How Your Oral Hygiene Relates to Your Future Brain, Heart, and Lung Health with Joy Poskozim
Who would have known all the problems that can start in the mouth? It's really amazing to think our oral care can cause brain, heart, and lung issues. It's also a shame that we don't fund more dental programs for the elder. As we age it becomes much more difficult to get out to go to a dentist. Take the time to practice good oral hygiene and visit a local dentist.
About Joy
A 1999 graduate from NYU College of Dentistry, Dr. Joy V. Poskozim completed a General Practice Residency (GPR) in 2000 and started practicing general dentistry in Gramercy Park in NYC.
Dr. Poskozim opened her own general practice in her hometown of Chicago in 2006. She started practicing geriatric dentistry all over Chicagoland in assisted living communities, memory care homes, and those that have chosen to stay at home in 2008.
"Dr. Joy" earned a Fellowship with the Special Care Dentistry Association (Geriatric Council) in 2020, and her CDP (Certified Dementia Practitioner) in 2021.
Full Transcript Below
Roy - AGEUcational - How Your Oral Hygiene Relates to Your Future Brain, Heart, and Lung Health (00:01):
Hello, and welcome to another episode of educational I'm Roy I'm Terry. So what we want to do is not only Chronicle our journey, but we want to talk to others going through the same journey. And we want someone to talk to professionals that can come on and help us all through this journey. And so today, uh, we're fortunate enough to have joy POS schism. Pascoes hope I got that. Right. So, uh, I'm sorry. Joy's is a 1999 graduate from NYU college of dentistry. She has also completed her general practice residency and 2000 and started practicing general dentistry in Gramercy park, New York. She opened her own general practice in her hometown of Chicago. In 2006, started practicing geriatric, geriatric dentistry, all over Chicago land in assisted living communities, memory care homes, and those that have to stay home in 2008, Dr. Joy entered a fellowship with the special care dentistry association, uh, geriatric council in 2020, and her CDP certified dementia practitioner in 2021.
Roy - AGEUcational - How Your Oral Hygiene Relates to Your Future Brain, Heart, and Lung Health (01:16):
Wow. That's an awesome resume joy. And I would like to, uh, also get, I got a couple of these, the initials after your name, the DDS doctor of dentistry, the F S C D fellowship the fellowship. Okay. And then the CDP is the, a certified dementia practitioner. So awesome. Thank you so much for taking time to be with us and welcome to the show. Welcome. You know, what really, um, it's a funny story. How we met, actually, it was on Instagram. I was looking through posts, but you know, what really stuck out was not only the ju the geriatric practice, but also that you take your practice into the communities and into people's actual home. I think that is such an awesome thing because transportation can become such a barrier, not only for dentistry, but for seniors and getting people, you know, really anywhere they need to go.
Dr. Joy (02:15):
No, it's absolutely true. And, um, you know, it, it doesn't really affect you until it hits your own backyard, so to speak. And, you know, with my, you know, it started with my grandmother and, you know, she needed a new, lower personal venture. And my, you know, I'm five 11. And so she's my height, my bills put a horrible sciatica going down her right leg and, you know, children and, and countless grandchildren eager and willing to help her, but she didn't want to move off her comfy chair or her easy chair or heating pad or in her public television. And she was good to go because she also wasn't eating, you know, she wasn't eating and she was beginning to lose weight and it was getting to the point that she really should not have been losing weight. We got to the point where one would say now failure, failure to thrive.
Dr. Joy (03:04):
Um, and so, and it wasn't like she was in any pain with her mouth. They said that she didn't have the proper amount of teeth to have a full diet. And so she was beginning to, you know, um, uh, have more liquids and, and, and we were really relying on that, ensure that I'm sure we're all familiar with. And unfortunately as great as insure is, is simply just not enough. And she actually began to grow tired of the flavors. So because she was using it all the time and which can also happen. So fortunately she was 10 minutes from my office. And so I went to her and made her a lower partial denture. And I remember inserting it on a Friday. I, and the great thing about making dentures and doing this, um, in someone's home is that it's all palliative. We don't need to worry about the teeth.
