Episode Transcript

Daniel Lobell: (00:00)
This podcast or any written material derived from its transcripts represents the opinions of the medical professional being interviewed. The content here is for informational purposes only, and should not be taken as medical advice since every person is unique. Please consult your healthcare professional for any personal or specific needs.

Daniel Lobell: (00:24)
Hello, and welcome to the Doctorpedia podcast. I’m your host, Daniel Lobell, and I’m honored to be on the line today with Dr. Caroline Webber. How are you?

Dr. Caroline Webber: (00:34)
Great, thanks. How are you?

Daniel Lobell: (00:36)
I am good. Not only do you have the distinction of being our very first dental doctor, if I can say that, but you are our very first oral and maxillofacial surgeon. Can you tell us what that means, to start?

Dr. Caroline Webber: (00:52)
Yes. An oral and maxillofacial surgeon is a surgeon that’s trained to recognize and treat a wide spectrum of diseases, injuries, and defects of the head and neck, the face and jaws. We’re also trained to administer anesthesia and provide care in office and hospital settings. We treat things such as extraction of wisdom teeth, misaligned, jaws, tumors, cysts of the jaws and dental implant surgery. It’s a specialty that’s recognized by the American College of Surgeons. And it’s one of the nine dental specialties recognized by the American Dental Association.

Daniel Lobell: (01:28)
Are there some that are not recognized by the American Dental Association?

Dr. Caroline Webber: (01:32)
Yeah, there are some sort of pop-up specialties. I couldn’t name those for you.

Daniel Lobell: (01:37)
Must be tough to be not one of the nine. Like one day, their day will come. One day. So somebody gets in a bad fight. Let’s say they’re a boxer or an MMA fighter, and they get their jaw smashed. They come to you?

Dr. Caroline Webber: (01:53)
Yes, we treat jaw fractures. One of the important components of a jaw fracture is making sure the teeth go back together in the correct orientation, in addition to making sure the bones heal. So an oral maxillofacial surgeon would be the surgical specialist that treated that injury.

Daniel Lobell: (02:11)
It’s like braces on steroids.

Dr. Caroline Webber: (02:14)
That would be a way to put it, yes.

Daniel Lobell: (02:19)
Like, okay. The little wires are not gonna cut it for this one. We’re going in.

Dr. Caroline Webber: (02:25)
Right. Exactly. Because many jaw fractures do involve having a patient’s teeth wired together. Some do not, but some do.

Daniel Lobell: (02:34)
So I read that you’re a native of Orlando, Florida. Are you still in Florida?

Dr. Caroline Webber: (02:40)
No. I grew up in Orlando, Florida, but I presently reside in Virginia Beach and I’ve been in Virginia Beach since about 2001.

Daniel Lobell: (02:49)
Not a big move, but you’re only a few hours away.

Dr. Caroline Webber: (02:54)
No, but I had a lot of big moves in between because I was active duty military for 21 years.

Daniel Lobell: (02:59)
Wow.

Dr. Caroline Webber: (03:00)
So I did have a lot of moves in between.

Daniel Lobell: (03:03)
Did you practice medicine in the military?

Dr. Caroline Webber: (03:06)
I did. I was a general dentist for about 10 years in the Navy. And then I was an oral maxillofacial surgeon for the other 11 years.

Daniel Lobell: (03:15)
I’m having this funny visual of like, it’s the middle of like combat, bullets are flying overhead, bombs are exploding. And you’re there with that little water thing and you’re like… Okay, you know the one where you pour water in the person’s mouth and you’re sucking it out at the same time? [Both chuckle] The soldier’s got the little bib on and you’re like, “Okay, we’re just almost done with the cleaning.”

Dr. Caroline Webber: (03:46)
Well, actually dental health is quite important for military forces because it’s really tough to evacuate a soldier or a sailor out of a remote area if they have a toothache or an infection. So it was a really important part of a soldier or sailor’s health, their dental health.

Daniel Lobell: (04:08)
I believe it. I was just making light of it anyway, but I’m sure it’s a very important…

Dr. Caroline Webber: (04:13)
It was a good visual.

Daniel Lobell: (04:14)
It was a Waterpik. That’s the word I was looking for. It’s a Waterpik. So what does it realistically look like? Are you in a tent? Are you in the battlefield areas, or are you removed from it all somewhere? What did it look like when you were in the military?

Dr. Caroline Webber: (04:31)
Yeah, so dentists and oral surgeons in the military are deployed and stationed in a number of different areas. They can be in dental clinics, hospitals, on ships, deployed with the Marines, and dentists, especially oral surgeons, have trauma training. So that becomes very important in a military setting. So it looks like a number of different areas one can live, and then in addition, there’s a lot of moving all the time to different duty stations every couple of years.

Daniel Lobell: (05:06)
Yeah. So does this desensitize you, when somebody comes in with a toothache and you’re like, “Listen, I’ve been through trauma training. This ain’t nothing.”

Dr. Caroline Webber: (05:19)
Right, right. Yes. I think all medical professionals, and especially dentists and oral surgeons, are desensitized, but you’re right. Yes.

Daniel Lobell: (05:33)
So you’re growing up in Orlando, Florida. And at some point you decide you want to go into medicine and then specifically oral medicine. How did that come about?

