Episode 23 – Theresa Sheppard with Theresa Sheppard Solutions

RJ Martino 

Welcome to the iProvMade Podcast where we help you build a more profitable healthcare practice. I’ve got beside me, my awesome co host, Jordan Smith. Hey, Jordan. Hey, RJ, how are you today? I’m doing great. I’m excited to bring our next guest who talks about something you never think about, which is all of our health starts with our mouth. You know, everything that comes into our system comes in an observable is absorbed, absorbed through our mouth first. And it’s obvious, but I kind of think about, I always forget that health kind of starts with our mouth.

Jordan Smith 

No, absolutely. And for all the listeners out there, you know, the dentists and the the oral folks that we have there, listen to this. This podcast is not just for you, she talks a lot about how communication between all forms of somebody’s health care is vital. So if you’re listening to this, and your regular doctor’s office or an admin, another practice, don’t turn it off. There are lots of good things in here that can carry across to all types of platform. So I’m excited to bring you guys, Theresa Shepherd with Theresa Shepherd Solutions.

RJ Martino 

Welcome to the AI prov made podcast where we help you build a more profitable healthcare practice. I’m RJ Martino CEO and founder of ipob. And alongside me is my partner, Jordan Smith. Hey, Jordan.

Jordan Smith 

Hey, everybody, RJ How are you?

RJ Martino 

I’m great. I’m excited about today’s featured guest. She came highly recommended and is doing something that, you know, in my circle of friends is is pretty new, novel and extremely interesting. So it is my pleasure to introduce Teresa shepherd. Hi, Teresa.

Theresa Sheppard 

Good morning guys. How are you?

Jordan Smith 

doing? Good. We’re excited. We’re excited to have you on.

Theresa Sheppard 

Yeah, thank you for having me.

RJ Martino 

So the first thing we like to do is just give our our group kind of a quick reminder of how we think about building a profitable practice. And really, it starts with looking at the symptoms in the business. And symptoms include things like I’m not making enough money, my people aren’t helping me build this business. Those are all symptoms to a deeper problem. Our step two is making sure that our owners are willing to take accountability for those problems. Step three, is triage seeing the problem and figuring out Is it a corporate culture problem. And almost always it’s a corporate culture problem. And that goes deeper into building a good culture means knowing what the vision of the future is. And often our our physicians, they don’t have a future. In their head, they don’t have a vision in their head. Not only is it not in their head, but even if it is they haven’t shared that with a team. So their team is struggling trying to keep them happy. Once they’ve done that, once they built a good vision, they built the corporate culture they want, then we build a strategy to help them get there. We build the tactics at which we hold people accountable to do and to complete. And then we teach them as a team how to hold each other accountable, making sure those tactics are done, and you measure that progress. And then and only then do you engage your team. It’s like we got to work it out in our head first, before we kind of tell our team, go forth and be prosper. So when when we talk about engaging team when we talk about the symptoms, often we try to figure out the guest who are speaking where do they fit at in this and, you know, I don’t want to speak for you. But I think in our conversations together, your thoughts and your background in history really align closely with what we’re talking about. So I want you to kind of give a brief introduction on yourself, how you got there and what you get what you do at Teresa Shepherd solutions.

Theresa Sheppard 

All right, well, thank you so much. I actually have two branches off the same tree. When it comes to my business. I have Teresa Shepherd solutions, which is a dental consulting company, I specialize in risk management. I try to teach doctors how to better maximize a patient’s benefits, while at the same time, they’re actually increasing their legitimate reimbursement. Many dentists don’t realize that health care fraud is a big issue within their practices, they think they’re doing okay. And I often find out that really once we start tearing apart those layers that they’re really not doing okay. I always find

RJ Martino 

Sorry to cut you off trees that when you say they’re not doing okay, do you mean that they’ve exposed themselves to risk or that they’re not billing as much as they should? When you say are there real exposures to healthcare fraud and in some cases, oh

Theresa Sheppard 

Yes, absolutely. They don’t realize the fraud that they are committing. Insurance fraud, particularly, when I teach I have a program that’s called how many felonies did you commit today? And, yeah, that gets a lot of attention. But primarily, you know, in a dental practice, fraud comes in the form of insurance fraud. And it’s certainly not intentional, they don’t even realize they’re doing it. But mis coding and not sequencing properly and doing things like that. Definitely put the practice at risk. So they don’t know what they don’t know. Of course, that’s a kind of a cliche, but it’s true. And so what I do is, I have a program that I call snapshots prevent mug shots. And what that is, is it’s just basically, I like catchy titles.

RJ Martino 

Yeah.

Theresa Sheppard 

So um, what that is, is it’s actually a virtual service, I remote in and I do an assessment of their practice. And I really find those areas that do cause risk, not only financial risk, but clinical risk, you know, and if you follow the processes and the procedures, whether it’s a medical office or a dental office, you get your systems in place to get everything nailed down, the money will follow. It just has to be done, you know, methodically and thoughtfully and legally. So when I do my snapshots, I typically always find at least two to $10,000 a month in either unbilled, miscoded or uncollected services. And when doctor, I actually found about 30,000 a month, because his inch, yeah, his insurance expert, did not realize that the abutments were a separate procedure and a billable procedure from the implant and the crown. So that was kind of all getting bundled in.

