Navigating Dentistry and Wellness in Surgery with Dr. Crystal Chang

In this episode of Scrubcast, host Rachel Baker sits down with Dr. Crystal Chang, a clinical assistant professor in the Division of Plastic and Reconstructive Surgery at Stanford University. As a hospital dentist, Chang treats medically complex patients who often can't receive care in a traditional private practice.

They also discuss the importance of mental health and wellbeing. Chang shares results of a pre-pandemic research study that shows Healthcare Professionals have the highest suicide rates in the country and opens up about her own previous struggles with isolation. Today, as Associate Director of Wellness for the Department, Chang shares the initiatives she’s helping to implement at Stanford to support her colleagues.

Key Topics:

• Dr. Chang's path to becoming a dentist and her experiences in healthcare
• The role of a hospital dentist
• The importance of acknowledging and addressing wellness as a priority in the medical community
• The "Tell Us About It" campaign aimed at improving communication and support among surgical staff
• Insights on peer support systems for surgeons after unexpected events

Rachel Baker: [00:00:00] Welcome to Scrub Cast, where we take a closer look at the research happening at Stanford University's Department of Surgery. I'm your host, Rachel Baker. Today we're speaking with Dr. Crystal Chang. Welcome to the show. Thanks. Thank you for joining us, Dr. Chang. You are a clinical assistant professor in our division of Plastic and Reconstructive Surgery, specifically our dentistry section.

Did you always know you wanted to be a dentist?

Crystal Chang: I did not. I knew I wanted to be in healthcare, but careers in healthcare can be just so different. I was really fortunate. I had a family dentist that knew me since I was like in third grade, probably all through college. And at one of my appointments I was talking to him about what the heck I was gonna do after college, and he just suggested kind of coming in and shadowing him in clinic.

Shout out, he's the best. Um, so I did that. [00:01:00] He was kind, he was really patient with all my questions, and he was a really good mentor. So I think probably by the third or fourth day I was pretty invested already. But really what happened, and he, we joke about it sometimes, is he was doing a procedure, removing a broken crown.

An actual sparks flu and he told me that my eyes kind of just jumped out of my face and I was like, oh. But yeah, I mean that's, that moment kind of solidified it to go from having, coming in with like a broken crown with pain all the way up your face, and then to leave like an hour later with a brand new tooth, no pain all just because this guy could do what he could do.

I loved it. So that's what I like about dentistry. It's an art, it's a science. There's an issue. There's options for fixing the issue, and I can do it for you all

Rachel Baker: in kind of real time. That's awesome. But private practice I feel is a little different than being a hospital dentist. And I have to admit that I didn't actually know what you [00:02:00] did at Stanford up until about like.

A couple weeks ago when I saw a few of your CoLab cases with otolaryngology and I was like, oh my God, this is so cool. So can you explain what it means to be a hospital dentist?

Crystal Chang: Sure. Uh, I mean, Rachel, I didn't know what hospital dentist was till probably the last year of dental school, and I bet a lot of folks don't know.

So. There's that. So I'd say technically being a hospital dentist is not really that special. It's just somebody who gives dental care in a hospital setting usually means like specialized services. You're treating medically complex patients who just can't be treated, like you said, at a private practice office.

Could be people with just extreme anxiety. Developmental disabilities, maybe behavioral or mobility challenges. And then the medical complexities could be things like cancer, heart conditions, or even autoimmune diseases. I think that's probably maybe the textbook definition, but [00:03:00] I think to be competent or even.

A successful hospital dentist, you have to be able to kind of juggle both the medical and dental worlds. Let me back up by saying like, obviously medical school is medical school and dental school is dental school separate. There are very few dental schools in the country that actually combine the first two years of academic study, and so they actually, we take classes with med students.