Dr. Caroline Webber: (05:44)
Yeah, so I always had an interest in science and I took a lot of chemistry classes and sciences, and then I like to sew and do things with my hands. And so surgery was a perfect crossover between the sciences and then liking to do things with your hands. And then to top it off, my very best friend in the world, her father was a dentist. And so she convinced me and we decided to go to dental school together.

Daniel Lobell: (06:13)
Are you still close friends?

Dr. Caroline Webber: (06:16)
I am, with she and her husband. And they’re both dentists and their daughter’s an orthodontist.

Daniel Lobell: (06:22)
Wow. Wow. What a dental family. That’s amazing. [Both laugh] There is not one dirty mouth in that family, I imagine. [Both chuckle]

Dr. Caroline Webber: (06:33)
Yeah. So that’s how it came about. And I went off to dental school and then shortly thereafter I had wanted to move to California and the Navy told me they could send me there. So I ended up joining the Navy with a plan to only stay for a couple of years. And then I ended up with 21 years in the Navy.

Daniel Lobell: (06:54)
So are you happy or do you regret it? Because you could have probably got to California a lot easier than that.

Dr. Caroline Webber: (07:00)
Oh, it was a wonderful experience. And I did my oral surgery training at Bethesda Naval Hospital, which is a fantastic program. And I made a lot of friends all over the country, all over the world and just had wonderful training in oral surgery. So it was a great career move.

Daniel Lobell: (07:18)
Somebody told me when you join the Navy, they promise you, you could — “Join the Navy, see the world,” but you just wind up seeing the inside of a boat,

Dr. Caroline Webber: (07:26)
Right. That can happen. That can happen. And they can also send you to remote places that you don’t necessarily want to go to. We call that being “voluntold.” You’re voluntold to go.

Daniel Lobell: (07:40)
So do you still get called back in for military medical things?

Dr. Caroline Webber: (07:47)
I do not. I mean, technically when you’re retired you can still be on a list, but I do not get called back in. I’ve moved on to the next chapter of my life.

Daniel Lobell: (07:59)
Do you still like sewing?

Dr. Caroline Webber: (08:02)
I still…. Oh yes, I do. I do. Not as much anymore, though.

Daniel Lobell: (08:07)
Got it out of your system?

Dr. Caroline Webber: (08:07)
I still might think, but sometimes… Yeah, I did. Sometimes it’s easier to drop it off somewhere.

Daniel Lobell: (08:33)
So I have a lot of questions for you. And many of them surround this topic that you presented me with before the interview, which is wisdom teeth but I don’t know much about them to be honest. And I know you do, so let’s start with why are they called wisdom teeth? Where do they come from? Who has them? And when do you get them?

Dr. Caroline Webber: (09:22)
Yeah. So they’re called wisdom teeth because they are the last teeth in the mouth to develop. They develop between ages of 17 and 21. And that’s supposedly when people become adolescents and they’re through their childhood. So you’re getting your wisdom and you get those teeth at the same time.

Daniel Lobell: (09:40)
I don’t know, I remember being 17 to 21. I can’t say that that rings true for me, but…. [Both laugh]

Dr. Caroline Webber: (09:51)
So that’s why they’re called wisdom teeth. And generally speaking, most people do not have space for them in their mouths. Some people do, especially if they’ve had braces and maybe had another tooth removed, they have space, but if they’re left, they can become impacted, which just means stuck or trapped in the jaw. They don’t erupt normally like other teeth. And —

Daniel Lobell: (10:21)
When you say erupt, you mean they grow out?

Dr. Caroline Webber: (10:24)
Right. Come into the bite, come into a normal tooth position. So a lot of wisdom teeth, because there’s not space, they’re sideways, they’re turned, they’re stuck in the jawbone and that’s called impacted.

Daniel Lobell: (10:40)
Yeah. So before you continue on, what I’m gathering so far is that these teeth, the name might be ironic because they show up late. They show up in a place where they’re often not wanted. They don’t perform well. They should be called stupid teeth.

Dr. Caroline Webber: (10:59)
I like that. Right, right.

Daniel Lobell: (10:59)
Why are these wisdom teeth? I mean, what’s going on here? These teeth seem like every other tooth is smarter.

Dr. Caroline Webber: (11:07)
Right. Or useless teeth, I guess they can be called.

Daniel Lobell: (11:10)
They don’t even know how to get into the bite. They have a lazy — show up late to the party. Don’t have a purpose, just sort of hanging out there causing trouble teeth. But somehow they got this prestigious title, but please go on.

Dr. Caroline Webber: (11:26)
Right. So an impacted wisdom tooth can form a cyst around it. It can get infected. It can decay, it can damage teeth in front of it. So that is why, generally speaking, they are removed. It’s much safer, and the recovery is easier to remove them at a younger age. So in that 17 to 21, sometimes even younger, 15 year old age bracket, wisdom teeth are removed. And the studies have shown that patients have a better quality of life and do better long-term when wisdom teeth are taken out.

Daniel Lobell: (12:03)
I knew there was a reason. I never had my wisdom teeth taken out. And I got a friend who’s in Hawaii right now and I’m sitting here and I’m going to blame the wisdom teeth. My quality of life, it’s been impacted. I never got the teeth done. [Both chuckle]

Dr. Caroline Webber: (12:19)
Right. Right.

