Episode description

What happens when dental hygienists look beyond the oral cavity and start connecting airway health, hormonal changes, and skeletal integrity? In this episode of the RDH Magazine Podcast, Kristin Evans discusses the relationships she sees among obstructive sleep breathing, hormonal changes, bone metabolism, and oral health—and why these connections matter in clinical practice.

Evans also shares her journey to becoming a speaker at RDH Under One Roof, the importance of finding your own professional voice, and the opportunity for hygienists to recognize risk factors, educate patients, and refer when appropriate. The conversation offers a practical look at how dental hygienists can become more investigative in their assessments while staying within their clinical role.

Finding the connections between airway, hormones, and skeletal health

Jackie Sanders: Welcome back, and thank you for joining us. My name is Jackie Sanders, chief editor of RDH Magazine. Today I am joined by my cohost, Andrew Johnston. Hello, Andrew. How are you today?

Andrew Johnston: Hey, how's it going? Man, it's a beautiful day. Excited. Love podcast days. These are my favorite days of the week.

Jackie Sanders: Energy is high. And it's even higher because our special guest today is Kristin Evans. Hello, Kristin. How are you today?

Kristin Evans: I am so good. Yes, it is a beautiful day, and we are energetic and ready to go.

Jackie Sanders: One of these days we have to record the pre–get-ready-to-record conversation because it's almost even more fun, more organic, and honestly more hysterical. It's Jackie making funny noises and Kristin and Andrew meeting for the first time. Anyway, high energy is here.

What we're going to talk about today, Kristin, is that you're speaking at Under One Roof, and it's a very unique topic: airway health, hormone health, and skeletal integrity. What brought all three of these topics together for you?

Kristin Evans: That is an extremely interesting question because I would have to say, in all honesty, it was a higher power that brought this together.

This really was not my path. I thought I was going to be a clinical dental hygienist for 30 years, retire, hang up the scalers, and be a grandma. God has had a completely different pathway for me, and He's done it through my life challenges.

As far as hormones, airway health, and bone health, I have become one of the leading experts in dentistry right now in prevention and screening for systemic bone health and the correlation it has with dentistry and the systemic effects of osteoporosis because of my life journey.

This beautiful opportunity at Under One Roof has come completely as a gift from God. There's a much deeper story behind it.

I wasn't even going to apply for Under One Roof this year because I had been turned away before, and I just thought maybe it wasn't meant to be. On the very last day we could submit, I felt God tell me to submit this presentation. It was actually one I had previously created for an airway group.

I had combined so many things, and I was fascinated that I had made these connections between airway, hormones, and bone health. My main focus had always been hormones and bone health, but I started seeing how obstructive sleep breathing—and even nocturnal awakenings, which happen during menopause and also in many men with low testosterone—all connect.

I kept seeing these interconnections, and it made me so excited.

Unfortunately, that original presentation was canceled, so I had this entire presentation ready, and I was heartbroken. Then I submitted it to Under One Roof on the last day, and it was the only submission I sent in—and I got accepted.

So I truly believe this is a gift from God.

Somebody sitting in my audience at Under One Roof is going to be the person who needs this message. I hope there are many.

I'm so excited because this is also a subject that simply isn't talked about enough in dentistry.

I'm really just standing on the tip of an iceberg. As we begin connecting systemic bone health with oral bone health, we're realizing there is an interconnection. There are so many comparable and interchangeable risk factors with periodontal disease.

We aren't screening early enough. We aren't protecting patients early enough. And we aren't using the incredible opportunity we have in dentistry—especially as dental hygienists—to screen and educate people beyond just what's happening in the mouth.

We have to move beyond the oral cavity. We have to become oral-systemic educators.

I'm incredibly excited because I believe dental hygiene is going to evolve dramatically over the next five years into something more than anyone has imagined.

We can become the primary screeners for chronic inflammatory diseases.

And we will be.

Persistence, purpose, and finding your own voice

Andrew Johnston: One of the things that I feel like—and I know Jackie gets a lot of joy in this, and I do as well—is when there are new voices, new writers, and new contributors to the dental hygiene space bringing completely different topics.