I think that's probably the better way to do it. I mean, the mouth is connected to your body. Um, and so it's kind of confusing to me sometimes why it's not a, its own specialty, but there's just too much ground to cover really for dentistry. Not only are you taking these kind of like basic science courses, biomaterial courses, but you're also trying to master all these hand skills.

Teeth can be really complex. I mean, every tooth is different, every morphology is different. So I guess going back to your original question. In dental school, you kind of miss out on all that interprofessional communication and [00:04:00] commonality. And so I think to be a hospital dentist is to be someone who's comfortable in that environment or at least has had some kind of training in that environment.

And hopefully that also means gaining familiarity, navigating a healthcare system, and then that way you can navigate it for your patients and advocate for them.

Rachel Baker: Love that. Well, so you touched on this a little bit. My dad had his triple bypass back in like 2002, and I remember that after he had this procedure, he had to take prophylactic antibiotics when he went in to like have a crown or a cavity, and I was like.

WTF, but then at the same time, I was looking at your bio and I was like, oh, you deal with cardiac patients. Mm-hmm.

Crystal Chang: Mm-hmm.

Rachel Baker: What do teeth have to do with cardiac disease and prosthetic joints and organ transplants?

Crystal Chang: Sure. The mouth is a dirty place. There's, you know, all sorts of bacteria. Some are good, some are bad.[00:05:00]

When you get bad bacteria that multiply, they create biofilms. They become basically new beasts, and if they overstay their welcome, you get cavities, you get periapical abscesses, bone infections, swelling of the face. You can get kind of the foundation holding all of your teeth, gets infected, severe periodontitis, everything becomes loose.

The kind of flip side of this, a lot of times patients tell me, it's like, nothing hurts, doc. And I'm like, that's great. I'm glad you're not in excruciating pain, but it's broken. Like you didn't start out like that. So your teeth literally start to kind of break down crack and, and fester. You're also swallowing all of this all the time, all, all day long.

So it's a direct communication to the rest of your body. So maybe not as pertinent if you're healthy and your body can kind of absorb that assault. But if you're someone with vessel blockage or aortic stenosis, or you know your heart's not pumping at the rate exposed to the ejection fractions really low, then this [00:06:00] bacteria is lingering in your bloodstream and.

So infection and then the subsequent failure of the prosthetics, the implants, or even the organ transplants are all really real possibilities. So that's why, you know, we, we love to kind of go in and see these patients ideally before something major. And that way a lot of it is actually just empowering the patients being like, Hey, this is an issue.

This is why it's an issue. How can we help you fix this?

Rachel Baker: We're gonna have to pause right now 'cause I'm gonna go brush my teeth. Oh,

Crystal Chang: I was like, okay,

Rachel Baker: I'm, I'm perfectly scared now.

Crystal Chang: Brushing teeth is fantastic. Very low maintenance way to keep things well maintained. But I mean, it, people might think, take this cynically, but you just need a dentist.

You need someone who puts on their little microscopic loops, looks at your teeth, and like. Thoroughly cleans out all the nooks and crannies you. You just [00:07:00] can't do it by yourself.

Rachel Baker: Brushing my teeth, plus go see my awesome dentist. Yeah, twice a year. Got it. Yeah. Okay. I will hopefully not die. You will not die.

My teeth are not gonna kill me. I will not allow it. Thank you. Well, so dentistry is only one facet of your work at Stanford. You also serve on our department's wellness committee as our associate director. Why is wellness so important to you that you're like, sign me up for extra work boss.

Crystal Chang: Yeah, I'm gonna be maybe a little vulnerable here.

I think I'm into the wellness because I'm selfish. A few years back I just felt like I was everywhere, uh, running around doing stuff and then everywhere I was doing something was just not the right place like I needed to be somewhere else doing something else. That was also very important. I was a mixture of private practice and then part-time at the hospital, and so I was running around from op to op in a private practice.