RJ Martino 

Wow. And nobody, nobody even knew it.

Theresa Sheppard 

They didn’t know it, they didn’t realize it. So this is

RJ Martino 

a very interesting from finding new revenue exposing risk. Are those the two branches? Or were you saying that’s, that is one branch ABS one branch? Okay. And that’s and coupled that together? You call that risk management?

Theresa Sheppard 

Yes. Okay. Risk Management, for sure.

RJ Martino 

Okay. So and it includes true, call it legal risk, but also leaving money on the table? I mean, I think,

Theresa Sheppard 

Oh, absolutely, it happens all the time, every day all day. And doctors aren’t, aren’t realizing it. Some practice administrators don’t even realize it, you know, as often I’ll see where, you know, it’s just one one, PA, so the patient doesn’t get charged for that, especially if they complain about it. But if you take one pa two or three times a day, three or four times a week, you know, that’s a couple hundred dollars a month, which doesn’t sound like a lot, but the one PA is just where it starts. Yeah, you know, then it escalates from there. And so, you know, not only, I want to make sure that the practices are protected, legally, I want to make sure that their patients are receiving optimum treatment. And when we perform pro fees on our perio patients, not only is that not delivering the level and the standard of care that the patients need to treat the disease that they have, it also is considered in some cases supervised neglect. And that puts the doctor in that position. So I take a look at all these little things and give them a good report afterwards.

RJ Martino 

That’s very interesting. We said that there are two branches, we’ve talked about one, I want to hear about the other but before that, to think that you’ve got two different divisions, and I know that the other one is very exciting too. Because not letting the cat out of the bag with that’s the one that I really want to dig into too. But knowing that you’ve got two you obviously didn’t start with just twqo tell us your your story. How did you get started? Like, did you just wake up one day and decide that you knew more about risk management than than everybody else? Or tell us out?

Theresa Sheppard 

Oh, gosh, no, I definitely don’t know more about that than everybody else. It’s just a passion of mine. So I’ve been in dentistry, oh gosh, my age is hanging out here about 40 years now. And when I started you know, we didn’t even glove up. I didn’t wear a pair of gloves until 1985. And that’s because that’s the first time we heard the word AIDS. And so that’s when things really started changing. I am a registered dental assistant in California. I chairsided it for about 10 years, I still hold my registration. So after about 10 years of chair sighting, I just kind of got where I wanted to try something different. And I got hired to To replace a gal that was going on maternity leave, in a practice, and so I was just going to be basically typing on the typewriter, insurance claim forms, mailing those out answering phones, making appointments, things like that was a very small practice. Three operatories, one dentist. And he wasn’t booked out more than just a few days at a time. And I’m kind of the perpetual but why girl? So I wanted to know, well, why is he booked out? Why are we not pre appointing?

RJ Martino 

Because I came? Well, I think we find a job I think audience members who are listening this know the why girl, and you love them. Love them. But you also those are hard questions sometimes. And, you know, asking why? What were what was the normal response? Or, you know,

Theresa Sheppard 

as you dug into things? Yeah, the normal response that I got then and it’s the normal response that I still get when I ask this question is, well, that’s just the way I was taught. I knew or that’s the way we always do it. Right? If I had a nickel for every time I heard that well and not even

RJ Martino 

know they do it. And our audience, they’ll say we do it. And we don’t even ask questions. We’ve just we’re too busy to even ask why sometimes, we just done it that way. So it is not uncommon if you’re listening to this to have lots of procedures that people are following. And they have no idea why it’s just how we’ve always done it.

Theresa Sheppard 

Exactly. And I and when I was chair citing for all those years, I came from a practice that was probably at that time definitely ahead of the curve, and more kind of thinking in terms of whole health and heavy on the perio. And I really enjoyed that. And it didn’t make me question things. So when I see this type of situation, I do want to question it, doctors go to school for a long time. And they invest blood, sweat, tears, money into making their practices as they should be. And it just makes me sick in the pit of my stomach when I see doctors that are working themselves crazy, and they’re not getting anywhere. And the first thing that I like to look at is okay, what are your systems? And what are your the tools that you’re using? And and I asked why. So with this particular practice went once I got in there, and I’m realizing, okay, this just doesn’t make sense. He’s just not making any money, but he’s seeing, you know, 35 patients a day What is going on? So, you know, I kind of just asked it one time, if I could take all the insurance company manuals home over the weekend and look at those. And, you know, you can play any game as long as you know the rules. So you have to find out what what are the benefits, what are the more importantly at that time, it’s what rates. So rather than do a three unit bridge, for a capitation fee, that’s an upgrade. And they weren’t upgrading. And so anyway, over the period of time, I really developed a love for not only perio, that’s always been a passion of mine, but just finding the risk, and really figuring out you know, what is going to make us successful? What is going to get us in trouble? What can we do? And what can we not do? How are we going to best treat our patients, because at the end of the day, we did go to school to treat patients. And so it’s all about that I basically I’m just self taught, and I love It’s love the risk management part of it.