Dr. Joy (03:54):
We don't need to worry about any medications that they're on. All we need to worry about is whether or not we can take impressions so that we can use those impressions as templates to make the dentures. And I have to say 90% of the time, no matter what kind of, uh, medical, um, case a patient or a resident is, we're pretty much able to take an impression, especially if they've had dentures before, because there's that muscle memory there. Um, so anyway, we made her a partial denture and, uh, she went to church on Sunday and she went to see her ladies afterwards. And when she talked, you only saw her lower teeth. And when she spoke, she was so excited to be there. Cause she hadn't seen her women's Guild in a long time. They're like Janette, you've got your teeth back. And she said, well, you know, my granddaughter goes to people's homes.
Dr. Joy (04:43):
So if you need her, let her know I'm Lily unbeknownst to me. And so I get a phone call that Monday, someone took her up on her offer and, uh, and you know, said, can you do that for my grandmother, make a long story. Short went, you know, never really thought about it, but okay. Um, the story goes, she's, you know, stroke victims two years completely, you know, um, not speaking, uh, and they, they were noticing a smell from her mouth and to make another long story short, she had dentures, they were brushing for dentures twice a day. So once again, similar situation, fellow parishioner, wonderful family, countless grandchildren, eager and willing to help. This is not due to neglect. They just didn't know what they didn't know. And so, you know what, no, she didn't tell, she didn't tell anybody. She did very formal woman and very quiet.
Dr. Joy (05:38):
She was a widow at this point. So maybe her husband knew maybe the grandfather knew, but he has passed by this point. And no one knew. And I mean, the amount of caregivers that have seen her by this point, no one had learned to lift up the upper lip to see if there was a line there to show plastic or drop the lower lip to look for the same thing. Yeah. They were literally brushing her denture. Now, granted youthful injuries. Let me tell ya, she paid a fine, you know, she paid a guide price for those, for those Dentrix, but at the same time, no one knew. Yeah. And so taking those dentures out, you can imagine what was underneath. We had to get some medications in, involved in, I had to get the medical doctor involved because of some serious issues that were beginning to form underneath those dentures.
Dr. Joy (06:26):
Considering it had been two years and she was eating, she did not have a tube. She was eating so food, you know, she was able to consume food and it was, it was, uh, fortunately was a, um, a situation that could reverse. But at the same time could totally been avoided. If someone in that path of her getting better, had the wherewithal, the knowledge, the education on oral care, on what to look for in case someone does or does not have deanships. And that's what really created my advocacy. And my career trajectory took a complete 90 degree Jaron on promoting and taking care of seniors, especially as seniors who can't communicate with us, we're trying to find secrets to potential problems. Yeah. Problems.
Roy - AGEUcational - How Your Oral Hygiene Relates to Your Future Brain, Heart, and Lung Health (07:14):
That's awesome. I think that, uh, you know, not only that it changed your career trajectory and you're able to help these people, but, uh, the other thing I wanted to bring up quickly is the communication. We talk about that, uh, communication sooner rather than later, while it's a corny thing to think about, it's good to talk to mom and dad before they get in a bad position. Like what, uh, you know, do you have a pacemaker? You know, some things like you said, maybe, uh, we would know because they were in a hospital and had done, but like dentures. So make it go, the dentist, get that taken care of. And maybe a child wouldn't even know, or if they lived out of town, uh, wouldn't have been there for that. So there are a lot of reasons why it can happen, but I think we just need to stress. The communication part is not only for that, but, you know, for other things, medications, uh, so many things, but anyway, have the conversation, write it down.
Dr. Joy (08:09):
Absolutely. And also, you know, have your power of attorney now. I mean, if you are the loved one and you're the power of attorney, I mean, are you strictly medical power of attorney or are you medical and financial power of attorney, are you? And if you are a medical power of attorney, that includes dental. So that information has to be provided to the POA in order, um, in order to make sure that sound, um, sound, uh, adjustment judgements have to be made, you know, decision you need for someone for their loved one. Yeah. I had a situation where I was going into a, uh, an assisted, a long-term care community. Um, and, uh, she had, uh, early onset Lewy body dementia. So she was no longer communicative once again, notice order, ah, they were brushing her teeth, um, except they weren't her teeth. They were all on four, all on four implant supported dentures and it wasn't there.
