Episode 7-
Rella Christensen, Part 2
Rella Christensen on Following Curiosity Pt.2
In the last episode, we introduced Rella Christensen of TRAC Research, a nonprofit institute dedicated to in-depth long-term clinical studies of restorative materials, preventive dentistry, and dental caries. Rella took us on a journey through her incredibly busy life - raising three children and pursuing her career as the director of the Clinical Research Associates Foundation. We also heard about Rella’s husband and mentor Gordon, who helped her follow her research interests by giving her access to equipment and resources.
In this episode, we’re delving into some of Rella’s most important discoveries, her opinion on work-life balance, and the challenges of raising three good kids.
Resources
Follow your curiosity, connect, and join our ever-growing community of extraordinary minds.
Dr. Rella Christensen's Profile
Clinicians Report (formerly known as CRA)
What's In This Episode
-
Rella’s findings in air abrasion
-
Did Rella ever achieve work/life balance?
-
Rella’s biggest career achievement
-
Gordon’s role as a mentor to Rella
Transcript
Recording:
Extraordinary.
Leader.
Innovative.
Integrity.
Honest.
Courageous.
Curious.
Thoughtful.
Brave.
Unafraid.
Dr. Kim Kutsch:
There is a place where technology and art meet, where work and play are one and the same. When the threads of curiosity are pulled in this place, the spark of innovation ripples across industries. Those who make this place their home are giants. Titans, who pursue creative passion while leaving their mark.
Recording:
Creative.
Flexible.
Brilliant.
Clever.
Confident.
Dr. Kim Kutsch:
They are courageous thought leaders, set on changing the practice of dentistry and their corner of the world. More than the sum of their parts, we deconstruct the traits that bind these uncommon innovators.
Recording:
Humble.
Daring.
Discipline.
Playful.
Principled.
Spontaneous.
Dr. Kim Kutsch:
To discover what makes them... Contrary to Ordinary, where we explore the extraordinary.
Hi there. I'm Dr. Kim Kutsch, host and founder at CariFree. I'm fascinated by what makes the paradigm shifters, world shakers and art makers tick. Let's embark on a journey. Extraordinary is a place where ordinary people choose to exist. Together we will track the peaks of possibility, illuminate the depths of resilience, and navigate the boundless landscape of innovation to discover how some of the most innovative dentists and thought leaders unlocked their potential, and became extraordinary.
On this season of Contrary to Ordinary, we explore the motivation, lives and character of the innovators who see limitless potential around them, the people behind some of the largest paradigm shifts in the practice of dentistry.
This is part two of my interview with Rella Christensen, the Co-founder and former Director of Clinical Research Associates Foundation, she's also current Team Leader at Technologies and Restoratives and Caries Research, otherwise known as TRAC Research, and an all-around extraordinary person.
Last time Rella was about to dive into the topic of air abrasion, a popular method for removing decayed material from teeth in the 1990s. Rella thought to ask the question, how safe was air abrasion for dentists?
Rella Christensen:
We were really concerned because most of us went home with that sand in our ears and in our nose and in our eyelashes and eyebrows and hair and the whole thing. And I began to really worry about these silicon particles. And this was actually the second time we'd looked at the operatory air when we looked at that time, and that was the first time we looked at what they call the FFUs, the types of equipment that blow down.
And those became a way of purifying air when really, I think it came a lot of it from the CDC and some of their work with the cabinets, the hoods. There are fume hoods and then there are biological hoods. It became huge and more known to people when they started making the microchips. And they needed a very clean environment-
Dr. Kim Kutsch:
Sterile, clean.
Rella Christensen:
... where they actually, I've been in one place where the floor is actually a steel grid, and they're pulling the air... They're pushing it down from the ceiling and pulling it in and recirculating it through HEPA filters to have virtually no dust.
It isn't just dust, it's any kind of particles, which could be microbes, could be little tiny hairs, it could be DNA and RNA floating through the air, it could be microbes, it could be a lot of things.
Dr. Kim Kutsch:
Well, one of the theories IPF is that it's a chronic subclinical inflammatory process.
Rella Christensen:
Well, see, there's your problem because dentistry hasn't paid attention,
Dr. Kim Kutsch:
And from the continuous daily exposure to fragments of microbial DNA that don't create a clinical symptomatic outcome, but you have this long, chronic, subclinical inflammation in the lungs that ultimately becomes scar tissue, and you lose your ability to breathe, essentially. I mean, it destroys the lungs and, well, idiopathic pulmonary fibrosis, the lungs turn to fiber. You can't live without lungs, right?