Jordan Smith 

Well, that’s great. And I want to I want to hit on something before we, before we dig in deeper to that I want to make sure all the listeners heard, which is take a step back, if you’re in the car, or you’re cleaning the house or whatever you’re doing right now, whatever issue you’ve got in your business, do what Theresa did, just asked, but why, right? And do that until you get to the actual core of the problem more often than not, you just asked that question three times. And you get to what the real issue is you get past that symptom and to the real issue. So if your revenue is not where it needs to be, why is that? And then keep asking yourself, why until you get to that core. So I think that’s a that’s a great lesson. Just a couple minutes in that I would like everybody to hit pause, do that, and then resume the rest of this.

RJ Martino 

Well, I think that’s a good segue. Jordan into Teresa, you and I were speaking previously. And you had talked about the sentiment that you heard when asking some of your practice owners where their costs were what are the most expensive things in business and it kind of talked to me a little bit about that. Can you talk about how you have those questions come out and what the typical answers are and what your thoughts are on that.

Theresa Sheppard 

Right. So when I am Teaching and I, I miss teaching in front of audiences, I love live audiences, I love the interaction, and just the vibe and the energy in the room. So, when I do that, I often ask, you know, doctors, what is the most expensive thing in your office? What’s the most costly, item or, or process that you have? And I usually will get something, oh, it’s my serac machine, you know, it’s my new You know, this, that or the other thing, my new scanning device, my new ceric machine, my new process and procedures, we just started doing ozone, or we started doing this and, and I always say, No, those are tools that we use to treat our patient. But what is the most costly thing in your practice is your team members and lack of training, because we lose a ridiculous amount of money every month, just on lack of training. And sometimes it’s as simple as one code over the other. It doesn’t have to be rocket science. And doctors are and team members are, especially I sat in those chairs for 40 years, I understand what they’re going through, they don’t like change, they’re already overwhelmed. You have an office manager, that is like an octopus, you know, she’s answering the phones and dealing with patients and dealing with the doctor and dealing with clubs and insurance companies and, and this out and everything. And what happens is they don’t, they don’t have time for change, they don’t want to change anything. And I don’t like to call it change, I like to just call it evaluate and correct our course. It’s just kind of making adjustments just come in the form of change. Yeah, it does. But if you have to think of, you know, you can eat an elephant one spoonful at a time, you can’t look at a task, or I look at a practice. And there may be eight or 10 items that are concerning, but one foot in front of the other. That’s all that’s where the triage part comes in, is we have to triage and first we have to stop the bleeding. And then we have to move forward with with the next thing that that will help improve our practices and deliver better patient care.

RJ Martino 

You know, when you’re talking about this, because I think you’ve intrigued some of our listeners already with the idea that risks with the idea that they know their staff needs more training, how they do that, how they identify which ones need, maybe they don’t know that you’ve hit on a topic of increasing revenue. And obviously, every audience member loves the idea that, how do you determine if you can help a practice or not?

Theresa Sheppard 

Well, the best way for me to start it with a dental practice with the risk management is doing the snapshots prevent mug shots, because no doctor can treat a patient until First they use the diagnostic tools that they have available. triage treatment plan, execute. So it’s the same with me, I can’t give any advice or look at anything unless I see what’s going on. So that’s one way that we do that. And from that, I’m able to give the doctors real concrete reports of recommendations and findings. So we know where the bleeding is, we know what direction to go in. And we know what to do. What the doctor does with that information is up to the doctor now can assist just like a patient, you can’t force them into treatment, all you can do is describe their condition and explain their disease and how it’s damaging them and what you can do to help them get through that manage that. But typically, once doctor, there’s juicy, I really don’t have a problem with with them not wanting to go further and do some training. And that can be done in really small little increments. Again, it depends on what is the problem?

Jordan Smith 

Well, again, going back to kind of the overarching process that we always talk about that taking ownership of the issue, you know, yes, we say all the time that the The bad news is, you know, whatever issues there are in your business, it’s your fault. The good news is whatever issues you’re having in your organization, it’s your fault. But you know, you are the one who can start down that path and fixing it even if you don’t have all the answers.

Theresa Sheppard 

Right and it doesn’t there’s there’s it’s scary. It’s scary for them because they do think, Oh my gosh, I’ve got not only now I’ve got to change things. And my team is resisting changing things. Yeah. You know, this is a consultant and consultants are 10s of thousands of dollars a year. But not this girl. That’s not how I work. So, well, there’s a lot of different things that you can do.

RJ Martino 

That’s good stuff. And, you know, I spoke in the intro about how this will be interesting for dentists but also physicians. I think a lot of times, our healthcare providers might think, Okay, this is just for goodness, this is just for dentists. And we talked about these two branches. We’ve talked about risk mitigation. Let’s talk about some things that maybe other people outside of industry might be interested in, whether it’s a healthcare provider, or even me who loves technology, this concept of tele-dentistry seems like it’s we can’t do tele-dentistry. away, you know, it is right hands in the mouth is how this is done. Let’s talk about the other branch in your business.