Dr. Joy (09:04):
It was all on four implants, all on four implants. So she had a total of eight implants, four on top four on the bottom. Beautiful. Once again, nutraphyl work beautiful dentures. Um, when the, uh, when she was entered into the home, um, in order to handle it financially, they actually had legally divorced so that she could financially be in that home, which we hear quite a bit. Well, he kind of took the ha the ex-husband kind of took that to the extreme and kind of just fell off the face of the earth. And so no one, they were not able to reach him at this point and do not know how to get ahold of him as well as find out what's going on with her medical care, as well as her dental care. So once again, lifting up the upper lip, it's going to be a common theme, lifting up the upper left is what's going on.
Dr. Joy (09:56):
And it turns out that she did have these beautifully made dentures, and I had to show the caregiver, um, and then also to help show, you know, the next shift and then the third shift, how to take them in and take them out and clean them. And they can be cleaned and taken care of just like any other denture. But once again, we don't know what we don't know. They didn't know that she had dentures. And it turns out that the, she was actually became a ward of the state. So there was a guardian put into, um, uh, into place for her. The guardian knew, but the, but you know, they were trying to get ahold of the ex-husband. So it's, so I, you know, to make a long story long, there is so important to make sure that there's at least one person in your corner who knows what's going on, not just with your mouth, but with your eyes, your ears, the rest of your body. It saves so much time and money in the long run and could save a life. Yeah,
Roy - AGEUcational - How Your Oral Hygiene Relates to Your Future Brain, Heart, and Lung Health (10:48):
No for caregivers. Um, maybe you could just give them a tip if you come in, somebody is non-communicative or if you just, if they can answer whatever the reason when they initially brush those teeth, what, what are some, you know, I guess it's simple, just lift the, lift their lips up and look, but they could probably take their finger and run on the gum line, or basically that's something that probably needs to be done sooner rather than later, just to make sure that somebody hadn't forgotten that they had dentures and, uh, you know, run into this, make a bad situation. Even worse,
Dr. Joy (11:23):
Well said, well said. Absolutely. So what I try to recommend is is if there's going to be somebody who, um, is going to be entering a home or is going to be staying in place, but now is going to be receiving care that an oral health assessment is provided. Now, there are, um, with the activities of daily living, um, there are unfortunately oral care is not listed specifically. So some places are better than others and some agencies better than others in helping to promote oral health care. There's also fear of being fixed. So that is another concern as well. So if someone is trying to take a look and they don't know how to do it right, they haven't learned the methodology in order to do that. So you don't get hurt. They're going to avoid this at all costs, or they, if they know someone who's gotten back or, you know, they're, um, they're just afraid of the mouth.
Dr. Joy (12:16):
In general. I was in a situation yesterday where, um, it was a stroke victim, minor speech. She was getting better. It had only been, it had been less than a year since his stroke. And, uh, upper denture had lost a bunch of weight. The denture no longer fit. And the daughter was at her wit's end because he really wants, again, cannot lose any more weight. So, um, contacted me great news. It was a great denture. It's a beautiful denture, but it's too loose on him. It literally was falling out. And what is kind of interesting is that the denture is actually resting on a page, Donald terminology here, buccal fat pads. So we're not only when we lose weight too. We lose weight in our bodies. We can also lose fat in our mouths. And so when that happens, there's no there's space. Now that fours between where the gums have receded or condensed on top of the bone and where the denture used to sex, we can rely on that.
Dr. Joy (13:12):
We can rely on the denture, we can rely on the partial denture. Um, and so that was an, you know, that is, you know, great news that, you know, they were able to do that. Um, but you know, fortunately for the family, everyone was on board. Everyone could tell that, you know, what was going on. And we were able, you know, I took the impression yesterday. We should have it back in about two weeks, but what I was also looking for for signs and symptoms of certain issues to be concerned about is dry mouth. The mouth can be incredibly dry and there's actually two ways the mouth can be dry. And that was by quality of saliva and quantity of saliva and a quantity. We noticed more often. And that's where anybody who can become dehydrated right, have become dehydrated. We're not producing as much saliva as we should be under normal circumstances.