Daniel Lobell: (12:24)
Why am I driving this car? Why don’t I own this home? Damn you, wisdom teeth! I should’ve got rid of you at the start. So was there a reason for them? Do we look at this in some kind of historical, biological context where in which we can understand why we have the wisdom teeth in the first place? Did they serve a purpose? What’s the story there?

Dr. Caroline Webber: (12:50)
Well, the theory is that back when we were caveman or many thousands of years ago, the jaws were bigger and there was actually space for them. And then as people evolved and jaws became smaller, the teeth stayed, but there’s inadequate space for them. And of course, that’s just one theory. No one probably knows a hundred percent for sure. But that’s just one theory on why we do not have space for them.

Daniel Lobell: (13:18)
It’s probably the only body part I’ve ever heard of that we don’t have space to accommodate.

Dr. Caroline Webber: (13:25)
Right. And it’s taken out in a preventative type surgery. That’s interesting. We don’t take out appendix, because it might get infected someday, but it’s always a risk benefit ratio. And the risk of surgical removal of wisdom teeth is quite low and the benefit is quite good to a patient. And so that’s why they’re taken out before a problem develops. Now, older patients that have held onto their wisdom teeth, especially if they’re impacted and there’s no problems on them, then those we tend to leave. But of course I do see older patients and that becomes a much more challenging surgery, when I see an older patient that has a wisdom tooth that’s developed a problem all of a sudden.

Daniel Lobell: (14:11)
Why is it more challenging when they’re older?

Dr. Caroline Webber: (14:14)
Well, you don’t heal as well, for one thing, recuperation is longer. The tooth usually is more submerged and longer roots on top of important anatomic structures like nerves. Sometimes there’s a higher risk of jaw fracture, nerve damage. And the risks just tend to go up exponentially after the age of 26 to 27.

Daniel Lobell: (14:37)
Hmm. Maybe that’s what happened with my brother. The roots were in there too long already.

Dr. Caroline Webber: (14:42)
It could be. Yeah, it could be. Because generally speaking, you described that he still had a hole and that’s pretty uncommon. The space where the wisdom tooth is taken out regenerates bone with a process called osteogenesis and the gum grows back over it, it becomes normal, healthy, jawbone as if nothing was ever done.

Daniel Lobell: (15:03)
That’s really interesting. Is that the only instance that we know of where bone grows back like that?

Dr. Caroline Webber: (15:11)
Well, a couple more things. So any other tooth that’s taken out in the mouth, there’s a hole and that will regenerate bone in the hole, and once again, grow gum tissue over it and become essentially normal jawbone without a tooth in it. Again, osteogenesis. So then when we break a bone and it’s put into a cast, bone grows between the broken segments and that’s how bones heal.

Daniel Lobell: (15:40)
And that’s also the same process of osteogenesis that’s…

Dr. Caroline Webber: (15:45)
Yes, yes. That’s the same process.

Daniel Lobell: (15:47)
So how come we haven’t found some mad scientists who can make you grow your finger back if you lose it or something like that?

Dr. Caroline Webber: (15:54)
Yeah, I mean, there’s all types of research now on bone grafting and bone procedures, there’s something called platelet rich plasma to help grow bone. And so that’s definitely an area of ongoing research in a lot of different medical specialties. Oral surgery, as well as orthopedic surgery and other bone related specialties.

Daniel Lobell: (16:17)
As soon as they figure that out, people are going to start putting extra hands on and stuff like that. It’s going to get out of control.

Dr. Caroline Webber: (16:24)
Right, right. That may be a ways’ off.

Daniel Lobell: (16:27)
Walking around with an Indian god with eight arms.

Dr. Caroline Webber: (16:32)
Yeah, that might be a ways off.

Daniel Lobell: (16:34)
Could be, but it’s possible and you can count on humanity to abuse it. I’m sure that’ll take place. Okay. So we understand now, “we” being me and the listeners, you already know, that the wisdom teeth are the late to the party teeth that are not super easy to accommodate, better if you take them out when you’re younger, the bone regrows, or it should anyway, my brother’s bone is obviously lazy, and the gum repairs itself. What else should we know about wisdom teeth? What are some of the things that we wouldn’t even think to ask?

Dr. Caroline Webber: (17:20)
Right. So it’s an office-based procedure. It doesn’t necessarily have to be done in a hospital. And it’s about a 45 minutes, depending on the surgeon, maybe 30, 45 minutes, an hour procedure. It is a recuperation time that’s pretty short, maybe ranging from two to three days. Most patients do like to be asleep or have an IV sedation with general anesthesia to have wisdom teeth out, and that’s something that can be provided by an oral maxillofacial surgeon at the same time as the surgery is being done.

Daniel Lobell: (17:57)
So it’s actually not usually like, unless like you said, it’s an older patient, it’s not usually a major surgery, but it’s one that’s done preventatively,

Dr. Caroline Webber: (18:10)
Correct. It’s not a major surgery, but I would emphasize it’s still a surgical procedure. Some patients have a perception maybe that it’s going to be like having a filling done. And it’s certainly more than having a filling done. It’s a surgical procedure. And most patients have four wisdom teeth. Although there’s some patients that don’t develop a wisdom tooth or there’s other patients that have extra ones. And most patients, as I mentioned, do like to be asleep for having wisdom teeth removed. While they’re sleeping, we would numb the mouth so that no one wakes up in any pain whatsoever. And the procedure is very straightforward and very safe. And so is the anesthesia.

