556 The Endoscope: Seeing What We've Been Missing in Dental Hygiene

0:00A special thank you to our sponsors for supporting the show. As a dental hygienist, your focus should be on patient care. Not tracking down supplies. Net32 makes it easy to find the products your practice needs, compare options, and order with confidence. Less time managing supplies means more time focused on patients. Net32, the smarter way to buy dental supplies. Visit net32.com-rdh. The biggest surprise I would say to me was learning that our probing... I mean, people don't like to hear this, but our probing depths often are inaccurate. And I show this when I lecture and teach, you know, we can be probing right on top of calculus. So it's not just a calculus removal, calculus detection device. It's also really a powerful diagnostic tool for dental work. And really treating things earlier, earlier the better.

1:03You know, then they don't end up in a route now or, you know, bigger issues. The beauty of a dental indiscopus that for my profession, for our profession, we can now regenerate bone around hopeless teeth. We can actually give patients hope where there was no hope before. Where they're facing full mouth extractions. I routinely treat patients facing full mouth extractions. I tell you to hygienist. For me, everything we do on this podcast comes back to one thing. That's patient, that's the patient in your chair. Every conversation, every lesson, every perspective we're bringing you exists to make sure that you're more confident, more informed, and more, more of a compassionate hygienist. So welcome back to a tale to hygienist podcasts. I am your co-host Dave, and I'm here with my amazing co-host Jessica.

2:05And I am so excited to be talking to your amazing guests today. So just tell us more about her. I am really excited to talk to Judy Carroll. Judy Carroll is a registered dental hygienist and the founder and clinical director of Pariopeak Innovations, which is a private period on therapy practice in Washington state. That's awesome. She provides regenerative, parodontal endoscopy and holistic parodontal therapy and medicine. Judy attracts patients from all over the world due to her consistently remarkable clinical results and her comprehensive approach to patient care. Judy is a clinical pioneer, patient advocate, national lecturer, writer, and private clinical instructor. Her 36 years of clinical experience has fueled her determined pursuit of a more comprehensive and preventative parodontal therapy methodology, as well as her strong emphasis on integrative care. Her mission is to teach and train others to routinely provide

3:09regenerative and holistic parodontal therapy. Judy, thank you for being with us today. Thank you Jessica. Hi Dave. It's so happy to learn from you. And I just recently had a colleague ask me, what is endoscopy? Is that some kind of laser? Like what is endoscopy? So what is parodontal endoscopy? And how does it work, Judy? So it's a miniature fiber optic camera about the size of your probe. That you can basically just think about your probe and it has a little camera on the end of it and it's got a bright light that you can place into the sulcus or the pocket and look around and see the roots and look at all the crown margins and fillings and anything that you need to see beneath the gums beneath the surface. So it's x-ray vision. Well it's better than x-ray vision because you're getting that 3D view of around the root surface, you know like I said, of crown margins, fillings,

4:10forcations, root depressions, all that kind of thing. So you're basically, you've got a high magnification, at least 48x magnification. Some of the new endoscopes I think up to 100x magnification and you've got a bright light. So it's really like having a little microscope with a light on it on the end of your probe. It's the best way to describe it. So anywhere your probe will go, the camera can go. And the probe with eyeballs. Yeah. And those eyeballs are wearing loops. It's like loops and lights on your probe. That's amazing. I'm just imagining like a visual of my probe with eyeballs wearing loops. I'm really enjoying this. So how does it, like what does it do for you when as new instrument? Like how so you can you can you can actually see what calculus you've left behind and you can remove it visually. You know, with what I like to use a PAZO ultrasonic.

5:12So you can have your little probe under the gums, you know, your eyes under the gums with your endoscope and then your PAZO tip in there removing the calculus. So you're actually being guided by the endoscope when you do what we call visual route planning basically. It's kind of like visual route planning, right? I call it a complete detoxification of the root. So it's just at a much higher level of a detoxification of the root basically. So that you're able to achieve much better results non-surgically. But also you can, you know, like I said, you can see crown large into K, root fractures, root decay, all sorts of things. There's just all sorts of things that we're not seeing on the x-rays. And the biggest surprise I would say to me was learning that our probing, I mean, people don't like to hear this, but our probing depths often are inaccurate. And I show this when I lecture and teach, you know, we can be probing right on top of calculus.

