Howard interviews Jennifer Hasch, BS, RDH and Kyle Isaacs, RDH on the pros and cons of silver diamine fluoride and mobile dentistry at the Kentucky Dental Association's 2019 Kentucky Meeting.
VIDEO - DUwHF #1242 - Jennifer and Kyle
AUDIO - DUwHF #1242 - Jennifer Hasch
Howard: it is just a huge honor today to be at the Kentucky Dental Association's annual meeting with Jennifer Hasch hashbrown like hash browns and Kyle Isaacs who do I say that right Kyle Isaac RDH who we've been in contact for years and years and years you guys are down here you need to presentation today what were you speaking on
Jennifer Hasch / Kyle Issacs: well this morning I did a presentation on silver diamond fluoride
Howard: which is I when I flew in here the airport is yes I know isn't that cool so this must be the home place the birth of silver diamonds right I know I'm so excited when I saw that and it was the Muhammad Ali Airport as so it was Muhammad Ali the inventor of SDF now so you were talking about
Jennifer Hasch / Kyle Issacs: SDF today this morning and a little bit about glass ionomer cements you know silver modified art and in this afternoon Jennifer and i co presented on mobile dentistry with her aspect mostly on the school-based programs and mine more on the nursing homes
Howard: well wow those are all the some of the biggest controversial issues in dentistry I mean like I never thought pediatric dentists would ever have anything to argue about on dental town for 30 years they found one with SDF why is that such a controversial hot-button white you Ari why do you pediatric dentists either love it or hate it and there's no middle ground
Jennifer Hasch / Kyle Issacs: that's a great question you should probably ask a pediatric are you here both proponent Ennis well that makes you a neutral position I mean if
Howard: ya ask your dentist to bring a lot of baggage to the discussion why do you think they're polarized on that
Jennifer Hasch / Kyle Issacs: I don't know the pediatric dentists that I know that have been using and have seen some great successes and they've been able to reduce the number of general anesthesia and sedation cases that they're doing you know it's not a cure for caries but it sure is helping so I'm not sure I've never spoken to one that is against it so I can't really speak for that and
Howard: you just need to get on dental I finally found the issue with your name I had it with two I spelled it wrong that's not a topic that's the thing with Microsoft them you have to there it is there she is did I find you yes yeah I um so you're already h EP VHS of what is what are all that even mean well what is are th EP
Jennifer Hasch / Kyle Issacs: I'm an expanded practice hygienists in Oregon so I can go into facilities or patients homes or schools prisons adult foster care homes I'm actually working three days to make now in a medical office well you know I'm back back to the silver lining fluoride
Howard: I think one of the most sad parts about actually that the the biggest advantage of being a man over a woman is that when you go four and a half percent of Americans finish out their life in a nurse you know if you don't do a dirty home there's it's all women and one man named lucky and these women are in there and they say they get the geriatric Jenna so they get one root surface cavity a month so after grandma's been in there a year she has 12 cavities and I know Dentist who after work will go to the nursing home with silver diamond fluoride and a lot of people say oh I don't want to do that because Medicaid or Medicare doesn't pay enough but you don't do one I mean you're usually these people need 8 9 10 11 12 but I think the the most embarrassing part of dentistry is the is the nursing home population it's really it's very sad for women it's very it's just I mean I've had a lot of male patients as well it's very very sad she works in a veteran's home tear and that's a veteran John - yeah and you go in there and it's so sad when you talk to the staff and they say no she's been in there a year and a half and no one's ever visited her I thought no one's ever visitor I mean it's
Jennifer Hasch / Kyle Issacs: sometimes I'm the only one that day visiting someone one of the things I said in my presentation today is I get to hold someone's hand and look in their eyes and just spend time with them and that that is a huge thing for them they don't get a lot of some of them don't get touched or hugged or or any attention other than the CNAs coming in and doing you know whatever job they have to do
HOward: well it just seems like a no-win situation because when I put a lot of time into nursing homes and in Phoenix Arizona it's a big retirement place and they because of everybody's dentures and parcels that they want to cook just a carb fest they just when I have cottage cheese pumpkin pie mashing I mean you look at it's just a carb fest and that's what they want and at the end then when you watch the CPN or the LPN and the CPA do the home construction it's it's a little bita toothpaste swish swish spit in a coffin that's it I mean and you couldn't expect that one little lady to bathe food medicine brush and floss I mean it's never gonna get done so what's so what's the answer - route service to get a nursing home