Theresa Sheppard 

Yes, and I’m very proud of this. I am the founder of Care 2 U tele-dentistry services. And I’ve had this business for about a year and a half now, I’ve been using tele-dentistry, it’s much different than what we think of Tella dentistry during cold times. Because dentists really didn’t understand that they had an option for that prior to this. And as it’s used in COVID times as someone’s, you know, taking a picture of their broken tooth with an iPhone and sending it to the doctor and saying, Is this really an emergency? Do I have to get seen or Can it wait? And, you know, is that Tella, dentistry, new kind of sorta. But that’s not how I use it. So it’s a background on how I developed this actually starts with kind of a sad story. My best friend was very ill several years ago, and she kept going to the physician and the physician ended up telling her you have just got a stubborn case of pneumonia. And you know, it just, she was sick for months, losing weight, just looking 20 years older, just terrible. And what ended up being a stubborn case of pneumonia was actually stage four lung cancer and stage two lymphoma. And, and she had no risk factors. She was never a smoker, nothing in the family history. Everybody was completely blindsided. So once the diagnosis happened, it was only just really a few days until she was in the intensive care step down unit, 92 pounds on her deathbed, literally. I didn’t leave her very often, because I was always afraid that was the last time I would see her if I did. So we’ve been friends, you know, since I was 12. So I wanted to be there. But I did have to leave from time to time. And as I was going back one day, you know, all medical or hospital rooms now they have these whiteboards in the doctors names on it, nurse, you know what we’re, we’re treating that them for that day or whatnot. And I just happened to look up at the whiteboard. And it said under oral care, remove partials and clean. And I thought, whoa, wait a minute. She doesn’t have partials. She has beautiful teeth. So she was the only one in the room. It couldn’t have been for the other patient. So I went over this was about day four or five of her being in this unit. I went over and I pulled up her lips. I was appalled. And I was livid. Her gums were so red and bloody and puffy, and her teeth were covered in such biofilm and fungus that I I lost my mind. I mean, I lost my mind. Everybody in the hospital knew it as well. I went straight to the head nurse, I went straight to the hospital administrator. And because that level of neglect, especially in a step down unit, ICU step down unit, it is not acceptable. And I have to preface that with no it’s not because the nurses weren’t caring or educated or anything like that. I don’t want to give that insinuation because that is definitely not the case. The case is they did not understand oral systemic link. And I find that very common in the medical community that dentistry and medicine seem to be polar opposite things and they’re not. Dentists are oral physicians. And if they ever doubt that they need to look at Box 34 on their dental claim form, because that’s where they need to be putting their medical diagnosis codes. So we are all going towards a medical model. Dental insurance, especially as we know, it is probably not going to be here in another five-ish years, I’m guessing. Because I’m seeing more and more. You know, we’re treating the health of the patient. So if I can, I’m just going to advance my slide. This is what I often see, not only when I’m doing risk analysis, but I actually see patients like this. But going, I want to step back for a second and kind of go back to what I was talking about with Janet. I started taking care of her oral care immediately, myself. And, thankfully, and by the grace of God, we got her transferred over to Stanford Medical Center a couple of days after that happened. Andshe is now six years in remission.

RJ Martino 

Wow.

Theresa Sheppard 

Yes. It. I mean, I just choked up every time I think about that, because she literally was on her deathbed. And so I’ve always had a passion for perio. That incident, though, really made me think, okay, people have to get care. People in hospitals, nursing homes, assisted living, there’s so many people, you know, we’re taking care of grandma at home. They don’t have access to care, necessarily. So I really had wanted to figure out a way to deliver these services. Now, I’m not a hygenist. So I can’t scale, right. But I can do certain things under the scope of my license. But I just do that. Somehow I had to drive this. And so what we did was we just started learning more and more about how I can, can use this. So when I talk about authentic link, especially to the medical community, you know, there’s typically somewhat surprised that some of these perio pathogens are very deadly and causing and contributing to some very serious diseases. You know, premature birth, gingivalis creates kind of an enzyme that stimulates contractions. So you know, we’ve got premature birth. The mouth is the beginning of the digestive system, right, the colons the end. So what happens when all of that nastiness gets swallowed? It runs through the digestive system, there’s a lot of cancers. Same with lungs, we’re breathing in that nastiness. You know, if you’ve got COPD, asthma, emphysema, that’s just going to make everything worse. These perio pathogens are unique to the oral cavity. So why are they being found in carotid plaque? Why are they being found in brains of Alzheimer’s patients? So we definitely know. And the sciences now really backing up the whole health dentists have known for a long time. And the issue that I probably see the most, not only just in practice, but also on the other side, when I’m doing risk analysis is diabeetus. There is a huge probably the strongest bi directional link between the perio pathogens and diabetics. Sometimes I’ll have a patient that will say, oh, I just found out I’m diabetic. My doctor said, don’t worry about it. Just watch what I eat, watch my carbs, and I’ll be fine. So then I see them again, six months, okay, we’ve now we’re on Metformin, I’ve lost 20 pounds, I’m watching I don’t understand why my blood sugars are out of control. You know, you see them again, and now they’re on injectables. And what we’re trying to explain to them this whole time is you’ve got moderate to advanced perio disease. And considering you know, a good 80% of adults have periodontal disease in some stage. It’s not a far stretch to figure that most of your patients as adults probably have some form of periodontal disease, and that isn’t being addressed. How would you expect to heal one infection if you’re ignoring the secondary infection? So I was actually really impressed with this. The British D Journal just put out whole study. And what they said was oral hygiene has to be maintained, if not improved during the SARS COVID infections in order to reduce the bacterial load in the mouth, and the potential risk of bacterial super infections. These precautions are particularly important for those with diabetes, heart disease, hypertension, etc. I’ve been preaching this for years. And I can almost guarantee if I walked into a hospital now to their ICU unit, Hope it or not concerned at how their patient’s oral care looks. And again, it’s just because it’s not put on the forefront of being as important because the link is is not quite being explored as it should be. That doesn’t mean that they’re not getting patients aren’t getting excellent care otherwise. But this is a huge contributing factor. Huge.

