Resolutions and realizing the importance of our teeth with Dr. Joy Poskozim

Summary:

This CareLab episode is hosted by Emilia Bourland and Dr. Brandy Archie, with guest Dr. Joy Poskozim, an experienced dentist specializing in geriatric care. They discuss the critical importance of oral hygiene for overall health, particularly for older adults and those in care settings. Topics range from the systemic impacts of poor oral health to practical caregiving solutions for maintaining dental hygiene in diverse settings. The dialogue emphasizes the connection between oral care and general health outcomes like diabetes, dementia, and systemic infections.

Key Takeaways:

• Oral Health Impacts Overall Health: Poor dental hygiene is linked to systemic issues like diabetes, heart disease, and even brain abscesses due to migratory oral bacteria.
• Gingivitis as Chronic Inflammation: Gingivitis, often overlooked, can strain the immune system and lead to serious health consequences if untreated.
• Challenges in Care Settings: Oral hygiene is frequently neglected in hospitals and nursing homes, leading to complications like aspiration pneumonia and failure to thrive.
• Innovative Care Techniques: Caregivers can simplify oral care by incorporating it into daily routines, such as brushing after meals while seated comfortably.
• The Need for Integration: Bridging the gap between medical and dental care through better training and hiring dental hygienists in hospitals could significantly improve patient outcomes.

Transcript:

 Emilia Bourland
Hello everyone, welcome to Care Lab.

Dr. Brandy Archie
Welcome to CareLab, it's CareLab Day. I'm so excited to be here with you both.

Emilia Bourland
Yes, very, very excited.

Dr. Joy Poskozim
Peace!

Emilia Bourland
We have with us here today a very, very exciting guest. We've wanted to have this type of guest on for a long time. I'm going to do a little quick introduction here for Dr. Joy Poskozm. Okay, so Dr. Joy Poskozm is the Dental Director for several nursing care facilities.

She educates staff as well as providing care to nursing home residents. She goes by Dr. Joy normally. She makes house calls in and around the Chicagoland area. And she's been in private practice for 25 years. She practices integrative health general dentistry at her office on the Northwest side of Chicago, has been performing dental procedures on the home bound for over 16 years. In 2017, she earned her dentistry and long-term care certificate from the University of the Pacific Dental School. Her fellowship with the Special Care Dental Association of Geriatric Counsel in 2018, and is certified as a dementia practitioner as of 2021. So you can see why we are super jazzed to have her on here. Dr. Joy, thank you so much for being on CareLab. We are delighted to have you.

Dr. Joy Poskozim
Thank you so much for having me. It's a pleasure.

Dr. Brandy Archie
We are.

Emilia Bourland
so I was, I was, I have so many questions. I was actually saying, yeah, we do. Okay. Let me start with the icebreaker. I, so many questions. All right. So it is the new year though. obviously sometimes people have resolutions, people don't have resolutions and I don't necessarily need to know what your resolutions are, but I would love to know from both of you.

Dr. Brandy Archie
I have so many questions.

Dr. Brandy Archie
But I know we had to start with the ice rigger.

Emilia Bourland
What are your feelings towards New Year's resolutions? Are these helpful? Are they stressful? Like, what do you think? How do you feel?

Dr. Joy Poskozim
So for me, I like to consider resolutions as goals, right? Things that we can strive for, things that we can do, obtain within reason, right? So for example, in my dental world, when I see patients at this time, and they don't always floss, right? That's a big deal, right? It really should be a four-letter word.

Dr. Brandy Archie
Mm-hmm.

Dr. Joy Poskozim
but it's not, it's five. But it's a matter of, okay, can we start with flossing on the weekends when we seem to have more time? Can we begin to think outside the box? Like for example, for me, I floss in the car on the way to and from work. I got one of those from the dollar store, one of those pre-strong flossers and there I am flossing away.

Dr. Brandy Archie
you

Emilia Bourland
Hahaha

Dr. Brandy Archie
Mm-hmm.

Dr. Brandy Archie
Can I just say that I do the exact same thing? And I'm so glad to hear I say that you do it.

Dr. Joy Poskozim
Yeah, that's awesome. Well, you know, we're women, can multitask, right? So yeah, I firmly believe that. But I bring it up to my male patients as well. But it's discovering ways in the new year for the new year to better ourselves, right? Because oral care is self care. And by taking our curves ourselves better through just little increments. Okay, so now I'm flossing on the weekends. Now I'm flossing on my commute. Okay, so maybe now you work from home.

Dr. Brandy Archie
That's right. That's right.

Dr. Brandy Archie
Mm-hmm.

Dr. Joy Poskozim
So, breakfast is not your first meal of the day. You have something maybe around, maybe around brunch time, right? Somewhere between 10 and one. Okay, fine, brush then. I'm cool with that. The whole purpose of brushing our teeth is to get rid of the crap that we don't swallow, right? So that our bacteria, oral bacteria don't get to it. So for me, resolutions is about implementing new things on a reasonable basis so that we can do better for ourselves throughout the year. That's me.