Dr. Joy (14:02):
And so we feel dry. It's the quality of saliva that becomes a big deal for our seniors, because they may have some resting saliva in their mouth. They may be producing some saliva, but the unfortunate thing is it might be thick and Roby and maybe mucusy and, and not as clear as it should be. And it's not really doing its job. It's what is our saliva is supposed to allow us to help break down food so that we can swallow. What it also is supposed to do is help us speak and is, and also to help move things around in our mouth. So if we don't have a whole lot of saliva, the stuff that normally is, you know, floating through our mouth, you know, our oral bacteria and such, they'll kind of stick to the teeth and that becomes a problem. And as well, tongues can stick to the roof of the mouth and that could be a problem. And so I'm looking for, you know, for looking for dry mouth, um, I'm looking for what kind of, what kind of appliances they may have in their mouth. I'm looking for any discolorations of routine. I'm looking for swellings, I'm looking for Adam assesses. I'm looking for, I'm looking for pimples. Um, you know, these are the things that I'm looking for that can become a truly serious issue. That can be a hundred percent avoided it properly taken care of and have caregivers know what to look for. Okay.
Roy - AGEUcational - How Your Oral Hygiene Relates to Your Future Brain, Heart, and Lung Health (15:21):
Yeah. And I think that the, uh, you know, another reason we were so excited to get you on here is I don't think, um, most common people understand the magnitude of problems that can start in your mouth that can lead to, and I'll let you talk into this, but I know heart disease is a big one that it can lead to that. Um, also if you don't get your plaque taken off timely, that it can actually start rotting your job bones. I mean, anyway, I'll let you talk to them.
Terry - AGEUcational (15:56):
So this makes me love you even more
Dr. Joy (16:01):
Well. So it's kind of interesting. The term black is a general term and plaque in the mouth is, is bacteria bacterial poop because they're living things, they poop to bacteria, bacterial pooping steps that you could digest it. I swear to God. And I talk about this all the time. And even to littles, I have two little girls walking out of my office because not only do I go into the homes, I also have a brick and mortar. And by the end of the appointment, those two little girls who are four and six they're bugs,
Terry - AGEUcational (16:32):
That's hilarious. Oh my God,
Dr. Joy (16:36):
Got it. We got to start young. We got to start young. Um, but anyways, so, um, the that's what plaque is for the mouth. And that's where we're brushing twice a day. You know, I ask people of all ages, you know, why do we have to brush her teeth? And I'm going to have to say 90% of us don't know. And I wouldn't know if I hadn't gone to dental school, which is a shame, right? There's not enough information out there that's readily available that we actually want to read, you know, about oral care, right. Bacteria, bacterial poop, and excess, if they don't get digested. So there's, there's that plaque, right? I'm going to actually start with the brain because the plaque, the bacteria piriformis, ginger Vollis, um, that causes, um, oral bacteria of, or it's part is one of the bacteria that causes plaque.
Dr. Joy (17:26):
The main one can cross the blood-brain barrier and those with compromised immune systems, and now help trigger the plaque deposits in our brain can start, um, the plaque deposits that are synonymous almost with Alzheimer's right, be early onset, um, dementia, which is incredibly scary. Um, NIH, the national of health came out with this huge study that just came out last year, July of last year, that has proven this. It is, it is, there is research out there and now it has been defended that we now know that this occurs. So yeah. So piriformis, Jinja Valez horrible. Horrible is just, it's unbelievable. And it is what it is, but the bottom line is less plaque here, less bacteria, less bacterial migration to the brain. So that's number one.
Roy - AGEUcational - How Your Oral Hygiene Relates to Your Future Brain, Heart, and Lung Health (18:17):
No, that's interesting that you mentioned that because just this morning I was reading an article on audio and it said that people that have lost some hearing are 200% greater or greater risk to get all timers as well. So I just think it's interesting of these things that nobody's really ever talked, or I haven't heard about, you know, starting in the ears or starting in the mouth that can actually, uh, you know, I guess maybe exacerbate the Alzheimer's process. That's unbelievable. Anyway, I didn't mean to interrupt you, but I just thought that's
Dr. Joy (18:53):
Not at all. No, this is the conversation. Absolutely. Um, the next one would be, I'm going to say the lungs so oral, so oral bacteria migrate, we'd be, I'd consider it. Um, I think, well, I tell my patients that is due to, um, overpopulation. They want to spread out there are still during the research on the why. Um, but suffice to say that 85% of bacterial pneumonia is oral bacteria. Wow. So yeah. Very small. Yeah, very scary. So the, the bacteria that decides to Trent, you know, to travel outside of the mouth can get into our lungs, wonderfully oxygenated, wonderfully moist, warm, great environment for them to grow and a great place for bacteria, for the bacteria to help create the pneumonia that can ultimately for those ones again, with compromised immune systems death. So yeah, so very scary. And then the third one would be once again, you know, we've got plaque in the mouth plaque in the brain, right?
