Dental Problems in EDS with Dr. Audrey Kershaw (Ep 143)

Transcripts are auto-generated and may contain errors

[00:00:00] Since I discovered about Ehlers-Danlos. Linda, I see being anxious totally differently. Now, I don't know if it was the way I was brought up, but if you were anxious, it was just, well, you pull yourself together, will you stop being so stupid? Nobody else is getting worked up about this. Being anxious is built in.

Welcome back every bendy body to the Bendy Bodies podcast with your host and founder, Dr. Linda Bluestein in the Hypermobility md. I am so excited to chat today with Dr. Audrey Kershaw. Dr. Kershaw and I have been chatting on social media and I did a presentation with her a few months ago, and she's such an.

Incredible wealth of information. She's an oral surgeon and she does such fabulous work in the [00:01:00] space of people with EDS and HSD. Dr. Audrey Kershaw is the founder of Oral Surgery Scotland. Her career has taken her all over the uk, gaining experience at nationally recognized centers for oral and maxillofacial surgery before settling into an associate specialist post at Dundee Dental Hospital and School in 1998, where she practiced and taught until 2017.

Through this, she has been involved in the education of well over a thousand of Scotland's dentists. Audrey works with the Scottish government's focus groups on rare diseases and the Aler Danlos Society. She has reached over 1000 clinicians and healthcare professionals with her hereditary connective tissue disorders and EDS teaching sessions.

I am really excited about this conversation. As I know people have lots of questions about dental problems with EDS and oral surgery with EDS. As always, this information is for educational purposes only and it's not a substitute for personalized medical advice stick around until the very end. [00:02:00] So don't miss any of our special hypermobility hacks.

Here we go.

Okay. I am so excited to be here with Dr. Kershaw to talk about so many important topics that I feel like are just not talked about often enough. And you got into this space in kind of a, an unusual way. Right. Can you tell us, start out by telling us how you got interested in EDS and related conditions?

Yeah, thanks Linda. Uh, for decades I knew there was something going on with some of our oral surgery patients. They wouldn't numb up. Uh, they were anxious. They definitely were feeling it. A lot of the staff thought, no, they were just anxious. They weren't feeling it. I just knew there was a lot going on.

And then back in 2007, no, 2000 and yeah, 17 I discovered, came across ELLs, Dan Loss, and it was like, my goodness, my goodness. It just [00:03:00] opened everything up and I saw exactly what was going on. So that was how I got in. Now, when I first came across it in 2017, Linda, you'll remember back then the Erston lost syndromes, where one in 5,000.

And I thought, okay, I've maybe found one, but it's gonna be another seven years at the rate I worked before I find another. So I wasn't picking so many of them because I thought, no, no, this can't be right. Mm-hmm. But now I'm much, much more confident and I realize it's much more common than we previously thought.

And there's the Northeast of England study from last year, said one in 227 I think it was. And I definitely find more than that. So that was basically how I got into it. And, and we're so glad that you did, because this is, thank you. Uh, yeah, you're, you're doing such incredible work and it's so great to, to get, to have this conversation with you today.

I know so many people are gonna benefit from it, just like your patients have been benefiting from the knowledge that you've, [00:04:00] that you've gained and everything. So in, so in terms of, uh, dental problems that you commonly see in people that lead you to suspect undiagnosed Aler Danlos syndrome. Yeah.

Hypermobility spectrum disorder, comorbidities like mast cell activation syndrome, um, or POTS and or pots. What things do you see that make you suspect those conditions? So if think, just take a little step back there, Linda. We can pick these up from a three line. Referral letter. We are that good at it now.

Reception staff, nurses, managers can pick it up when they phone a patient. We just get a little inkling there's something going on here. So to begin with, I think a big thing is failed local anesthesia. Yeah. Um, so that is a big question I ask in my history taking, and that sounds quite an easy question to ask.

You know, does LA sometimes not work for you? But I find we've got to ask it three times. Now, some people think they [00:05:00] should get a numb lip, and that means it's worked. Mm-hmm. But they still feel the pain. And I have to explain, no, no, no, no, no. That's not the way this is supposed to work. It's supposed to numb you up and you shouldn't feel any pain.

Um, other people, when you say, does local anesthetic work, they say, the dentist tells me it works. I say, well, I'm not, I'm not really very interested in what the dentist tells me. What do you feel? Now, I, I've even had medical students and dentists. Not realize either what it should mean to have local anesthetic work.

So we make a real point of asking in our history, does local anesthetic work? There are many, many, many things that we can pick up. Linda. Um, white spots in the teeth, poorly formed molar teeth, some missing teeth if the patient comes in, or we quite often pick up staff. We work with bruises on their body.

They don't know where they've got the bruises from. Um, they may be bleed after having a tooth out. Their gums may be bleed quite easily when they're [00:06:00] brushing their teeth. Very anxious. As you know, Linda, the patients are anxious. They want to know, they want to check. Is it okay if they bring some shopping bags with them?

Where will they park their car? Lovely, lovely people, but they just want to get it right. Mm-hmm. Um, they're also the ones that may be, they show the signs and symptoms of pots, you know, so they'll be taking the postures with the arms, clo crossed, the legs crossed over, we'll maybe be walking around the waiting room.

So we are very clued in to all these signs and symptoms. Now, um, we also had a lady referred to us, um, 40 years of bad breath. Mm. And she was at the end of her tether. Dunno how she found me. But that's another sign and symptom and it's so satisfying to be able to help these people out. Yeah. Also in our medical histories, uh, a, a sort of a.

Thing that's quite often said about medical histories is tell us any relevant medical history. Yeah. Um, [00:07:00] now I always say that word needs to go 'cause everything is relevant. I want to know if you've got reflux, if you've got IBS if you've had spine surgery, we need to know it all. And I think as dentists we need to move to a, a full proper medical history.

Tell them we want to know everything. Patients just think it's a dentist. I'll just make this quick for them. Yeah. Yeah. That's really interesting because whether you're a dentist or, um, I know like my husband who's a urologist, you know Yeah. They're used to dealing with a very discreet part of the history.

So it's very interesting that you're saying that, um, all of the history is relevant. I know, I know. For me, I feel like that's true, but that's super interesting and I love that you, uh, feel that way. And I'm also curious about the halitosis or bad breath because um, I have been told that by my husband, ah, that I have bad breath.

Ah. So, and I always thought that was related to sinus problems that I've had for [00:08:00] a long, long time. Uh, can you tell us more about that? That's really interesting. Well, this lady who is of the same name as yourself, and she will not mind me talking about her, but I will not give too many details. But, um, hi.

Um. She had seen every specialist going, she'd seen gi, ear, nose, and throat, everything. Uh, it was affecting her life, 40 years of it. And, uh, we think this is coming from her acid in her stomach. Hmm. Yeah. So, uh, we are now getting her along to try and get some decent help for this, but as you see, it could be coming from your sinuses.

Uh, yeah. You know, there's, there's about 13 different reasons for having 40 years of bad breast. So we needed to work through each oven and say, we don't think it's that. We don't think it's this, but she, uh, very much thinks that we Right. And she's now gone on to be diagnosed with hypermobile, e Ds. Oh, okay.