Emilia Bourland
That's a really good answer.

Dr. Joy Poskozim
Thanks.

Dr. Brandy Archie
It is. Nothing to follow up. I have nothing to say.

Emilia Bourland
Mic drop.

Dr. Joy Poskozim
It's all good.

Dr. Brandy Archie
I was gonna say something a little bit similar because I know sometimes New Year's stress people out and I've never been one to be like, because the calendar has changed to January 1, now it's time to start a new habit. To me, it's like if I recognize I'm doing something or not doing something that I wanna do, then I'm gonna just start then and just change it. I don't need to wait till a trigger. So I've never been one to set goals, I mean, or set like actual New Year's resolutions but I am going to co-op this thing that my husband has been doing for a long time, which is he sets an intention for the year, like a theme. 

And so like, if the theme is, I'm just making some up. Like if the theme is like self-care, let's say, then everything, every time he gets a chance to make a decision about something, he's like, this fit the theme? I'm trying to make sure that I'm focusing on self-care this year. And so, all the things that happen over the years, just like, I'm gonna keep the same theme. So he takes a real intentional effort at thinking about like, what does his life need over the next year? And then makes that the theme. And I was like, I've always admired that. So I'm gonna try to do that myself.

Dr. Joy Poskozim
love that. I'm gonna try to do that too. That's fantastic.

Emilia Bourland
Yes, so your husband stole mine. So that's kind of how I view it. I'm not like a big goal setter. I mean, I would say that I...

Dr. Brandy Archie
Yeah.

Dr. Brandy Archie
You're an OT who doesn't set goals. Are you telling me this?

Emilia Bourland
I mean, I was actually going to say, have I ever set a smart goal for myself as a New Year's resolution? Smart, dear listeners, being like specific, measurable, action-oriented. There's a timeline. Is it realistic? It's a smart goal. I don't do that for, and I actually do do that kind of thing in small increments. For example, like in business, I might.

Dr. Brandy Archie
You
What we do is set goals.
measurable.
Mm-hmm.
Yes, that's the smuggle.

Emilia Bourland
set myself that kind of goal to follow. But in terms of New Year's resolutions, I'm really kind of the same as your husband. I try to think of it more as an intention. I love the idea of the New Year as a fresh start and having a moment in time to reframe things and say, okay, whatever happened before is done, whether it was good or bad. have this choice right now to set a new intention and move forward in a way that's gonna create meaningful positive change. And so sometimes that my intention has been to make sure that I was being more present with my kids. Not trying to do work at the same time that I'm with my children. Maybe it's maintaining clear work-life boundaries. So saying like after this time, the phone's not gonna get picked up or whatever it is.

Or maybe it's something to do with, for example, what your husband saying, like, how am I going to take better care of my own health or wellness or something this year? But I think having something to your point frame the year around so that you know what your focus is. It's the same as having an organization or a practice. You have to know what your values are. 

You have to know what your focus is so that when you're making decisions, when all of these different choices are coming at you, you can say, does this choice align with what my focus and what my values are right now? Or does it not? And that makes it a lot easier, I think, to make healthy decisions that move you in the right direction. yeah, so same thing, intention.

Dr. Joy Poskozim
I love it. That's great.

Dr. Brandy Archie
Intention, yes.

Emilia Bourland
So I think that's a good segue though into what we're going to be talking about here. I just want to say that it has been my intention to have a dentist on CareLab right from the beginning because I love, as I was just telling Brandy before the episode, I love talking to dentists. It is one of my favorite things because you know so much about so many things. think.

Dentistry is really undervalued in our health care system. And like for me, both as a person, as well as an OT, the value of like good oral hygiene, it's just, it's so important in our overall health and wellness. Can you start by just talking about that? I realize that's like a big deal, but.

Dr. Joy Poskozim
You got it. No, and absolutely. So what is the purpose? I mean, when we're brushing our teeth, right? Let's just start from the very beginning. Let's just start with brass tacks here. When we're brushing our teeth, what are we brushing off?

Emilia Bourland
haha

Dr. Brandy Archie
Mm-hmm.

Dr. Brandy Archie
Black, food, bacteria.

Emilia Bourland
bacteria stuff.

Dr. Joy Poskozim
We'll start with plaque. And there are three ingredients to plaque.
Yeah, quiz. Yeah, three ingredients to plaque. So the three ingredients to plaque are bugs, poop, and food. Oral bacteria, bugs, oral bacteria, Poop, because they're living creatures too, they excrete. And excess food steps that don't get digested, right? I'll start with the poop, because when we have morning breath,

Emilia Bourland
I love this so much already. my gosh. I told you, I love talking. Neither do I, and I love talking to dentists.