Rella Christensen:
Yeah. They can't expand and contract properly.
Dr. Kim Kutsch:
Exactly. And you don't get the oxygen exchange. And scar tissue is not lung tissue.
We as a profession haven't really taken seriously the risk of these microbial DNA fragments pose to our long-term health. Rella has been following this trail for a while now, and has unearthed some interesting results in her latest two-year study.
Rella Christensen:
One of the major findings was by converting a dental operatory for, and now I'm talking about a restorative dentist here, because there are some aspects of dentistry where it's not as big of problem, but with a restorative dentist, and we'll talk about the hygienist separately in a moment here, but turning that operatory into a negative airspace didn't solve the problem.
Dr. Kim Kutsch:
Really?
Rella Christensen:
It didn't solve the problem, and I'll tell you what we found out why. Anybody that is using a rotary instrument in the oral cavity spins out the saliva and whatever else, what's being cut. Now, if you look at some of our calculations-
Dr. Kim Kutsch:
I just assume not.
Rella Christensen:
... of the numbers of organisms in a caries lesion, millions and millions.
Dr. Kim Kutsch:
Oh, millions. Yeah.
Rella Christensen:
And we're flipping that out. And one of the reasons that we've calculated, we've taken the time to calculate the numbers of organisms, is I want dentistry to understand what they're up against. They have no idea. No idea. Billions of organisms in some of these lesions, and they're just flipping that right out and into the environment.
Dr. Kim Kutsch:
Into their own breathing zone, and-
Rella Christensen:
Here's the problem, it flips out at a speed up to 47 miles an hour. And so it's flipping out in such a velocity that it'll go clear down and hit the wall on the other side of the patient's feet. And normal air circulating equipment can't stop it and draw it in. It needs to be super strong. And you work with a device that was a suction device, we could make it happen with a suction device if it exceeded 200 CFM, but by then it was so noisy.
Dr. Kim Kutsch:
Oh, yeah. Now you're into 70, 76 decibels.
Rella Christensen:
Yeah. That nobody could really operate there. We also worked with devices where the patient's head was completely encased and everything was happening. You could learn to operate like that because, look, physicians operate with endoscopes, and they're operating out here, and you're sitting six feet away in an operating...
Dr. Kim Kutsch:
Robotic surgery today is like, yeah.
Rella Christensen:
So I mean, we definitely could learn to operate like that, and that too would solve the problem. But where we are today in dentistry, we found that even FFU, fan filter unit is what that stands for, and we found that even most of them wouldn't do it. We could only find one that really properly cleared the air in the breathing zone. But because we couldn't suck it up down here, that meant that...
Dr. Kim Kutsch:
It went all over.
Rella Christensen:
... that it was on the patient, on the clinician. So that means you've got to be using covering. You've got to be using your-
Dr. Kim Kutsch:
Gowns and yeah.
Rella Christensen:
Yes. And your disinfectants and so on. And you've got to be having a hard floor that you can at least mop. You're not going to sterilize it, but you're also not going to eat off of it either, so we just need to get it good and clean. But we found that that was actually the best solution in today's technology.
In tomorrow's technology, they'll probably be doing dentistry in a bubble or the technology that I described to you, sucking it from the bottom and pouring it out the top.
Dr. Kim Kutsch:
All the way through the floor, yeah.
Rella Christensen:
Because see, the breathing zone, we could count next to and even sometimes zero particles in the actual breathing zone. Now bear in mind, the clinicians had on facial covering, and you would still wear that, but still, we could clean the air till it was really perfectly clean. Now, in your microchip industry, you'll notice they totally cover because they don't want the droplets-
Dr. Kim Kutsch:
Yeah, they don't want anything.
Rella Christensen:
... onto their microchips. But we definitely know how to clean it up. And we needed to do that for our caries work, because when we want to publish this information, we've got to be able to publish our controls and say, we can prove to you in all these places that were cultured all through the operation, that they were sterile. So that anything that we report had to come from the lesion only, and the burden of that proof is on us because they'll see some of these organisms that you don't think of in a lesion.