6:14Your periodontist can probe right on top of calculus. Or let's say you're probing a vacation and it's filled with calculus. Well, you might probe that as a seven. You might probe a, you know, the sulcus as a two and it's actually a seven. You know, I show pictures of all this in my lectures. And I think that was the biggest surprise for me was to not only find out that the probing was inaccurate in a lot of cases. It's pretty routine. But also that we are missing a lot of decay on our x-rays, you know, especially crown margin decay. But even, you know, I can even see inner proximal decay or root decay, things like that that just don't show up on the x-rays. So that was a big surprise for me initially to find out that we're very limited. We have very limited diagnostics, right currently, right? The probe has been around for over 100 years. Basically hasn't changed that much. And we rely on that for our, you know, very heavily for diagnosing our patients for disease and pocket death

7:18and all that sort of thing. And the endoscope is just a much better tool. So I tell my patients, you know, when they come to see me, I'm guided by the endoscope and then I get the real, the real picture of what's going on. Because really nothing can hide from my endoscope. So you're still using the x-rays to guide you, you know, you kind of put everything together. You're looking at tissue, you're reading the tissue, that sort of thing. But it's just adding another tool. It's just taking you up to a higher level. And a higher level of understanding as well as, you know, is why there's an 8-millimeter pocket. Okay, why is there an 8-millimeter pocket? Well, now you're as a dental hygienist, you're able to go in there and figure out why. Whereas before we had to refer those patients out to, you know, have the period on us, either flap that open or, you know, do osteosirgery or whatever they're going to do. And so so much more of this can now be kept in a dental hygienist's hands. And that's really where it should be. You know, we should be, it's just a more preventative higher level of care.

8:21If we can keep, you know, most of our patients in-house and provide comprehensive parodont therapy, then when we need the period on us to do things like grafting or extractions, implants, bone grafts, those sorts of things that can focus more on that. But as far as parodontal therapy, this is very comprehensive, very comprehensive approach to use in Endoscope. But, you know, even just in regular general practice, let's say you're doing traditional root planning. Let's say you just got maybe five or six-millimeter pockets. Well, you're going to do a better job, you know, you're just going to do a better job. And here's one thing that people don't think about. I think a lot of the doctors and even the hygienist think of the Endoscope as a just a calculus detecting tool. When in maintenance, let's say you're doing dental hygiene, your regular day and the patient comes in, there's some bleeding around number 14, Meeziell, you can actually just pick up the Endoscope and look in there, you know. You can use this to diagnose things

9:22right there, chair sides, and then the dentist can look at it and say, yeah, we need to do, you know, there's crown margin decay there, or whatever it is that's causing that bleeding. And you can treatment plan the patient right there, you know. You like I said, stuff doesn't show up on your X-rays. You can pinpoint it with your Endoscope, show the patient, and then get them in for the needed treatment. So it's not just a calculus removal, calculus detection device, it's also really a powerful diagnostic tool for dental work and really treating things earlier, earlier the better, you know, then they don't end up in a root canal or, you know, bigger issues. Well, my brain's about to explode because I want to go ahead and zoom in, that will tap to zoom in into the conversation, because I've never seen one I have an experienced one, and I'm so happy to be talking to you. And I'm sure that there's listeners out there who's like,

10:24wait a minute, wait a minute, is this, is this like essentially shrinking ourselves down into the pocket of the gums and then being able to see everything more so than ever? Is this something that as we're scaling, we are using as well? Because also, forgive me, because again, I just feel so unlocked right now, things like claims, right? Like insurance claims, how can, how can you show a photo or video about using this amazing tool and explain to them why the pocket is there? That the necessarily the measurements are not as accurate as much as what this tool is able to show. Can you show me a little bit more paint the picture of exactly what it is for somebody who's never used it? Because now I'm jealous that, you know how we've got that feeling that as Hygienez, we left the piece of calculus because we took a checkup X-ray and we just immediately feel like, I thought I got it all. And now you're telling me that we don't even have to do all that,

