Hi, everybody, and welcome back to Airway First, a podcast from the Children's Airway
First Foundation.
I'm your host, Rebecca Downey.
My guest today is patient health advocate and wellness coach, Chris Duvall.
Over the course of her four decade career as a hygienist, she has been recognized for
her contributions to patient-centered dental hygiene, with honors from the International
Association of Ozone and Healthcare and Dentistry and the Oral Cancer Foundation.
A sought after speaker, Chris has taught masterclasses and presented in locations from Las Vegas
and Chicago to Cuba on topics including patient communication, ozone therapy, and advocating
for patient health.
You can find out more about Chris and her mission to change the mindset of dental professionals
when it comes to patient health on chrisduvall.com or the lifeguardinitiative.com.
We are also proud and honored to have Chris as one of the members of the Children's Airway
First advisory board.
And now, here's my interview with Chris Duvall.
All right, good afternoon.
Thanks so much for joining us on the podcast today, Chris.
Oh, it's my pleasure.
Thanks for having me.
Absolutely.
So before we dig in to really, you know, the lifeguardinitiative and things like that,
I'd like to talk a little bit about your philosophy and what led to it.
I believe you had a life-changing event when you were a competitive swimmer.
And that's really what has led to your change of philosophy of care, if I understand correctly.
That is correct.
Yeah.
So would you mind sharing a little bit about that story with us?
Absolutely.
I have been carrying this event and the impact that it had on my life for many, many years.
So I'm happy to share it.
When I was 14, I had been a competitive swimmer for quite a few years.
And I almost always won the events that I swam in.
And I would, when I would finish swimming, I'd touch the wall and then I'd turn around
and lean against the wall and wait for the other swimmers to finish.
And this one particular event was at our home pool.
And I swam the event, won it, turned around, leaned against the back of the pool, and I
blew a great big bubble.
I had swam that race with a big wad of bubble gum in my mouth.
And when I got out of the pool, I said hi to the timer in my lane was a local physician
that I knew.
And the lifeguard got down off of her perch.
And the two of them met me on the way out of the pool.
And they stopped me and asked me if I wanted to live to be an adult.
And I thought, well, that's a stupid question.
Of course I do.
Why?
Why are you asking me that?
And they said, well, if you had aspirated that wad of bubble gum during the race, you
would have gone dead in the water and we would not have room out of help you.
And so just because, you know, we care about you, we want you to think about that and maybe
reassess doing that in the future.
Did you ever chew with gum again?
Oh, no.
No, no, no.
I learned my lesson.
But like I said, I have carried that with me for, you know, since I was 14.
And it is a kind of an anchor that I use to evaluate my communications and my relationships
with patients.
The great thing about them stopping me was that they cared enough and they were in relationship
enough with me that they felt comfortable that they could broach basically any subject
with me no matter what I did.
And so I wanted to have and be sure I had that kind of relationship with my patients.
Because I think when you're in relationship with your patients, you can discuss anything.
And that's how I felt and have felt is that I'm overlooking a pool of patients.
And when I see them doing things with their lifestyle or habits that I become aware of,
I had the opportunity to talk to them and tell them about what we now know and how that
can impact their dental health, their overall total body health and how it impacts their
longevity.
You know, and my goal has always been to help our patients have live a long and healthy
health span, not just a long lifespan.
Yes.
I love that.
Yes.
The amount of time that they're healthy during their life and extend that.
I love that.
And then it's this philosophy that has led to the lifeguard initiative.
Yes.
And so just that's my philosophy of care.
I developed it.
And over time, I've shifted my mindset, my message and my clinical habits to match the
information, the science-based evidence we know now, or the evidence-based science, excuse
me, that we now know.
And I think that's the main impetus behind the lifeguard initiative is right now we have
such a mismatch between our protocols, our philosophy of care, how we're taking care
of patients, what we're doing for them.
There's a mismatch between the science that we now know.
What do you mean?
Well, like many of us that are hygienists are still focusing on scraping and scaling
tartar off a patient's teeth.
And what I'm focused on doing is helping them create a healthy biofilm or a healthy
plaque.
So my focus is helping my patients create a healthy biofilm because I have learned that
when you create a healthy biofilm, the localized diseases and problems of the mouth go away.
And also the oral systemic impact of the biofilm creates a huge impact on the total
overall body health of the patient.
So my goal is in creating the lifeguard initiative is to create an atmosphere of change.
And that's what I call myself as an architect of change because it's so important that we
match our protocols with the science that we know today.
And we have to be flexible and keep updating how we take care of our patients.
So that's pretty much what the lifeguard initiative is all about.