Interesting. Interesting. Mm-hmm. [00:09:00] And so that's great that you're picking up on these other things and, uh, making referrals for people then, or how do you approach that when you do suspect that someone is in this category of, you know, a connective tissue disorder, maybe mast cell activation syndrome? Yeah, so what I do is I make it very clear to them, I'm just the dentist they've come to see.

Yep. Um, I'm not qualified to be diagnosing even if I was qualified, Linda, which I, I will be if I go to a conference. This, this is such a complicated field, we need to make sure we're not missing other important things that it could be. Right. So I say to them, have you considered that all your seemingly unconnected signs and symptoms could be connected?

And then you see the light bulb going on. Um, and then we discuss. When we've discussed that, they then think, oh, well, okay, I didn't bother to tell you this. I didn't answer that question correctly. They need time for [00:10:00] all this to process for them. And they quite often message us later to say, forgot to tell you about this, and is this relevant that my sister's got this, my dad's got this.

Mm-hmm. Um, so we let them have time to think about it. Uh. National Health Service in Britain, very difficult to get help. We don't have good pathways for help. I think, you know, my colleague Janet Ner mm-hmm. Shout out to Janet here. Janet and I work very, very closely together and I send a lot of my patients to see Janet.

Mm-hmm. And I am so lucky to have Janet. Our patients are so lucky to have Janet. And Janet and I work as a team, but that's only the sort of private patients. I have completely flooded Janet with patients, so I have to be very, very careful who I send. I know Janet has got some other colleagues, uh, in Moffitt and in Glasgow, and we're trying to sort of send a few that way as well.

But it's not easy to get help. It's not easy to get help, as you know. I, I also would [00:11:00] stress to the patients, Linda, that getting a label stuck on you. It's not the be all and end all. Right. Um, you know, it doesn't matter what label we're going to put on this, at the end of the day, all that matters is, I know you're going to be difficult to numb up.

When I take your wisdom tooth out, you might bleed a lot afterwards. You are anxious. You cannot stand up without falling over. Mm-hmm. So, at the end of the day, to me, yes, it would be great to have a label on them to help them with their lives, but that takes time. But that's not the be all and end all. And, and I know there's a lot of people listening to this thinking, oh my gosh, I wish I could go see Dr.

Kershaw. I definitely want to, in the latter part of this conversation, touch on how people can find someone who may be more likely to listen to them. But I wanna make sure we dig more first into some of the other problems that people may see. Lovely. 'cause that's so important. Um, 'cause unfortunately, not only can, not only can not everyone get to you, but you couldn't see everyone that you would, you know, need to see.

So, and I'm sure [00:12:00] you're already really busy. Yes. So, so let's talk a little bit about gum problems. So gum, recession, gingivitis, periodontitis. Um, what kind of treatments can be done? What, what do you see in terms of gum problems, um, in this population? So I think this bit is very poorly known about and.

Managed patients with ler Dan loss syndrome, unless it's the periodontal type of EDS, are not more prone to periodontal disease, they're not more prone to gum disease. I'm, I'm trying to use layman's terms here as well. Mm-hmm. Yes, please do. They're not more prone to these issues. If you've got periodontal EDS, which is one in 1 million maybe.

Um, I think there's only been 134 cases written up. Um, so periodontal ed s is very, very rare. You do not get more gum disease if you have LERs Danlos syndrome. There may be more [00:13:00] reasons why your gums are giving issues, or you do have the gum disease that everybody else would if you're too tired to brush your teeth, if you're too tired to go to the dentist, if, if your joints are too sore and you can't get in there to use, uh, the cleaning aids we have, um, patients with L Oran loss, they bleed easier.

So their gums will bleed easier than other people that don't have s Dan loss. But we could see that as a bit of an early warning sign that they need to have their oral hygiene 100% or they're going to have some bleeding. So for these patients, we do not have to manage them many differently than we do the general population with, um, gum disease.

Um, and other patients with underlying medical issues. They will have issues cleaning their teeth, interdental aids and whatever else. Mm-hmm. Yep. So that is what I think we need to do with that. Yeah. And in terms of, [00:14:00] uh, enamel defects, uh, root anomalies, pulp stones, are those things more common in people with EDS?

Yes. Yes, they are. Um, I think we take a step back as well and say research into EDS and dental issues. Uh, we're needing much more. Done on this. Yep. Mm-hmm. Um, there are our colleagues in Austria, um, Ennis and Ika. I'm not sure if you're aware of them. I'm not even going to try and pronounce their second names, but with all respect to them, and they are, they've got some things on YouTube mm-hmm.

And they are quite good things to watch, but they are being very, very honest. They seem absolutely lovely people being very, very honest and saying, we need much more research into all of this. So we are aware that we can get a condition called mo molar, incisal hypo mineralization. So that means basically the teeth have white spots on them.

So when the [00:15:00] patient. Smiles. You can see white spots in the front teeth maybe, or the molar teeth are poorly formed. That is another way that I pick up these cases of if I get sent an x-ray before I see the patient, I think, ah, right, the first molars are very badly decayed, or they're missing, that could be a sign of LERs Danlos syndrome.

So sometimes the first molars are so poorly formed, uh, that they might be taken out earlier on in life. Maybe even the child is nine or 10 to make way for the wisdom teeth of the patient has wisdom teeth, and then the spaces will, will all close up. Um, you also mentioned about root, uh, shapes. That's not so much an issue for us.

Um, I know in classical EDS we can get maybe shorter roots. Mm, very, very occasionally. That might mean. The teeth could fall out, but that is so rare. I've never seen it. I've [00:16:00] not heard reports of that really at all. And in vascular EDS, we can have longer roots on the teeth. So it just gives us maybe a little bit of an idea.

If we are looking at an X-ray, think, ah, that's just another little sign. This could be a ERs Danlos syndrome case with pulp stones. I messaged a colleague of mine last night, Gareth Calvert, a restorative consultant, and Gareth said yes, uh, when he is doing root canal treatment on a tooth. Yes, they do see pulp stones, but this doesn't really interfere too much with what they're doing.

So again, that's more something that I can see on an x-ray. When I take an x-ray for their wisdom teeth, I can see the other teeth, they could have pulp stones. And I think that's just another little sign there. So what are pulp stones? Just so we make sure that everyone Pulp stones. So the way the tooth is made there is the outer harder layers.

The, there's the inner pulp, which is the nerves and the blood vessels. You can get calcified stones in there. Mm-hmm. [00:17:00] Yep. And they're normally in the, in the higher up part of the root. And we can just take them out, uh, if we're doing a root canal treatment. Yeah. And, and you can actually see those on an x-ray, then you can very often see those on an X-ray.

Yes. Interesting. Okay. Yeah. Okay. So with my patients and my clients, I would say if not a hundred percent, it would be probably very close to a hundred percent. Have jaw pain, jaw pain clicking, um, you know, difficulty with chewing harder foods, difficulty with dental work because of, you know, needing to have your mouth open, um, and that kind of thing.

And I've, and I have done an episode on, uh, TMD specifically, or temporal mandibular joint disorder that I've watched Yes. As well as most of the 140 episodes. Linda? Yes. Oh, bless your heart. Bless your heart. Um, what is your experience in encountering TMD with this population and [00:18:00] what treatments do you find most effective?

So, we've got to remember, I don't see a routine sample of the population. Right. I, I work as a specialist in orals surgery. Mm-hmm. And I get patients that other dentists and healthcare professionals are maybe not managing. So I maybe get the more difficult cases. Mm-hmm. Um, I see a lot of TMD cases that are referred to me.