But let's talk about why they're there. Kim, they're there because anything you put in your mouth is covered with organisms, and it's warm, and there's plenty of nutrient, and it's moist, and those guys are going to hang around, and they might even establish a home.
Dr. Kim Kutsch:
It's the human incubator, right?
Rella Christensen:
Well, you put objects in your mouth. We found some soil organisms. Well, how did those get there? Did we screw up? And it just happened to be at a time when it was the spring and the berries were on. And my colleague Brad came in one morning, he says, oh, he says, I've picked these blackberries. He said, oh, they're just so good, I went out this morning and I just picked them right off the vine and ate them.
And I thought, that's how we get the dirt. Because of course, there's dirt all over those and all of us do that. I mean, even if when you get berries or fruit or something at the grocery store, it says wash them, but do ya?
Dr. Kim Kutsch:
Yeah. I've gotten better at doing that.
Rella Christensen:
Yeah. So it's an interesting thing, clearing air. What do you think is the future of dentistry with the air? We're going to have to have a pandemic that kills people who are dentists, who we can say, it hit dentistry worse than something else.
Now, let me tell you about the hygienist. That was declared the most dangerous profession. And of course, the hygienist, you can't blame them, they left the profession in droves. They said, look, it's not worth it. I've got kids, I've got a husband.
Dr. Kim Kutsch:
I've got a life.
Rella Christensen:
Yeah. But we've actually found that yes, they have lots of particles, but most of it is water.
Dr. Kim Kutsch:
Right. It's attached to water.
Rella Christensen:
Most of it is water and organisms attached to that water. And of the actual microbe, it is the restorative dentist, cutting on a carious tooth, and it doesn't even need to be carious because of the saliva is just loaded with microbes. It's anybody using a rotary instrument, and that would go for orthopedic surgeons, possibly oral surgeons.
Dr. Kim Kutsch:
For sure.
Rella Christensen:
Anybody that is using this high speed rotary. It doesn't need to be air turbine, it could be any kind of-
Dr. Kim Kutsch:
The electrics are just as... I think-
Rella Christensen:
Exactly. It could be a prophy cup. But the hygienists are not the most...
Dr. Kim Kutsch:
They're not as at risk as the restorative dentists, yeah.
Rella Christensen:
That is true. Now, that is true, but yet we found that most were interested in the information, but had no intention of really changing much and have tried to calm the patients' fears because you need a fairly strong system to prepare that operatory for the next patient. Now see, this fan filter, the best one that we found, will clear that operatory out. If you just empty it out and everything is closed and you just let it work, it'll do it in a matter of minutes.
Dr. Kim Kutsch:
The results of Rella's tests on the air quality of the examination space are truly shocking. And I really do hope that publishing results will help wake up the profession to the harm that is being done to its practitioners. You can probably tell by now that Rella has always worked really hard. Has she ever managed to achieve the elusive work-life balance?
Rella Christensen:
Well, I did have a balance once Kim, but it only lasted for about 60 seconds. And I've never had a good balance. I'm always too heavy on the work. It's just that professionist personality.
Dr. Kim Kutsch:
But do you see it as work, or is it-
Rella Christensen:
I really enjoy it, but other people see it as work, and you have to be careful that you've set aside enough time for your family and your people relationships.
Dr. Kim Kutsch:
Right. Yeah. So you're fully present wherever you're at at the time, but when you're here, it doesn't seem like you're working. I look at you and it looks like you are having fun, like you're pursuing your curiosity and passion.
Rella Christensen:
I'm finally interested in what I do, and what I did with at least the two boys is I brought them in here, and they enjoyed earning the money, but they also, I had time with them. Gordon has always been very permissive about this, because he works all the time.
Dr. Kim Kutsch:
Right. So it's kind of a good thing for him that you stay busy while he was focused on his passion as well.
Rella Christensen:
And we understand each other well that way and have lots of empathy and sympathy. There are times you really would like to rest, but you've committed yourself and you can't, and he's never criticized me for... What he does criticize me for is being so single-minded, he says. He says, all I need to do is just slam the door and lock you in the lab and push your dinner under the door about every 12 hours.
Dr. Kim Kutsch:
Well, he's been very supportive, and I've seen that from Gordon too in the times I've been here. Gordon-
Rella Christensen:
He has. Very supportive and a mentor at the same time.