And we're just wanting to get the enthusiasm and the support behind the initiative to just
help hygienist and dentistry and medicine really take the approach and their philosophy
of care that they're willing to prepare their patients for this healthy lifespan as opposed
to what we have been doing in medicine and dentistry is just repair the damage since
they were in the last.
And so that's, hence we just focus on tartar removal.
But the lifeguard initiative believes that when we are taking care of our patients in
this manner, we're leaving them to live in what I call the danger zone.
And that's that zone where the immune system has lost the ability to manage the bacterial
load throughout the body.
And that has tremendous impact on the health span.
Because as you know, heart attacks, strokes, diabetes, all kinds of oral systemic problems
actually originate in the mouth.
So we're just trying to create a new paradigm and a new standard of care for how we take
care of patients.
Because what we're doing right now in mainstream medicine and dentistry just is not good enough
anymore.
It's not enough.
Right.
Literally participating in our patients disease process when we just repair the damage instead
of prepare them for help.
Right.
And one of the things that you and I have spoken about before is instead of just when
somebody comes in to visit the hygienist, you come in and you get your cleaning, one
of the steps that's missing, one of the critical steps is asking questions and not just asking
but actually listening to what they say, catching, you know, hey, I'm having trouble sleeping
or my allergies just don't seem to go away.
These kind of small little statements that traditionally are just overlooked and you just
keep claiming them move them on through.
Absolutely.
And that's a big, big issue.
And that's the other part of with what we're doing is not good enough anymore.
So what has happened is that our questions that we have asked our patients for eons are
still being asked today.
Like just to give you a quick example, I've taken out the question, hi, how are you today?
I think that is not a useful question for me when I want to find out what my patient values.
That's most important to me because when I know what my patient values, I can direct
and preframe all my conversations and questions around what the patient values.
And so instead of saying, hi, how are you today?
I say, it's great to see you as we're walking back to my operatory.
Tell me about something great in your life.
Because I've never had a patient say, oh, I made a big deposit in the bank today.
Or it just doesn't go, patients just go there.
Don't go there.
They want to talk about, oh, my wife had a major illness and now she's doing so much
better or I got to spend the weekend with my grandchildren.
So information like that helps me and cues me in to how I can preframe my conversation
with my patient.
Because one of the other things I always know about a patient is I have asked them the question,
tell me about what you want for yourself.
Patients either want health or they want to avoid the consequences of not doing what they
think they should have or they want to avoid the consequences like what their brother ended
up with a swollen face.
Okay.
So I am very focused on knowing what they value and what they want for themselves.
Those are the two most important things that I can use to help patients extend their health
span.
And this line of questioning not only tells you what they value and what they want for
themselves, but it gives you insight into how are they sleeping?
Are they eating correctly?
What is their exercise like?
Yes.
So those questions then become matched to the information that we know today.
So I will ask them questions like tell me about how you sleep.
Not do you sleep or do you sleep well?
I don't ask yes or no questions.
But I ask questions that are what they call open-ended so that patients will give me some
feedback so that I can then ask some follow-up questions.
So questions need to be matched with the science today.
So questions are hugely important.
And here's a belief of mine, the quality of your questions determines the quality of your
service that you give to your patients.
Because if you're not asking quality questions, you're not finding out good information.
You're not being a good lifeguard.
Exactly.
And that's the purpose of the lifeguard initiative and becoming a lifeguard is to guard and guide
the health and wellness of your patients.
Right?
So with the science that we know is out there, why do you believe hygienists aren't being
trained to ask these questions, to find out, for example, like we just discussed something
as simple as asking questions about their sleep, which could tell you whether or not
they have an airway issue or some other underlying concern.
Why do you think they're not being trained to ask these questions?
That's a great question.
And that's why the lifeguard initiative exists, because it's our goal to help hygienists shift
their thinking.
That's most important, because when you change the way you think about things, the things
you think about change, and I totally believe that.
You know, I think there's several different reasons, but a big one, what caused me to
change was my dentist that I was working for.
I started working for him 21 years ago, and in the first week, he said to me, I want you
to develop a wellness program for our patients so that they come back to see you when they're
healthy.
And I thought.
It's a novel idea.
But have you been smoking something for me?
What planet do you live on?
How am I supposed to be able to do that?
But what I learned through a lot of reading and coaching is that the change has to begin
with me.
I had to change first, and then I could affect change in patients.
And that's why I develop those questions.
Tell me about what you want for yourself.
You might as well take a three-inch piece of duct tape and put it over my mouth.
If I don't know the answer to that question, I can't go in and effectively work with a
patient.
So.
Because at that point, you're just scraping, cleaning, moving them through.
Right.