Dr. Joy (19:56):
And now we've got plaque in the arteries, which can then lead to the heart. So for those that have certain heart conditions, um, it's not all her conditions for food, certain heart conditions they're required to prophylactically or before dental appointment take antibiotics. And it's called prophylactically because it's helped to prevent any issues. It's not that they already have an infection is to help prevent an infection. And it will be anything from amoxicillin it's one hour before, you know, if you're allergic to amoxicillin, it's another type of antibiotic, a broad based spectrum antibiotic that is taken beforehand before dental cleaning. And some of my residents, you know, will still be, you know, require this. It's not age dependent. It truly is a heart condition dependent. What can transpire and don't carditis endocarditis. And the endocardium is the inner layer of our heart. And if it's muscle layer of our heart and if it becomes inflamed, um, then we're looking at potential chronic heart disease, heart failure, um, and potentially once again, unfortunately death. So we, especially for those with, um, pacemakers and with stents, they really want to make sure that they prevent any bacteria or bacteria foreign bacteria for that part of the body to create, you know, a home or subdivision or community.
Dr. Joy (21:17):
Um, and so we're prophylactically providing this antibiotic for them. So that, that prevent, that prevents that from happening. So oral bacteria can penetrate into our brains, our hearts and our lungs, and even more reason why taking care of the mouth is a literally taking hero three vital organs.
Roy - AGEUcational - How Your Oral Hygiene Relates to Your Future Brain, Heart, and Lung Health (21:36):
Yeah. And the basics, I guess, even before we get that far off, is that a lot of people that, um, have teeth problem, it hurts them to eat. So like you were saying, they don't get the nutrition or they, uh, may be, if they don't have any at all, they can't eat solids. So again, getting the protein and things, they have to make adjustment. So this is such a serious, um, the mouth is such a serious thing that, and I know that, you know, this in a probably will set, set you off when I say this, but yeah, no, just that, just that, um, as we get older insurances, Medicare, Medicaid, it's different everywhere, but in general, we tend to pay very little attention to elderly's mouth health. And it's just unbelievable. I, I, you know, and it, I used to think it was terrible before, before you just told us all these other things about, you know, the, the brain and the lungs, but now it just, it's even more that, you know, we're missing a very big component here in providing care to our elderly, that we don't take care of this to ensure because it just, um,
Terry - AGEUcational (22:48):
To reactionary thing. I mean, it just, if it's, if you don't work on the preventative part of it, I mean, you're just reacting to however you take care of it. And it's an emergency situation by the time they see you.
Roy - AGEUcational - How Your Oral Hygiene Relates to Your Future Brain, Heart, and Lung Health (23:02):
Yeah. Well, and it's serious because of some of these things, the heart disease and the brain, for sure. They're not reversible. It's like once we let it get to a certain point, it's just too late to, to do anything about that. So anyway, I just, uh, it's amazing. I, I will say that. I mean, I'm actually speechless, you know, after hearing that one thing I was going to say are asking you about is my dentist recommended. So I've got the little cool flossing mechanism. I can't use regular floss for some reason. It just difficult, but I've got that the, um, it's got like the little horseshoe on it where you stick it back and do it's good. But, um, they were still finding some plaque on me. And so they recommended, I use this gum stick. It's the little, uh, it's just like a rubber toothpick almost, but even after you floss, then you do this thing.