Jennifer Hasch / Kyle Issacs: the answer is to have a dental professional either a dental hygienist or demo assistant I think would work in every single facility working there every day providing daily oral care today and one of my present patience I talked about there was a study done he was in Virginia it was 147 residents and half of them were assigned a daily oral hygiene aid to someone who provided oral care for that patient and that resident every single day I don't know how long it lasted and the other half didn't get it and the ones that didn't get it they were three times more likely to die from pneumonia oh my gosh so not only are they having issues with their teeth but we know that connection between oral health and systemic disease so we know it will explain the connection with oral health and systemic disease well yeah why really more likely died from pneumonia because they have more bacteria in their mouth and they can aspirate it a lot of the patients in these facilities have dysphasia so they have trouble swallowing and clearing bacteria a lot of them have had strokes and people who are post-stroke are more likely to have aspiration pneumonia because of that as well as people with dementia and that older people go again the worse their swallowing reflexes so that's a lot of the people who are in long-term care facilities people who have had strokes people who have dementia and people who are older yeah
Howard: and that's a rough group to have good oral hygiene brushing flossing I mean when you have dementia Alzheimer's stroke
Jennifer Hasch / Kyle Issacs: Oh dementia is really really murdered so they're at that point they are reliant on others to care for them completely and like you said the diet is really bad a lot of them are on insurer which is really high sugar content they're not chewing so they're not getting that self cleansing mechanism that happens when we chew and there a lot of them are on these carbs some places they have a lot of juice and they're giving medicine with sugared puddings jello applesauce things you know throughout the day and then their medication causes xerostomia and then the right so you have a perfect storm of dry mouth and carb-loading like you said I know I know oral here and so their oral health goes down really fast and because they have probably they have a lot of cavities and they have a lot of disease that they're gonna have a much higher bacterial loud yeah in their in their mouths
Howard: so um you're an expanded duty hygienist it's not a practice expanding part what does that mean that well then you you're from Oregon I'm not originally but I live there and that's always been kind of a market mover I mean you're the first state to legalize marijuana right I mean but were you like number two or we were close up there I can't remember if it was a Sur Washington State yeah Arizona Arizona is just the last election they vote it down again I mean they uh but but anyway but I don't know I don't deal with that but what I understand is um it's funny when they started to just pass hi Dennis your profession it was never the same controversy oh yeah and Bob Berkeley had to go around the country telling these people well why can't she get you know why can't you do this and they said well I'm so busy pulling teeth making dentures I don't have time for this and
Jennifer Hasch / Kyle Issacs: that's a great point I mean everyone should be working at the highest scope of their license that's where we are most productive that's where we are most effective so why should dentists go into a nursing home and brush teeth once a week like the high life program they shouldn't that's the answer they should be working at the top of their scope let assistants brush teeth let hygienist take care of prophylaxis and the other things that we can do sealants sta you know when we're all working at the top of our scope that's when we're being most productive and most effective it just it makes sense
Howard: but there you're fighting yeah well what are your thoughts on the dental therapist is that that come to Oregon yet and
Jennifer Hasch / Kyle Issacs: we don't have dental therapy there are we do have the D hatch the dental oh my gosh I hope you remember that it's a pilot project that's happening kind of like what they're doing in Alaska where they have maybe the reservation all right internal therapist we don't have not called dental therapist it's a Technical Program yeah so it's not a mid-level provider or someone goes back to school and receives further education and has a master's or something like that which is the Minnesota model if you're familiar with that the D hat is a specific technical dental therapist that has a very limited scope of practice and is not formerly a hygienist finished trained to go give relief to a population who is suffering which is you know in the Indian Health reservation there and there from there that culture so it's the and the versions from that goal yes and then