Daniel Lobell: (18:55)
So the fact that I still have my wisdom teeth, and I don’t think they’re crammed in there, does that mean I literally have a big mouth when people have always said, “Oh, you and your big mouth,” they were right?

Dr. Caroline Webber: (19:07)
Yes. Because it sounds like you have space for them if all four of them have come into your mouth.

Daniel Lobell: (19:12)
I’m very hospitable.

Dr. Caroline Webber: (19:16)
Yeah. So a really important thing for you would be then to make sure that you’re cleaning them adequately. If they’re, sometimes they’re a little tougher to clean, because they’re all the way in the back. So making sure that you’re using the dental floss and the toothbrush back on those back teeth, as long as they have come into your bite or into occlusion, would help prevent future disease, decay and infection of the wisdom teeth.

Daniel Lobell: (19:42)
Has anyone invented a special tool for cleaning your wisdom teeth? Because it is hard to get to them with the brush.

Dr. Caroline Webber: (19:49)
No, just your standard toothbrush. And then of course dental floss is very important on all your teeth and then especially on your wisdom teeth in the very back. You have to floss the back of the back tooth.

Daniel Lobell: (20:01)
So flossing really is that important? Why is that?

Dr. Caroline Webber: (20:05)
Flossing is really important because otherwise you develop bacteria under your gums and over time the bacteria cause bone loss and then bone loss is known as periodontal disease, teeth that can eventually become mobile, they can abscess and then you lose a tooth or even more than one tooth. And again, having a full dentition or good teeth for chewing is really important, especially as people age, because nutrition is so important. So it’s very important to have good oral hygiene, and then also to see your dentist every six months for a checkup and a cleaning.

Daniel Lobell: (20:49)
So the bacteria that grows underneath your teeth is a specific type of bacteria that eats away at bone?

Dr. Caroline Webber: (20:56)
It’s a whole host, it’s a polymicrobial low grade… It’s not what I would call an active infection, but the mouth is full of bacteria. And if you don’t clean them, then you can develop plaque on your teeth, which is the stuff we’re always trying to brush off of teeth. And that just stays trapped under the gum. And the gum is sort of like a turtleneck around the tooth. And if it stays trapped, then again, over time you lose bone and can develop an abscess.

Daniel Lobell: (21:28)
Is plaque just basically leftover food that’s attached to your tooth?

Dr. Caroline Webber: (21:33)
Plaque is basically just debris on the tooth. It’s not leftover food. It’s just basically debris from bacteria on the teeth. So we kind of call it when your teeth feel like they have fuzz on them. That’s bacterial plaque.

Daniel Lobell: (21:56)
What’s the best way to remove plaque if it’s not coming off with a brush? Do you have to go to a dentist for that?

Dr. Caroline Webber: (22:03)
Yes. So plaque, since it’s a mass accumulations of just bacteria, the best way is with brush and floss, but if it becomes calcified, then that’s called tartar or calculus. And then that’s when a dentist or dental hygienist has to remove it.

Daniel Lobell: (22:23)
That’s when they have to get out the old chipper and start chipping away at it.

Dr. Caroline Webber: (22:28)
Yes. When it becomes calcified, because it’s just sort of a constant film of bacteria on your teeth, but if it becomes calcified, you can’t really get it off.

Daniel Lobell: (22:37)
It’s never the good bacteria though. It’s always the bad bacteria. Why can’t the good bacteria hang around more often?

Dr. Caroline Webber: (22:43)
Right… It’s the bad players. And tooth loss, tooth infection can be very painful, it can be a medical emergency. If a patient develops a large infection and it can be costly to replace teeth. So it’s like every other aspect of health, prevention is really everything.

Daniel Lobell: (23:04)
When we get a cavity, is that basically just plaque and bacteria building up and and penetrating its way through the bone or is there more to it than that?

Dr. Caroline Webber: (23:17)
So a cavity is basically decay of a tooth. So it’s when the tooth becomes actually decalcified from… It’s called dental caries. And it’s when a tooth becomes decalcified and starts breaking down.

Daniel Lobell: (23:33)
Why does that happen? Is it genetic?

Dr. Caroline Webber: (23:36)
Some genetics do play a role, but again, it’s all about the cleaning and it’s caused by bacteria being on your teeth. And then the diet is very important. Sugar and a high carbohydrate diet can lead to more cavities.

Daniel Lobell: (23:57)
Yeah. It’s always that. It’s never salad. Why can’t it just be like, “One thing that sugar is good for is clean teeth.”

Dr. Caroline Webber: (24:08)
No, no. I know. Sugar is bad in so many ways and the teeth are just another way that sugar is not good.

Daniel Lobell: (24:16)
So what are some of the interesting developments in your field right now that you’re excited about, some of the things on the horizon that we may not know about as consumers or as patients?

Dr. Caroline Webber: (24:31)
So I would say this is maybe not a new thing, but probably the best invention in dentistry since I’ve been in it, which is I’ve been in dentistry over 40 years at this point. And I would say that the best invention in dentistry has been dental implants. In the old days, when a patient lost a tooth, then the teeth on either side had to be cut down into two little pegs and crowned over and then put a fake tooth between them and that’s called a bridge. But with the advent of dental implants, which is a screw that goes into the bone, and it actually fuses to the bone, that has just been an unbelievable thing for patients to replace a tooth or to make a denture fit better. So that I really, I think has just been incredible.