11:26that we actually have a tool that we do. And you know, it's, you know, I just want to say we're all doing the best we can with what we have, right? And you don't know what you don't know. And that, when I don't see what you don't see, when I picked up an Endoscope 26 years ago, and it was just shocked. It was like, you know, it's, it's an incredible learning curve, but it's so, I was going to say, I think one of the things that holds people back is that learning curve. Tell us a little bit about that too. You know, it's so much fun, you guys. This is, I've been doing this for going on 26 years, and I'm still having a blast. Okay, I've treated thousands of severe cases. And I am still having fun. This is really the most fun that dental hygienists can have. Being able to profoundly impact your patient's health. So again, let's go back to your tools. What's in your toolbox for diagnosing and treating and providing parodontal therapy? You've got your

12:26x-rays, you got your probe, you know, you've got your eyes on with your loops and looking at the tissue, reading the tissue, right? This is just a, this tool will just take you to a whole another level that you can't even imagine. You just can't even imagine it. And you really, you really have to see it in action, Dave, to really get a full appreciation of what's going on. Not just a video of somebody posting on Facebook or something. Really get it in your hands and or stand over someone's shoulder. And by the way, always, my door is always open for anyone that wants to shadow me anytime. I'll put you to work and you can do my parodontal charting for me. Being able to see on a big bright color monitor, a sub-genjually, let's say you're in a 12-millimeter pocket, I routinely treat 12 to 16-millimeter pockets, which blows my mind, right? Because our policy is after six, we refer. Yeah. So you don't, so there's no cutting. I'm just slipping that

13:29little micro camera down into that 16-millimeter pocket. And then I'm guided visually on a screen, a beautiful color screen that's magnified. You've got at least 48x magnification with a bright light. And currently we've got water coming in. There's water coming out of the end of it to flush, flush the blood out of the way and the granulomites is tissue. And completely thoroughly detoxify that root surface in that whatever pocket depth, it doesn't matter what it is. You don't really have a lot of limitations. So if you can remove all the calculus in these advanced vacations and these vertical bony defects everywhere, which I treat every week, you guys, if you can do that, your patient, and it goes back to the research, look at the early research, your patient won't need to have flat surgery or osteosurgery. So if you can eliminate most of the surgery, I call this a first phase treatment approach over traditional root planning. So normally

14:33our first phase treatment approach is root planning. This is just a higher level of that. So I call it a first phase. This is the first phase, Mrs. Jones, then we're going to have you see a peridonist in six months or a year depending on the case and what their needs are and reevaluate things. And then the peridonist will take it to the next level from there. That's basically the order of things. Okay. Meanwhile, I'm correcting all the risk factors, airway stuff, deficiencies, blood sugar, all that kind of things, smoking, diet, on and on. So I'm very comprehensive in treating all the risk factors. But the beauty of a dental endoscope is that for my profession, for our profession, we can now regenerate bone around hopeless teeth. We can actually give patients hope where there was no hope before where they were facing full mouth extractions. I routinely treat patients facing full mouth extractions, which is really back in 2000, what got me down this road was watching a 27 year old in my periosefacialty practice have all his teeth extracted.

15:40And he had these gorgeous teeth, not a single cavity, but he had severe rapidly progressive periote. All his teeth were taken out that day and I just said to myself, that's it. I'm either I'm going to leave. I'm I was so done because you feel so helpless as a dental hygienist in periopractus. You know, you've got n-stache disease, you're looking at it all day long, you're assisting in surgery, you're removing sutures. There's piles of extracted teeth. Okay. And I just said, you know, there's got to be a better way. And that year, because I was in the right place at the right time, my periodontist was given the first generation dental endoscope. It was actually a prototype. And he gave it to me as a gift and he said, here, do something with this, you know, create a protocol. So long story short, 26 years later, I'm still very excited about this technology. I have been able to really push the envelope on in what's possible by treating these very severe cases worldwide