they're trained they don't have a demo of background and they're they're trained for a couple of I think it's a couple of years and then under a dentist for a certain amount of hours and I think they have to work so what do you think that program I don't know if I know enough to make her comment on that yeah I think there's a lot of need in that population I think we can all agree with that and so I think for all of us to be nimble and creative with our workforce models is good I definitely think technical programs can be more challenging for you know dental procedures than a coda accredited educational institute but I think we have to answer the need so I'm willing to support anything that's answering the meet as long as its quality care and personally I mean there are times when I would like to be a dental therapist because my patients in and homes you know could benefit from that but I don't want to I'm like it no and I don't want to do that and actually I'm you're getting old and you're do that what do you mean your PA okay
Howard: so what do you mean you're getting old so you don't want to go into I know I don't well I know I don't want to be a dental therapist
Jennifer Hasch / Kyle Issacs: I don't want to go back to school do that and I really like the prevention aspect of dental hygiene that's really what drives me and so I'm not into like wanting to extract teeth and do feel like yeah I guess what I was going on what do you think it'd be as
Howard: why why the I mean my I graduate 87 and I remember when the Colorado which is the first state to legalize recreational marijuana and the first one to recognize independent hygiene practices and seven went out on their own and you would have thought Chernobyl had blown up and among all 50 states and it's I wonder like why is this such an emotional rap because of course me I was lecturing there so I went early ready to carve drove down there and it always was a hyjean a town of a thousand the only way she can afford to do it was she got rid of her dining room table and got a good opportunity wrote a note and that guy would drive an hour up the street and that Dennis says I love that lady she sends me a broken tooth a cavity and so so what I could see working was perfect but the hormonal reaction so I'm curious you as a dentist what's your perspective from the dentist's side that they're that they're just it's some emotional trigger word like lately nobody's died right in Colorado did anybody die because of dental hygienist no but I to resort and some of you going to Khrushchev wine go get a facial I don't want to facial I go get my mani-pedi I don't want to be petty I'm just like can I get my teeth clean I don't know that illegal I mean I mean you go to any of these resorts you know again your wife's and they're getting a mani-pedi facial with cucumber slices put on Rin a man just wants to go get his teeth cleaned and access to care
Jennifer Hasch / Kyle Issacs: think there's too much red tape and if there's that much red tape for you imagine how much red tape there is for someone struggling with poverty or a rural area you know there's a real issue here and so I think we need to spend less time on the turf war
Howard: so to speak and more time on bringing the care to people who need it it's like all these righteous dentists and I'm saying okay at the end of the day so you're saying that no care is better than some care really preach larger in Alaska this is an area that's larger than some US states with zero dentists so can we send in someone who's not quite somewhere between a dentist and zero oh no unacceptable it makes no sense they make no sense none yeah
Jennifer Hasch / Kyle Issacs: so I'm gonna tell you in Oregon you know we started out the expanded practice hygienist with a much more limited scope of who we could see and where and when it first came in I remember the exact day because I wasn't living there then I want to say maybe around 97 and so as the years have gone by we've gotten more and more of freedom of who we can see and where and so that's opened up the availability for these vulnerable populations for someone to go and provide care I see people in facilities that no one's looking in their mouths and they're not getting the care and nobody has any idea what's going on in there and I you know people are complaining maybe they don't feel it maybe they don't know how to express that when they can't communicate it saying that
Howard: the craziest one is remember that lady who in Houston who ran over her husband three times here she was a dentist in prison for like a decade they don't even let the prison dentist do dentistry she kept saying well I'm in here can I be their dentist can I do better now you're not a license I mean at least you should let all the dentists and hygienists in prison at least treat their own license their own inmates so the minute you're in jail on your roommate and your they had a dentist in jail for a decade that the population could benefit from yeah it'd be interesting to see how many abscessed teeth let infections that led to hospitalizations during that time in that jail so you lecture on silver diamond fluoride highlights the school-based programs so his mobile dentistry is that really is that a thing now is it taking off I think so and what is mobile does that mean that you're driving down the street it can't be bad