Dr. Brandy Archie
I don't know what the three ingredients of plaque are.

Dr. Brandy Archie
Bugs? okay. Okay.

Dr. Brandy Archie
Mm-hmm.

Dr. Joy Poskozim
And you know, we can have the best oral hygiene in the world and we can still have morning breath. That morning breath is literally the coop that we're smelling. It's the bacteria. No, it's true.

Emilia Bourland
Hold on a second. If nothing else gets people to brush their teeth, if like, if you won't brush your teeth and floss after hearing that your mouth is full of poop, then I can't help you. No one can help you, right?

Dr. Joy Poskozim
sorry.

Dr. Brandy Archie
You

Dr. Joy Poskozim
Literally. Right? I can't, I can't. Yeah, exactly. I'm gonna just hang up my, hang up my, you know, my mirror and explorer right now. Just let them collect us. Yeah, don't worry. But yeah, so that's what we're smelling is the oral bacteria's poop.

Dr. Brandy Archie
Then no, you are a lost cause.

Emilia Bourland
You are a lost cause.

Emilia Bourland
Yeah, okay. Okay, I'm sorry. Continue poop.

Dr. Brandy Archie
You

Dr. Joy Poskozim
And then excess food stuff. So I think one of the reasons why the Paleo diet has gotten to be so popular is that because we're going back to basics when it comes to food and nutrition. But from a dental perspective, I love the Paleo diet. I can't maintain it, but I love the Paleo diet because our salivary enzymes have not kept up with our modern processed food diets, right?

Dr. Brandy Archie
Mm.

Dr. Joy Poskozim
So unfortunately, our salivary enzymes can't really break down or emolliate the foodstuffs that we're consuming, AKA, okay, I'll just mention the one that I love so much, pretzels. I'm addicted. It's my crack. So I love pretzels of any kind, doesn't matter. Insert name here, yes. But the problem is, is that it's processed, right? So the salivary enzymes have a really difficult time breaking all of it down.

Dr. Brandy Archie
Yes.

Dr. Joy Poskozim
and making sure that we're swallowing all of that. Okay, even if we're consuming it, if I'm consuming it as a snack, even worse, because I'm maybe drinking a little bit, but I'm not eating anything else with it that can bind to it for me to swallow. but the problem then is that, well, the oral bacteria will take over, right? So the oral bacteria, what is carbs broken down to? Sugar.

Dr. Brandy Archie
Mm.

Dr. Brandy Archie
sugar.

Dr. Joy Poskozim
So, and sugar bugs, right? I mean, you for kids, you know, we tell our kids, this is the reason why we're brushing your teeth. want to get rid of the sugar bugs, right? Well, one of the reasons why carbohydrates, they are great for an instant spurt of energy is because the carbs literally are starting to break down. Digestion starts in the mouth. So the carbs are broken down in the mouth and then the bacteria are like, woo hoo, brunch. And then, so they start eating that.

And if we're eating something sticky or chewy, like a Starburst or whatever, then that sticky stuff will stick to our teeth. And the oral bacteria are like, yay. But they're dumb too. So they're gonna eat that coating on our teeth, right, from that sugar. But then they'll also begin to permeate into the tooth saying, what's this? I'm gonna start eating this. And guess what that is? A cavity, right?

So a cavity is the bacterial invasion or bacterial infection of a tooth. So we're brushing off the stuff that are salivary enzymes that we cannot break down in our mouths to remove any source of food for our oral bacteria. And when we're brushing our teeth, it's really about staying ahead of that bacterial growth.
Right? As long as we're staying ahead of that bacterial growth, it's famine for them, not feast, famine for them, then we can maintain a very healthy environment in our mouths. And how we treat our mouths really affects the rest of our body and how we treat our bodies really affect the rest of us. So what really affects our mouths. 

So another thing that I can mention too, so that's the teeth part of it, gingivitis. Gingivitis is chronic inflammation.

Emilia Bourland
that we can maintain a very healthy environment in our mouths. And how we treat our mouths really affects the rest of our body and how

Dr. Joy Poskozim
And as we all know now, chronic inflammation wrecks havoc on our immune systems, right? The last thing I want my immune system fighting for is for my gums, right? I want my immune system fighting for my heart, lungs, and brain, right? My vital organs. So, and I tell this to my patients all the time, it's like, look, when we are brushing our teeth, we are literally preserving our immune system and keeping it strong so we can do the battles that we can't, we don't have access to, that we can't help support.

Dr. Brandy Archie
Mm-hmm.

Dr. Joy Poskozim
Right? And so chronic inflammation, really bad, chronic inflammatory diets, chronic inflammatory, you know, mouths, we don't need it, we don't want it. And we know the end results, diabetes, right? Unfortunately, one of the dementias, you know, these things we now know, and you know, this research has been defended several times over that by taking care of our mouths really does help improve that overall health of our bodies. How's that?