I had one this week, their dentist had tried for 18 months. Didn't manage and she said, you need to go and see Audrey. So she came to see me and um, yep. So that is the way I get the TMD patients. Yeah. Mm-hmm. Um, I think the figures are, TMD occurs in about 25% of the general population, but in the EDS population it's 75%.

So yes, a lot of the EDS population will have [00:19:00] issues. What I think is important about all of this, Linda, listening to other people speak and reading stuff, I think it's very important. We always take a step back and we see the bigger picture. So there's a very good document came out last year from the Royal College of Surgeons in England and it's, uh, get it right first time.

It's called G-I-R-F-T-T-M-D document. Very easy to Google and find and that is an amazing document. Um. And it really has looked at all the papers out there, all the ways. It gives you everything in there. And that is what I follow. And I think we should be following, at least in Britain, I dunno how you have similar over there.

What I, what we find is if you have TMD and you go to a restorative dentist, they're likely to give you a splint. Mm-hmm. If you come to see me, I'm likely to diagnose EDS. [00:20:00] If you go to a max fax surgeon, um, surgery may be spoken about sooner rather than later. Mm-hmm. It's just, if you go to a physiotherapist, they're going to do physio on you.

Mm-hmm. We need all of these different people, but we need them at the right time. Right. So this document is brilliant. It takes it through it, it takes you through everything stage by stage. So we have to start with self-supported management. There is the 92 page document or whatever. There's also a clinician's handout and then a patient handout.

Mm-hmm. So it's a complete cheat on clinic. 'cause you just get the patient handout. You can work through that, you can give them a take it away. Um, and it has to be very much patient led as well. Mm-hmm. Mm-hmm. So I will very much do self-supported management with them. And we will also discuss whether we go to physio, [00:21:00] whether we go to Janet for being the osteopath.

Um, we see what's actually going to work. I also feel with a lot of these, Linda, I have a physiotherapist, Cameron, who I use, we have to see the body holistically. Mm-hmm. And quite often if. One of our physios, Cameron, for example, can sort out the head, the, the shoulder pain, the shoulder pain, the neck pain, the back pain.

We don't even need to look at the TMJ 'cause that'll sort itself. So I'm very much for, I don't do, we don't concentrate just on the TMD. We're concentrating on the rest of the body. And by the time I speak to my TMD patients, I think, I think I said most of my TMD cases I find are actually an undiagnosed connective tissue disorder.

Um, when we get everything else out on the table, all the other things that are wrong with them, we find maybe some of these other things [00:22:00] are so much bigger. So we have to tackle everything, not all at the same time, but we have to decide on what we're going to do and where we're going to go with all this.

And they may be talking to me about their TMD because I'm the only one that's gonna listen to them. At the moment. They have been to all the other specialists that then they're not getting anywhere. So we need to see the body as a whole. So that's just my sort of take on TMD and the get it right first time.

Our CS document is absolutely brilliant. And when we've done this podcast, Linda, I'm going to send our link to our podcast to the guys that wrote this. Uh, it's Emma and I'm so sorry. I'm so bad with names Dave. Uh, not Damien. Sorry. Can't think at the moment. I know you well, but Sorry. That's, that's okay. I, I definitely struggle that with myself and when I started teaching at the medical school, I would ask the students to please wear their name tag every time.

'cause I, I would, I would teach a class and then I wouldn't come back for a little [00:23:00] while. So I totally hear you about the names. Yeah. Yes. I, I could totally relate to that. So I'm also fascinated because I feel like this is literally exactly what I was struggling with maybe five years ago when I was trying to get more care for my TMD.

And I'd had it for quite a few years. And, and I know you've listened to the episode where I talked to my own mm-hmm. Doctor here in Colorado. And it was so interesting when I was, I was in Wisconsin still at the time, so it was about five years ago. And I was starting to explore who else I could go to.

I'd already had physical therapy and I, you know, my dentist had already fitted me for a splint. And so I was, I was wearing that. But it had gone from being very stable to being a lot more problematic. And it was so interesting because I did realize exactly what you just said. If you go to this person, you're likely to get this.

If you go to this other person, you're likely to get, you know, 'cause of course we, we all offer what we have in our armamentarium, right? Like, I, if someone comes to me, I'm not gonna offer to [00:24:00] take out their wisdom teeth. I, I have no idea how to do that, you know? Yes. So, so I'm gonna offer the things that I know how to do, and that was one of the real challenges I faced was, you know, I would literally call the offices and I would ask, well, what kind of appliances do they use?

Or treatments or, or whatever. Um, because yeah, it is tricky if you have, if you have TMD and. You get offered surgery before you really need it. That would be something that I think would be really problematic potentially down the road. I mean, any surgery, right? Patient selection is everything. Mm-hmm. Like making sure that you're offering surgery to the person who needs it, but that you're not operating on people who might be able to have more conservative care.

So if someone is listening to this and they're like, okay, they're gonna check out the document, which we're gonna link in the show notes, um, all those documents that you mentioned, the patient handout, the clinician handout, the, the full document, which I did pull up yesterday after you mentioned it to me.

Oh, great. Um, so yeah, and I love that title. Get it [00:25:00] right the first time. 'cause boy we should, we should apply that to everything right. Get it right the first time. So, um, if someone is trying to figure out, you know, who to go to and they're aware of these kinds of differences in approaches, what do you recommend that they do?

I think it's very difficult for patients, Linda. I think if they can read as much as they can on it, read the 92 page document, read the patient guide. I think what you'll see with LERs Danlos syndromes as well is it's difficult enough finding your way. If you are educated, you have the time and the resources to do it, but people who are maybe not educated enough, they're maybe not into reading scientific.

Even just having a scientific background to be able to understand what you're reading, it is very, very difficult for patients. [00:26:00] You need to find somebody who's going to take a very holistic view of it. Mm-hmm. And that's difficult. I think if they approach somebody or if they go along for a hospital appointment, they need to make it very clear.

They want a very holistic view. They don't just want to go, go to see somebody that does one sort of splint and that works and that's what everyone gets. Yes, they might need that sort of splint, but we need this holistic approach. Yeah. And we're asking patients to do more and more as things have gotten more and more complicated.

You know, they are the common thread between their specialists and I, I don't know about you, but I use an EMR that doesn't connect with other EMRs because I'm in solo practice, so I don't have the ability to afford something like Epic or, you know, that then has care everywhere. And, and you probably have completely different systems where, where you are.

So we are, we are asking patients to do more and more, which, which I feel very badly about. Um, because [00:27:00] again, if they're, if they're already sick and they're dealing with these complex illnesses. It's even harder, right? 'cause they've got brain fog and, and, uh, yes. It's very, very hard. Even, even for the best of them, it's very, very hard.

Yeah. Yeah. Yeah. We are gonna take a quick break and when we come back we are going to talk about, um, oral ulcers, Tori, right. How to find a dentist that, uh, wonderful. That might, that might be a good fit for you. Mm-hmm. And we will be right back.

This episode of the Bendy Bodies Podcast is brought to you by EDS guardians, paying it forward in the Ehlers Danlos syndromes community patient to patient for the common good. I'm proud to serve on the inaugural board of directors for EDS Guardians, a small charity with a big mission and a big heart now seeking donors, volunteers, and partners, patient advocacy and support programs available now.