And you're assuming a lot.
So it's just, it is a transformational approach to your relationship with your dentist and
with your patients and with your team members.
And you know, I lived this for many years.
And when I did decide to retire clinically, because I wanted to spend more time with my
husband.
I'd never been more inspired and excited about dental hygiene and dentistry and caring for
patients than I was on that day that I retired.
But the interesting thing, I think, what was the driver behind this was a challenge.
Because I had started work for this dentist because I quit my previous job.
I was so burned out.
I could not stand another day.
But I had to go back to work financially to support, help support us.
And I had made the decision that it was going to be different this time.
I was going to just change my approach.
And then when, when Dr. McKay said to me, gave me that challenge, I thought, wow, I can
get excited about doing this.
And it really brought me back to my enthusiasm for what I could accomplish and how I could
use my education and my knowledge and the fact that what he said to me was so empowering.
It really shifted something in my brain that said, I'm taking this on.
I love that.
Yeah.
And you actually wrote a really great article about that, which is on your website.
And we'll put a link to it in our show notes so that others can read and really get a firsthand
look at the impact that that had on you and your thought process.
Exactly.
And you know, the other thing that made it a big impact in it was that he said, create
a wellness program.
You are the person that can do it.
And as high genus, we don't hear that and get that empowerment and freedom to help create
something good for our patients.
We're just told, you know, get them in, get them out, clean their teeth.
And so that was extremely empowering and powerful for me.
You're listening to Airway First with today's guest, Chris Duvall.
You can find out more about the Children's Airway First Foundation and our mission to
ensure that every child has access to screening, evaluation, and treatment of all children's
airway disorders before the age of six on our website at childrensairwayfirst.org.
You can also find a ton of great resources for parents on our website, including videos,
blogs, recommended books, comprehensive medical research, and more.
As a reminder, this podcast and the appendage expressed here are not a medical diagnosis.
If you suspect your child might have an airway issue, contact your pediatric airway dentist
or pediatrician.
And now back to my interview with Chris Duvall.
But along with that challenge, he said, I'll give you continuing education that you need.
I'll give you the technology that you need.
And I'll give you a personal coach.
So imagine what I could do with those kind of marching instructions.
Right.
Because this is your deal.
I'll walk along beside you.
And if you need my help or if you get off on a bunny trail, I'll be there to help.
But it literally changed my life, literally changed my life.
And focusing on what I could do to prepare patients for health was the shift.
Shifted from repairing the damage to my mindset, my message, and my clinical habits all got
shifted to what can I do to prepare patients for health?
So that's when I learned that the majority of my patients and I was participating in
their disease process, they were living in that danger zone.
So my goal was to shift everybody to living in the safety zone, where their immune system
and their responses to different bacteria and problems, I could help prepare them and
mitigate those possibilities.
Well, in this paradigm shift that you're undertaking together, it's not just in how
the hygienists are changing their mindset and what they're asking.
It's also you're going to have to take on the dental practice itself, that it's no longer
the expectation of the hygienists just clean and get them to us within 15 minutes.
We have to change that mindset.
You have to go a step further and you're going to have to get to the curriculum, what these
hygienists are being taught in school, correct?
Yes, that is a huge part of it.
So we're, like I said, this is a global endeavor and we're going to be working in hygiene schools,
dental schools.
It's just a huge different, it's a different architecture.
An architecture of change to update your and match your clinical habits, your mindset and
your messages to what we now know today.
It's been a long time that we have not been taking great care of our patients.
So it's time for a change.
And this education that you'll be doing in fostering within the hygienist community globally,
hopefully, also will transition into parents.
For example, parents, there are a lot of parents that walk around with the mindset of, it's
okay if your child has cavities, if they're baby teeth, they're little, they're going
to fall out, let's move on.
But a hygienist that is actually focused on the health span of a patient is going to identify
that as an issue and now has to educate the parent.
Absolutely.
Because we now know that children's dental health affects many other biological systems
in a child's body and that poor dental health or that lack of health will carry on and predicts
that an adult is going to have, when they become an adult, they're going to have the
same kind of problems carry on and carry through into older age.
So it is critical that we start and change and the best place, that's why I love, I
love working with the Children's Airway First Foundation and you is that it's got to start
before birth and at birth and have the, the CAHF is developing the technology and the
resources and the, just the know how to, how to start preparing children and babies for
a healthy life span.
It's so critical.
It is critical.
Yes.
I know because today, that's one of the things, well, let me back up just a little bit.
One of the challenges that happens when kids go through orthodontics and a lot of kids
go through orthodontics today is that today, mainstream ortho and in the past so heavily,
we were focused on treating the malocclusion or the crowding that we paid no attention
to the airway and what type of tongue space we were creating when we extracted teeth and
headgeared everything back and I am a product of having that type of care.
