Who are you going to BE?

Ahh, your favorite place on planet Earth… the beach!

The sound of the sea waves relaxes and renews your mind and body. Breathing in the fresh sea air lifts your emotional state and boosts your immune response. Beach chair in place, check. Umbrella overhead, check. Sunscreen applied, check. Favorite beverage in hand, check. You are determined to let nothing disturb this peaceful day…

At last, all you hear are gentle rolls of sea waves lapping against the sand…

Suddenly, a frantic man rushes up and yells in your face: “Don’t just lie there!” He then gestures out to sea: “Those people out there in the water are drowning! We must save them!”

You leap to your feet. But as you look out toward the victims, so very far out in the water, maybe even caught in a rip current, you wonder: “What can I possibly do to help?!”

This narrative is based on events that occurred at a Floridian beach in the summer of 2017, when eighty strangers formed a human chain to save ten struggling swimmers caught in rip currents. This potential tragedy unfolded when two small boys, chasing waves, started to struggle in the water. Seeing their distress, four adult members of the Ursrey family, including the parents and a grandmother, rushed into the water to save the boys and several other swimmers, only to be swept up in rip currents themselves.

(1)After professional rescuers' attempt to save the drowning family failed, a couple of civilians, Derek and Jessica Simmons, took action. Mr. Simmons ran up to strangers on the beach, shouting: “Don’t just stand there! There’s Statistics show that nearly 80% of beach rescues involve rip tides and currents, and that ripe tides and currents kill nearly 100 people per year in the U.S.! (2) got to be some hope left for humanity in some of you.”(3) With purpose,(4) Mrs. Simmons repeated a mantra to herself: “These people are not drowning today. It’s not happening. We’re going to get them out.”(5) Mr. Simmons yelled: “Form a human chain!”

(6) In response, law enforcement warned against attempting a civilian rescue; (7) after all, their own attempts had failed. (8) And, perhaps believing that someone more qualified should still make the rescue, hesitant beachgoers also yelled “don’t go out there!”.

(9) “That’s when the extraordinary happened”, (10) for Mr. Simmons’ message – in tandem with Mrs. Simmons’ mindset – “set the tone”11 and moved complete strangers into action. Linking arms to create a human chain, 80 strangers waded into the rip currents to reach the ten swimmers.12 Of these 80 people, some couldn’t swim themselves, but wanted to help from the shallows. Others who could swim waded into water up to their chins. (13) At the end of the human chain, now 100 yards long, Mrs. Simmons, an experienced and confident swimmer, closed the gap to the children.

(1) Rip tides are especially deadly, because they are fast, heavy, strong waves capable of capsizing boats. Albeit smaller and slower, rip currents are still exceptionally dangerous, because they can surprise and overpower even strong swimmers in shallow water.
(2) www.usla.org/page/RIPCURRENTS
(3) stories.usatodaynetwork.com/humanchain/
(4) Paul A, Henny, DDS. m.facebook.com/groups/635076059978897/permalink/2053234444829711/
(5) www.newsherald.com/story/news/2017/07/11/human-chain-saves-family-from-drowning/11528528007/; nationalpost.com/news/world/floridabeachgoers-form-human-chain-to-rescue-family-swept-away-by-riptide (6) www.washingtonpost.com/news/morning-mix/wp/2017/07/11/a-riptide-swept-away-a-florida-family-then-beachgoers-formed-a-human-chain/
(7) nationalpost.com/news/world/florida-beachgoers-form-human-chain-to-rescue-family-swept-away-by-riptide
(8) www.theguardian.com/us-news/2017/jul/11/80-people-form-human-chain-rescue-gulf-of-mexico-florida
(9) stories.usatodaynetwork.com/humanchain/; www.newsherald.com/story/news/2017/07/11/human-chain-saves-family-from-drowning/11528528007/
(10) stories.usatodaynetwork.com/humanchain/
(11) See Sinek’s talk on TedTalks
(12) stories.usatodaynetwork.com/humanchain

(14) Mrs. Simmons told news outlets: “I got to the end [of the chain], and I know I’m a really good swimmer… I practically lived in a pool. I knew I could get out there and get to them…”(15) And, “I was calm because I knew they [were] coming out alive. I knew how to get out of a rip tide, and I knew I could swim for long periods of time.”