Travel grants launching in 2025. Learn more shop for a cause at their swag store, and join the [00:28:00] revolution@eedsguardians.org. Thank you so much for listening to Bendy Bodies. We really appreciate your support. It really helps the podcast when you like, subscribe and comment on YouTube and follow rate and review on all audio platforms.

This helps us reach so many more people and spread the information to everyone. Thank you so much again, and enjoy the rest of the episode.

Okay, we're back with Dr. Kershaw and talking about so many great topics related to dentistry and her expertise of oral surgery. I had a patient the other day who has oral ulcers and she has had them for many, many years, but they've been particularly bad lately. And I had some different things in my differential diagnosis, but I would love to hear how often you see that and if you have any thoughts on oral ulcers.

Yeah. Um, this is another way, Linda, that we pick up some LS down loss cases. They come into us with oral ulcers. Um, with your [00:29:00] medical background. I'm, I'm, I'm sure, sure. You know, a, a fair bit about this. Um, in my sort of career, I did a lot of oral surgery, hospital jobs, some oral medicine jobs. I'm, I'm very much not an oral medicine specialist, but.

In the, while doing oral surgery jobs, you have to see oral medicine patients because there's not enough oral medicine consultants. So, um, we have a, we have the British and Irish Society of Oral Medicine and they, again, help me cheat in my job and they've got wonderful leaflets on a lot of oral meds and things, and they've got very good leaflets on recurrent oral al ulcers.

Yeah. Mm-hmm. So if somebody comes in to see me with oral, oral ulcers, you would want to take a really good history. Um, some of the reasons for having oral ulcers would be low iron, so probably do is we do a full blood count, ferritin, folate, B12, blood [00:30:00] glucose, a celiac screen, and vitamin D screen here.

Mm-hmm. And if patients are low in any of these things, they can get oral ulcers. Yep. Mm-hmm. So. That's fine. Maybe to discover somebody's low in B12 or low in folate. But as you know, we then need to think, well, why is the patient low in say, folate? Yep. Mm-hmm. So, fol low in being low in folate could be from celiac disease.

And correct me if I'm wrong, but I think the figures are something like 70% of people with celiac haven't been picked up. Um, that are, I think I've seen a similar statistic Yeah. Papers out there to say that. So, you know, we, we can pick these patients up on clinic and pe pe people with s dan loss, they're more likely to have celiac disease and Crohn's disease and all of this.

So Yep. It just starts us off in a little bit of the detective work there. Yep. To see what we can find. So yeah, that's another way that we can pick up [00:31:00] these patients. And I think it's also very important to get in here somewhere, um, when we find one thing wrong with somebody. We shouldn't just stop there.

If we can put a label of Celiac on somebody, that doesn't mean they don't also have Crohn's disease. Mm-hmm. Or they don't all don't also have ER's, Danlos syndrome in there as well. So maybe I'm quite difficult the way I work, but I'm not going to let anything pass me, Linda. Mm-hmm. I could stop passing the, yeah.

Yeah. That's amazing. That's amazing. I do think that that is something that is, um, very important for people who have EDS is to remember that. You can also get other problems. And so don't attribute everything to EDS because you could miss some really important things. Um, yeah. And you know, while, while EDS can cause an NHSD can cause a lot of other problems and mast cell activation syndrome, of course we know the overlap there and [00:32:00] all of those things can be related to so many other other things.

Um, there's a saying, I don't know if you've heard this or if you've heard me say this before, um, you know, people are entitled to as many diseases Absolutely. As say damn Well please. Yeah. And I always say that, I always say that and I think patients need to know this as well. Mm-hmm. Just because they've already given us a great big story about their type one diabetes, it doesn't mean everything has to do with their type one diabetes.

Right. There could be other things. Yeah. Right, right. So, um, so that's it about ulcers. Yep. I think as well, patients don't maybe feel they should say to their dentist, oh, they keep getting ulcers every so often, you know, uh, we really want them. To tell us as much as they can. Another thing maybe I, I, I didn't, I didn't put on my notes to you was, I think at least in Britain, I qualified 37 years ago, Linda, there was, there was a big divide between dentists and doctors.

I think as the, as the decades are going on, we need to [00:33:00] value every single member of the healthcare team. Mm-hmm. We need the physios, we need the osteopaths, we need the dentists, and we need to see that all of us can pick things up. Mm-hmm. And then should be able to take them along to whoever is looking after the patient's care.

So we, as dentists, we have got a big, big role to play Yeah. In managing the patient's healthcare. And we're in a very lucky position of, well, as a general dentist, they would be seeing a patient maybe every six months, every year. Mm-hmm. Whereas you might go decades before you, you go and see your gp. Those are excellent points.

And um, speaking of oral surgery things, I have had multiple surgeries for Tori. Ah, and that's where that question came from. Yes. So, uh, you know, I try to, I try to sneak in some of my own personal questions, but I did. Why not? Why not? Yeah, why not? Why not? But I did also, [00:34:00] when I asked for people to give me, um, questions that they wanted me to pose to you, a couple of people did also ask me about Tori.

So can you tell us what Tori are? If you happen to think that those are more common with EDS or HSD? And also is surgical excision the only option? So we're into a private consultation for you here then. Uh, Linda, of course, um, Tori are little lumps of bone, which they are normal in most people. We quite often see them on the inside of the lower jaw.

Mm-hmm. Or we can see them on the roof of the mouth. Could I ask where your, where yours are, Linda? I did have some to were excised. You don't have to share. Yeah, no, I'm happy to share that. This is not highly personal. Um, the inside of my lower you don't jaw. Yes. And then I had some that were very, very big.

Right. The skin was getting, or the mucosa Yes. Was getting, uh, very, very thin On thin, yes. So yes, Uhhuh. Yeah. Yep. [00:35:00] Yeah. We, we do see cases like this and it is fairly rare, I take it, that we're sent away to be looked at under the microscope. I would think so. This was a number of years ago, but Okay. I would think so.

Yeah. So this is not something that I was aware of was related to LERs Danlos syndrome. I think it's worth keeping in mind though. Yeah. Um, what can we do with them? All we can do is take them off mm-hmm. And make sure they're not down to some other reason. For example, something like fibrous dysplasia. Mm.

One of those other sorts of conditions. Yeah. Mm-hmm. Uh, the time where I have removed Tori recently I've got here, I've only maybe done it three times in the past seven or so years. It's when on the inside of the lower jaw, they've been too big for, for a patient to be able to wear a denture easily.

Mm-hmm. And have had to take them off for [00:36:00] that reason. We quite also, uh, for your listeners here, we quite often give patients coming in terrified they're dying of cancer because they've noticed these great big lumps on the inside, like the place you had them. And we have to see. You've had these at every single checkup for the past 20 years and you've now just noticed them, there's nothing to worry about.

Yeah. And that's is why it's good When we're doing a, doing a checkup, we write everything in the notes. Even if I'm doing just a oral surgery, I will always put in the notes if there's Tory there, because that patients suddenly realize they're there. Yeah. Right, right. Really, most, most of the time, they're nothing to worry about.

If they've, if they were very fast growing or if you had several in different areas of your mouth that did seem to be growing, uh, we would. Want to be sending them off to be looked at. Mm-hmm. Mm-hmm. Okay. Okay. And what about wisdom teeth extraction? Um, if you could maybe refresh our memory a little bit about, [00:37:00] uh, local anesthetics and how those might act differently in people with EDS and if there's other considerations for wisdom teeth extraction for people with EDS and HSD and the comorbidities.