Jennifer Hasch / Kyle Issacs: it also encompasses portable dentistry where we take equipment into a setting and use it inside there are lots of different models I think tella dentistry is one of the things that is incorporated into a lot of the mobile programs so you know we just discussed best practices and how things are moving which one of these mobile dentistry models do you think is gonna be the winner I think it depends on the population that you serve for us we're in a school-based program and we're only intending to stay within you know 10 miles or less of our fixed clinic so that they have a restorative home to go to if there's need so for us it makes more sense to have small equipment that we can take in be within the classroom or the nurse's office or wherever we set up that day but there are outfits that want to see a whole state of kids and if that's the case they may want a big rig with three chairs in the back so are you doing preventive or are you doing restorative I think that makes a big difference what type of facility you're going to and the patients that you're getting their care to and all go to move excuse me we have portable equipment what was the night we're in Kentucky okay you're in Kentucky Oregon right so you sell tobacco and she sells weed neither no no no I do anti tobacco cessation counseling tobacco it is indeed unfortunately yeah I sit on this steering committee for the kentucky oral health coalition and we do a lot of advocacy around smoking and vaping which is the new you know risky yes so it is definitely a thing and we're always you know neck to neck with West Virginia on the amount of attention adults because of our tobacco use this is Kentucky one or two and right now we're two and West Virginia's one that's right any dental is 'm in adult dental ism that's and what will read it and how high is it you know I don't know that statistic
Howard: I know for the USA it's on my 864 it's 10% by 874 it's 20% we must be higher than that and you think that's mostly correlated to tobacco use
Jennifer Hasch / Kyle Issacs: yes I think so and it also has a lot to do with the lack of oral health literacy and poverty in rural areas not having access to care in rural areas yeah so I'm what I'm
Howard: what where do you so what are you doing with mobile dentistry in Kentucky so
Jennifer Hasch / Kyle Issacs: I work for a Shawnee Christian Healthcare Center which is a federally qualified health center in the West End of Louisville and it's the historically segregated area of Louisville Louisville is the third most segregated city in the nation and a lot of it had to do with our read zoning laws and where african-americans could purchase homes and it's still pervasive today and there's an access to care issue there's a food desert issue in the community and so I work in the clinic over our staff we have five operatories and then we also have the school-based program that goes into ten schools within right now we're within an eight-mile radius of the office and what do you do what is your goal when you go into schools its preventive focused so we do screenings cleanings fluoride sealants x-rays we have a dentist with us because that's the law in Kentucky and
Howard:you do that with the mobile dentist so you bring the chairs
Jennifer Hasch / Kyle Issacs: put it in the Jeep Grand Cherokee yeah head to the school and unpack it set it up see the kids if they do have restorative need they're referred back to our office most of the schools are actually within walking distance so we cut out very cleanings and but you won't do a filling or extract not yet we've talked about it but so how is that what's the full look dental chair is it a we use a dental works unit it's a that's a brand it's called dental work gentle works there's all kinds of different brands but that's what we use it's a CL W oh yeah they're out of Colorado yeah the mobile compressors so use the pro seal which is one of their units and then one of their chairs which is also portable they have all kinds of different equipments if you're interested in starting a mobile dental program it's called ent L works and
Howard: and why a compressor as opposed to just going electric
Jennifer Hasch / Kyle Issacs: oh you need a compressor so it looks like a suitcase and it has air water section some of them will have a high speed handpiece attachment you can customize it based on the service you want to provide you can have one where you can attach an ultrasonic for scaling so you still need an air compressor for that for sealants for high-speed suction to keep a dry field for seal yeah and the compressor is the vacuum - yes it's all in one suitcase we have it here we brought it to our course so if you want to come play with it later how long what is it customizable depending on what you want but I would say they range between 5 and 9
