I Smell Sex and Perio: Nella Ospina, DA, on Oral Bacteria, Sexual Health, and the Dental Assistant Nobody Thanks

Episode 22: Meet Nella Ospina, DA

In Episode 22 of The Unhinged Hygienists, Lauren Kennedy, RDH and Anastasia Dallas, RDH welcome their first dental assistant guest: Nella Ospina, DA. Nella grew up split between New Jersey and Ecuador, graduated high school in Ecuador, and went straight into dental school, earning a dental degree there. She returned to the United States to care for her father, life changed course, and rather than repeat six years of dental school she expanded her original passion — periodontics and hygiene — into surgical assisting and phlebotomy.

Today she works chairside in a biological, fee-for-service, whole-body dental practice, drawing blood for surgical procedures, managing five chairs and a full surgical schedule, and translating complex treatment into language patients actually understand. This episode is equal parts hilarious and clinically serious: oral bacteria and sexual health, sexually transmitted infections that show up in the mouth, airway, referrals, root canals versus extraction, the real cost of care, and the standard of care she refuses to compromise.

Key Takeaways From Episode 22

• Oral bacteria travel wherever the mouth travels; intimate contact is a two-way route for infection between partners.
• Sexually transmitted infections can produce oral findings, and unexplained severe gingival bleeding in a young patient deserves a real workup — not a lecture about brushing.
• Necrotizing ulcerative gingivitis can coexist with another infection, and the wrong antibiotic will not resolve the wrong organism.
• Periodontal inflammation is linked in the research literature with erectile dysfunction and with vaginal microbiome disruption — the oral-systemic conversation includes sexual health.
• Dental assistants are not instrument holders; they coordinate the doctor, the schedule, the lab, sterilization, patient education, and the surgical tray.
• A great assistant asks the doctor why. Clinical curiosity is how both sides learn — and how patients get better care.
• Nella will not work for a provider who leaves overhangs, calculus, or voids. Standard of care is a hiring requirement, not a preference.
• Patients deserve every option — not the option their insurance happens to cover.
• Mouth breathing, nasal obstruction, and airway dysfunction affect sleep, intimacy, and quality of life. Refer to the ENT and myofunctional therapist.
• Internationally trained clinicians often carry a full dental education into assisting roles, and licensing pathways vary widely by state.

Why the Dental Assistant Sees Everything

Hygienists work one patient at a time in what Lauren calls her hygiene Zen den. The assistant works the entire building at once: five chairs, one doctor, two other assistants, the front desk, the lab courier, the CT scanner that just went down, and the crown that came back wrong. Nella thrives in organized chaos, and she is the person who notices the patient's anxiety, the medication list nobody flagged, the lesion in the corner of a photo, and the treatment plan that does not match what the patient believes is happening.

Anastasia's message to the profession is blunt: a great dental assistant with real work ethic and critical thinking skills makes the entire practice function. If you have one, protect them, pay them, and listen to them. Dental assistants matter — clinically, not decoratively.

Oral Bacteria and Sexual Health: The Conversation Nobody Starts

Patients ask dental teams remarkable questions. Nella has been asked, mid-appointment, whether the dentist would be able to tell what a patient did with her boyfriend. A surgical patient going home after an extraction with bone grafting asked whether he would still be able to give his wife oral pleasure that night. Funny, yes. Also a signal that patients genuinely do not know how the mouth connects to the rest of their intimate life.

The clinical point underneath the comedy is straightforward: wherever the mouth goes, oral bacteria go with it. Untreated periodontal disease, heavy calculus, bleeding gums, fissured tongues, and active oral infections are not sealed inside the mouth. Intimate contact can transfer oral organisms to a partner's genital tissue and transfer genital organisms into the mouth. Recurrent, stubborn infections in one partner sometimes make more sense once someone finally examines the other partner's mouth.

Gum Disease, Erectile Dysfunction, and the Vaginal Microbiome

This is not a punchline invented for a podcast. Systematic reviews and meta-analyses report an association between chronic periodontitis and erectile dysfunction, consistent with the broader link between periodontal inflammation and vascular and endothelial dysfunction. Separately, research on the vaginal microbiome has identified oral-associated bacterial species — including organisms familiar from periodontal disease — among the community shifts described in bacterial vaginosis. Association is not proof of causation, but the direction of the science is not subtle: oral inflammation is a whole-body issue, and that body has a sex life.

Oral Chlamydia and ANUG: A 16-Year-Old, an ER Visit, and the Wrong Antibiotic

Nella's most sobering story involves a 16-year-old patient who arrived with severe gingival inflammation and bleeding. The office completed a comprehensive exam and planned four quadrants of scaling and root planing with reassessment in four to six weeks. Two days later, the patient returned after an emergency room visit — her gums would not stop bleeding.

The suspicion was acute necrotizing ulcerative gingivitis. A biopsy confirmed it, and it also revealed why the bleeding would not stop: oral chlamydia alongside the necrotizing gingival infection. The antibiotic she had been given was not appropriate for that organism. Then came the part nobody teaches you: the doctor asked Nella to explain the diagnosis to an underage patient sitting beside her elderly grandmother. The patient's own explanation of transmission involved three other teenagers, meaning partner notification and treatment mattered as much as her own prescription.