Dr. Brandy Archie
So that's awesome. And that only adds to more questions that I have. And I already started with questions. So one of the things you just said that stuck out to me was that brushing our teeth and oral care is prevention for our bodies and it's helpful for our, and then that's so valuable and important, but also do you think that that is the reason why dental care is separated out from like our health insurance and that it's underutilized? Like people are told all the time,

Dr. Joy Poskozim
Cheers!

Emilia Bourland
amazing. So good. Yes.

Dr. Brandy Archie
go see your primary care doctor, we start with primary care, then you go do everything else. And dental has felt like, and also you should probably go to the dentist twice a year. I don't feel like it's like a, this is a thing that you're supposed to do. And do you think it has to do with the fact that it's very preventative and that people don't always see the problems until later?

Dr. Joy Poskozim
Yes, yes to everything you said. And I was having this conversation yesterday as a matter of fact with one of my patients and it was really interesting. I think part of it too is our codes that we use. In medicine, they're diagnostic codes, right? For dentistry, they are procedural codes. Why? I think personal opinion is that because when I do a filling, which is a procedure that is a code, and I have now cured that tooth. The problem has been solved. This is not an ongoing thing. So when the codes first started coming out, they were marked or designated for an end result, for a procedure that has now been completed. A root canal, tooth fixed. Crown, tooth fixed. Denture, done, right?

You know, and there's different prices for different things and some things like dentures take more time than others, right? But I'm not coding every single time I see that patient for the next step of the denture. It is one code and it takes, you know, for some people it takes five appointments, for some people it three appointments depending on the type of denture, so on and so forth. But the bottom line is we code for each procedure we do, not for the diagnosis.

Emilia Bourland
It is.

Dr. Joy Poskozim
And I think that really does make a difference because diagnostically, you know, I can tell a patient that, you know, you've got chronic gingivitis and you probably, because you have diabetes, should probably be brushing three times a day to the point where the American Diabetes Association recommends that those living with diabetes should be seeing their dentist three times a year. But, you know, these are, you know, recommendations. These are suggestions.

These are not things where I can show on a, and literally they're not prescriptions. Well said, yes. And yeah. And so therefore, you know, you know, they, and when I hand them their invoice, shall we say, it's not diagnosis with a code to that. It is literally just the procedure. And that makes it just very almost like, you know, it's very business oriented versus health oriented.

Dr. Brandy Archie
They're not prescriptions.

Dr. Brandy Archie
Transactional. Yes.

Emilia Bourland
Mm-hmm.

Dr. Joy Poskozim
Exactly. You come in, I feel your tooth, you're gone. And I think there's so therefore that's one of the reasons why I think there's such a disconnect between medical and dental because we look at things differently. And I think that might even be ring true for, you know, for ophthalmology as well for vision, right? You come in, you've got problems with your eyesight, they fix the problem, you're, you know, you've got glasses, you're done. Versus medicine, where these people are living with chronic conditions,

Emilia Bourland
Mm-hmm.

Dr. Brandy Archie
Mm-hmm.

Dr. Brandy Archie
You're done.

Dr. Joy Poskozim
So they're coming in for different reasons and they're living with this problem. The only thing the general population globally are potentially living with is gingivitis. And it's very difficult for people to wrap their heads around that because very similar to diabetes, it's asymptomatic, right? It's not a problem until it becomes a problem. And what is a problem with gingivitis? Namely, a medical condition and there's still not that

Emilia Bourland
Mm-hmm.

Dr. Brandy Archie
Mm-hmm.

Dr. Joy Poskozim
strong enough bridge for people to really realize that that's why these podcasts are so important. But number two, it's a tooth loss, right? The gums get weak, they recede from the source of the gums, gums like a clean environment too, but they're also very patient. you know, this chronic condition can last for decades before there really is a problem. And then all of a sudden, the thinnest part of our jaws are the lower front teeth.

Emilia Bourland
Mm.

Dr. Joy Poskozim
So I see a ton of patients in my long-term care facilities with partial dentures that are hitting the lower front teeth because those are the teeth they lost first because those were the dirtiest teeth, they're flatter, they can collect more versus a curved surface like a molar, so on and so forth. So the problem, I think, is that thinking of gingivitis as a chronic inflammation that people are living with, it's gonna take a long time for people to really grasp that and also for the medical field to consider gingivitis to be serious enough for them to say, and now here's my order for you to go see your dentist.

Dr. Brandy Archie
Mm-hmm.

Emilia Bourland
So all of this, think, is mind blowing for me on two levels. One, just like the education that you delivered, a lot of which I didn't even necessarily know or think about those things, even though I've always been a strong advocate for oral care as part of overall health. That stuff is mind blowing. But then on the other hand, it blows my mind that we don't think about these things as so deeply connected. It's like your mouth isn't part of your body.