Okay. So most of my work is probably removing wisdom teeth. And there's many, many things with LERs Dan lost that can make this a little bit more difficult. And so there's many chances for me to find a, find an LERs Danlos case. Yeah. I'm just, I'm just laughing for some of the ones I've found. Yep. Um, so the patient is anxious and stressed because anxiety goes with having LERs Danlos.

Mm-hmm. And since I discovered about LERs Danlos, Linda, I see being anxious. Totally differently now. Mm-hmm. I don't know if it was the way I was brought up, but if you were anxious, it was just, well, you pull yourself together, will you stop being so stupid? Nobody else is getting worked up about this.

Right. Being anxious is built [00:38:00] in. It is a very good early warning system. Mm-hmm. It's maybe the way that you're made anxiety. Anxiety will be worse. If your pots is worse, your blood pressure issues are worse. So we have to keep that in mind as well. So we've got an anxious patient to begin with. Yep. Mm-hmm.

Uh, the local anesthetic may not work. Um, and that is quite a big thing. Now in my history, Linda, I always ask about LA not working and I ask three times and I sometimes literally pin the patient against the wall and say, you will tell me the truth. So a lot of patients don't realize, and I, I've actually had a final year medical student.

A dentist who I had to explain this to, that this is just crazy. Crazy. So some people think if the dentist tells them they're numb, they must be numb. Mm-hmm. And I have to say, I'm not [00:39:00] interested in what your dentist thinks. Very much. I'm interested. Does it feel sore to yourself? Yes. It feels sore, but the dentist tells me I'm numb.

No, no, no. That doesn't count. Mm-hmm. Uh, some other people think because their lip goes numb, it's crazy. They feel their lips numb, but they still feel pain when the dentist working on the tooth. And I'm saying, I'm sorry, this does not make sense. This was not the part, this was not the point of it. Mm-hmm.

Yes. Your lips should go numb. And that suggests the nerve we're trying to get numb is numb, but you shouldn't be feeling anything in the tooth. Mm-hmm. So we, we need to make a real, real point of getting this outta them because. They have been told, they're just being silly. It's pushing, it's pressured, it can't be sore.

Mm-hmm. And it just makes our treatment so much harder and we need to say to them, I actually believe you that you're not numb and let's work on this together. Mm-hmm. That then reduces the anxiety, the stress, and it's so much, so much easier. Mm-hmm. Yep. I think later on we'll talk about [00:40:00] local. Yep. We'll talk about that later on.

'cause that's a d that's a different question. We've got, I've got a bit more to say on that later. But going back to wisdom teeth. Yep. We, we've got the patient anxious, local anesthetic maybe not working, they can bleed easily. So, um, if I know the patient's got elders done loss, or I think they might be, we'll put in some, some special gauze to stop it bleeding.

Yep. Mm-hmm. Um, they can bruise easily. Um, so it, it's important because I work in so many different practices. Once had a patient come in with bruising. Down to their chest. I dunno if you can see my hand there. Down to down to their chest. Now this was surgery. Quite an easy from oral surgery. This was an easy wisdom tooth.

I did, and I hadn't long started at that practice and I had to say, this patient has got a bleeding problem. They have got tellers done, loss, and this isn't anything wrong that we've done. So there's all these little things that can just uncover a case. [00:41:00] I know Linda, a lot of the time when I put my number 15 scalpel blade onto the lining of the mouth, it's fragile.

Mm. The mucosa breaks up, it's fragile, it doesn't suture back Well, your suture needle sometimes just pulls out. Yep. That's Ehlers-Danlos for you. Wow. My nurse al my, my nurse also sees it when I do it. Yep. Mm-hmm. Another thing as well, just thinking about is sometimes when I try to numb up the patient. It is very, very sore.

Now I know I'm being gentle elders, Dan lost patients, correct me if I'm wrong, but they feel pain earlier than other people and they can maybe put up with more pain, but they definitely feel the pain much, much earlier. And so that's another early sign in symptom. And I have to say to them, I know this is all a great big learning curve, come curve coming in to see me, but [00:42:00] I know that you're feeling that.

I know it's very sore. You are feeling it more than anybody else will. And I'll try and be as gentle as I possibly can. Mm-hmm. When I'm taking out wisdom teeth, patients think their TM joint, that might be an issue. Uh, 'cause they think they have to open very, very wide. So if anybody's there thinking of having their wisdom teeth out and you open wide, I'll say to you, would you mind not opening wide?

'cause that's making it difficult for me. So if I'm doing wisdom teeth, I have to go from the, from the sort of cheek side. And if you open wide, your cheek gets taut, I, I can't get in there. So I don't actually need a lot of room to get the wisdom tooth out. So what I say to them is, you just open to where it feels comfortable to sort of where the muscles are not either open or closed.

You're jaw just hanging. And if you're not doing it right for me, I will tell you. Mm-hmm. Yeah. I think it's maybe different if you're going along to have fillings done or whatever. Um, there are some wisdom teeth the TMJ can be an issue for, but [00:43:00] um, normally I just have to explain to them it's maybe not going to be just so much of an issue.

Yep. Um, oh no, you'll be good to speak to about this one, Linda. Um. Over the past however many years, eight years I've known about Ehlers-Danlos. Seven years, we are seeing the healing can be delayed in patients with ER's, Dan loss. Mm-hmm. Healing can be delayed. We actually had a man, and I'll call him Steven.

Steven if you're listening to this, I know you won't mind me speaking about you 'cause nobody will know who you are. Steven. Steven was a man, is a man. Mm-hmm. And you know, it's much harder to pick up ER's, Dan, loss cases and men than ladies. Mm-hmm. Last year I picked up 120 s Dan loss cases, possible s Danlos cases.

Wow. They have all, they have all gone on to be diagnosed or are being diagnosed. Only three of those were men. Yep. Really. So Steven, Steven came in, uh, now I, I don't know if you agree Linda, but I find ER's [00:44:00] Dan lost characters, some of them. Oh my goodness. They're just gorgeous. This man, I was 15 minutes late to see him.

So reassuring. That's not a problem. You just take your time. I'm very happy to sit. No, no, that's not a problem. I know you're so busy. I know You're doing, and he came in, local anesthetic didn't work and it hadn't worked in the past. He had a couple of little things in his medical history and he took the best part of a month to heal.

Oh wow. We got him in, we got him in four weeks afterwards. Um, and that was when I then really pushed him on his medical history. He was 39 years old. He looked about 29. 'cause I, I dunno if your, your audience know people with s Dan Moss can look much, much younger. Mm-hmm. So we pushed, we pushed Steven nicely.

Steven said, no, please, please, please ask me all these questions. The more and more we pushed, he said, I'm sorry I didn't put that [00:45:00] in my medical history. I didn't know what, didn't think you needed to know it. And then it was my, uh, dad has had a collapsed lung. Could there be anything to do with it? Mm, interesting.

So by the end of it, we had Steven seeing that all of his unconnected signs and symptoms that he, that he didn't think I needed to know about were probably connected and he is taking time to think about it and we're going to send him on to Janet. So we're seeing more and more cases delayed healing and I'm now saying to the patients, more and more, you've gotta tell us, Dan lost this might just take a long time to settle.