Daniel Lobell: (25:24)
Are they going to have it so that you can click your teeth in and out if you have the… They can just attach different teeth to the screw. Like if it’s Halloween, you can put on vampire ones or whatever? [Daniel chuckles]

Dr. Caroline Webber: (25:35)
Oh… they haven’t gone that route yet, but there may be a whole new market for that. [Daniel chuckles] There may be an entirely new market for that. So I really think, when I think of just everything that’s going on in dentistry, that dental implants are just the greatest invention. And I’m not sure anything could top that for a while. I’m sure there are some things on the horizon.

Daniel Lobell: (26:02)
I’ve got something, but I don’t know if you’re going to be open to it. You need to be really thinking outside the box.

Dr. Caroline Webber: (26:11)
Okay. Let’s hear it.

Daniel Lobell: (26:13)
Laser teeth. They’re teeth, and they’re made of lasers and they do all the chewing for you because you don’t have to use your teeth. They just cut right through the food with lasers. What do you think?

Dr. Caroline Webber: (26:26)
That’d be hard. I’m not sure where you would install them. [Caroline chuckles]

Daniel Lobell: (26:31)
I can’t figure out every part of it. Some of it’s for you to figure out. I just came up with the main part of it, which is the laser teeth.

Dr. Caroline Webber: (26:38)
Well, I will tell you lasers are used in dentistry though, like they’re used in the surgical specialty for doing certain oral surgery procedures, removing lesions. They’re also used from the technical end of things, when a crown is made, sometimes it’s laser cut or it’s computer cut and it’s a custom laser cut crown. So they have been used in dentistry and other aspects, but I don’t know, directly applied to a patient for chewing. That is a new one. [Both chuckle]

Daniel Lobell: (27:17)
What about robotics? Are they playing a role in dentistry these days?

Dr. Caroline Webber: (27:21)
Not yet. Not yet. We don’t have robotic surgery… The ENT doctors, the otolaryngologists, I know they’re doing a lot more head and neck cancer robotic surgery, which is wonderful.

Daniel Lobell: (27:36)
You mentioned at the onset that you deal with certain kinds of mouth cancers. What kind of cancers have you treated?

Dr. Caroline Webber: (27:48)
Yeah, so oral maxillofacial surgeons, we always do a really thorough cancer screening exam when we do an exam of a patient. Oral cancers are definitely on the rise. It used to just be older patients that smoked and drank, but oral cancers have greatly increased in the younger patient population. A lot of that’s due to the HPV virus. So we’re always doing cancer screenings. And then we have a pretty low threshold for getting a biopsy because an oral cancer can be devastating and has a high mortality rate, depending on what stage it is. The most high risk areas are really the tongue and floor of the mouth. And most dentists do an oral cancer screening exam every six months. When you go in for a dental check, oral surgeons, typically we will biopsy things, and determine whether it is cancer or not, because there’s some pre-cancers where a patient needs to be followed for a long time. And then a lot of times the definitive surgery is done by an otolaryngologist, an ENT surgeon, but there are a number of oral surgeons at some of the major hospitals and in practice that do oral cancer surgery as well. So I myself am not doing big cancer surgeries, but I’m very involved in the screening process and then also the biopsy process.

Daniel Lobell: (29:09)
What do you look for, like what should we know what to look for?

Dr. Caroline Webber: (29:13)
Oh, that’s a great question. Because most people don’t look inside their own mouth. That is a great question. It is just like other parts of the body. A non-healing ulcer would be of particular concern, especially if it didn’t heal in two weeks. So red areas, white areas, white plaques or red ulcerated areas. And as I mentioned, the tongue and the floor of the mouth, because there are lots of lymphatics in the tongue and floor of mouth, those are particularly high-risk kind of areas. And if there’s ever a doubt, the best thing to do is to go to your dentist. And there, the general dentists are very well trained in oral cancer exams. And then they would most likely get you off to an oral surgeon to get a biopsy of that area.

Daniel Lobell: (30:03)
So is my dentist screening me without me even knowing? Because I’ve never heard her say it.

Dr. Caroline Webber: (30:09)
Yes, yes, they probably are. And your dental hygienist, they’re very well-trained also. Some of the cancer cases that have been referred to me for biopsy, the dental hygienist found it when the patient went to have their teeth cleaned. Ulcer of the tongue that did not heal, and it ultimately turned out to be an oral cancer.

Daniel Lobell: (30:28)
Should you be wary if your dental hygienist practices poor hygiene?

Dr. Caroline Webber: (30:36)
Yeah. But most dental hygienists are very meticulous, not only with their patients, but with their own mouths as well. [Both chuckle] Most of the dental hygienists are very, very meticulous.

Daniel Lobell: (30:53)
So we sort of led into this question a little bit when I asked you about looking yourself for things in your own mouth that might be cancerous or something to worry about. I’m going to use that to segue into the online health space. How often do you find patients are going online before they come in and doing their own diagnoses?

Dr. Caroline Webber: (31:26)
Oh, yeah, that is frequent. And I think that’s a great thing. So I would guess upwards of 90, 95% of my patients, certainly the elderly patient population may not research online as much, but wisdom tooth patients and their parents have done a lot of online research. And it’s great. And then patients with specific conditions have also done online research. I think the only problem is sometimes there’s a plethora of scary information or misinformation, and sometimes patients do come with some preconceived ideas that maybe aren’t correct.