No, your mouth is the first part of your body where your food goes and your food is like essential to keeping you alive. Like all of this is so deeply connected. The... Yeah.

Dr. Joy Poskozim
And I'm going to cut you off really quickly because I, and I'm sorry for that, but I have to tell you, I'm the last person called when someone in one of the homes is beginning with, is beginning to have failure to thrive, right? They're beginning to lose weight. Okay, fine. You know, do the blood shocks, you know, they're, you know, whatever, but you know, they're no longer eating. Okay. So why? Number one, but number two, what kind of teeth do they have?

Emilia Bourland
Mmm.

Dr. Brandy Archie
Mm-hmm.

Dr. Brandy Archie
Maybe because our mouths taste like crap.

Emilia Bourland
Yeah.

Dr. Joy Poskozim
What are the quality of the teeth? And a problem that I see a lot is that when the nurses admit someone, they are not looking in the mouse. And another thing we need to focus on too is that there's a difference between an oral exam and a dental exam. A physician or in the medical field, they're gonna press that tongue down and they're gonna look straight in the back and they're gonna be taking a look in the oral pharyngeal area. Fantastic, that's great, the throat, awesome.

Emilia Bourland
Mm-hmm.

Dr. Joy Poskozim
I can do that too. I can screen for issues with the adenoids or whatever. for me, I'm gonna be looking at what are they eating with? Because this really is gonna affect their care plans. If they've got a partial denture and they're holding that thing in by one clasp and a ton of denture adhesive, you're right, absolutely. The food's gonna taste like crap because of all that denture adhesive. But number two,
Can they really be chewing and eating a regular diet? Or should they be on a mechanical soft or should they be on a puree diet? It starts with the mouth. And you're absolutely right. I am the last person called even though the first area that we should be focusing on is the mouth, let's start there. See if there's a problem. Because I guarantee you the mouth was not looked at upon admission. And then maybe we need to adjust the care plan.
Granted, maybe they haven't had a CBC Chem 7, whatever. They haven't had a full panel of blood workup for a long time, and that should be taken care of as well. Let's review the blood sugars. Let's review their LDLs and HDLs. Maybe they are not feeling well enough to be eating appropriately. But for me, it's really, but now we're waiting for those tests to come back. And now, so it's been three months since they've begun to lose weight and they've lost, let's say 20 pounds, and now I'm called in

Dr. Brandy Archie
Mm-hmm.

Dr. Joy Poskozim
And I'm like, well, here's the problem. There's an abscess on the upper right side. This person is in pain. And this is, I'm speaking of somebody who is nonverbal, mid-stage, let's say Alzheimer's. Yeah.

Dr. Brandy Archie
Yeah.

Emilia Bourland
I love so much that you brought up this issue of failure to thrive because it's something like OTs get called in fairly frequently for failure to thrive issues. one of the first things that I so often we go down these really complex paths. And to your point, of course, we want to run the blood work. We want to do all these other things and do a full check. But doing a full check, we that means that we should also be looking at the most simple, obvious answers. And a lot of times.

We assume people with failure to thrive are not hungry and have no appetite when in fact it has more to do with their dentition, with their oral motor skills, with their ability to get the food into the mouth, or even their cognitive ability to process how to eat that meal. Like there are so many levels of nutrition that we just completely set to the side that are often actually the real genesis of the problem and are things that we can solve. Like you get a dentist in there, you get an OT in there, you get a speech language pathologist in there, and all of a sudden this person doesn't have failure to thrive anymore. But we ignore that so often in going down just like this one medical pathway, which again, to your point, we should do that. We should rule out all the options. But let's not rule out the most simple, obvious answers.

Dr. Brandy Archie
Yeah, I mean, and you can even see this like in acute care. This is one of my biggest pet peeves. Like as an OT in acute care, your goal is to help people get back their ADLs, right? And the first thing everybody's talking about is walking to the bathroom. That's good, we need to walk to the bathroom. But you know the last thing that gets talked about? Brushing your teeth, right? And like nobody's teeth get brushed in the hospital unless somebody initiates doing it. And if they're not capable, the patient is not capable of initiating that.

Dr. Joy Poskozim
Yeah, no, it's totally true.

Emilia Bourland
Mmm.

Dr. Brandy Archie
Then some other clinician or somebody has to like, be like, here is a toothbrush and let's brush your teeth. And so much crap comes out of there. And like, how can you eat when you, when your mouth is full of grossness and you don't taste anything, your taste buds are covered with stuff. It's like, nobody's dealing with that. Even less the first place for intake of everything. Intake of air, intake of nutrition, know, output of sound and the exactly. So yeah.

Emilia Bourland
yeah.

Dr. Joy Poskozim
Yeah

Dr. Joy Poskozim
Yeah, no, I completely agree with you. And there has been so many studies, both on the medical and on the dental realm, in the dental realm. So like medical monies or dental monies, where hiring a dental hygienist at a hospital would make so much sense if nothing else are taking care of those in one of the ICUs or all of the ICUs, right? I mean, it would make so much sense to hire a hygienist. Has it been done yet? No.