Mm-hmm. Mm-hmm. Yeah. We've also got to think as well, Linda, and you are the best one to talk about this, um, postop. Long-term pain. Oh. Mm-hmm. Patients with LERs down loss are more likely to have long-term issues with pain. Mm-hmm. Even just from being numbed up, they, we've seen a few, Janet and I have seen a few, 'cause Janet's great at getting these things outta people.

Just numbing somebody up [00:46:00] to say, have a filling done. They can have years of long-term pain from that. We need much better resources on this. But yeah, that's all there as well. It's not the patient's fault, it's not my fault. It's one of those things, but we need to be very, very sure before we do surgery on these patients that they're aware of what the consequences could be.

Mm-hmm. Does that make sense to you, Linda? Yeah, absolutely. Makes sense to me. And, and as you were talking about this, I dunno if you noticed that I shifted my headphones and if anyone watches regularly on YouTube, they'll see about halfway through most interviews. I do that because it's funny that you mentioned about, um, being more sensitive to pain at the same time that people with EDS, including myself, um, are used to living with low levels of pain that other people.

Probably don't have. Yes. So I know for sure that my nervous system is sensitized and probably most people can wear headphones for for hours and they're fine. But it really starts [00:47:00] to hurt the top of my head. So I have to, so I have to shift so that I don't have that pressure on the top of my head anymore.

And so we know that people who have central sensitization or no CPL pain, they develop, uh, allodynia and hyperalgesia. Those are, those are two things that we see that, uh, let us know that the nervous system is altered in how it's processing the pain signals. So allodynia being something that's normally not painful is painful.

And hyperalgesia being something that is normally a little bit painful but is. Uh, a lot more painful. So I would call this allodynia, like most people can have headphones on for, for a long time. It's padded, you know, it's padded, but, uh, but you know, I, I ha I have this problem. So, um, it's, it's definitely really important for people to be aware of because you're, you're exactly right at the same time that we are dealing with so many, uh, problems and, and pain and we cope.

I think in some ways, like you're saying about Steven, [00:48:00] I feel like the people that I take care of, like you said, they're, they're lovely, lovely people and incredibly resilient because they've been dealing with all of these different things. Um, but at the same time, we can end up having. Other things that, where we react even more so than than other people.

So it's, it's kind of, it's, I think it's probably confusing to people who don't specialize in these conditions because, you know, they don't understand how you can kind of have like a higher pain tolerance, if you will, for chronic things. Yet there are other things that are, that make you more sore. And, uh, the postop pain thing is, I think, really, really important for people to be aware of.

And I'm so glad that you're working with a team so that way you can, you know, really address those things. 'cause you're right, it's not anything that, that you did or, you know, um, can necessarily do differently. Um, what about sedation options for people with EDS, um, MCA or pots are there, especially when it comes to like wisdom teeth, are there different things that you might do for that population?

[00:49:00] Yes. That's a very good, it's a very good topic. That one Linda. Yeah, so, um, I have been qualified for 37 years. I've done a lot of different jobs. I've been everywhere. I've done everything, mainly oral surgery, max maxillofacial, uh, you know, to children's dentist. Loads of loads of different stuff, but mainly oral surgery for the 37 years.

Um, seven or so years ago, I left the hospital service and I went to work privately tally throughout Scotland. So I'm spoiled, Linda. I can choose where I work. I can choose who I work with and I can choose how I set up my clinics. Hmm. I am absolutely spoiled with the people I've got working with me. I am getting going to answering your question, but it's so important.

It's so important. I'm spoiled with who I have working with me. Um, I could mention a few names, but I don't want to miss anyone out. [00:50:00] I work with nurses who completely understand what I'm doing. With my patients and how I want it to be and how I wanted it to be very patient-centered. Mm-hmm. It is not one size fit, all fits all.

It is not a production line. We see everything. Right. So we can take out wisdom teeth just by numbing them up. We can do oral pre-med Yep. Some tablets to make them feel a little drowsy. We can do IV sedation into a vein or we can put them off to sleep. Mm-hmm. These days, at least in Britain, we don't put many people off to sleep to have their wisdom teeth out or, or things like that.

Because, because of the risks involved. That's, that's what your job was in. Yeah. Mm-hmm. Um, yes. For sedation into a vein, when I first left, left, left the hospital side, I, uh, started an IV sedation service. It's really been a complete flop, Linda, because we get patients referred to us for IV [00:51:00] sedation. And we, we call them up beforehand.

We have a chat on the phone. Uh, we have it all lovely set up in the clinic. I go out and greet them. I shake their hands, I bring them in. We have a good chat about life and I say, these are your options. If you want sedation, we can do the, the, the sedation op workup. Uh, but you'll have to come back for the sedation 'cause that's it.

And they just go get on with it. Ah. So we just numb them up and we get on with it. I think if you've got a really good setting, we do not need sedation. So what I find is I can still do sedation, but I do not do sedation because we've got such a lovely setup. Mm-hmm. Yeah. Um, what I would say about LERs Danlos patients and sedation is I've done a few LERs Danlos cases that were not diagnosed under sedation, but.[00:52:00] 

They needed very, very huge doses of the drugs we use. Hmm. And it was not feasible to sedate them. They were not getting sedated with the amount of drugs we could give them mm-hmm. To be able to do this for them. So what I, so just, just having a little peek at my notes there. Um, yeah. So I don't feel that I need sedation with the setup we've got.

Mm-hmm. And I think we have to start from the minute the patient is referred to you. Um, I saw A-A-T-M-D patient this week, won't say where she was referred from, but she came in saying she'd tried everything else for 18 months and her dentist said, you need to see Audrey because Audrey's going to do amazing things for you.

Yeah. The pressure, the pressure was on in anybody listening, I don't necessarily need you to say that to people, but this patient came along believing. And what we might be able to do for them. Mm-hmm. So, you know, we need, [00:53:00] that is so, so helpful for somebody to say, listen, Audrey and our team will do whatever.

Is possible to make, to make this easy for you. Yep. I think it's really important to have a lovely clinic set up, and this will be the same for your clinic. If you are going to get people's deepest, darkest secrets outta them that are full medical history, if they're going to remember back to their childhood, you've got to have them relaxed and happy to be able to do that.

Right. Um, so I think it's also really important that when the patient comes in, they can feel the nurse and the oral surgeon just have a really good setup between them. And as I said, you know, I've got, um, I've got one nurse I always call my dog's name I won't repeat. And yeah, so that's one of the nurses.

Uh, and I've got Kim, I've got Kim and West Hill, I've got Caitlin, I've got Cory, I've got Sophie and, sorry, whoever's names I've forgotten here, but I can't remember names. But you know, I, I am really [00:54:00] absolutely lucky to have what I've got there. So I don't need sedation, but that is an option. Mm-hmm. That is an option for our patients.

Yeah. Mm-hmm. Yeah, I totally agree with you. From my experience, you know, working for over two decades in the operating room, the way that we, um, treat people is gonna set the tone right from the very beginning. And we don't need to give anywhere near as much sedation if we're doing a general anesthetic.

Oftentimes you'd give a little ed before you, you know, roll down the, the, um, the or hallway and, and things. Yes. But, you know, it's, it, it makes a huge difference if you are making somebody more anxious or if you're making them more comfortable, um, it makes a huge difference. And then how things are going to go and, uh, what you need to do.