Daniel Lobell: (32:05)
Well, I know that that’s one of the missions of Doctorpedia, is to hopefully sift through all that. Can we talk a little bit about Doctorpedia and what attracted you to Doctorpedia and what role you’re playing in the company?

Dr. Caroline Webber: (32:19)
Yes, I was attracted to Doctorpedia, first of all, I really like the leadership of the company and I just had some great conversations with the CEO. And I think the mission is something that’s really needed for patients. And that is good online accurate information provided by doctors. And more and more are people who want to watch video. People don’t want to read anymore. They want to watch video and doctors are making videos about all kinds of things, their practices, their instructions. And so this is another great opportunity for patients to learn about their condition. So I really was drawn to the professionalism of the company and then the mission to further patient care.

Daniel Lobell: (33:12)
Yeah, absolutely. What role are you playing in the company now?

Dr. Caroline Webber: (33:17)
Well, right now I’m going to be making content video on oral maxillofacial surgery. And we’re going to try to provide education in that arena. Oral maxillofacial surgery is interesting because it’s the crossover between dentistry and medicine. And so we’re looking at getting a dental channel going and also, again, providing patient information on oral and maxillofacial surgery.

Daniel Lobell: (33:47)
So what are some of the videos that you’re either in production with, or hoping to start shooting, going to cover?

Dr. Caroline Webber: (33:55)
So we’ve just talked about wisdom teeth, so we’ll have a lot of wisdom teeth video. Some of the topics, again, that we covered today on why they need to come out, the post-operative care, what’s involved in the surgery. Also other alternative surgeries, if it’s a high risk situation to remove wisdom teeth, other alternative surgeries, to wisdom teeth, patient self exam for oral cancers, that’s very important for patients, and also content on just what oral maxillofacial surgeons do and what our role is.

Daniel Lobell: (34:36)
I know you’ve touched on it, but I kind of am hoping that you can go a little more into what that role is. What do you do, other than what you already mentioned with wisdom teeth?

Dr. Caroline Webber: (34:47)
Okay. So we’re a dental specialist and most of our patients come to us through their general dentist. So if there’s — and lots and lots of patients need different teeth out for different reasons or need dental implants placed. So the general dentist, generally speaking, would send us a patient. Even if it’s just to have one tooth removed and sometimes teeth are more challenging to remove. So that would be a patient that would come to us. And then we’re also, since we do a four year hospital-based residency and we rotate through all the medical specialties, including general surgery, anesthesia, we also are well-versed in medically compromised and medically complex patients. So the tooth is attached to the patient, so there are always a lot of things to consider before we just take out a tooth or do surgery on a patient. So basically we take out teeth, we do trauma, as you mentioned, jaw fractures, even fractures of the upper jaw, fractures of the orbit.

Dr. Caroline Webber: (35:58)
We remove lesions of the mouth. We biopsy things. We place dental implants. We do what’s called pre-prosthetic surgery, which is a bone surgery to smooth things out in the jaws to make the jaws ready for dentures. Some oral maxillofacial surgeons are trained in facial cosmetic surgery. That’s a fellowship. Some oral maxillofacial surgeons are trained in trauma and reconstruction, meaning they can move flaps of bone and muscle to rebuild jaws and rebuild faces. They do a lot of things like the plastic surgeons do. So we do a variety of things that cover the mouth and the face.

Daniel Lobell: (36:47)
So somebody who feels that they cosmetically don’t have as nice a mouth as they would like would come in?

Dr. Caroline Webber: (36:53)
Yes, that would be one of our patients. They usually start with their general dentist because a lot of our work is done in conjunction with the general dentist. We do the surgical component, but the general dentist is actually the one that would make the teeth, if let’s say we were placing a dental implant. So the general dentist would be the one that would make the crown or the tooth to go over the dental implant.

Daniel Lobell: (37:17)
So in a way, what you’re doing is a lot like the movie Face Off.

Dr. Caroline Webber: (37:23)
I haven’t seen that movie, but now I need to watch it

Daniel Lobell: (37:26)
When one person takes their face off and replaces it with another face, but you’re just doing it for the mouth.

Dr. Caroline Webber: (37:31)
There have been medically documented cases of facial transplants, right. I have not done that, but there have been medically documented cases of that. So I’m going to watch that movie.

Daniel Lobell: (37:42)
It’s an old one, but yeah, you should definitely check out Face Off. So what is the most difficult part of the mouth to operate on and why?

Dr. Caroline Webber: (37:55)
Oh, okay. That’s a good question. So the hardest part is probably the back of the mouth, just because it’s further back and it’s a small space and we have to get the patient to open wider. And of course we have the tongue in the way kind of pushing things around. So my assistants are very well-trained to retract tongues and shine lights and hold things. But the posterior or back part of the mouth is probably the most challenging.

Daniel Lobell: (38:24)
So are there ever scenarios wherein you have to disconnect the jaw completely?

Dr. Caroline Webber: (38:30)
I don’t do that type of procedure in my office, but there are some cancers and things that are done by having to do a midline split and move things around. Yeah. But for something routine, like a tooth extraction, we wouldn’t have to do that invasive of a procedure.