The problem we run into a lot is hearing the same story you just told. We hear people say, "I've submitted to Under One Roof five times."

So this is kind of a two-pronged question. One part is actually for Jackie Sanders, but also for you, Kristin.

What kept you going? What kept you pushing through the challenges and what felt like rejection?

Because on our side, obviously, for Under One Roof, we weren't rejecting anybody. We simply had so many amazing speakers that it ultimately came down to the scoring process.

So what kept you going?

Kristin Evans: I think because it was on my bucket list.

Jackie means a lot to me.

Emotionally, this is hard to talk about, but Jackie was the person who really got me to where I am today—speaking on stages and doing what I'm doing.

She was the very first person who ever talked to me about what I needed to do.

I was just someone with a desire and something on my heart. I connected with her, and she called me. I think we talked for about 45 minutes. That was in 2020.

She told me, "I can teach anyone to write."

I'm not a writer, and I didn't believe I could do it.

Then she said something I'll never forget: "We can teach anybody to write, but we can't teach passion."

I still remember that, Jackie, because you gave me that confidence. You put that hope in me.

My bucket-list dream has always been to speak at Under One Roof because I wanted to support Jackie the way she supported me.

I hope I can continue doing that because Under One Roof and RDH Magazine have helped hygienists become so much more.

I'm just incredibly proud to be on that stage and contribute.

I think what kept me going was this inner passion. I always knew someday I'd be on that stage. I just didn't know when.

When we stop making it about ourselves—about wanting to be on stage or wanting people to love us—and instead give it over to something bigger than ourselves...

For me, that's God.

I just say, "I'm on Your journey. I'm going to do what You want me to do."

I believe every one of us has a divine purpose. If we allow that purpose to be used to help, heal, and love others, then we naturally grow into what we're meant to become.

This opportunity is a complete gift.

I also had to silence the voice inside telling me I'd never be enough. That's a huge battle.

"You'll never be enough."

"Don't write that article."

"Don't submit that presentation."

"Don't reach out because you're not one of those people."

I used to put people like Anne Rice on a pedestal and think, "I'm not her."

Then I realized...

No, I'm not her.

There's room for Kristin Evans.

There's room for all of us.

So blossom where you are. Find what you're passionate about and pursue it. That's what I tell everyone.

And Jackie was the person who first helped me believe that.

Jackie Sanders: Thank you for the kind words. Of course, now I have to dry my eyes and stop crying.

But I'm a firm believer in timing, Kristin. We met exactly when we were supposed to meet. It also took time for your message to develop into what it needed to become so you could present it this year.

I really don't look at those previous years as rejection. It simply wasn't the right time yet.

And it is hard. We receive more than 300 submissions every year for only 25 speaking spots. It is incredibly competitive.

That's why we use a scoring rubric and more than 30 judges. Every submission is scored independently.

I have a dear friend who's a speaker coach, and she always tells me the busiest day in her office is the day after the Under One Roof speakers are announced because everyone calls her crying. She jokes that it's great for business.

"Jackie, when are you announcing the speaker list?"

But for everyone listening to this conversation, remember: You are not supposed to be like anybody else.

Please don't try to be Jackie Sanders. There's only room for one Jackie.

As soon as you find your own voice, stop comparing yourself to everyone else, and understand the message you're meant to share, doors begin to open.

People simply need to keep moving forward. Their time is coming.

Thank you for those kind words.

Kristin Evans: You're welcome.

How airway, hormones, and bone health intersect

Andrew Johnston: One thing that really stood out to me when you were talking earlier was how you kept connecting these different areas—airway, hormones, and bone health.

For someone who hasn't heard your presentation yet, can you explain how those three areas intersect? Because on the surface, they don't necessarily seem related.

Kristin Evans: Absolutely.

When we look at hormones, particularly estrogen, we know estrogen plays a tremendous role in maintaining bone density throughout the body. As estrogen declines, especially during menopause, we begin seeing accelerated bone loss.

That doesn't just happen in the hips and spine. It also affects the alveolar bone that supports our teeth.