RJ Martino 

And is this due to traditional training? Is this the the same concept is what we talked about previously, which is just this is how we’ve always done it. What is the systematic? You know, what is the core of the problem?

Theresa Sheppard 

I’m sorry, you cut out a bit. What was the what?

RJ Martino 

What is the core of the problem? What is the fix here? Is it proper education, during healthcare training? Is it you know, a change? What is the fix?

Theresa Sheppard 

Yes, the fix is definitely education. I speak to a lot of in services with assisted living facilities. I speak to school nurses, I go to senior centers and give presentations, I will talk to anybody that will listen to me. Because this is so important. And what we just don’t realize is the damage that has already been caused through our systems by having this prolonged inflammatory response and infection because periodontal disease is an infection, and also has an inflammatory response as well. So you have patients with advanced periodontal disease that also have rheumatoid arthritis. They’ve got they’ve got psoriatic arthritis, and all of those are inflammatory diseases. So there’s definitely a link there. I have friends that are nurses. And I’ve asked them, What do you know about oral systemic link? What were you taught in school about a patient’s oral care? And it’s, it’s kind of like, yeah, we talked about it one afternoon for about an hour. Mm hmm. You know, and we were told how it was really important, it was stressed to us, we have to brush a patient’s teeth. Because you know, with a fresh mouth, they’re going to look better, they’re going to feel better, they’re going to eat better, they’re going to socialize better, all of those things are true, but we’re treating the disease. So their thought processes, I just have to brush a person’s teeth. And when I go into assisted livings and nursing homes, especially if I’m dealing with memory care patients, you’re not going to come at them with a toothbrush, they won’t allow it. So there’s a lot of different ways that I train teams to be able to provide alternate forms of treatment that way. You know, we just, we just have to make a little bit more of a point to do that. Your mouth, if you were spontaneously bleeding, and had an infection in any other part of your body, that would never get ignored. So our oral cavity is getting ignored. And we need to really take this opportunity to collaborate. So the way that I use tele-dentistry is I take a patient, let’s just say I’m going to be going into a nursing home to see a new patient, someone I’ve never seen before. I’m going to do a discovery period ahead of time. I’m going to get health histories. I’m going to gather all their medication list I’m going to get all their information, because that information. If I need to get a medical clearance, I have to know that ahead of time and need to know what I’m dealing with. And that information then gets reviewed also by a dentist. I share that information with the dentist because in California, only the dentist can diagnose obviously well every will everywhere but hygienists are a little bit more limited in California. For something. So first of all, the dentist gets that information and then says, right based on this information you’re giving me and of course, more in depth intake forms, and discoveries that I have with them. Let’s do for bitewings and intraoral photos, perio charting, whatnot. So then the hygienist goes on site with me. And we do these things. Everything I have is completely portable. My x-ray machine is portable. My suction airway syringe polishing everything is is portable intraoral, camera, oral cancer screenings. Everything I can do is portable. So we’ll go in and we’ll do that we’ll do the perio charting. And then that information gets uploaded to the dentists too. So he can either agree or disagree with what the hygenist is seeing in terms of is this appropriate patient, this apereo patient, what do we need to do to treat the perio patient. And so there’s that communication, and then we provide those services on site. And we’ve been doing that for a long time. And it works out beautifully. And this is a fairly new concept, or not only dentists, but physicians. Yeah. And it easily easily. I can have, I can be, let’s say in a room with a patient, I can have a dentist on one screen, and I can have their physician on the other screen. And we’re getting it done right then, wow, yeah, we’re having this conversation with everybody.

RJ Martino 

If I’m thinking about, you know, for for my grandmother or my mom being taken care of in a nursing home, I just want the pain to go away immediately. And sometimes that means multiple, you know, a doctor and a dentist, so it’s great to provide that level of care

Jordan Smith 

well, which makes from a, you know, it makes sense. If you think about any other aspect of health care, you’re gonna have your general physician and your oncologist talk to each other. You know, you’re gonna have your, you know, all these specialty. You’re right, when you’re when you’re talking about kind of oral systemic care. Well, there’s no excuse why, you know, the dentists that are out there listening, or the other types of physicians that are out there listening, that they shouldn’t be talking together about the overall care of the patient. So for those. Yes. So for those dentists, those practice managers or the hygienists that are out there listening to this, and they’re saying, I love this concept, and I hundred percent agree with everything that you’re saying. What would you tell them? As far as you know, they say, all right, I agree with this, how do we get this going? in my area or with my practice? What are some of the things that you would talk through them as far as you know how to implement with what you’ve been doing for years?