So, so that makes perfectly good sense. And I wanna just circle back 'cause we're gonna need to wrap up soon. I wanna circle back to local anesthetics and what you do. Yeah. If somebody does have local anesthetic resistance, how do you address that? Uh, if you're [00:55:00] going to be, you know, working on them. Yeah, so I, I made, I made a few, I made a few notes here.

If I can just get to this. Yeah. Perfect. So, um, what do I do? Mm-hmm. What do I do if they've got issues with LA That was your question, was it? Sorry. Yes. Mm-hmm. Yes. What do I do? So, to begin with, we have a really lovely setup, so getting patients numbed up. Yes. There was that very good paper from 2019. Alan Hakeem was one of the people mentioned on it as an author.

Author, and that was saying approximately 80 to 90%, sorry. No, 88% of patients with s Dan lost had issues being numbed up at the dentist. Yeah. Mm-hmm. You asked me in an email earlier on how many, what, what percentage of my patients with s did I think there was an issue? And I wrote before I remembered what the paper said, I wrote between 80 and 90%.

So, yeah. Um, a lot of patients have issues. So, um, to begin with, as I said, I asked them three times. Do they [00:56:00] go numb? And so I, I need to know, and they need to know that I know and we all need to know we're working on the same team here. Mm-hmm. Yep. And if they don't go numb, we will try our very best. The paper from 2019, it lists the different local anesthetics and, uh, that work the best.

I don't quite know what you guys use over in the states a lot, but we use lidocaine a lot. Uh, and that is the least successful one. I think that, uh, does that work in 8% of cases? There's a few things with that study. It's great to have that study, but there's a few things with that study that we need to go on and do much, much more research.

So we need to use some of the local anesthetics that work better. One of those is, um, so. We can try and use that. So we can use a variety of local anesthetics. We've got them in the drawer. Uh, we can also use many ways of giving anesthetics. So we can give a nerve block. We can just put it at the side of the tooth.[00:57:00] 

We can open up the tooth and put it inside the tooth. We can give it down the side of the tooth. Now I discuss issues with local anesthetic a lot, and I discuss it with my nurses a lot. And we have a lot of people come on clinic to watch us and whatever. And in, in these talks, we always talk about this. I almost always get my patients numb and we don't know why.

So I think we need to take a step back, Linda. We need to say, why is it not working okay. Right. And could it be mass cell? A mass cell issue? Okay. And if it is what you were talking about a few minutes ago was getting the patient. Relaxed and not anxious, that is going to reduce your MCAS side effects. So, you know, is it MCAS and does it, does it happen from the waiting room to coming in that I get the patient settled, so I don't know how it works for me.

I've got a patient, Deborah, who works in Dundee [00:58:00] and Deborah is wonderful and we work so, so well and closely together and she's now started picking up, Ella's done those patients and she emails me every so often to say, how do you do it Audrey? I still can't get this patient numb. I say, I don't know Deborah.

I'm not hiding anything. So we just try to reduce the stress. Mm-hmm. Uh, we don't over, we don't over promise. Mm-hmm. We say we're all on the same team and we're here to help and please help as you tell us whatever it is you're feeling. One thing we discussed the other day, Linda, and I know this sounds crazy, but we are clutching at straws here.

We have, we have a lot of laughing on our clinic. Hmm. Uh, once a few weeks ago, the manager came in because she thought the nurse was cry. No. The manager came in because she thought, she thought the patient was crying her eyes out and I said, no, we are just having a good old laugh. Could it be having a laugh?

It makes local anesthetic, but I don't know. I do not know. So some [00:59:00] patients will not numb up well, but luckily, so far we get most patients okay. But we need much more research into all of this and, you know, and that would be lovely if the world can try and do all of this. And I wonder if part of that is the onset time.

You know, I've, I've observed with some of my colleagues, um. Not to, not to, not to brag, but I had quite a few patients who were like, wow, that epidural was so much less painful than the epidural I had with somebody else pre, previously. And you know, once you inject the lidocaine or whatever local anesthetic you're using, you need to give it a little time to work.

Right. So I wonder if part of that too is, you know, maybe it takes longer, maybe it will work in a lot of patients if you, if you give it more time. I think in some patients we need longer. Mm-hmm. But I tend not to give it maybe as long as other people would and it works. Mm-hmm. So I think [01:00:00] some people, if you leave it too long, it's already begun to wear off.

Right. Especially lidocaine. Yeah. Yeah, for sure. But anything is worth the trying. Sometimes when we're working through all these different solutions and different ways of giving it, we don't actually know what's going to work. Whether it's the solution the way we've given it or the length of time we've waited, while we've been messing around, giving it in all these different ways.

So we need much, much more. Research done into all this? Yeah, definitely. And I'm gonna try to roll these last questions kind of all into one so that, um, in the interest of time. Sure. So some people asked about, um, being shamed by their dental professional, whether it was their dentist or their hygienist, because they didn't really understand that they really were trying their best with their oral health.

Um, so in terms of what patients can do, either, you know, on, on their, I apologize, this could be kind of a a, a bigger question, but you can decide which parts of this you wanna, you wanna address in terms of what people can do on their own [01:01:00] for, for their dental health. Besides like the normal things that, things that would be more EDS specific things that they can do in interacting with their hygienist or their, or their dentist and choosing a dentist that might be able to better understand their circumstances.

What do you recommend to people? Well, Linda, I would recommend a very good Bendy Bodies podcast. Do you know one podcast you did? I thought it was amazing. It was a podcast on how to, how to interact with your healthcare professionals that when you go in, you try and see if they've had a busy day. And you, you, you talk nicely to them.

When you, I thought that podcast was amazing. That was basically you telling the patients to get on the same side as their team have. Mm-hmm. Compassion, understanding, realize it's not their fault. They don't know things. Don't go in blaming. I thought that podcast was amazing, Linda. Oh, thank you. And I would direct people to that podcast.

Yeah. Um. [01:02:00] What I would say here is, you and I both know Linda, we are both healthcare professionals. You were not diagnosed, I think until you were 47. Mm-hmm. You had decades not knowing what was going on. I had decades of not knowing what was going on. This is all down to how we're taught. Mm-hmm. Um, we need to be patient with people and get on the same side and, and try and help healthcare professionals understand what's going on here.

Mm-hmm. The same way as the things we don't know today, Linda, we would like people to come in and say, listen, we maybe just need, need you to think about this in a different way. Or there's this new stuff out. But it's very hard. Um, I think a lot of the individuals who feel they're being shamed, they are being shamed.

And I've seen a lot of mothers who have had children with their first molars, as we said, they're not properly formed, so they decay. They've, they've been shamed. And I have to say to them, I don't think that was your fault. [01:03:00] I think these teeth were poorly formed. Mm-hmm. And then they have a completely different view on it.

Mm-hmm. But that, that's not right. The patient is being shamed. But that's, that was the dentist and the dental team doing the very best they thought. Mm-hmm. It's very difficult, but it is so rewarding to be able to say to these people, I'm going to explain this to you in a different way, and we know you were doing your very best to look after your child's teeth.

Yeah. Yeah. No, that, that makes, that makes a lot of sense. And as you know, because you've listened to the podcast, um, we always end with a hyper-mobility hack. Do you have a hyper-mobility hack to share with us? I think for the patients with LERs Dan Loss get on the same side as your healthcare team.