Dr. Kim Kutsch:
Rella may not have figured out how to achieve the perfect work-life balance, but at least she had Gordon supporting her during her long nights of work and study. Rella is a pioneer in many ways, but what was her experience of building her career in a space dominated by men?
Rella Christensen:
I only felt it once when I really felt a barrier, and that was when I wanted to do a basic science PhD at BYU. Bear in mind, I was already 42. The thought was, well, you're middle-aged, you're a woman, and you'll be taking a place from one of our bright young men.
Since then, even while I was still in my graduate program, everything changed. At BYU, they actually started looking for women coming back to school, they started what they called a re-entry program aimed at women that had gone let's say to a bachelors, or maybe didn't even get their bachelors and were entering now.
Dr. Kim Kutsch:
You helped break that glass ceiling.
Rella Christensen:
Well, I don't know if I helped break it, but I was right on that edge of it.
Dr. Kim Kutsch:
As the ceiling broke, you were there. Yeah. Yeah. So another good question I've got for you is, so looking at your life, what would you consider your greatest success?
Rella Christensen:
Kim, you could ask that question to a lot of people, and they would answer it many different ways. But my life has had two very definite halves. And the hardest thing I ever did was be a mom and raising up three good kids who are good citizens and contributing and good people. That was the hardest thing I did because at a certain point, you lose all control. You have no say. In fact, you hesitate to say, because the chances are it'll push them in a direction you don't want them to go.
Whereas professionally, bear in mind I was almost 50 when I was really starting. I had credentials and could start in things I was really interested in. And by then my kids were reared. So if I were to look professionally, I would say that I was given an omission by Gordon. And it sounds funny, but I was so naive, I took it seriously. When we started CRA, I was working on a resin based composite finishing system for a company, Kirk. And Gordon came in one night and he said, what I want you to find is a material that lasts and handles like gold, but it's white.
And I was so dumb, I just took that right on and scoured the world. We've worked with all kinds of ceramics and polymers and unique materials that don't fall into that category. And about two thirds of the way through it, I could see that anything that was white, the old PFM era, that was really expensive, and people that single moms and college students and anybody was struggling a little bit, they weren't going to get it.
And basically, I started talking about something that the people in Europe understood. I wanted to have something like, I called it a Volks crown, V-O-L-K-S. German word for folks, or the common man. And it was kind of like the very popular time Volkswagen, which was actually developed by Hitler in his regime. He wanted a small, solid little car that could go on these autobahns and last for a good long time, and that was an innovation during that time. And I was looking for this crown. If a person had a highly involved tooth that wasn't a-
Dr. Kim Kutsch:
A direct restorative-
Rella Christensen:
... a five surface restoration, that really needed a crown but wasn't going to have a chance of getting it. And I would say, honestly, that one of the most interesting things that we did was to follow BruxZir. Because at the time it came to the market, I don't think there was anybody that was positive about it, except possibly Jim Glidewell himself. There was a feeling that, look, I mean, it's fine as a substructure material, but as a full contour crown, it's going to wear the dickens out of the opposing, it's ugly to look at, we can't cast it, so how are we going to make it? And just all kinds of impediments all along the way.
And as we took on that project, we compared it nose to nose with Emax, and we thought Emax would just trip it up in no time. And the person at Glidewell that was in charge of producing these crowns for our study, he actually separated his pros lab in half. He said, this half is going to make Emax, which is going to win, and this half is going to make this stupid BruxZir, which is never going to make it. And basically, the lab was almost competing on the two sides of the aisle.
The way it turned out, that came out in 2009. And first of all, it was called BruxZir, which sent this huge message to the dentist, and it could be used on a patient that had bruxing habits and would never recommended a ceramic for those people. Secondly, it gets introduced at $99 a crown. If you could scan it, which would be unusual in those days, you'd get another $25 off if you sent in your scan. And usually your lab bill was what, about 300 a crown, and this was 99, and you could get it down to about 75 if you did your own scan.
Dr. Kim Kutsch:
Which is just unheard of.
Rella Christensen:
Yeah. And right at the end of the recession. So here we have coming into play something that is white, it's economical, and Jim Glidewell said it could have a preparation like a gold casting, which meant minimal removal of tooth structure. And all of us at this lab, we just felt like it didn't have a chance.