(16)The Simmons used a boogie board to ferry the drowning swimmers, one at a time, back to the human chain, and the people forming the human chain then provided a LifeLine™(17) for the saved but exhausted swimmers back to the shore.(18) Ultimately, eighty strangers, inspired by the message and actions of one couple, waded into dangerous rip currents to save ten struggling swimmers.

This event on the beach and the 80 strangers’ willingness to help save lives moved humanity forward by leaps and bounds. It provides, by means of analogy and metaphor, an excellent model for patient care, which will dramatically reduce the risk of life-altering events, including death. Basically, if we get enough healthcare professionals together, “link arms” in the professions, and “get out there” to raise awareness for patients at risk, we can pull our patients back into the health and wellbeing of the safety zone.

(19) Amongst those patients in the danger zone (20) are young children with structural anomalies within the Cranio-Facial Respiratory Complex (CFRC). (21) While the CFRC is normally healthy and well-functioning in most children, and thus is often overlooked during routine care, structural anomalies such as a high Vshaped palate, severe malocclusion, and retrusive chin do occur within the CFRC of some children.

(22) Structural anomalies within the CFRC can restrict the growth of the maxilla and mandible, limit the size of the tongue box, encroach on the tongue, obstruct the nasopharyngeal area, and further inflame the adenoids and tonsils.

(23) Affecting the musculature, structural anomalies within the CFRC create or impact anterior, middle, and posterior tongue-lip adhesions, limiting the tongue’s ability to reach the top of the palate, which is the normal resting place for the tongue. Instead, the tongue rests back into the oralpharyngeal area, obstructing the airway – especially during sleep.

(24) Notably, obstruction of the airway often prompts mouth-breathing, which causes/exacerbates inflammation of the adenoids and tonsils.25 According to Dr. Christian Guilleminault at Stanford University, even though adenotonsillectomy is the standard of care for many ENTs and pediatricians, (26)- 61% of children continue to suffer from OSA after their adenotonsillectomy. Because adenoids and tonsils contribute to our immune response, (27) this statistic is unfortunate.

(13) newsherald.com/story/news/2017/07/11/human-chain-saves-family-from-drowning/11528528007/
(14) newsherald.com/story/news/2017/07/11/human-chain-saves-family-from-drowning/11528528007/
(15) www.washingtonpost.com/news/morning-mix/wp/2017/07/11/a-riptide-swept-away-a-florida-family-then-beachgoers-formed-a-human-chain/
(16) nationalpost.com/news/world/florida-beachgoers-form-human-chain-to-rescue-family-swept-away-by-riptide
(17) www.thelifeguardinitiative.com/
(18) https://www.newsherald.com/story/news/2017/07/11/human-chain-saves-family-from-drowning/11528528007/
(19) I coined this term, the safety zone, to connote a patient’s positive state of physical health (the optimal structure and function of one’s body free from disease) and/or a positive state of mental/emotional wellbeing (the optimal balance of one’s emotional, intellectual, spiritual, and social wellness).
(20) I coined the term, the danger zone, to connote a patient’s poor state of physical health (the impaired structure and function of one’s body in the presence of disease) and/or poor state of mental/emotional wellbeing (the impaired balance of one’s emotional, intellectual, spiritual, and social wellness).
(21) Kevin Boyd and a collaborating illustrator captured these structural anomalies in a drawing that renders a child’s face like an x-ray. As you “look inside” the child’s face, you can see how CFRC affects the nasopharyngeal area, adenoids and tonsils, maxilla and mandible, and hard and soft palates of the tongue box.
(22) See www.childrensairwayfirst.org/breathing-problems-research; www.nature.com/articles/s41368-018-0012-3; pubmed.ncbi.nlm.nih.gov/23449902/
(23) See www.childrensairwayfirst.org/breathing-problems-research
(24) health.usnews.com/conditions/sleep-apnea/articles/best-sleeping-positions-for-sleep-apnea
(25) See Michael Gelb. Gasp!: Airway Health – The Hidden Path to Wellness. CreateSpace Independent Publishing Platform; 1st edition (September 9, 2016) See also www.childrensairwayfirst.org/breathing-problems-research; 3 University, even though adenotonsillectomy is the standard of care for many ENTs and pediatricians,
(26) www.uclahealth.org/head-neck-surgery/workfiles/Secure/Suggested%20Readings/Holty_Guilleminault- %20Surgical%20Options%20for%20OSA.pdf?msclkid=c92e154bbd8611ecb7b4862f698d477e
(27) www.ncbi.nlm.nih.gov/pmc/articles/PMC6531274/