Dr. Brandy Archie
Mm-hmm. Yes.

Dr. Joy Poskozim
And it's incredibly frustrating because these people potentially are suffering from bacterial pneumonia, aspiration pneumonia. What are they aspirating? They're aspirating oral bacteria. And so this aerobic bacteria that cause cavities get into our lungs and they have a free-for-all. They have a field day. They're loving this environment. And I was telling this yesterday, oral bacteria are very migratory. They're not sedentary. They like to move around. And if there's overcrowding, they're gonna find another place to live.

You know, and this is a potential problem and we've seen it time and time again. The studies are there. Oral bacteria is a main cause of bacterial pneumonia, especially for those that are sedentary, especially for those in acute care in the ICUs. And still nothing is being done about it. Another thing I will say about having someone, an ancillary, maybe a certified nursing assistant or somebody is going to be brushing their teeth, they're only brushing their patient's teeth because
They either themselves have had a problem dental wise and they want to pay it forward. They've had a loved one where they had a dental issue in the hospital and now they're once again, they're paying it forward because they learned something from that experience. Or they had a prior patient who demanded a toothbrush and wanted to brush their teeth, saw what the problem was and then once again is now paying it forward again to their other patients. But when push comes to shove, there's really not enough time, I feel.
And please correct me if I'm wrong, for the caregivers to be doing everything they're supposed to be doing, and then on top of it, taking the time to pat the hand, ask, tell Shodu, I'm gonna be brushing your teeth now, I'm gonna start with the upper right, and doing this for them, there's not enough time in the day, the ratio of caregiver to patients, no matter where you are, and I go into some really nice places, they've got cocktail hour every Friday.

Emilia Bourland
Mm-hmm.

Dr. Joy Poskozim
I mean, it's a deal, right? I mean, you walk into these places and it looks like a hotel, but when push comes to shove, what is the medical care like? What's the overall care like? And the ratio is so poor that they're more concentrating on making sure that their blood sugars are good and making sure that the 18 medications that they're on are all being modified and all being appropriated during the day.

Dr. Brandy Archie
Mm-hmm.

Dr. Brandy Archie
Mm-hmm.

Dr. Joy Poskozim
making sure they are achieving their ADLs. Are they going to the bathroom? Are they going to, are they sitting in something? How often should we be taking care of this patient just for those basic things? And the mouth, 100 % of the time gets overlooked in those situations. So yes, I could not agree with you more. And I think a really good way of solving that problem is hiring hygienists. And the hygienists, let me tell you, they are eager and willing and ready. They would be thrilled to be a part of a hospital team.

Emilia Bourland
making sure they are changing the radios are they going to the bathroom

Dr. Joy Poskozim
And yeah, it's still, I don't know what it's gonna take. I can't even name one hospital that has a hygienist that will be, that do rounds, so to speak. Yeah.

Emilia Bourland
want to pivot this over a little bit because I think talking about having better oral hygiene and hygienist in the hospitals would be, I can't even imagine what the outcomes would look like if we had that. I definitely believe that we would see much, much better healthcare outcomes just having that required and intensive and daily oral care for folks in those situations.

There's also this whole group of folks who live in nursing homes or perhaps home bound who also have a lot of trouble accessing dentistry and having good oral care and oral hygiene. And I know that's an area of your practice. And so I wanted you to talk a little bit about that and the importance for that particular population as well.

Dr. Joy Poskozim
You got it. So when it comes to as we age and as we become homebound, eventually at some point we're all gonna be living someplace, right? We're either gonna be choosing to stay in place or we've chosen now to live in an assisted living skilled nursing, memory care facility based on our needs and our wants, right? That being said.
when it comes to as we age, well, okay, let's start medically. A lot of women have osteopenia or osteoporosis, right? So the bones become brittle, right? And then there's frailty involved. Guess what? Teeth and bones are cut from the same cloth. So the teeth will become brittle as well. And you'll start to see in older people, especially in the front teeth, these vertical lines in their teeth. And those vertical lines are called...
craze lines, C-R-A-Z-E, craze lines. And they literally are superficial fractures of the teeth. No one's done anything wrong. It's not bad dentistry. The teeth are clean. But it's because, you know, I think personally, once again, anecdotally, that, you know, that someone should be, probably have, that woman should probably have a bone density test if they haven't already. Because if the teeth are beginning to internally or externally fracture, what's going on with their skeleton? What's going on with their bones?

Emilia Bourland
Mmm.