16:47and being able to follow their progress for decades now, really. And that's how you learn, that's how you learn what's possible. And, you know, the patients save a lot of money. You will, you get to be the hero you guys. I mean, the dental hygienist can help patients that can't afford extractions and implants and crowns and all this stuff that, you know, bone grafts. I can, you know, it's expensive. Not everybody has that kind of money. And by the way, the research doesn't support it. This is, you know, I demonstrate this in my lectures that the research doesn't support extracting teeth and placing implants over non-surgical peridontal therapy long term. It doesn't, you know, read some of the latest research on that by some of the best peridontal researchers. We need to come back to comprehensive peridontal therapy. And this is where the hygienist shines. This is where my profession shines, right? We're the ones that go to school to learn how to detoxify

17:49that root, to get the calculus off, to read the tissue, to read the x-rays to really provide comprehensive peridontal therapy. This is our specialty. And the endoscope makes so many things possible that were never possible before. Just by using this tiny little micro camera in those deep pockets around those crown margins, inter-proximal areas, vacations, like I said, flutings, all this kind of stuff. And you can treat patients with class two and three mobility even. I mean, I don't really have a lot of limitations. I really don't. So, Judy, why is this not in every office? Okay, that's a good question. I'm listening to you, like, talk about this, like, this feels like the Disney land of dental hygiene. Like, I will tell you, the here's the reasons, well, first of all insurance, right? You know, if something's not covered by insurance, there's going to be some hesitation there. So is there an extra cost? So, yes, there's an extra cost. Currently,

18:55there's an extra cost. That is going to change in the near future. There's a new endoscope coming very soon. It's in certification right now. And this is so exciting, you guys. This new endoscope is going to be very competitively priced. It's going to be a lot lower for hygienists even by. Okay, because they know who their market is. Yeah, they know who their market is. So, they're going to market this to dental hygienists, just like if you have, you know, your ergonomic loops, that kind of thing. Hygienists typically buy their own tools when it comes to loops, right? So, if a hygienist can get this very small endoscope and there's no cost to use it. So, he or she is just picking it up. It's right there on her counter, his counter, and you're picking it up and using it. The hurdle right now is that the current endoscope and the ones past, you know, we're on our fourth company right now. The fifth one is yet to emerge. You know, it's not in the marketplace yet. But we're on our fourth company right now. And the endoscope

19:58costs just keeps going up. The cost to use it. It's at least a hundred bucks every time you pick it up. So, these are hurdles that need to be overcome. I could go on and on about the hurdles other than... Well, because I'm thinking I'm like, this sounds like a no-brainer, but now that I'm hearing that it's an extra cost to the patient, there's an extra cost to the clinician, the office. So, I'm hearing that cost is a barrier. Are there any other barriers that are keeping you training education? Training and ongoing education are a barrier. So, here's we need more robust education. We need... You know, I shared all this information with the new company. We need not only better clinical training, more robust clinical training for at least two days for that clinician, but then we need follow-up training and also an online forum where these professionals that have been trained can go in and continue to grow. Robust education, because this isn't like using

21:00just loops, you guys. This is one of the hardest things probably there is to learn. And to... You have to keep it in your non-dominant hand while you're simultaneously instrumenting with your dominant hand. And so, there's... Think of it as your mirror in your non-dominant hand. So, you replace your mirror with your endoscope and you actually, with a little bit of practice, get very good at that in a very short period of time. I don't know how hard it was for me to do an indirect vision with my mirror. I think what people struggle with. I think what people struggle most with is image interpretation and inefficiency. And those are things that I teach very well. I really focus on those things where, you know, I want every person I teach to just master this. I want them to be not only skilled with an endoscope, I want them to be become a master parodontal therapist. You know, I want them to be a great clinician,

22:02not just use an endoscope to remove calculus. Well, with that endoscope, it is giving you that feedback that so often we don't have, unless like Dave said earlier, you're taking that next set of radiographs at their next appointment and you go, oh, I thought I got you. Thank you for breaking that up, Jessica, because every time you pick up the endoscope, you grow. It's exponential. And then, okay, so after you use that endoscope on Mary last week, now you're seeing this other patient today. And you know, after treating Mary last week, you've got a whole another comprehension, if you will, acute awareness that you didn't have before you treated Mary's case. And now that goes forward to this person in your chair and you're going, aha, I remember that. That's probably what's going on here. You know what I mean? So the endoscope is actually your greatest teacher. It's the greatest teacher you've ever had. Do you remember in dental hygiene school when the teacher, the instructor would come over and check your work with the explorer?