Craniofacial abnormalities affect all systems of the body, profoundly impairing a child’s physical health and neuropsychological wellbeing. Craniofacial abnormalities cause physical harms, such as hypoxic brain injuries, airway- and sleep-disordered breathing, hypertension and cardiac dysfunction,(28) tooth decay, musculosketal and autonomic conditions, and various cancers.(29) Craniofacial abnormalities also cause neuropsychological harms, such as fragmented sleep, poor concentration, diminished IQ, ADD/ADHD, poor self-esteem, untreated anxiety, severe depression, school attrition, difficulties with impulse control, and suicidality.(30) Indeed, Dr. Suresh Kotagal, a Mayo Clinic pediatric neurologist, has evaluated how the structural anomalies injure the prefrontal lobes, resulting in cognitive and emotional decline.

(31) Yet, craniofacial abnormalities do not simply manifest problems in childhood; rather, they cause life-long complications and disease, such as heart disease, heart attack, stroke, dementia, sleep disordered breathing, and many types of cancer.(32) Notably, for several decades in traditional extraction-retraction orthodontia (unlike more contemporary airway/face-forward orthodontia), the patients’ severe malocclusions were prioritized, but the patients’ airway and facial structure were inadequately considered in the outcome.(33) This oversight exacerbated injury to the patients’ airway, augmenting the patients’ risk for developing later complications and disease.(34) It is necessary that we see this connection while evaluating and treating adult patients who suffered from uncorrected structural anomalies within the CFRC and/or underwent extraction-retraction orthodontia for malocclusions.

Ultimately, structural anomalies within the CFRC must be evaluated and corrected, preferably in childhood. Dr. Dania Tamimi, a top Harvard trained radiologist specializing in head and neck issues, conducts her evaluations with CBCT imagery.(35) The CBCT imagery shows the quality of the musculature and the narrowness of the airway.(36) “If the muscle is lax and the airway is very narrow, corrections need to be made within the structure of the CFRC.”(37) Corrections include but are not limited to expansion of the tongue box by gently advancing the jaw forward and by widening the palate with non-surgical means.(38) After corrections have been made, myofunctional therapy (i.e. oral facial muscle therapy) may be used to establish and maintain the proper relationship between the muscles of the face, mouth, and throat. (39)


(28) Indeed, the American Heart Association sees kids with CFRC who suffer from hypertension as children!
(29) See Michael Gelb. Gasp!: Airway Health – The Hidden Path to Wellness. CreateSpace Independent Publishing Platform; 1st edition (September 9, 2016) See also www.childrensairwayfirst.org/breathing-problems-research
(30) See Michael Gelb. Gasp!: Airway Health – The Hidden Path to Wellness. CreateSpace Independent Publishing Platform; 1st edition (September 9, 2016) See also www.childrensairwayfirst.org/breathing-problems-research
(31) See newsnetwork.mayoclinic.org/tag/suresh-kotagal/
(32) See Michael Gelb. Gasp!: Airway Health – The Hidden Path to Wellness. CreateSpace Independent Publishing Platform; 1st edition (September 9, 2016) See also www.childrensairwayfirst.org/breathing-problems-research
(33) See Michael Gelb. Gasp!: Airway Health – The Hidden Path to Wellness. CreateSpace Independent Publishing Platform; 1st edition (September 9, 2016)
(34) See Michael Gelb. Gasp!: Airway Health – The Hidden Path to Wellness. CreateSpace Independent Publishing Platform; 1st edition (September 9, 2016) See also www.childrensairwayfirst.org/breathing-problems-research
(35) info.beamreaders.com/cbct-tmj-sdb-patient
(36) info.beamreaders.com/cbct-tmj-sdb-patient
(37) Candy Sparks, in a correspondence with the author. For information on Candy Sparks efforts at CAFF, please see www.childrensairwayfirst.org/
(38) Candy Sparks, in a correspondence with the author. For information on Candy Sparks efforts at CAFF, please see www.childrensairwayfirst.org/
(39) aomtinfo.org/myofunctional-therapy/

We are facing a dire situation now.