Dr. Joy Poskozim
and you know, that should be tested and, potentially they need to have some kind of medication for that, to help promote, you know, a bone strength and obviously OT and PT would be fantastic to help in, you know, for overall strength. But you know, we can see a lot of things in the mouth that, that are signs and symptoms of what's going on in the rest of the body. And those craze lines are numero uno because they're right in front. can, anybody can see those lines. So that's, that's a problem. So what happens? Teeth will chip. Teeth will break.
People are no longer able to because of diabetic neuropathies, because of osteo or rheumatoid arthritis. They're having a difficult time now to take their partial dentures or their complete dentures out of their mouths. And if the caregiver hasn't been told, you know, or I see a lot of times too, where the person that I'm treating is too proud to say that they can no longer do that.

Emilia Bourland
Mm-hmm.

Dr. Joy Poskozim
And they'll say, yes, yes, yes, I'm doing it, I'm doing it. Well, I'll take one look in their mouths and no, that's obviously not happening. So I'll ask them to take it out for me. And then there's the rub, right? That's the problem. And so the caregiver is there or even more importantly, a loved one is there, a family member is there and they're like, mom, why didn't you tell me? Right? And because they're embarrassed, they're too proud. They know they're aging and no one wants to say that, right?

Dr. Brandy Archie
Mm-hmm.

Emilia Bourland
Mm-hmm.

Dr. Brandy Archie
Nobody wants to say that they can't do what they used to do.

Dr. Joy Poskozim
Exactly, exactly. And so then, you know, I show the, I show the loved one or insert person here, I will show them how to do it. And then I can take them out. The problem though, is that now if they haven't been taken out, those clasps that are holding, you know, like a partial denture, for example, a removable partial denture, bacteria will generate around that. And now I see new decay, decay that wouldn't have formed if the person was still able to take their partial dentures out or let's go the other extreme, we'll go to someone who's suffering or living with Alzheimer's and they forget that they have dentures in their mouth and they just don't take them out. They totally can, they're physically able to, but they just don't remember to, they forget. And that becomes a problem too and the end result is the same where you can start developing these cavities around the teeth. So a lot of times when I am called into a regular home,
It's because yesterday, for example, I re-cemented two crowns back on, one for one person in one area of Chicago and then another area. fortunately, there was nothing wrong with the tooth. There was nothing wrong with the crown. It was just the cement gave way. These crowns had been in their mouths for decades. And the weakest link for all crowns back in the day, not so much anymore, but back in the day, is the cement. They just lost its adhesiveness.

Emilia Bourland
Mm-hmm.

Dr. Joy Poskozim
its ability to hold on. So I cemented those crowns back on and everything was good. The idea of not having the ability though to truly have those, that the care on a daily basis to be brushing the teeth. I really try to educate the loved ones, the caregivers to think outside the box. For example, when it comes to someone living with one of the dementias,
I learned becoming a certified dementia practitioner that having an activity that they've been focused on, let's say eating a meal, right? Then follow it immediately with another activity. Follow it immediately with another, with something else for them to do. They can help maintain that focus, retain that focus. So they're having dinner at their dining room table. Immediately they're done with dinner. They've had some water. Now we're gonna immediately afterwards brush their teeth.
They've already been focused. We're not gonna wait until nine o'clock at night. We're not gonna wait until they potentially are beginning to sundown, especially as the days are getting shorter. That time starts earlier and earlier. They're gonna have their last meal, let's say at three o'clock, because the family knows better that's a good time that they can eat. Immediately brush their teeth then, now you're done. Now you don't have to worry about it. Teeth brushing does not have to be done in the bathroom. Or if they're in their comfy chair and they're watching TV.
and they've had lunch with the TV table in front of them, whatever. Fantastic, remove that, bring in the toothbrush, have them brush their teeth or you're brushing their teeth in their genital convertible comfy chair. This way, there's no fear of falling, right? There's no, because they're unstable, they're holding on and they're trying to brush their teeth or they can't even see themselves if they're in a wheelchair, the mirror is not low enough or
on the design of the bathroom, there's no way that, you if they're in a wheelchair, they can't access underneath the sink, right? So they can't even get themselves to the sink to be able to spit out. Forget all that, forget that nonsense. You know, have that napkin across them so they don't get spittle on them and they can brush their teeth right then and there. Keep it simple. You know, it's easier, much easier on the caregiver. They, you know, the,

Emilia Bourland
Mm-hmm

Dr. Joy Poskozim
person that has to have their teeth brushed for them or are in this situation, my patients, it's a lot easier for them too. They don't have to go anywhere. We're not disrupting them. We're not disrupting their routines. We're just adding something on to something that they always do. And by explaining those things to them, it's kind of like an aha moment. Why didn't I think of that? Because you've got so many other things to worry about. Let me be a resource for you. Let me help you.

Emilia Bourland
Sure.

Dr. Joy Poskozim
and coming up with ways that are easier for your loved one while we're still maintaining oral health as long as we can.