Howard: I want to see you try to check that on this carry-on when they go on mission trips yeah so so we talked about a mobile dentistry SDF expanded function what there was access to care that was like
Jennifer Hasch / Kyle Issacs: people who don't get care and they can't get it why why does our country have it so that some people are I don't want to call it the have-nots you know why everybody should I mean I feel that everybody should have access to health care and included in that should be dental because our mouth is connected to the rest of the body what are your thoughts I think probably the best way to start the conversation about oral health as a social justice issue is to remind folks that where there are food deserts there are also health access to and so there are specific communities a food desert in the west side of great so that means low access to healthy food choices whether that be grocery stores or farmer's markets and so a food desert is an actual designation by the federal government as a health access desert actually you can look up right now on the National Health Service Corps where there is a dental service provider shortage area in your city county state and website is that on National Health Service Corps men in HSC org and weight and age SC org that's correct dot org will tell me where a PSA scores health provider shortage areas and they have one for dental providers and they'll say an operation so NHSC well what does the NH herald stands for National Health Service Corps I think even more might be gov actually oh yeah it's probably gov but I've seen too is even though you might have a dental home near where people live often I've noticed in Oregon there aren't enough providers to take care of the needs of all the Medicaid patients and we do have an adult Medicaid dental for people who are at a below a certain income so I'm called that even though they're there and in the area and close but if you can't get into an office for four or five months national what are that's in for National Health National Health Service Corps Service Corps yep cor PS o Corp cor PS
Howard: so do you consider me deaf and dumb or just we're just walking you through okay there it is so it's NHSC dot HR say okay oh my god it's Owen herself and then wind what do I am where do I find the shortage of dentist so just put in the search box HP sa HP s HP s
Jennifer Hasch / Kyle Issacs: that's gonna give you your health provider shortage area they probably have a whole page health professional shortage area yeah aren't you good and that includes dental yes it breaks it down by the type of provider and you could probably even uh because usually dentists aren't right that that ever that aging silo I'm gonna actually search dental PSA and what is the PSA main provider shortage area I don't see the list but I can give you the link later can you are we happy to tell you I can tell you of course you're always saying when they come out of school you know some businesses supply and demand where am I needed right you go this is a great place to go and we have dental students that rotate through my clinic and I point them in this direction all the time it's been a while since I've been on this page but
Jennifer Hasch / Kyle Issacs: health centers actually gets scored by this system this National Health Service Corps system the HPSA score allows them to offer loan repayment programs for example to dentists and hygienists based on how high the score is so there are FQHCs health centers in West Louisville that have a score of 14 which says it's high which basically means there's not a lot of dental professionals in that area and or the dental professionals that are in that area don't accept Medicaid and or the dental professionals that accept Medicaid have a long wait list or will only see children and on and on and on and on so there's all kinds of barriers that limit access to care the federal government tracks that and incentivizes providers to work in those areas to answer that need
Howard: and at the at the bottom at the end of the day economics is poverty or is it other factors you said
Jennifer Hasch / Kyle Issacs: I think it's poverty I think it's racism I think it's the history of segregation in our nation I think it's all the isms really I think there's a huge immigration factor especially for those folks that are undocumented in our nation there's a trust issue with seeking care at this point to fill out paperwork afraid to be seen by health professionals and you know kids that may be citizens have parents that are undocumented aren't accessing care either and so I think there's issue yeah there's a lot of there's a lot of problems but
HOward: yeah it's um you never suppose talking about religion sex politics or violence but I have an MBA and I love two things love they go hand in hand and you ask anybody with the PhD what made America what it is they and they say 500 years of immigration from every corner of earth we're all immigrants and then you say so what would be the best thing to do for the economy all everyone will say open back up Ellis Island and then you talk to every American so are you you want to open back up Ellis Island Hale no