As dental hygienists, we spend our days evaluating periodontal tissues and bone levels, yet many of us haven't been taught to think about what those findings may indicate systemically.

Now let's add airway into the conversation.

Patients with sleep-disordered breathing or obstructive sleep apnea often experience fragmented sleep, chronic inflammation, elevated cortisol, and physiologic stress. These factors influence hormone regulation and can also impact bone metabolism.

During menopause, many women begin experiencing disrupted sleep because hormonal changes affect airway stability. They wake repeatedly throughout the night, often without realizing why.

So now we have declining estrogen, disrupted sleep, increased inflammation, and changes in bone metabolism all occurring together.

They're not isolated issues.

They're interconnected.

As hygienists, we're uniquely positioned to notice those patterns because we often see our patients more frequently than their primary care providers.

That gives us an incredible opportunity to screen, educate, and refer when appropriate.

We're not diagnosing osteoporosis. We're not diagnosing sleep apnea. But we can absolutely recognize risk factors and help patients connect the dots.

That's where our profession is headed.

Moving beyond the oral cavity

Jackie Sanders: And I think that's one of the things that's so exciting.

We've spent years talking about oral-systemic health, but now we're beginning to see much more specific examples of what that actually looks like in practice.

Instead of saying, "The mouth is connected to the body," we're starting to understand how it's connected.

Kristin Evans: Exactly.

We've moved beyond simply saying inflammation exists. Now we're asking better questions.

Why is this patient experiencing inflammation?

Why is this patient losing bone?

Why are we seeing periodontal changes that don't seem to match the amount of biofilm present?

Those questions lead us into much deeper conversations.

Sometimes it's airway. Sometimes it's hormones. Sometimes it's nutrition, medications, or systemic disease.

Our role is becoming much more investigative.

That's exciting because hygienists are naturally curious people. We like solving problems.

And our patients benefit when we start asking better questions.

Additional reading: What to look for in a true oral-systemic dental practice

Connecting with Kristin Evans

Jackie Sanders: So to our listeners, if anybody wanted to get in touch with you, Kristin, or learn more about hormone health—which is huge in the dental hygiene industry right now...

I don't know why, since 97% of us are females.

But how can our listeners get in touch with you?

Kristin Evans: So I have a website, and the best way to get to it also is just go to my LinkedIn, Kristin Evans.

I'm the pHRDH. Many people know me as that. It's what I started in 2019. That was my branding—the pHRDH.

I still love and believe that acid is the primary contributor of oral health and disease. The way we control it is all about that. And so I still focus a lot on that because it interplays, again, with the hormones, especially the hormones and bone health.

So I'm the pHRDH. You can find me on LinkedIn. On LinkedIn is also my intro to my website. You can get to my website there, along with Instagram. The link is in my Instagram profile.

I just barely launched it, so it's kind of a newer thing for me.

But I am also starting a Bone and Balance for Life, which is really...

I want to be a bone advocate. There is not a ton of information out there on what people should do, how to prevent it, or what their journey should look like. Everyone's journey is absolutely 100% different.

And I want to be that friend that helps them along that journey.

So I'm starting a Bone and Balance for Life program that will be absolutely 100% individualized.

So I'm really excited about that. I want to get the word out because I'm going to change the world with early screening, education, and prevention for systemic bone health—which is really osteoporosis.

One in two women, and by the way, one in four men, Andrew—you are not out of the woods. It's not an old woman's disease.

So I'm excited. Anybody can go there, message me, and we can get connected.

Jackie Sanders: Well, thank you for your time, Kristin. Anything you want to add, Andrew? Are we good?

Andrew Johnston: I think we're good, Kristin. Thank you. I can't wait to learn more from you. This is going to be awesome.

Kristin Evans: Yeah, show up early. My presentation at Under One Roof is at 7:00 o'clock, Andrew. I would love to have you there.

Andrew Johnston: Pretty early.

Kristin Evans: Seven o'clock on a Saturday. But you know what? I'm thrilled, I'm excited, and we'll have a lot of fun.

Andrew Johnston: Thanks for being here.