I had orthodontics done twice when I was right out of hygiene school and it has impacted
my life with AFib and sleep disorder breathing and weight gain and I can't begin to tell
you the impact of that in my life and so not only with our children, do we have to prepare
them for a healthier tomorrow and take all of these things into consideration but we
now have millions of people that are out there as adults that have suffered the consequences
of what they call extraction, retraction, regret and so it's a lot of the reason why
we are seeing people with cardiovascular disease, having strokes, diabetics, sleep
disorder breathing, the impact of not considering airway in how we take care of children has
had a global impact and so that's part of the retraining for hygienists.
I shouldn't say retraining, it's more of a shift to a healthier way so we've got a lot
of children worldwide that we need to impact and we also have millions of people worldwide
that have been a product of the extraction, retraction, regret syndrome and are suffering
the consequences.
We don't want our little ones to go through.
To do the same suffering the consequences and impacting the healthcare system because
now we're all adults walking around with all of this.
Yes, yes, yes and as you get older and older the more these consequences pop up in our
life.
Right, in ways that you just can't even see coming.
Yes, yes, so it's an opportunity to have an impact, it's an opportunity to do good, it's
an opportunity just to give back.
My whole goal is I don't want to leave this earth with any arrows left in my quiver unshared.
I feel that a lot of my philosophy of care and how I take care of patients has been a
gift to me and it's my responsibility to share these gifts that I've been given and so that's
what I want to do is I want to shoot every arrow in my quiver and have them have an opportunity
to be used by others.
I absolutely love that and I know that along with Children's Airway First and the Lifeguard
Initiative you've also worked with some other groups that are very near and dear to your
heart including the Oral Cancer Foundation.
Absolutely, my first patient in clinic in hygiene school was my husband's grandfather
and I found a lesion in his mouth that turned out to be oral cancer.
So, you know, I am so grateful that I've had the gifts of having, you know, shoot some
bubble gum in the pool and blew a bubble of having my husband's grandfather sit in my
chair as my first patient.
What that's such a gift to be able to take those experiences and say, you know what,
there are other people out there, everyone has somebody they love and care about just
like I love to care about his grandfather.
So I made it my goal in hygiene school after that that I was always going to do an oral
cancer screening on every patient every time and I can honestly say I have lived up to
that in 40 some years worth of hygiene.
And I think that the whole backstory to the Lifeguard Initiative is guarding and guiding
patients' health.
And what I mean by that is when you get your patients living in what I call the safety
zone where the immune system can manage the bacterial load and everything that's going
on in your mouth, it creates time in the appointment for you to do the things that are so important
and those are the life saving screenings and you'll find out when you help manage and help
your patients create a healthy biofilm, they're going to come back to see you healthy.
So a lot of the reason why I was so inspired and enthused at the time that I retired is
that my patients started coming back to see me healthy when I started this.
I no longer saw Tartar.
Really?
Like your biofilm or their plaque was healthy.
Yeah, it's just amazing when you manage the patient's biofilm and create health in that
biofilm and create an urgency and a need for the patient to understand that they need to
come back to see me while they're still healthy.
So I can do whatever it takes to get them back at the beginning of that safety zone.
See most patients come to see you.
Oh, when their gums start to bleed.
You know, you ask the patient, how come you're here to see me today?
Well, my gums started to itch and they started to bleed, so I thought maybe it's time to
come back and see you.
Uh-uh.
Right.
That's a patient living in the danger zone and when you go along with that by not asking
some important questions, you're literally participating in their disease process.
And that is about all I knew at the time.
But now I know about their health process and what it takes to keep them in this safety
zone.
Well, not just their health process.
You also know a little bit about this relationship, you know, a little bit about them personally.
So why is it that they don't come back except for when they're in pain?
Because you know more about them as a person.
Is it they just they're afraid of the dentist?
Is it a financial thing?
Is it you know a little bit more about them?
Yes.
The relationship rules, the quality of care.
And I think that is, you know, I just recently wrote an article with CAF.
And the thing that I also believe is you've got to who you're going to be for your patient,
like make the decision to redefine yourself, step into a new pair of shoes.
I decided I'm going to become a lifeguard.
I'm going to help guard and guide my patient's life.
And when you do that, that's what determines what you're going to do.
Who you're going to be determines what you're going to do.
And that's part of what we help shift in hygienists is that right now, most hygienists are just
thinking about what am I going to do to the patient without giving consideration to.
I'm going to be that hygienist that has made the decision to be a lifeguard, and I'm going
to guide the health and wellness of my patients.