Jennifer Hasch / Kyle Issacs: well there's this false belief that there's one pie and and I get a piece means you get less of a piece type of thing when in fact our strength is in our diversity and until we admit that and embrace that I don't I don't think we're gonna come I don't think we're gonna have a chance well I
Howard: I actually think the country is absolutely been in decline ever since after 9/11 we choked off immigration no decision made out of fear is a good decision yeah and so now I look some of the white greatest minds in the world that used to come to America and now they're going to Canada they're staying back in India they're going to South you know they're there to watch they're not coming here and you know they also lust is do you know what was the the the America before America was Argentina the Irish diaspora they were all going to Argentina because it was the new America and then what did they decide to do they decided oh we want to go back to the colonial system where you work on my land to give me half your crops they're like that's why we left so what do they do they just Argentina would have been the United States of America and on that one policy they said we'll forget this and all the Argentinians all the Europeans that got our tune I'll start going the United States and it's just like history I guess history always repeats itself and it's time for the United States to just shoot itself in the foot
Jennifer Hasch / Kyle Issacs: I sure hope not I think we can rise to the occasion I call myself a patriot and I think there are some scary things going on right now but I have faith in my fellow American to be compassionate and open to diversity and to make decisions out of science and fact and research and what is proven rather than fear or hyperbole or unfortunate assumptions about other people well they're closing the commence at all here that so on that note
Howard: I love it you should never make decisions based on fear thank you so much on you and by the way em we've dental town has a quarter million members we put up four hundred online courses they've been viewed almost a million times the love just be able to watch of course an hour at a time I would love to have some courses from you on this I mean all your hot buttons I mean every everything you just talked about is a political no no so I'm dentistry a highlight so we don't talk about things and come to common ground we're never gonna make progress and I think we have more commonality than we have differences
Jennifer Hasch / Kyle Issacs: so come into tables having discussions talking about difficult subjects and you know working together is the only way we're going to make any progress and that goes in dentistry and in anything and again
Howard: so like the dental therapist the end of the world I just didn't filling the dental therapist so me I'm out there on the road so when I'm on the road and I hear this I find out where are they I go there and so what the dentist said that I found with dental therapists say oh my god you know I don't want to do my cleanings I got too high dose and I don't like den fillies I have to deal with herpes do the fillings so now all I'm doing is root canals and extractions and dentures working at the highest out for their for the practice and then it's a regular over the world think that's gonna bring down the professional Mike how come everything that's gonna bring down the profession I always find a dentist totally love it it you think maybe it's based out of fear oh absolutely scapegoating and and and then and then the roots of your entire profession was Bob Berkeley who died in his own smaller craft you know on his way lecturing trying to convince these dentists who did not want you guys as they were so busy doing immediate dentures that you were a threat to their profession I mean and then you just got a national I mean and what I'm most concerned about now is now that I'm old I'm now not as old as you but I you know I'm at the new my four boys have made me five in children I don't want to die and have my grandchildren go to a dental office it's owned by a corporate Wall Street guy saying for ground you should upgraded that filling to an online to a crown and why why did you know I mean I want I want my at least my granddaughter to go to a dental office where it's owned by a dentist is that is that too I think for a servant if treatment plans are the goal and I think even more than that prevention is the real goal and I don't think yeah and I don't think anyone argues that there's enough disease to go around here
Jennifer Hasch / Kyle Issacs: I mean if you if you're in the small confinements of a high income private practice on a prominent area of town I implore you to step out of that office go to a rural area or in the urban area and volunteer one time and the mouths you see will change your life not just your practice your life I've been to Honduras Jamaica you know on mission trips I've seen mouths worse and the West End of Louisville and the eastern parts of Kentucky and I have seen in third world countries we have people suffering right next door if you're feeling like your business is threatened then you have a real misconception of our nation's oral health but do you but do you think my specific concern the dentist office should be owned by a dentist