Daniel Lobell: (38:53)
And the patient, I think you mentioned is asleep when you do it, correct?

Dr. Caroline Webber: (38:57)
When we take teeth out, yes. The patient is asleep. It’s their option. And if their health history is such that they can safely be sedated in the office, then we can provide anesthesia even for a single tooth extraction if a patient has a lot of dental anxiety. The oral and maxillofacial surgeon is very well versed in treating anxious patients, because we do have those anesthesia skills.

Daniel Lobell: (39:23)
Yeah. I can’t imagine a patient not being anxious while having their teeth removed.

Dr. Caroline Webber: (39:30)
Right. You’d be surprised. Some people, they want to be awake and they can have a lot of teeth removed while they’re awake. Other patients have one baby tooth and they want to be asleep for it. So every person is just so different that we tailor the anesthesia and the anti-anxiety protocol to the patient.

Daniel Lobell: (39:52)
Right. Reminds me of the game Hungry Hungry Hippo. Remember that? Where you could go in and the hippo — Wait, no, it wasn’t that one. Which was the one where you’d remove the teeth from the hippo? Was that Hungry Hungry Hippo?

Dr. Caroline Webber: (40:06)
Well, again, I’m embarrassed. I don’t know that one. [Daniel chuckles] I do know the game of Operation, which I liked to play as a child where you grab the little things and move them out and it buzzes.

Daniel Lobell: (40:15)
Oh yeah, I remember Operation. Sure. You mentioned that sometimes the teeth have really long roots. Have you ever found a root that’s so long that it goes down to the knee?

Dr. Caroline Webber: (40:30)
No. Not to the knee. [Both chuckle] But some patients do have longer roots and other patients don’t have long roots on the teeth and it’s just a case by case basis on what we need to do to remove the tooth. There’s also a lot of studies that show that you can leave some roots in a patient’s jaw. The bone would grow right over the top of it. And it becomes part of the jawbone. So if the risk of removing a long root outweighs the benefits, again, then we would leave that root in place and the bone grows over it. Like I said, there’s a lot of good studies on that. That’s called a coronectomy procedure. And that’s actually one of the content videos that I’m looking to make with Doctorpedia, is to explain coronectomy procedure.

Daniel Lobell: (41:26)
It almost begs the question, why ever remove the root in that case? Maybe just always leave it in there.

Dr. Caroline Webber: (41:32)
Well, there’s some risk of infection. So you have to weigh the pros and cons. If the root can easily be removed, then that would be your first choice. But if there’s a risk of jaw fracture or nerve damage, then a coronectomy procedure, particularly with wisdom teeth removal, would be indicated. And I always like to cover all those choices with my patients.

Daniel Lobell: (41:53)
Got it. Do you ever take these roots out of somebody’s mouth, plant them in a little pot in your kitchen and watch a tooth tree grow?

Dr. Caroline Webber: (42:01)
[Caroline chuckles] As a matter of fact, we don’t even like to give the teeth out to patients. Some patients want them, but they’re contaminated by blood and saliva. Especially during the era of COVID virus, we don’t like people walking around with contaminated teeth or body parts in their pockets.

Daniel Lobell: (42:18)
Well, I said the question obviously in jest, but it got me thinking in terms of a serious question, are there tooth transplants that ever take place, where there’s a healthy tooth, let’s say in somebody who died in a motorcycle accident? Can it be planted into a mouth that needs a tooth and adapt and grow in there?

Dr. Caroline Webber: (42:41)
So years and years ago, I don’t know how many, they used to do a tooth transplantation procedure, especially with a wisdom tooth where you don’t need that tooth anymore, and then move it into the spot of a tooth that you lost that you do need, but they didn’t work well and they ultimately became infected. And so it’s in the advent of dental implants, which are so much more predictable, dental implants have about a 98% success rate, low risk infection, much more predictable, less surgery. That would be the indication over trying any type of tooth transplantation.

Daniel Lobell: (43:21)
Once again, wisdom teeth let us down.

Dr. Caroline Webber: (43:25)
Right, right.

Daniel Lobell: (43:28)
Let’s shift gears for a minute and talk a little bit about the doctor patient relationship. What do you think are the most important facets of that relationship?

Dr. Caroline Webber: (43:38)
Well, for my patient population, especially my wisdom teeth patients, it’s a first time procedure. So I think a patient feeling comfortable with their doctor and feeling that their doctor cares about them. I love the expression “No one cares how much you know until they know how much you care.” That the most important thing is just for the patient to know that you really do care about their welfare and then a patient certainly has to have confidence in your abilities. So I think those things are extremely important. And then also taking time with a patient, no patient wants to feel like you’ve rushed or they weren’t heard. So those, to me, are the most important things.

Daniel Lobell: (44:21)
Absolutely. How do you build trust with a patient?

Dr. Caroline Webber: (44:26)
For me, I build trust with the patient by taking time with them. I schedule a consultation where they can ask any questions that they want. I try to provide as much information as I can about the procedure and about my background. What’s interesting is many times they’ve already looked me up online and they know about me. So they come in with a preconceived notion, but just really taking time with the patient and answering their questions builds confidence.

Daniel Lobell: (44:58)
Have you been able to use any of your military training to better assist your relationships with patients?