Mm-hmm. Get on the same side as your doctor or your dentist. I know it's frustrating. I know it's very, very difficult, but [01:04:00] try to get on the same side. Don't blame them. It's not their fault every day in their job doesn't do things right. I would also urge every patient with ER's Danlos, try and help us spread the word.

Um, what I would like is every, every patient in Britain here. Uh, I have shared on the Facebook pages a two page writeup we did in Scottish Dental Magazine. If, if you can't connect the issues, then connective tissues and it just gives a brief summary. One of my dogs is, you know, one of my dogs, isn't there?

Sorry. Um, just to make it easier to look at it, just, if you could take this to your dentist, if we could get this, this article to every dentist in Britain, the world, we can share it on there. Yep. We can share it on there. Take this to them, print it out, get them to stick it on a notice board. Also, if people can listen to our talk here, if they can [01:05:00] listen to the talk we did back in December.

So it is just help us, help us to spread the word. Help us to spread the word and we are on your side and help us. Yeah, yeah, yeah. I, I, I think that's, those are great, great points. And for people who want to learn more about your work and the fabulous things that you're doing, where would they find you? So.

Uh, they can find me on Facebook. I think there can't be many people of my name on Facebook. I've also got a website, oral Surgery Scotland. Uh, you can go on there as well and you can email me through there. Um, I think that's all. I don't do a lot of social media, um, don't do a lot of social media, Linda, but you know, they can get me on all of that.

Yeah, yeah. It's wonderful the education that, that you've been doing. 'cause it's so, so important, like you said, each. Each discipline really can make such a huge difference. So it's so [01:06:00] wonderful the, the work that you've been doing, and I so appreciate you taking the time to chat with me today. This has been such a fun conversation.

You were talking about laughing in your clinic. We've done plenty of laughing. Well, I hope Linda, I hope so. Start starting with taking off our socks at the very beginning. Um, yeah. We should maybe tell people that Linda said, would you just give me a minute, Audrey, I want to take my socks off. And I said, Linda, I'm just taking my socks off as well.

Yeah, maybe neither of us can regulate our temperature that great. But I, I can't get too overheated. So. Well, I think, I think, Linda, I don't really want to say too much here, but I think for the people that have been. That have, that know about EDS and have been listening here, I think they've maybe seen quite a few signs of EDS.

Things like having to take off your socks. Um, not being able to remember people's names and maybe looking younger than both, both of us are Linda. 'cause I think both of us are the same age. And that you can quite [01:07:00] often pick Eller Danlos cases up by looking at somebody. And what I always say, Linda, is this is not to do with me what I do.

Spreading the word on Eller Danlos. It's not, it's it's not about me. It's not about my health. It's not about me. It's very much about helping the patients. And it's so wonderful and it is very interesting that you say that because I do feel like at the same time, you know, we call these invisible disorders, but there are definitely signs if you know what to look for.

You can definitely, like you said, you know, at least, at least have a suspicion and then you need to do the proper evaluation to, you know, actually confirm or come to a, a proper conclusion. So I have got my hairdresser educated and now now able to pick up cases. Yes. That's amazing. If I can get Katie, Katie, my hairdresser, who's asked to see this, if she can pick up cases, um, when you've got your eyes open, it's [01:08:00] easy.

And that's what we're wanting to do with healthcare professionals. I think that, I think the last thing if, if I can say it, is a friend of mine, Lincoln. Lincoln is an artist. Nothing to do with this. Lincoln is also picking up cases in his local pub. Uh Oh wow. But just before, just before he was to say to the lady serving behind the counter, she actually came out and told him, but he knew.

So anyway, Lincoln very nicely put it, I am doing my work upstream. I'm trying to pick up cases before they are in such a bad state of health. Right. And coming downstream to you guys and your clinics where you're trying to sort out all the issues. And I think if we can pick them up upstream so much earlier on.

We cut down all the hospital appointments by 50% or whatever, we, we reduce morbidity, mortality, suicide rate, everything. So yes, if people say, why are you trying to do this? It [01:09:00] is, we can make such a big, big difference. Absolutely. All the, the physical and psychological sequelae that can happen, we can reduce that by so much when we acknowledge and properly diagnose people and provide them with resources and, you know, instead of gaslighting them and having them go from appointment to appointment to appointment, just being told no, there's nothing wrong with you.

And Yeah. Yeah. And the toll, the toll that takes on every day. Emotionally, financially, marriages, families, children, work situations. Yeah. Yeah. Yeah. Well, that's why I do the podcast, as you know, uh, to provide that information to people and, and give, give something where people can easily share, you know, a link to an episode or, uh, if I can button there, Linda, I just have to say I'm sorry.

People with s Dan lost. We, we just have to say things, emotions. I feel you've done more than probably [01:10:00] anybody else, anybody. Four Ls, Dan Lost with those 140 podcasts and your website. I have a, a le I, I have a standard email I give to my patients and you feature so, so heavily in this. I now don't send them to other websites.

I say, if you want to know anything, Linda has got a podcast on it. Go on there. And they're so easy to find. I am not just being kind, I'm being honest, Linda, and I love what you do and you are you. What you've done is just astounding. I really mean it. And I have some of my patients, uh, have you as their poster girl, and they are just, they are just so pleased that I'm on here with you, you know, you are held in such high regard.

Oh, that's so, so sweet. I'm, I'm really, really touched. It's true. Thank you. I'm sure the audience will, I'm sure the audience will completely agree. It's just amazing what you're doing and thank you. Thank you for giving me all this to read and thank you. Yeah, of course. Of course. Absolutely. And thank you for [01:11:00] your incredible generosity with your time today, and it's a pleasure, Linda, sharing your expertise.

Pleasure. Yes, yes. I'm so glad we finally got to do this. We've been wanting to do it for a while. So yes, thank you. And we'll see you next time. Thank you. Take care.

Well, that was a super fun conversation with Dr. Kershaw, and I feel very confident that you will have found that as helpful as I did. Thank you so much for listening to this week's episode of the Bendy Bodies. With the Hypermobility MD Podcast, you can help us spread the word about joint hypermobility and related disorders by leaving a review and sharing the podcast.

This really helps raise awareness about these complex conditions. If you would like to dig deeper, you can meet with me one-on-one. Check out the available options on the services page of my website@hypermobilitymd.com. You can also find me Dr. Linda Bluestein on Instagram, Facebook, TikTok, Twitter, or LinkedIn at Hypermobility md.

You can find human content by producing team at Human [01:12:00] Content Pods on TikTok and Instagram. You can also find full video episodes of every week on YouTube at Bendy Bodies Podcast to learn about the Bendy Bodies program, disclaimer and ethics policy submission verification, and licensing terms. And HIPAA release terms or reach out with any questions, please visit bend bodies podcast.com.

Vende Bodies podcast is a human content production. Thank you for being a part of our community, and we'll catch you next time on the Bend Bodies podcast.

Thank you so much for watching. If you enjoyed this video, give it a thumbs up and leave a comment below. I love getting your feedback. Make sure to hit that subscribe button and ring the bell so you will never miss an update. We've got plenty more exciting content coming your way, and if you're looking for more episodes, just click on one of the videos on the screen right now.

Thanks again for tuning in and I'll see you in the next episode.