To date, medicine and dentistry have not known how to adequately screen for this silent epidemic, leaving 11 million children at risk in the U.S. and almost 400 million children at risk around the globe for detriments in both childhood and beyond.(40)

The Children’s Airway First Foundation (CAFF)(41) and The LifeGuard Initiative™ (TLI)(42), which together comprise a multidisciplinary coalition of dedicated healthcare professionals, are here to raise the alarm. Just as the beach rescue started with two struggling boys, our call to action must start with young children. We must identify babies at risk, and barring that, we must ensure that children with developing airway and sleep disorders are screened, evaluated, and treated for structural anomalies within the CFRC before the age of six! These steps must be taken to prevent tragedy!

But we must not stop there! Just as the beach rescue evolved from saving children to saving adults too, our call to action must not forgo adult patients suffering from the aftermath of untreated structural anomalies within the CFRC and/or airway injury from extraction-retraction orthodontia. We must be more aware of risk factors and more inclusive of the patients that we see. These steps must be taken to mitigate persistent harms and prevent more deaths.

On the front lines of patient care, dental hygienists can make a difference chairside and beyond.

Yet, it may be necessary to leave your comfort zone: i.e. adhering to the now outdated teachings that you learned in medical/dental school. As late as 1993, it was primarily perceived that: “[a]s cotherapists in providing total patient care, dental hygienists must foster their pivotal role in the prevention, recognition, and initial therapy of periodontal disease.”(43) Today, the evidence-based science also indicates that dental hygienists must screen for oral-systemic conditions beyond periodontal disease.

To do so, you may need to tailor your philosophy of care.

I made a shocking and key realization when I developed my philosophy of care: to steer my patients toward total body health, I had to make a change, and that change had to begin with me.(44) Such a paradigm-shifting change necessitated a major reorganization of my thoughts and perceptions, and it took time and self-trust to execute.(45) Ultimately, I found that the only sustainable way to save the lives of my patients (as well as the health of our practice) was to develop my ability to change, adapt, and evolve – and to do so in a spirit of group collaboration. “Collaboration begets synergy, and synergy creates positive change and growth unachievable through independent functioning.”(46)

Collaboration drives the work of the Children’s Airway First Foundation and The LifeGuard Initiative™. And, we’d like to work with you, too, so that we can be there to help inspire and guide you; you needn’t do it alone! In a sense, we’ll be forming a human chain together. Like the human chain on the beach, which included people from all walks of life and swimmers at all ability levels, the best human chain in healthcare comprises a full complement of people – doctors, nurses, dentists, hygienists, counselors, educators, moms, etc. – all committed to the health and wellbeing of the patient. The health and wellbeing of your patients, your practice, and your career is a team sport. Really, the entire team must be “on the right page” with the practice philosophy and vision in order to propel the patient toward lasting total-body health and wellness. Simply put, collaboration saves lives.

(40) www.childrensairwayfirst.org/
(41) www.childrensairwayfirst.org/
(42) www.thelifeguardinitiative.com/
(43) J M Uldricks, M J Hicks, H L Witacre, J Anderson, M L Moeschberger. “Dental hygienists’ utilization of periodontal assessment skills and perceived collaboration with dentist-employer.” J Dent Hyg. 1993 Jan;67(1):22-9. Available at pubmed.ncbi.nlm.nih.gov/8331393/ (emphasis added).
(44) Duval, C. “Getting Your Shift Together.” RDH Magazine, 32:7. July 2012.
(45) See more on paradigm-shifting changes in Paul A. Henny, DDS (citing Piaget at m.facebook.com/groups/635076059978897/permalink/2053234444829711/)
(46) Paul A. Henny, DDS 5 

“When those who know are able to show, those who learn are able to grow.” ~Mark Sanborn

After you leave your comfort zone and join our human chain, you may need to shift your mindset, protocols, and messaging, so that it’s possible to accomplish more than just a prophy or perio maintenance during a 60-minute hygiene visit. As healthcare professionals, we see patients every day, and sometimes every hour, who are caught in a metaphorical rip current. As we race against the clock to merely remove calculus in a bloody environment, we repair the damage from yesterday. These patients live in the danger zone, where they risk suffering a life-altering event and even death.