Theresa Sheppard 

Yeah, well, I would actually, again, if for a dental practice, I would start with batches, the triage situation, because if they’re ducks aren’t in a row in their practice, they’re not going to be able to manage this on the outside. But what I would say to them is, don’t be afraid of this, the doctors that I’ve talked to sometimes about Tella dentistry, and a hygienist being off site, the first thing they think of is Oh, my gosh, you’re taking my patients away from me. And that is completely not the case. I mean, think of how much more efficient a practice could be if they had an extra operatory for ortho or for operative, and no extra overhead, because we don’t work for them. We’re not employed to set them. So my gosh, they’re just using our services. And the x-rays are already done, your periodic evaluations done, the hygiene is done, the oral cancer screenings done, and you as their dentist still get to have all that information and boom, they’re scheduled for restorative saves the patient a trip, saves you a chair, all these other things. There’s one other slide that I’m going to share. And what we’re looking at now is school-aged kids, and we have a serious problem with ADHD. And we all we all heard of that. We know a lot of school-aged kids have that. But there is also a good portion of children that are being put on some really hard, serious drugs like Adderall and Ritalin that don’t have ADHD. What they have is airway development issues. These kids don’t have any air and that’s why they’re behaving the way that they did. Try to try to imagine not sleeping because you can’t breathe not being able to concentrate because you can’t breathe. You’re focusing on breathing, you’re not focusing on what’s on the chalkboard or anything else. And I want to tell a story about this, because this really does hit home. When I teach school nurses and I go, I have several other slides that I showed them. They all say, Oh my god, I know, you know, 10 kids like this, maybe we need to rethink what it is. So the story that I want to tell is actually something that did happen when I was managing a dental practice. There was a family, mom, dad, and there was three kids that two of the girls were twins, the youngest, and I think they were probably around 13-14. And supposedly identical. But when we put their photos up side by side with the parents during the consultation, there was definitely a difference. You can tell a kid that has oxygen deprivation and has airway development issues, because you can see through this slide, that there’s a common look about them. And so what the dentist had suggested was that one of the twins, goes and gets an evaluation by an EMT. And definitely take a look at their airway. Their tonsils are huge, almost touching, their adenoids are huge. So, you know, perhaps if the EMT felt that it was appropriate to remove those, so they took the child in. Yes, we’re going to take these out, there’s definitely a problem, what to do all the pre ops and found that this child had a life threatening hole in her heart. That would have never been diagnosed, had the doctor not been in tune to airway development. And this type of thing and referred, the dad came in the office, really literally in tears, saying, can I talk to doctor, can I talk to doctor I, and you know, doctor was with a patient. So I said, let’s just see what’s going on. Are you okay? I pulled him into the office. I didn’t know what was going on. He says, I just want to thank him. He saved my daughter’s life. Because we and they moved around a lot because dad had a corporate job. And they were in a lot of different places. He says, I can’t tell you how many pediatricians? How many dentists how many times that my children have gotten care, and we always do routine care for them. And nobody ever has said this. And that would have been tragic had that little girl lost her life. Only because of a doctor, a dentist saying this is an airway development issue. So we do see a lot of that. And so not everyone I see is elderly, in nursing facilities. But it’s so important that we do that. You know, talking about nursing homes and facilities, I often run up against, you know, children that are now taking care of their parents, right and making decisions for them. And when I explained about the tele-dentistry services, I explain about the screenings. You know, I get a lot of pushback sometimes because they I hear, you know, she don’t need no exam. She’s got dentures. Right? Well, I can talk for eight hours on oral systemically and I never want them in some cheese. It’s not about teeth. It’s about hereo pathogens, and what they’re doing. So what we see very often in nursing homes and assisted living facilities and things like that is actually saw one man, little tiny of a man that had an upper denture that I could barely get out once we got it because it was so heavily embedded in calculus. So once that denture came out, the inside was so nasty, and he had a hole in his palate that was about the size of a dime.

RJ Martino 

Wow.

Theresa Sheppard 

I probably had been months since his denture was removed and cleaned. So we see that we see ill fitting appliances if you’ve ever had a blister on your foot and been forced to wear that same shoe every day and walk miles in that shoe. That’s painful. Ill fitting appliances to the same thing. Oral Cancer you can get oral cancer without teeth. Yes. So we need to screen for these things. are we providing care services? Yeah, absolutely.

RJ Martino 

You know, I love that you’ve got this teacher’s heart. I mean, I can just tell love it while I’m here. And I think, you know, you have definitely changed my perspective on a whole host of things. And I know speaking for our audience, you’ve got slides here and audience, if you’re listening to this, I urge you to go to the show notes. And we’ll have the slide deck available for you to see that, you’ll also be able to just watch clips of this on YouTube. But when I meet people like you that move me to change, I just think, man, I got to get your message out, you got to talk to more people. And then I think, who do I know that I need to connect you to? What kind of groups can can you speak to I know, knowing you, you’d speak to anybody, but you know, to help our audience members try to trigger off who they can kind of connect you to? Can you help and tell us who would be great to connect you with?