23:06And I was so frustrated, I complained constantly to my instructors. I think I drove them crazy because I couldn't feel anything with the explorer. Then they would come over and they would feel around and fish around in the pocket and they would find something. And you know, now in the schools, let's just pretend you've got endoscopes in every school. You know, I mean, you have no idea how fast this turns you into a masterful clinician in a very short time, actually. Is the unit large? Is it something that I could have just on my bracket tray? Like, is it something that would be easy for me to implement? Or is this maybe another hurdle? The current endoscope is large. And the one that I'm using is large and I don't like that. And we all don't like it. So the next generation endoscope is one that you will be able to put on your tray or your counter. It's not going to have a bunch of, you're not going to have to hook into water. It's not going to have all

24:08of those things that the current endoscope has. It's just a whole new technology. I don't want to go into great detail, but I will tell you that it only has one explorer for the entire mouth. So you're not going to be putting, you know, using four explorers like we currently do, which is time consuming, taking the camera out, putting it in a new explorer. The explorer is what helps you get around, say the measiel of the buckle. Then you've got one for distal. You've got one for palette. You know, that kind of thing. Now you're going to have one explorer. You're going to have an endoscope that's small and portable. So let's say it's needed in another room. Let's say you only have one. And maybe your hygienist in the, or the dentist, he wants to look at a crown margin real quick. They can come in and grab that. Or because it's going to be competitively priced, they'll be able to get more than one. Right now, what you've got is this great big thing on a cart, which is what I have. And the current endoscope that's being sold. I think they were

25:10pricing that their current endoscope is like $45,000. Now that's just, that's, that's cost prohibitive for a hygienist for me. It's cost prohibitive, prohibitive for me. So like I said, the next one is going to be smaller, portable. It's, it's designed with an entire team of engineers. Is it completely different design and way it's, it's crystal clear imaging. So I'm really excited about that because I don't, I really, I've been waiting and tromping at the bit that we get over these hurdles so that I can finally teach. Yeah. No, because, um, because I see this as standard of care. This will become standard of care, just like your loops in your lights are standard of care pretty much now, right? I mean, I don't know. Loops in that, that is standard of care. Have a loop. Yeah. Yeah. Um, go ahead and take away somebody's loops and come forward. There, there is going to start a riot. That's a good point, Dave, because you know, if someone

26:12takes away your endoscope, let's say you have to do traditional root planning after you've used an endoscope, you're going to be lost and you're not going to be happy. You do, once you can actually see, this is what I warn people when I teach them, I tell them there's no going back. Once you, once you can see what you're doing, it's, it's, it's very difficult to go back to, you know, blind, it is a blind approach. It's based on tactile, you know, and like I said, my instructor could feel calculus. I couldn't, you know, it's very subjective. My periodontist would call me and show me what I missed. He would call me at home to tell me what I missed on the distal of 13. And that's why I said to him, look, I, I am doing the best I can, but there's no such thing. It would be like a dentist trying to do a crown prep with a blindfold on. And there's not a periodontist in the world that can do blind root planning well. I'm sorry. It can't, yeah. I'm a vision being able to see is always better than yeah, not being able to see something that