Howard: do you think that getting more difficult for the private dentists because of the bigger corporations they can do things from you know more cheaply and dentists they are attracted to that business model they don't have to worry about hiring and firing and buying supplies
Jennifer Hasch / Kyle Issacs: so I don't know around here but in Oregon we have a lot of those corporations yeah I think I think Medicaid and Medicare make it really difficult for private dentists to offer services to those populations I think you know the DSOs and health centers are sometimes more incentivized to offer services and get higher reimbursement and as you know Medicaid reimbursement is pretty low and so that's that's a real issue for sustainability for a private practice I don't really have a dog in the fight of whether a dentist should own a practice or not but I can say that it's really difficult for a dentist to own a private practice and see an ad need population because they're not covering their costs or their overhead and that's a poor business model so how do we level the playing field so that we have more capable providers seeing the populations that need to be seen I don't know all the answers but I know we need to come together and come up with some solutions like yesterday I think one of the things that would be really helpful is to and Jennifer and I you know we we've been in a group together about this is getting all the dental hygienists to be able to work in medical offices and get care earlier educating parents in pediatric offices because if we can prevent disease then we're going to have happier patients and we're gonna have people who aren't going to necessarily be having to go visit the emergency rooms we're gonna save money and so early intervention and connecting and collaborating with the medical providers and not only that it's going to educate the other medical corps fire and who we are as healthcare providers that were just because we're in the dental field doesn't mean that we're not healthcare providers we are
Howard: last but not least question is on dental town there's a long thread about yeah we all know that smoking is really bad there's no question with that but isn't vaping a little better than smoking yeah laughing yeah um she just had to laugh
Jennifer Hasch / Kyle Issacs: so we're already seeing how long is vaping been out I mean I don't know ten years maybe and we're already seeing explosions in people's mouths popcorn lung we have no idea what's in this stuff it's not FDA regulated there's high huge high levels of nicotine there's research still needs to be done but the short answer is no propylene glaze not better it's been tobacco there's chemicals are chemicals and natural flavors and and the sad part is and I know that I think companies have done this too is they're marketing towards the kids I mean if you look at the names of some of the products and how they market them to look you know cute and some ladies couple weeks ago like overdosed on nicotine from and if
Howard: you see what they do in Asia and Africa those warning labels are in there should be easy not no no I mean they're the predatory to practices where they go into villages and give out free cigarettes until they're addictive than think about I mean that and then to know what will happen to their lives and to know and as androids are publicly traded companies I mean they're there that's corporations over human beings and it's not a murdering people that you know right lately no we look at some things like today that no or bad that we didn't see 50 or 100 years ago I think 50 years now there's a really and everybody just looked the other way I mean they would go into an entire country get half am addicted to this and then you look at the mortality I mean it's just like it's heartbreaking I mean you know what you know what's going on when it's a gun with a bullet and it's a war but just a little slower process but ladies there was much for all that you do for dentistry thank you so much for stopping by the booth it's been a pleasure
Jennifer Hasch / Kyle Issacs: our goal my goal is to inspire as many people to step out of wet is comfortable for them and start doing something to bring care to those need is there a lot of people and what they were looking for where to begin what were would you tell them to go well they can contact us yeah I'd be happy to talk to anyone and then also each state has that World Health coalition it's not organized you are there already go for dental town with all this stuff I'd be happy to yeah we'd love that but if you're wanting to get involved and not sure where to start reach out to the folks in your oral health coalition and just google it you can find those that are passionate about access to care and about making an impact within your state
Howard:and that's a Philip Morris