Theresa Sheppard 

Yeah, absolutely. Um, you know, study clubs are a great, everybody’s got study clubs, physicians, as well as as dentistry. And now with zoom, it’s so easy. You know, we have study clubs, we have nursing programs, we have physicians that are just getting ready to graduate that I really think need to hone in on this message. We even have just caregivers associations. Anybody that is taking care of school nurses, particularly because like I said, we’re not really focusing on this today. But you know, I have about a three hour presentation just on kids, tongue ties, and different things like that, and how that affects skeletal formation, which is going to affect their airway, and obesity, and kids, you know, metabolic syndrome in kids, which is going to affect their airways. So there’s all kinds of different things. So there, there is no one group, it’s It is literally, you know, everybody, I can even go in and teach a sixth grade class. Just the very basics of, you know, oral care, we can do just closing, I love to be hands on. I also have been fortunate enough to go to one of our local high schools for the last couple of years into their nursing RNP program. And the teacher there has me speak oral systemically. And I’ve done that every semester for a couple years now. And again, that’s a little bit different. We start with oral systemic link, but then I talk about things like HPV, which has taken over as the number one newly diagnosed cancer for 15 to 24 year olds 15 to 24 year old shouldn’t have cancer.

RJ Martino 

No, that’s incredible.

Theresa Sheppard 

But they do because of the HPV because they don’t realize what is going on. I show them some pretty graphic slides of piercings, tongue piercings that have gone awry or whatnot. So every group and every demographic has a special you know, I don’t want to say problem, but a special area that is focused on and can’t be focused on. So it’s just a matter of collaboration. And, you know, we have as not only a new slide this here, I’m just showing now that, you know, collaborations between medical and dental have always been pretty thin. I sat in that office manager chair for close to 25 years. And so my experience when I would try to contact a physician for a medical clearance, or to ask a question, because I you know, I was concerned about the patient. It really well. I’ve actually even been told well, the doctor doesn’t talk to dentists. You can have the patient call me. And I was like, what? Oh, that’s like, like, they’re snake oil salesmen or something. You know, that’s their oral physicians. You would never say oh, I don’t I don’t talk to oncologists, or I don’t talk to OBs. You know, it’s the same thing. So, we have now right now. We’ve, we’re definitely more aware of tele-medicine. We are definitely now just hearing things about tella-dentistry and we are all healthcare professionals treating a patient Can you imagine if we really used all the tools in our toolbox? To treat that patient? healthcare costs would go down, patient’s prescription costs would definitely go down. They’re not looking at making trips to the ER, especially for oral issues. You know, because the ER can’t do anything for them, except give them a prescription and say, See your dentist. Yeah, I have often had patients that have come in and say, you know, I just got diagnosed with breast cancer, for example, I’ve got to start chemo. And I asked them, Well, you know, did you do? What did you say about your oral care? and some will say, they don’t mention it. I just knew that it had been a while. And I’m going to be out for a while I wanted to get my teeth cleaned. And others will tell me that, yes, they mentioned it in the respect, as they should call, call their doctor and try and get their teeth cleaned. Well, teeth cleaning is only going to work if you don’t have perio disease. You don’t profi your perio patients. So it’s if that’s what I’m saying, using these tools in the toolbox, getting the physician and the oral physician on the phone together and discussing this patient? And how are we going to treat them? What’s the best course of treatment? Now we could start perio treatments, that that might have a four to six week treatment time. But that wasn’t communicated to us that Oh, no, they need to be isolated in three weeks. But had we had that information ahead of time, that would have been helpful? Well, I guess we could have changed our our modalities. No, but we just can’t ignore the fact any longer that as healthcare providers, we are treating the whole patient, and your mouth is connected to the rest of you.

RJ Martino 

This just been so fascinating. You know, I usually wait until the end and ask the audience to share this with somebody but our audience who’s listening at this point. We’re all involved in so much education. Theresa’s offering to provide that, especially in zoom, where we’re all going to be for the next, you know, foreseeable future. Send this to someone who leads or tries to get education speakers. If you’ve never done that before, it is hard to find good speakers, good educational experts that can speak to a group of highly intelligent people like our audience. So I will urge you please forward this podcast to an education director, a professor, or anybody who’s in charge of trying to educate a group of people that you’re a part of, they would be thankful. And we’ve got to get this message that Theresa’s brought with her out to the world. Theresa, we are running out of time. So I want to conclude and kind of ask you directly, is there anything else that our audience can do for you? Are there any other opportunities that the audience should be taking advantage of when speaking to you?

