in the sand heck is this person thinking? But if it wouldn't have, if it would have been something that philosophically the dentist was like, oh, that sounds like a great idea. I would have been like, what? Yeah, that sounds like one of those COVID cures during COVID using bleach. Yeah, crazy time. But no, so there has to be, obviously, everybody needs to be on the same page. And I think it's important when a dentist comes in as an associate or a hygienist is about to be hired for a new job at a new practice to make sure that you're in tune with the way that. Practice runs their operation. Dentistry is a business, so cost effectiveness is certainly a consideration. But if the office only buys on price, and that's their major priority is price, price, price, they'll tell you, Emily, we just can't buy that right now. We have a volume practice. And if we buy that product, that premium product, we'll just not make any money here. So it's important for someone looking for a job to understand that culture before they... accept the position. And considering it's an employee's market right now, I think it's important that the hygienist is selective in which practice he or she decides to work in. Oh, yeah. It's an employee's market. Oh, for sure. I used to get maybe one job advertisement sent to my email at the college every, I don't know, every couple of weeks. It's not unusual for me to get three or four a day now. Right. And I run an alumni page that does free advertisements in our area. And it's sad. I can't graduate people fast enough to fill the need. And so I tell people, if you're not in an office where your practice philosophy matches the owner or the provider, because in a lot of states, the owner is not the provider anymore. The provider is not the owneremil anymore. If that doesn't match, find somewhere where that matches. If you can't find somebody that matches, temp so you can. Because right now we're in a situation where we have the- Upper hand, upper hand for sure. And we have the ability to do that. When I graduated 25 years ago, that was not the case. Right. COVID had a lot to do with that. Right. Because the aerosol scare and hygienists started to think, do I want to take a job where I'm on the front line of pandemics and more of them are coming down the road? And the attrition rate of hygiene school could be upwards of 20%. Oh, yeah. Right, right. So there's definitely, it's an employee market right now. And my recommendation is pick and choose, find out the culture of the office before you take the job. Just like Emily said, look for a group that's looking to understand what's safe for the patient, what's best for the patient. Also ergonomic for you because your career matters as far as how long you're going to work. And products are out there. ProFlare is an example of it from Premier. And there are many others that are out there that fit into the hygiene world where you can use products that are effective for that. ultimate goal of removing that biofilm that you just talked about, Emily, which is so important and which is, of course, a world health problem. There's no question. It's the most rampant disease. The most common infection in the world is caries by far. Thank you so much, Emily. You've been a great person to interview. We certainly want to have you again on the show. And thank you so much. We learned a lot. My pleasure. Thanks for having me. So nice to meet you guys. Yeah, absolutely. Thank you very much.