The clinical lesson is not to assume that dramatic gingival bleeding in a teenager is poor home care. Severe, atypical, ulcerative, or non-resolving gingival presentations warrant a full medical and social history, appropriate diagnostic testing, medical referral, and — in adolescents — careful, ethical, confidential conversation. Anastasia's takeaway said it plainly: unexplained severe bleeding gums in a teenager now belongs on the list of findings that trigger testing rather than a flossing lecture.

Oral Manifestations of Sexually Transmitted Infections

Sexually transmitted infections are commonly imagined as strictly genital. Public health guidance is clear that many can involve the pharynx and oral cavity, that oral infections are often asymptomatic, and that they can still be transmitted onward. Oral or pharyngeal involvement is documented for gonorrhea, chlamydia, syphilis, and herpes simplex virus, and HPV is strongly associated with cancers of the oropharynx including the tonsils and base of tongue. Dental professionals are not diagnosing STIs chairside, but they are often the first clinician to see something that does not fit — and the referral they make can change a patient's outcome.

Airway, Mouth Breathing, and Yes, Intimacy

The episode veers — as it always does — into airway. A fissured tongue harbors more bacteria. A patient who cannot breathe through the nose becomes a chronic mouth breather, which changes oral moisture, plaque control, tissue health, sleep quality, energy, and mood. Nella notices facial structure, gingival margins, and breathing patterns even outside the office. Lauren's advice, delivered as a joke that is not really a joke: see your ENT, clear your sinuses, and get evaluated for myofunctional therapy. Airway health affects how you sleep and how you show up for the person next to you.

Phlebotomy, Surgery, and the Whole-Body Dental Practice

Nella earned her phlebotomy certification specifically to support the surgical side of dentistry, and she wears a wristband of tubes she keeps in motion so the blood does not clot before it reaches the centrifuge. That workflow supports procedures that use the patient's own blood concentrates during surgical healing, and it belongs to a broader trend: dentistry moving away from 'polish your teeth and go home' toward collaborative, whole-body care with medical-level protocols, comprehensive exams, full periodontal charting, and real diagnostics.

Standard of Care Is Not Negotiable

Ask Nella what she is adamant about and the humor stops. She will not stay in a practice where she does not respect the dentistry. Radiographic overhangs, retained calculus, voids under restorations, patients who are not treated the way she knows they should be — she cannot stand behind it, so she will not work for it. She will, however, ask the doctor directly why a treatment decision was made, and most of the time she gets a valid answer, which is exactly how a clinical team should function.

The same standard applies to referrals. Anastasia refuses to refer to a provider who is not practicing to the appropriate standard, friendship included. Good online reviews measure likability, not quality of care. Matching credentials do not guarantee that a website's promises appear in the treatment room. Lauren's approach is to actually meet people — she reached out to a TMJ and craniofacial therapy facility to sit down before ever sending a patient — because collaboration starts with a meeting, not a brochure.

Give Patients Every Option, Not the Insurance Option

Nella's practice does not bill insurance, so treatment plans are built from clinical need rather than coverage tables. A plan can be expensive, and patients still have the right to choose. In a biological setting, she estimates the overwhelming majority of patients presented with a root canal option choose extraction instead — an informed decision, not a pressured one.

Anastasia's position is the one that should be printed on a wall in every dental office: give patients all of their options, explain why one choice may be better than another, and let them decide. Do not quietly decide for them based on what insurance covers. Dentistry can be expensive; neglect is more expensive. For patients who already have root canal-treated teeth, she recommends 3D imaging to confirm there is no smoldering infection rather than assuming everything is fine — and she is candid that emotional attachment to teeth drives many of these decisions.

From Ecuadorian Dental School to U.S. Dental Assisting

Nella's credential story mirrors a conversation the podcast has had before with internationally trained clinicians. Her dental credits did not transfer, and repeating six full years was not realistic physically, mentally, or financially. She studied for board exams with dental decks in one hand and an English-Spanish dictionary in the other. Instead of quitting dentistry, she built a career around what she loves, added certifications, chose her colleagues carefully, and — as a former dental assistant instructor — now mentors others who message her with questions.

Licensing rules vary state by state and change over time, so any internationally educated clinician should verify current requirements with the dental board where they intend to work. What does not vary is what Nella demonstrates: a full dental education does not evaporate because a job title changes.

The Unhinged Bottom Line

The mouth is not a separate country. Oral bacteria affect partners, pregnancy, vascular health, sleep, and intimacy. Sexually transmitted infections show up in the mouth and hide there quietly. The dental assistant beside your dentist may be the most clinically observant person in the building. And the practice that gives you every option, meets the standard of care, and asks the uncomfortable questions is the practice worth keeping. As Nella puts it, she is not just an expensive instrument holder and saliva sucker — and as this episode makes clear, she never was.

Medical and dental disclaimer: this article is educational and reflects a podcast conversation. It is not medical or dental advice, diagnosis, or treatment. Consult a qualified dentist, physician, or other licensed clinician about your individual health, and seek prompt care for bleeding, ulceration, pain, or any lesion that does not resolve.