Theresa Sheppard 

Well, I just I think that we just need to kind of rethink and open our minds to all health, not only in dentistry, but in medicine. And let’s communicate, and I’m more than happy to show you know you how to do that dentistry. I have letters of introduction to physicians. I do have just this one last slide really quick. This is my portable Care 2 U service. And you can see the types of different facilities that we can go into. I go into a family’s home and see a family of five on a Sunday afternoon. Your dentist’s doesn’t open them. We’re very involved in the community. We see hospice patients, we see three year olds, we’ve seen headstart kids. So there’s no limit to what we can do to serve the needs of the people that are not getting care. There’s a there’s not only physical barriers to care because of travel, there’s emotional barriers right now, some people are scared to go out. Some people are scared of the dentist entirely. Some people just have this fear of the practice. And we’ve had some good success with memory care patients as well as some autistic kids that would never sit in a dental chair. But they’ll sit in their own chair, watch SpongeBob on TV while we’re taking care of them.

Jordan Smith 

Well, I love this message. And I know that there’s a lot of our listeners out there that are saying yeah, you’re speaking to the choir. I’d love to be able to you know from a dental perspective To pick up the phone and talk to one of my patients primary care physician, so those those listeners out there, and, you know, Theresa has mentioned all the education that she does RJ had a good point a second ago. You know, we we’ve gone kind of an inch deep on a lot of different subjects. And I think we’re probably gonna have to have a part two of this conversation a little bit deeper on a couple of the things that he pointed out. But for those listeners out there that have questions or want to reach out to your want more information, or some of those resources that you talked about, whether they are one of these groups that you say are great for you to, words, just a physician that has said, You know what, you brought up a lot of stuff that I’ve been thinking about for a while and I just, I just need a roadmap, or I need to figure out how to get started, what is what is kind of the best way to get in touch with you personally. What’s the best way for them to get more information and reach out to you.

Theresa Sheppard 

So I can be reached by email, which is Teresa, t-h-e-r-e-s-a, at Teresa shepherd.com, s-h-e-p-p-a-r-d. My phone number is 209-222-0750. And if you’re going to call me clear your schedule, because you know how I love to teach, and I’m going to talk to you for quite a while.

Jordan Smith 

That’s so generous, not too many guests give out personal phone number. So

Theresa Sheppard 

that’s my, that’s I’m more than happy to anybody that has questions. And let’s let’s get our patients healthier. Let’s keep them healthy. And they’re just going to be happier, all around.

Jordan Smith 

I love that I don’t I don’t think there’s a good a better kind of book into this, which is, let’s keep your patients happier. Let’s keep them healthier. And, you know, let’s let’s collaborate with others who have that same end goal in mind. So Teresa, Shepard, thank you so much. We appreciate it.

Theresa Sheppard 

Thank you so much for having me.

RJ Martino 

It was a phenomenal job. Thank you, Theresa. And we’ll talk soon.

Theresa Sheppard 

All right, thank you so much. Have a great day.

RJ Martino 

Jordan, that was really, really good. I know, you and I had spoke just a little bit about this beforehand. But once we’re wrapped up, what are some of the things that kind of stuck out to you.

Jordan Smith 

I mean, one of the things that she kept talking about, which and I think she said it directly. But this concept of training or lack thereof is the most expensive thing in your practice, it’s it’s one of the things that can have the most impact if you train everybody properly. And it’s one of the things that can affect your practice the most, if you don’t do it properly. So I think that’s a huge deal.

RJ Martino 

Well, if there are ways that we can help at all, as a listener, we’d love to, if you want to reach out to her, I’m telling you, I call her for instant advice on a number of things, anything that affects dental practices, or I just want to get her take on historical information. She has just been an open book for us. And I can’t express how much I hope our listeners heard. She loves to take your phone calls, she’d love to give you free advice. Take advantage of that.

Jordan Smith 

Yep, check her out. Teresa shepherd.com. She mentioned her email Teresa with an H at Teresa Shepherd calm, whenever she said yeah, just reach out to me, I’d love to talk to you. She will with anything from, you know telemedicine advice, what she always talked about, which is the oral systemic link, training, any of that type of stuff, she’s an open book, she does this, you know, on an international level. So she is a she’s a great resource and add it, I would encourage all of our listeners to take advantage of it. But also ask you guys take advantage of something else. We have a YouTube channel, she mentioned a couple times, uh, you know, on this slide, and this, this podcast specifically that we recorded is barely illustrated because she had a whole bunch of PowerPoints with some slides and some pictures and some additional information that we didn’t get to. So our link below go through, check out the YouTube page, especially at those points when she talked about specific things that were on the screen. We’re going to put that out there and share this wherever you want to.

RJ Martino 

And if you struggle find the YouTube page will have links to everything on our website like normal. But good point. We’ve been trying to build our YouTube subscriber for a little bit and check it out. And if we can do anything at all, to help you the listener, please shoot us a message we’d love to hear from you. We’d love anything that you’d like to hear or people that you’d like us to talk to you. As always like subscribe. Anything else Jordan?

Jordan Smith 

No like, subscribe, comment if you’ve got people who you think it’d be good fits on the podcast to reset came from one Have you guys the listeners kind of dropped her name in one of the comments. So we reached out we were lucky enough to bring her so part of the reason that we’re able to get such such great guests are referrals from you guys, so keep those out. So like, comment, subscribe, especially if we earned it and until next time thanks, RJ.

RJ Martino 

Thanks, Jordan.