A tailored philosophy of care, updated clinical habits, and purposeful patient messaging, all grounded in current evidence-based science, provide LifeLines™ for pulling patients back into calmer, more manageable waters.(47) The science, which emphasizes the oral-systemic link, places hygienists on the frontlines for identifying and reducing risks. Essentially, the mouth is the gateway to the body. Improving oral health reduces one’s risks for atherosclerosis, major cardiac events, stroke, dementia, various cancers, and comorbidities.(48) When patients return to the practice healthy, hygienists have more time to cast their LifeLines™, or rather, to conduct life-saving screenings. These screenings include but are not limited to evaluations for pathogenic oral bacteria, periodontal disease, diabetes, caries risk, airway/breathing-associated disturbances, high blood pressure, and oral cancer. By conducting these screenings, we focus on extending and enhancing our patients’ healthspan.(49) Adopting this approach, we prepare our patients for a healthier tomorrow. Our patients then live in the safety zone, where they can maintain their health.

“Overlooking or ignoring clinically-based evidence for whatever reason can have a catastrophic impact on patients' overall health and wellness, and open the door for disease and even death.”(50) ~Cris Duval, RDH, LifeGuard & Patient Coach

Both the Children’s Airway First Foundation and The LifeGuard Initiative™ seek to raise awareness of structural anomalies within the CFRC. Raising awareness amongst healthcare professionals, educators, patients, and families is a powerful tool, for it can facilitate early screening, diagnosis, and treatment. Raising awareness works in any context; the Ursrey family now spots rip currents and warns other swimmers to heed dangers in the water.(51) Once drowning victims, they are now the experts on these dangers, championing vigilance to save others’ lives. The Ursreys have joined the human chain that once saved them.

(47) https://www.thelifeguardinitiative.com/
(48) See academic.oup.com/eurjpc/article/25/6/596/5926457; www.mayoclinic.org/healthy-lifestyle/adult-health/expert-answers/heart-diseaseprevention/faq-20057986; pubmed.ncbi.nlm.nih.gov/33240188/; www.ncbi.nlm.nih.gov/pmc/articles/PMC8041071/; www.ncbi.nlm.nih.gov/pmc/articles/PMC6927401/
(49) Healthspan – part of a person’s life during which they are in good health
(50) Duval, C. “Getting Your Shift Together.” RDH Magazine, 32:7. July 2012. 51 stories.usatodaynetwork.com/humanchain/ 6

To make this difference chairside and beyond, you may need to leave your comfort zone, collaborate with other professionals, shift your mindset, protocols, and messaging, and raise awareness of structural anomalies within the CFRC. To accomplish these concrete steps, you may need to ask yourself: who am I willing to BE for my patients (for who I decide to BE will drive what I will DO for my patients!)? And what will I DO for my patients? Do I want to watch or act? To extend the beach analogy, do I want to be the healthcare professional who says “Don’t go out there! Let someone else, let the specialist, care for these patients!”. Or, do I want to be the healthcare professional who links arms with my colleagues – some with special gifts and some with more general experiences, but all who join together to save lives? Dental hygienists work on the front-lines and may be the first ones able to identify patients at risk for structural anomalies within the CFRC, but we needn’t stop there! All persons with a hope for humanity, regardless of backgrounds or skills, may join the human chain to save patients’ lives.

So, now that you know more about the impact of structural anomalies within the CFRC, are you ready to join the Children’s Airway First Foundation and The LifeGuard Initiative™ to save lives?

Notes about the Author, Cris Duval, RDH, LifeGuard & Patient Coach: As a dental hygienist, patient-health advocate, and wellness coach, I have been recognized for leveraging science-based evidence in patient-centered care. By shifting my thinking, messaging, and clinical habits, I developed a new science-based wellness program in 2001. This approach improved the health and wellness of my patients and generated more revenue for our patient-centered practice at the office of Dr. Brian McKay in Seattle, WA. After four decades in patient care, I also founded The LifeGuard Initiative™, which encourages team members to appreciate the benefits of shifting their mindset from calculus removal to oral systemic health. I strive to be an “architect of change” for dentistry and medicine’s approach to health. I also actively participate in various professional associations. I am on the advisory boards of the Children’s Airway First Foundation (CAFF), the Oral Cancer Cause, and Dental Entrepreneur Woman (DEW). I was a founding board member of the International Association of Ozone in Healthcare & Dentistry (formerly, IAOHD), as well as, the former oral-wellness liaison for the Bale Doneen Method. Recently, I became a support coach for Inspired Hygiene. If you have any comments or questions, please feel free to contact me at cris.duvalconsulting@gmail.com or (425) 445-7944.