Roy - AGEUcational - How Your Oral Hygiene Relates to Your Future Brain, Heart, and Lung Health (23:57):
It's been tremendous because I can't, this is gross sounding, but I can't tell you, like, after I, after I eat, but after you eat, you know, eat some popcorn and you go do the regular floss, I'm very surprised at the stuff that still comes out when you use the little gum sticks. It's like, so for all these years, you know, we think we've been doing enough, but, um, you know, uh, I'm a novice, I'll let you decide if people should use it. But I think it's a recommendation that people should know about it. It wasn't that I was opposed to using it. I just didn't know any such thing existed. And I think that's been a topic or theme that, uh, you know, me and you have had with Terry in our previous conversations as a lot of this stuff is, it's just, we don't know what we don't know
Dr. Joy (24:47):
Exactly, you know, with the case that I had yesterday with the relining of that denture. Um, she's a, she's a very holistic person. You know, she is very concerned about what, you know, she's putting into her own body, let alone into her father's body. Um, and so she had found these bamboo based toothpicks and she figured because it was bamboo, it was fine for the mouth. And I had to very politely for professionally and firmly say, no, absolutely not. Because unfortunately, even bamboo can, can splinter, right. He bites down on it because he's now watching TV and he's not paying attention to his daughter, or she gets distracted or whatever. He has six teeth left on the lower front teeth. So we're only really concerned about getting the spaces in between those front teeth, where we have the best access to. But once again, unfortunately, you know, he is, you know, he's not fully cognizant and he might not fully respond to her requests or, or commands if you will.
Dr. Joy (25:48):
And so I also had to recommend something very similar to what you're talking about, you know, a gum based product, a gum as the name of the company, Sunstar, um, company, where they made these amazing they're called interproximal cleaners. Interproximal in between the approximation of the, of the walls of the teeth, right. You've got this triangle area and we want to get in between there because our teeth are curved, right. They're not like they're like this, right. So we want to get up in there between the teeth and the gums. Why? Because that's where the bacteria live. I mean, we wanted to make it like it's a hurricane twice a day in our mouths every day we re, you know, when I made me want to make it, like, it's so disruptive for the bacteria that they come up to the surface, and now we are rinsing and spitting and, and, you know, getting rid of, you know, all that extra bacteria and plaque that we can see because we have to remember something and I have to remember it too.
Dr. Joy (26:41):
Bacteria is microscopic, right. So if we can do it, ideally is bacterial poop. So if we can see this stuff, you can imagine the trillions of bacterial colonies that have created this and how long it's taken to get there. Yeah. And I also too, it's, you know, this is a chronic condition, right? Gum disease is chronic. It's not acute. Meaning was, it's only happened in the last three to five days. That's a big problem. There's a huge similarity between gum disease and diabetes, because for the first, you know, few years, potentially, you're completely asymptomatic. You don't, you don't have any issues. You don't have any pain, you might not have any inflammation or you figure, you know, every once in a while you brush your teeth and it'll go away and you're fine. And all we add, the gums are Pinker again, and yam drinking more water, Woohoo.
Dr. Joy (27:29):
But if we're not consistent about it, then, then those things will begin to build up. And then when you do have pain and you, you know, I would be called in to take a look at it. This is something that I would have liked to have seen three years ago when this person was first decided to stay in place and with the first diagnosis of dementia. And when they first had an agency come in, you know, I, it would be very wonderful, ideal circumstances is that I'm called into right. So we've got the nurse practitioner coming in. Maybe we need some physical therapy and occupational therapy after a stroke case. Um, but we're also calling in, we're calling in audio and we're calling in dentistry because, um, we don't know what we don't know. And if these things aren't being assessed at the very least, um, then potential problems can occur.
Dr. Joy (28:21):
And I think that's a problem across the country is not just in one part is from East to West coast, North to South is being able to address all the cities, all the problems once again, to prevent problems. What's that old expression, a stitch in time saves nine. Yeah. Right. You know, you can nip it in the bud. Um, that's use another colloquialism. Uh, you know, if we can, if we can truly, you know, catch these things when they're small, so much easier to deal with completely reversible and a whole lot less expensive this man.