Cutting [00:08:00] on teeth and cutting on teeth is very exacting. The tooth is like a centimeter wide, centimeter long. Everything I'm working on is that tiny little, that's my canvas. And then I would jump and maybe do an OR case that's like really late at night, and then I would drive home and then try to catch up on charts and notes.

This was the juice. I drank it. I kind of believed in it. I was like. To be success. I need to multitask and I need to just keep pushing. And it worked for me. So I was kind of like, you know, this is it. But I just got to the point where I felt very isolating and I just felt like, hmm, something's gotta change.

Like I'm gonna have a meltdown. The American Dental Association published a paper. A while back before the pandemic and it found that male dentists have the highest suicide rate. Female dentists come in at fourth, and then I think the other top five or top 10 rates all included physicians. Pharmacists and nurses.

It's all healthcare.

Rachel Baker: My brother-in-law, I told him I was [00:09:00] interviewing you today, and he was like, oh, dentists have a really high suicide rate. Yeah. I'm like, okay, one, why do you know that? Two? What? I was shocked.

Crystal Chang: Yeah. It's just, I think it's, it's really isolating, like in, in a private practice. You are the doctor, you have a team around you.

They're fantastic. I, I have worked with lovely folks, very motivated, very educated, but you are the doctor. Everything kind of comes down on you. And so being at the hospital kind of mitigates that. 'cause then I get to talk to like my colleagues and interact with other disciplines, but at the same time, it's just, it was just too much.

So I just felt myself feeling like, not that the walls were coming in, but that they could. And I didn't like that. And so I just think that. You know, wellness should not be branded as being selfish. I think wellness is just. Allowing yourself to take care of yourself. We've got to take care of yourself. It sounds, sounds silly, but we've got to, and then taking care of ourselves, that means we gotta take care of our colleagues.

It's the only way the system has any longevity. [00:10:00] So truly lucky that when I did kind of say, Hey, I need to do something else. Sign me up for the extra work. It's more that it was like Stanford already has an incredible infrastructure for wellbeing and that I.

Rachel Baker: Was walking by the construction mm-hmm. The other day, um, on Stanford's campus.

And I saw this sign and I thought of you who, uh, it says, warning, if you don't schedule time for maintenance, your equipment will schedule it for you.

Crystal Chang: Yeah. I think that applies to so many things,

Rachel Baker: right?

Crystal Chang: I was like, oh, talking machine, but also your body,

Rachel Baker: but your body, right? I was like, oh, this feels like it is not just about screwdrivers or whatever they're, they're talking about.

I was just like, oh, wow. That's, that's deep random wisdom. Yep.

Well, so May is Mental Health Awareness Month. Um, can you tell us about some of the things your team is working on to improve the mental [00:11:00] health of our faculty and our residents?

Crystal Chang: Sure. So I mean, Cindy Kin is the director. She's amazing. We've, I think, done a pretty good job of hopefully acknowledging that our surgery colleagues just need time to take care of themselves.

So she's launched the Tell us about It campaign, which is anonymous or not. QR code, voicemail, however you want. Just to leave feedback and tell us how your day's going. Tell us what's working, what's not working. Tell us you want drinks in the lounge. Tell us you don't. So tell us about it. I think is just opening that up to say like.

Your wellbeing is not being selfish. It's important. Other things that we've kind of, you know, similar line is just we've had events with speakers sharing about reproductive infertility, wellness, menopause, and hopefully, uh, in the upcoming months, we're working on kind of the New Parenthood or parents information exchange, getting vision and dental resources to our surgery residents.

Uh, we also did, uh, surgery peer support, which [00:12:00] is something that we learned from my anesthesia colleagues. It's where if a surgeon has experienced an unexpected event and wants to talk to someone about it, we would automatically reach out to them and say, Hey. If you'd like, we're here, we can pair you with someone inside or outside of your specialty.

Um, that's the surgeon as well, just to talk about things. And if you don't want to talk to us, that's fine, but here are some kind of broader resources that Stanford has to offer. And I think just getting that implemented in a timely fashion is helpful.