27:16you are addressing. I mean, but there's, I just, I know that my own personal reasons of not using an endoscope. And I'm happy to hear that those things are being addressed and that there is the future of dental hygiene could be, could be looking very differently now because of the changes that are happening. It's going to look very different. You've got to put even further than that, because I imagine a patient looking at the things that you see as well. You know, it's like an intro photo, right? Like you, the patients are like, oh, I got a clean air of six one. They take a photo or like, mm-hmm. And they're like, oh, I have floss every single day and I brush like 900 times a day and you take a photo and you're like, yeah, are you? Yeah, thank you for bringing it. Exactly. That's what I meant to mention. Thank you for bringing that up. It is like having your intralural camera. It's this very similar. You'd be able to show the patient and you'd be able to do that right there. It's, you know, you don't have to go set some great big machine up. You see, you don't have to go get it out of the closet and bring it in and test it off. Yeah. But you'd be

28:19able to do it just like your intralural camera. And that's the way it should be. And this new one, you'll be able to put the image, the image will actually go into your monitor. You know, that'd be nice. Yeah. So I just see great things for for the dental hygiene profession. You guys, this is going to take our profession to such incredible level that we as a whole have never experienced. Now I've been doing this for a long, long time and I've been waiting and waiting and waiting because I'm chomping it to call myself, you know, many times over because I want all the dental hygiene as out there to feel like I feel every day. And to have, you know, to, it gives you, it empowers you, but you know, it empowers you, but it also gives the patient some results, some a tons of them there in your choice for treatment. So maybe Mary doesn't want to have five teeth extracted. Maybe it's, you know, if it's just periol and we can do bone regeneration

29:24as a dental hygienist with an endoscope, that's what I do. I specialize in regenerative procedures with regenerative proteins. And I've been doing that a long time and, you know, it's, it's a beautiful thing. There's a lot of research coming out now. And all the research is catching up with my protocol, finally. This is great to be indicated. And like, like an endoscope, I can see you being so excited about this because there's a lot of hygienists out there that are just feeding a little burnt out, not motivated. I got to tell you my enemy, my nemesis is these vacations, right? But being able to have a tool that takes me far beyond what I can see, show the patient, show my doctor and think critically to reassess and potentially save that tooth or two, or three. Can you imagine the psych, the psychological factors that we have or conversations,

30:25as you say, when we tell patients your teeth are hopeless, but being able to have a little bit of hope because we have this technology on our hands is worth trying, right? So I can see hygienists using these tools and saying, yes, all right, version 2.0 of micro-rear. Here's how we're going to level up, three, probably going to come through and see the patients and do the right things for them through our skills, through our experience. I love that. I love that day, that's excellent. And, you know, like I said earlier, not only treating those hopeless cases or even moderate to severe cases, but actually diagnosing and treating things really early on and just being at that highest level of preventative care possible, that's what this enables us to do. Just being able to see, isn't it interesting just being able to see what that does? And you know, dentists that use microscopes and don't just that use microscopes and dentists and even high genus, they understand that as well. You know, just being able to see, just change, it changes the

31:31game, you guys. And I really see the dental hygiene profession embracing this. I think it's going to take off like wildfire as soon as we get a more affordable, easier to use, by the way, this thing's going to be easier to use and teach, you know, less expensive, all of that good stuff, right? Now, if we get enough people doing it, then the insurance game will start to happen. You'll start to, you'll start to see insurance. By the way, if I love to teach, I love to lecture. So, I love to get invited to all over the country, if anybody wants to invite me to lecture, I love being invited. And I just want to extend the invitation for anyone that wants to come shadow me. My door is always open. Okay. Thank you so much, Judy. Thank you for helping us see what the possibilities can be for our profession. And we are so happy to have had you today. Thank you. I'm glad to be here. Thank you guys. Thank you, Judy. That's a wrap on today's episode of a tale of two high genus podcast.

32:32If this conversation made you feel seen, inspired or even just a little fired up, share it with a fellow high gemist or fellow dental professional, share it with your neighbors, your friends, share it with everyone. That is how this community grows. Make sure you subscribe, even to the review and connect with us on social media so that we can keep on going with this conversation. Remember, you career, your voice and your story matter here. We're David and Jessica. And until next time, keep learning, keep laughing and keep showing up for yourself and for each other. This has been a production of Endeavor Business Media, a division of Endeavor B2B.