Dr. Brandy Archie
That was like, there were, are so many gems there. And I want to like go back a few steps because like, just really want to like draw the connection that you just made to, if you see craze lines, which all of us can see, that means there's likely bone dissonant issues everywhere else. And what happens when we have bone dissonant issues everywhere else? A little fall or a bump even, or a hard landing into a chair can cause a fracture.

Emilia Bourland
So good.

Dr. Joy Poskozim
I'm sorry.

Dr. Joy Poskozim
Yes. Yes.

Dr. Brandy Archie
And what did we talk about a few episodes ago about hip fractures and what the outcomes of those are so bad, especially after a certain age period. And so it's like, this stuff matters a lot. And I think we sometimes are like, yeah, if you don't brush your teeth, your breast stinks. That's inconvenient, but not big deal. Like the things are a big deal, you know? And so like, I just, there's so many times that you've said this in different ways throughout this podcast episode. I just want to like highlight that like your dentistry, because it's part of your body,

Emilia Bourland
Mm-hmm.

Dr. Brandy Archie
is connected to your body and it can either help you or hurt you. And so you should pay attention to it. You know, I remember the first time I recognized that somebody came to me because I worked at a neuro outpatient place. So we only worked with patients who had some kind of neurological issue and they had had a stroke because of dentistry, like because they had bad dentation. And so like the reason they had the reason they were seeing me was because of that.
That's how come they ended up with a stroke. And I didn't even realize it was that connected, like that directly connected. And so I just, I just want to make it plain and clear for all the listeners to know that like there are direct correlations to healthcare and outcomes based on what you actually can't see. We can't see what's going on inside our bodies unless you got machines, right? But you can see this. And so this should be one of the things that should be, triggering all of us, especially as caregivers, because you can be the advocate for that.

Emilia Bourland
Yeah, the number of people that I've treated on neuro ICU who have abscesses in their brains that started from abscesses in their teeth that migrated to their jaw that might like.

Dr. Joy Poskozim
Absolutely.

Dr. Brandy Archie
Thank you.

Emilia Bourland
Plenty, plenty of these. This happens way more than you think. And you just don't know about it because you don't hear about it all the time. But it is so, so important to understand how these things are connected. Dr. Joy, as I said, I love talking to dentists and I love talking to you even more than I love talking to regular dentists. We would love to have you back again for more episodes because I think there are so many things.

Dr. Brandy Archie
Mm-hmm.

Emilia Bourland
about oral care and dentistry and how they connect to the body and function and overall wellness and especially like senior cares and senior care and caregiving, we could go down so many different pathways. Don't want to take up all of your time this morning though. Thank you for being here and for being so generous with your time and your knowledge. It's been absolutely fantastic.

Dr. Joy Poskozim
Thank you so much for having me. would love, yeah, we didn't even talk about abscesses. my gosh, shame on me.

Emilia Bourland
I know this is this is what I'm saying like I'm think we we got to have you back and we got to talk about like Just dentures like we could do a whole thing on just denture. Yes We would love that too

Dr. Brandy Archie
You

Dr. Joy Poskozim
Please can we I would love that Yeah, yeah, yeah, yeah, I would love to do that Yeah, and then I how I've been guided is in the first place and that was the mind-boggling experience as well So yeah, so no absolutely, please have me back But this has been a pleasure your questions were absolutely fantastic and thank you for allowing me the time to to explain things And I you've been very generous with your time and and having me on so if this has been an honor and a pleasure

Emilia Bourland
Yes!

Dr. Brandy Archie
Yes!

Dr. Brandy Archie
So if people want to find you and connect with you directly, how can they best connect with you?

Dr. Joy Poskozim
You know, email is really the best way. So I'll give my email address. That's my personal email. It's j as in Joy, as in Victor, P as in Paul, Dent. So it's my initials, J-V-P-Dent at Gmail. Feel free to email me. I'm on my phone all the time. And then I would please consider me a resource and I will be more than happy to answer any of your questions. Send me pictures. Hey, you got a question about one of your clients.
I can give you suggestions, I can't diagnose in different states, but I can be like, you know what, yes, this is a situation where a dentist is gonna be the most helpful and let me help you find one in your state.

Dr. Brandy Archie
That is super generous of you and I really appreciate you for one doing that and two being on the show and three coming back. We can't wait for it.

Dr. Joy Poskozim
Absolutely.

Emilia Bourland
Yes, definitely can't wait for that. We'll go ahead and link your email if that's OK with you. We'll link it in the show notes too, so to make it easy for folks. If you made it all the way to the end of this episode and you enjoyed it, please, dear listener, make sure that you are liking subscribing. Leave us a review to help make sure that the podcast is widely accessible to all the people who can benefit from it from it and make sure that you join us.

Dr. Joy Poskozim
Thank you.

Dr. Joy Poskozim
Please do.

Emilia Bourland
right here again next time on CareLab.

Dr. Brandy Archie
Bye everyone.

Emilia Bourland
Bye! 

 
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