And they were placed like that with a minimal prep, whereas the Emaxs had a much more substantial cutting away of the tooth, more than double as much, and then to watch it all of these years as it came along. That's one of the really interesting things-
Dr. Kim Kutsch:
That you've worked on.
Rella Christensen:
... in my career. The microbiology stands alone. I think that we have proven a theory by a fellow by the name of Marsh in England, his theory, the ecological theory, that it isn't really any one organism and maybe not even any group of organisms that causes caries, it's the environment in the oral cavity that the patient creates through various things. It can be a diet, it can be chemicals like marijuana and meth, and something-
Dr. Kim Kutsch:
Can be lack of saliva, medications.
Rella Christensen:
Because of medications or these habits.
Dr. Kim Kutsch:
Yeah, yeah. For sure. Even vaping.
Rella Christensen:
And all of these kinds of things, the patient creates this environment in their oral cavity, and organisms that maybe you wouldn't think of as caries causing can switch on certain enzymes and become another person, so to speak.
Dr. Kim Kutsch:
Right, right. Join the party.
Rella Christensen:
Function in a different way. And when I look at this guy down here with all of these. And so we've been trying to figure out, okay, how do we communicate this to the profession? We can make these maps of a lesion that are very accurate, but there's so much to look at. How do we communicate it so you can just look and just see? And we've finally learned how to do that, and now what we've got to do is publish it.
Dr. Kim Kutsch:
Yeah, yeah. Exactly.
Rella Christensen:
You know what our biggest problem is? We started our work as loaners, and we don't have an IRB.
One patient led to another.
Dr. Kim Kutsch:
Oh, you're right. Yeah.
Rella Christensen:
And here's all this vast accumulation of information that I don't know where or how we'll ever be able to publish it, we'll just have to see. Either that or start it again.
Dr. Kim Kutsch:
I find it truly astounding how much self-funded and important research Rella has engaged over the course of her career. It's probably not going to surprise anyone to hear that Gordon is the person Rella admires the most in the world.
Rella Christensen:
Hands down, I have seen this man do miracles in the oral cavity. I admire some other people that are that same caliber, that are so creative with how they can make things go. I've learned to know these people in the Academy of Aesthetic Dentistry. Ronnie Goldstein is one. Dr. John Kois is another one. There are a whole group of them that helped to start that academy that were just giants in their area.
And I never would've, first of all, known about the academy, second of all, wouldn't have been able to attend if it hadn't been for Gordon. He was always hauling me along. So he's been a tremendous mentor and an amazing person to watch. He can place gold foil without a problem, which a lot of docs struggle with. He knows occlusion. Nobody places a rubber dam like Gordon.
Dr. Kim Kutsch:
I think of Gordon, I think of his passion.
Rella Christensen:
And he's the... What's this bunny? The bunny that keeps going.
Dr. Kim Kutsch:
Oh, the Energizer Bunny. Yeah, yeah.
Rella Christensen:
The Energizer Bunny.
Dr. Kim Kutsch:
I was going to say, his drive-
Rella Christensen:
He runs circles around everybody.
Dr. Kim Kutsch:
... and I think the difference that he's made for so many dentists in their lives, just in terms of the education-
Rella Christensen:
Well, he takes complex things, and he boils them down to their lowest denominator.
Dr. Kim Kutsch:
Right. Simplifies it, so that-
Rella Christensen:
And makes it so that it seems easy. And you can watch him, I've assisted him for years, gee, I think I can do this. Because he talks while he's working, now I'm going to do this and I'm going to do this because it needs this. And he's just kind of talking really kind of to himself and to the patient. And you're just watching all of this happen. Yeah, he's amazing. But these other people, I'm not naming, I'm missing so many of them.
Dr. Kim Kutsch:
Thank you so much for spending this time with us today, Rella. I really appreciate it. Appreciate you.
It's truly amazing to look back on everything Rella has accomplished. She's not only a curious person, but someone who's willing to go the distance if they think that what they're digging into could help others. As a co-founder of Rolls Royce, Sir Henry Royce said, "Take the best that exists and make it better. If it doesn't exist, create it." Thanks so much to Rella Christensen for building the organizations we needed to drive change.
And thank you for coming on this journey with me today. Around here, we aim to inspire and create connections. We can't do it without you. If this conversation moved you, made you smile or scratched that little itch of curiosity today, please share it with the extraordinary people in your life. And if you do one thing today, let it be extraordinary.