Roy - AGEUcational - How Your Oral Hygiene Relates to Your Future Brain, Heart, and Lung Health (28:56):
Wow. Yeah. And it's just something I know it gets harder as it, as it's a difficult to transport people. And I think that's the, you know, the beauty of your practice or part of your practice is being able to deliver that care to where they are. So I, I guess, you know, I would challenge people to let's, don't forget about this oral care, look out in your community and see what resources are available. There may be other traveling people, but, uh, the other part is find programs if you don't have it on your insurance, because I know that becomes a worry, uh, you know, people are running short on money when they get old. So, you know, eating and paying the rent or top of mind, we tend to let other things go. So, you know, reach out and see what resources are available, because I know that every profession has people that try to help other people that don't have the resources for their services. So I would say that you're going to be able to find something, but it's just a, I think the oral care is something we just can't forget about. Really. We should never forget about it. You know, we're, we're speaking to the, the elderly audience and their caregivers and adult children of course, but this is something that really from birth, you need to get on it and stay on it because it just, it can create a lot of problems for you, you know, even at younger ages as well.
Dr. Joy (30:18):
Exactly, exactly. Right. And you know, it starts at the, with your own dentist, right? And so you start asking questions from the own dentist, you know, and if the dentist doesn't have the resources, then it's usually what they recommend doing is contacting like a RP, you know, because that's across the country and they can be a very big help in, in, uh, finding resources, uh, for those that, um, you know, that require that kind of help because yeah, medivacs are fairly expensive, especially if they have to go up the stairs and then go down the stairs. I mean, I've had situations that prior to me, before them, they find me that they're literally calling the, the fireman in certain towns too. Cause you know, smaller towns to, to call the fireman, to come get the person, to bring them to a medical appointment or a dental appointment.
Dr. Joy (31:05):
Now this is of course pre COVID. This is before telemedicine has become so prevalent. Right. And tele dentistry. Um, but once again, you know, I had a patient who chose to stay in place, had her medical appointment. It was, it was telemedicine. So he's, you know, pretty much it's the phone, you know, and he's, he's got the, the daughter's got the phone and everything. Now, if he was there, he might've looked down her throat, but she chose not to open her mouth at that time. And, and the daughter didn't feel comfortable in touching her mouth. Yeah. So, you know, fast forward, I now have to, I pull out 18 from this woman. I mean, so yeah. So, you know, there's a wonderful thing about telemedicine. There's a great thing about teledentistry too, but it's, it's, you know, boots on the ground actually being there and, and being able to communicate with this person I leveled, I love, you know, eye to eye being at their same eye level and, and having that extra time to really communicate like we were just talking about earlier being, having that communication and those communication skills so that we can provide as much cure as possible during that time.
Dr. Joy (32:11):
Um, that is, that is absolutely huge, but yes, going to the dentist first, you know, asking for help from that dentist, you know, do you know anybody or have any resources? The great thing of now is that we've fed do have social media, right? Yeah. And so there are Facebook groups that we, we talk to each other all our time and in our closed Facebook groups. And so there'll be a post, you know, at some point, you know, saying, Hey, you know, we really need a, we need a mobile dentist or a house called that I noticed in Alabama, you know, who can help. And so then we have got our groups and we one person when we network all that stuff. And so their information is out there. It's just a matter of knowing who to ask. So those are the two things Dennis or ARP are great resources and trying to find someone in your area to, um, provide that type of world here.
Roy - AGEUcational - How Your Oral Hygiene Relates to Your Future Brain, Heart, and Lung Health (32:57):
Yeah. Let me talk about the misconception of, uh, you know, kind of getting back to dentures. Maybe there's a misconception that, uh, my mother has dentures, so she really doesn't need any oral care from now on I, and I would assume that is a very misconstrued misconception that even if we don't have teeth, if we have dentures, we still need to have our mouth looked at just to make sure nothing else is going on in there.
Dr. Joy (33:21):
Absolutely. Oh, I could not agree with you more. It'd be the problem is that if, if the dentures aren't being taken care of appropriately, so if, if the, you know, your grandmother was taking their denture for dentures in and out every single day, and all of a sudden she's not doing that anymore. And the dentures are being left in that is a problem. Um, and if you don't feel comfortable in taking the dentures out, then find someone who does feel comfortable in doing that. And hopefully a nurse practitioner, a physician assistant, a PA, um, a dentist, a dental hygienist who, you know, makes house calls will, will feel comfortable in doing that for, for your loved one, because you don't want to let them sit because it's stuff in their wool. Right. And get that thrush. Right. And what is thrush that is a fungal infection that wants to get is completely preventable if the dentures are being taken out every night.