And so this type of transformational approach, it creates time in the appointment to do these
life saving screenings that match the science that we know today.
You need to do an oral cancer screening.
Rarely is that done by hygienists in the mainstream.
You got to take blood pressures because there's lots of reasons why people have high blood
pressure, sleep, diabetes, cardiovascular disease.
And so take blood pressures.
I do a screening that is used a product called Carey Free, and it helped me determine the
pH of the biofilm.
And when the pH of the biofilm is low, that's when cavities occur.
And it also made a huge impact on the periodontal health of patients.
When we got them using this Carey Free, it helped manage and balance the pH.
And so these are just all ways to help your patients create a healthy biofilm.
I did oral DNA testing, which we had.
What's that?
Your biofilm, or what we used to call plaque, is made up primarily of probably 700 different
species of bacteria.
And there's viruses and fungi.
There can be parasites in there.
So we did a swish test that would identify the high risk pathogens.
There's five or six of them that are causing all the problems in the mouth and in the body
with periodontal disease.
And now it's now one of them is linked to certain cancers in the body.
One of them is linked to now, linked to Alzheimer's disease.
There's some that are linked to periodontal disease.
I mean, it just goes on and on about what they're learning about these high risk pathogens.
And so in order to create a healthy biofilm, we had to create a way to get rid of these
high risk pathogens.
So all this stuff is really important.
And you have to create time in your appointment to be able to do whatever life-saving screenings
you can.
And those are what, in the Lifeguard Initiative, those life-saving screenings are what I call
lifelines.
They connect you to your patient, and that connects your patient to their health span.
And these lifelines, the other one that I've learned from working with you is just talking
to them, especially if it's a child.
As you talk to the mother and you find out, pardon me, about how do they have ADHD?
Because that's a sign of potentially an airway issue.
What are they eating?
How are they sleeping?
But as you're speaking to the parent, you're watching the child.
You can see how they're behaving.
You can watch how they're breathing.
Yes.
Absolutely.
And I had a patient one time that the parents alternated nights sleeping with their child
because they had to sleep with her because she woke up so many times during the night
that she was frightened.
She was little.
She was maybe five years old.
And so the only way they could soothe her and help her get back to sleep was if one of
them was there.
And so we suggested, we have some things we're concerned about.
We'd like you to see her pediatrician.
The pediatrician said, oh, her problem is just that she has so much stress in her life.
And the mom said, stress, my daughter leads a charmed life.
She has no stress.
We work very hard on diminishing stress in our child's lives.
So she just took that and she said, no, I'm not taking that.
So she ended up switching pediatricians.
She walked out the door and found another one and come to find out when she went to see
an airway physician that was focused on airway, her tonsils were touching.
And you can imagine the impact that that had on her.
Being able to get air and get oxygen in to feed her brain and her developing body and
it was just a mind boggling experience.
So all those things, in a relationship, you're able to talk about those things with the parent.
Being in a relationship with your patient or your child's parents, it's so important.
So important.
It's absolutely incredible.
As we wrap things up, if you could leave one message with the up and coming generation
of hygienists, what would you say?
Oh, boy.
You know, I had the benefit of having a challenge given to me by Dr. McKay.
And I don't think you have to have a challenge presented to you.
You can present it to yourself.
And I think you just have to take the time and realize that there's got to be a better
way.
There's got to be a better way to match the protocols, your message and your mindset to
what's happening in the world today.
And that is we are losing patients right and left from very serious effects.
And I think that I would tell them to pay attention to the life-saving screenings and
the clinical evidence that they see on a patient.
Because if you're not paying attention to it, you are absolutely doing a disservice
to the patient and participating in their health or in their disease process and possibly
without your intervention, they could have a life altering event or even death.
So really get in relationship with your patients, shift your mindset, shift your message.
You know, brushing and flossing, asking the question, do you brush and floss isn't good
enough anymore?
Because brushing and flossing won't keep your mouth healthy.
So educate yourself as to what's going on and share that knowledge with your patients.
And decide who you want to be for your patients.
Absolutely.
Who are you going to be?
I love that.
New fair shoes.
I love that.
And I just personally want to thank you for being a part of the advisory board for Children's
Airway First and for allowing me to be a part of the Lifeguard Initiative and helping you
to share your arrows of knowledge.
It's truly an honor.
Thank you so much.
It's been a privilege and an honor for me to be here today.
So I appreciate it.
Awesome.
Thanks so much.
Thanks again to today's cast, Chris Duvall, for sharing her medical insight and each of
you for listening to today's episode.
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Take care, stay safe, and happy breathing, everyone.