Dr. Caroline Webber: (45:07)
Well, I live in an area where we have a lot of retired military or a lot of people in active duty that have spouses that come to see me. So my relationships with patients since I have a larger patient population, a lot of times we have something we can bond over, which is the military and my military experience. But I learned a lot. I did my residency in the Navy at a really prestigious Naval hospital, Bethesda Naval hospital. So the skills I acquired there really enabled me to be a good doctor and a good surgeon.

Daniel Lobell: (45:45)
Cool. Yeah. I mean, obviously having that relatability is definitely gotta be a big part of it.

Dr. Caroline Webber: (45:51)
It is. It is.

Daniel Lobell: (45:53)
What are some of the things you do for fun?

Dr. Caroline Webber: (45:57)
Well, I love to travel, although not right now with COVID as much. And I do a lot of power walking. I live near the beach, so my husband and I do a lot of bicycling and I hit a few golf balls, not very good, but I still enjoy it. And then a little bit of fishing and reading and then cooking. So those are my hobbies.

Daniel Lobell: (46:22)
Yeah. COVID seems to have really gotten in the way of a lot of things for so many people. How has COVID impacted your work as a doctor?

Dr. Caroline Webber: (46:32)
Right. Dentists and oral maxillofacial surgeons were probably one of the highest risk professions out there because we deal with an open mouth, with air particles and aerosol coming back at us. So we’re probably one of the highest risk professions there is, but we have really put into place as all of dentistry has a lot of safety precautions with wearing N95 masks, wearing face shields, air purifiers, certain suction devices. And so far, dentistry, even though we’re one of the highest risk, have had a great track record. And there just aren’t instances of spreading it to massive patients.

Daniel Lobell: (47:24)
That’s fortunate at least. And do you attribute that mostly to wearing masks, or…

Dr. Caroline Webber: (47:31)
I attribute it just to the approach that was taken by the American Dental Association and all of the specialty organizations in dentistry from the very beginning of looking at what we were going to do to be safe with this thing, because we had to reopen before there was a vaccine and one of our roles was we had to take care of people with toothaches because we don’t want people with toothaches going to the emergency rooms because the emergency rooms needed all their available assets to take care of COVID patients and other people. So dentistry had to reopen, even though we were high risk and there was a lot, a lot of research done and a lot of webinars on how to safely practice. And we added things, like I mentioned, N95 mask, we added face shields. We cut down the number of people in our waiting rooms. We just did all kinds of things and it worked. But I remember back in the eighties with hepatitis and HIV, when we added gloves and masks, and again, dental offices have not spread those viruses and dental offices and oral surgery offices have had a great track record with COVID because we’re well-versed in infection control. And we were used to adding things and doing things to keep our patients safe.

Daniel Lobell: (48:56)
Right. So it paid off now.

Dr. Caroline Webber: (48:58)
Yes, it paid off, it paid off.

Daniel Lobell: (49:01)
Well, it’s one of the few times you’ll ever say thank you to, what was it, hepatitis C?

Dr. Caroline Webber: (49:07)
Right, well, yeah, B and C. B and C are both challenging viruses, but they’re controlled.

Daniel Lobell: (49:16)
Yeah. Something I never think about is all the disease that dentists face through the mouth, head on. But it’s a fairly intimate relationship you have.

Dr. Caroline Webber: (49:30)
Right. It is.

Daniel Lobell: (49:33)
I’m going to round off this interview by asking you the same question I ask all the doctors on here, which is, what do you personally do to stay healthy?

Dr. Caroline Webber: (49:44)
Oh, that’s a great question. So I power walk, which keeps you mentally and physically healthy. So I try to do that six out of seven days a week, and I live in a beautiful neighborhood. So it’s just a great time for meditation and walking. And then I try to maintain a healthy diet. It’s not always healthy, but I have a smoothie service so I can have a smoothie for breakfast.

Daniel Lobell: (50:10)
Oh wow, fantastic. A smoothie service.

Dr. Caroline Webber: (50:10)
I use that… I forget what that’s called… Daily Harvest smoothies. And so I have those delivered and have one of those for breakfast every day. And then I try to get enough sleep, but that doesn’t always happen as you can imagine. I just listened to the Doctorpedia podcast on sleep, so I gained some tips on how to make that happen. That was a great podcast. Thank you.

Daniel Lobell: (50:34)
I appreciate you checking it out. That’s awesome.

Dr. Caroline Webber: (50:37)
Yeah. I like what she said that the pillars are the sleep, the eating and the exercise. And then lastly, I really try to keep my stress down if that’s at all possible.

Daniel Lobell: (50:48)
And floss!

Dr. Caroline Webber: (50:50)
And floss, right! Keep your mouth healthy. It’s important for your overall health. Keep your mouth healthy.

Daniel Lobell: (50:56)
Well, unlike those teeth, you are filled with wisdom and we appreciate you sharing it with us. Those stupid teeth. Thank you for sharing your wisdom with us on the show here today.

Dr. Caroline Webber: (51:07)
Well, thank you so much, Daniel. I really appreciate the opportunity to speak with you.

Daniel Lobell: (51:11)
Thank you, Dr. Webber.

Daniel Lobell: (51:15)
This podcast or any written material derived from its transcripts represents the opinions of the medical professional being interviewed. The content here is for informational purposes only and should not be taken as medical advice since every person is unique. Please consult your healthcare professional for any personal or specific needs.

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