Rachel Baker: So one of the initiatives I wanna dive into a little deeper is you mentioned, tell us about it.

And I think one of the first things that came in on that anonymous form was, or efficiency. And so you've made it one of our goals for the year and we're working on it with our QI team. Mm-hmm. How, how do you even go about starting something as.

Crystal Chang: Yeah, that expansive, right? Yes. Yeah. So [00:13:00] I mean, I, I think the first is just to find the common ground.

Everyone here really cares about the patients. Everyone here wants to do a great job. And also everyone here is really good at what they do. Um, and I think if we find that commonality and then take a step back and say. These are very common things that are happening once or twice a week. Can we hit these high, high yield issues and maybe make that change or inefficiencies?

So broad, the wellbeing committee or team decided to tackle communication, and again, this is just about making sure everyone in that room feels comfortable speaking up. And saying something. And I also think it's about building empathy for each other in our roles. Like we obviously all value each other, but at the same time, I don't think we all realize that moments of high pressure for me are very different than moments of high pressure for me being the nurse I'm working with or the [00:14:00] anesthesiologist or the patient.

And so working on that communication and kind of finding ways to improve it has been that focus still a work in progress. Very exciting.

Rachel Baker: Well, that sound means it's time for our lightning round uhoh. On each episode of Scrubcast, we ask the same two questions.

Crystal Chang: Okay.

Rachel Baker: First one is, who is a surgeon do you admire and why? Huh? You could say dentist instead if you want it. Okay.

Crystal Chang: That one's kind of tough. Um, because I, again, I, I guess alluding to your previous question, it's, we're a little bit fish out of the water, although I really believe we belong in the ecosystem.

I had a professor in dental school, uh, he's a oral maxillofacial surgeon. He gave us our, some of our didactic lectures and some, he was in charge of the implant program, uh, when I was there, and he was [00:15:00] just a cool guy. He would give us lectures. He wasn't afraid to talk about cases that didn't go as well as he expected.

In fact, I feel like he needed a point to be like, what do you guys think about this? Like, I think I should have tried something else here. Or maybe this would've worked better. Let's do it the next time. So he was humble and all of his lectures were kind of a mix of clinical cases and evidence based literature.

He's the main reason I pursued a general practice, residency and got hospital training. Yeah, he's the guy I would point to. Dr. Husing.

Rachel Baker: Awesome. Yeah. Sounds really cool. Well, the second question is, uh, the best advice you have received in 10 words or fewer

Crystal Chang: at this moment. I think the best advice is appreciate how far you've come and then keep going.

Rachel Baker: Oh, I like that. Do you put that into your daily practice at all?

Crystal Chang: Yeah, I do. I, I think it's sometimes when I'm in a high stress moment, I'm like, [00:16:00] but you know what? I watered my plants, I brushed my teeth last night and I put my head on a pillow. We're good. And you just move forward. I think we should all try and remember that, um, going through our daily routines. I know it's, it's tough sometimes.

Rachel Baker: Well, it's been an absolute pleasure chatting to you. Uh, but before we go, I wanna ask you one final question and that is. What is next for Dr. Chang?

Crystal Chang: Oh, next for Dr. Chang. Well, I, I became full-time at Stanford, so I'm still kind of exploring all of the wonderful opportunities that entails, so I guess we'll see.

Rachel Baker: Awesome.

Crystal Chang: All

Rachel Baker: right. Well, thank you for coming on the show. Thank you so much. I loved it. It was fun. Great. And thank you to our listeners for tuning into this episode of Scrub Cast. Until next time, stay sharp. If you like Scrub Cast, we hope you'll tell your friends and [00:17:00] subscribe wherever you get your podcasts.

Scrub Cast is a production of Stanford University's Department of Surgery. Today's episode was produced by Rachel Baker. The music is by Midnight Rounds, and our chair is Dr. Mary Hawn.