Dr. Joy (34:08):
Um, and so it is, it's crucial that, I mean, even if they're sleeping during the day, you know, if they're having a morning nap and an afternoon, nap is perfectly fine to leave the dentures in, but not over night. And another problem that we see too, is that they'll take the dentures out. Let's say, because it's just, once again, muscle memory is ingrained in them. They'll take the dentures out, but now they're sitting on, you know, they're sitting on a table or something. We want to make sure that the dentures stay wet. The, the, um, the plastic, the acrylic that is used for the dentures are required to stay wet because, um, over time, if they stay dry, the material can actually become riddle and it can either a chance of fracture. So you really want to make sure that, you know, if when the gingers come out there and sitting in, if nothing else just water is fine, it doesn't, it could be tap water. It doesn't have to be distilled just regular, old water, as long as it's sitting in something. So that those, those, those dentures, the acrylic stays moist and, um, it's will be safer, uh, the next day for the dentures to go back in. Okay.
Terry - AGEUcational (35:10):
Well, we also, sorry. We always thought as kids, that Papa was just terrorizing us with his chompers and the, and the glass and the water, you know, just trying to make it, Oh, here you want some water. Okay. There you go. Now I know.
Dr. Joy (35:27):
Well, I mean, isn't that a great life lesson of what can happen if you don't take care of your mouth? I mean, seriously, you know,
Roy - AGEUcational - How Your Oral Hygiene Relates to Your Future Brain, Heart, and Lung Health (35:34):
About that. Uh, what about the denture care? Is there, if you put it in the glass, do you, is there a tablet, a cleaner you throw in there just brush it or kind of what's recommended for that?
Dr. Joy (35:46):
Absolutely. So soft toothbrush, the acrylic is just as capable of, of getting, you know, having problems as, as the teeth do. So definitely soft toothbrush. Um, and then the tablets are fine. I don't care. What brand do you use? It's all pretty much the same as I'm going to be pretty much a former Bart carbonated soda. Okay. You know, and in a tablet form, I would not use baking soda. That's too abrasive for sure. Um, even the Arm-in-Hammer toothbrush or toothpaste, excuse me. Um, waterfall toothpaste. Great. For some people not good for dentures too. Abrasive also charcoal. The charcoal toothpaste has gotten to be very popular once again, not recommended or for dentures, partial dentures, complete dentures, not recommended for plastic teeth. Um, it's just too abrasive for them, but yeah, having them sit in, um, I have some patients too, um, that once again, they, they're trying to be more in a more holistic, less chemicals.
Dr. Joy (36:40):
Uh, one part hydrogen peroxide, just that typical Brown bottle of hydrogen peroxide that you can get at any pharmacy, right? One part hydrogen peroxide, two parts, water. Um, and that is a wonderful whitening agent, right. And as wonderful cleansing agents and what a blend is aseptic. One thing that I would not use is any alcohol based mouth finishes. Alcohol is a drying agent. I am totally pro alcohol. I just don't want alcohol. I don't want alcohol in my, in my mouthwash. Um, yeah, because it's going to dry out that plastic and over time can, once again, help it break. So you're like, well, gosh, you know, I had it, I kept it in something water is better than, than an alcohol-based mouthwash. And also just as an aside, a lot of the generic, like the target or the Walmart brand, or the Walgreens brand mouthwashes tend to follow the Listerine formula. And, and the Listerine is 26, 26 to 28% alcohol, depending on which, uh, flavor or which color you get. So, and not all Listerine products are alcohol based, but that being said, it is safer if you have the choice between a Listerine product and water, choose the water.
Roy - AGEUcational - How Your Oral Hygiene Relates to Your Future Brain, Heart, and Lung Health (37:53):
Okay. So what are some signs, uh, you know, we've talked a little bit about, of course pain, or maybe a smell coming from the mouth, but what are some other signs that somebody may need to seek immediate, uh, dental care?
Dr. Joy (38:07):
Absolutely. Um, an abscess or was, would be known as like a Whitehead or a pimple, um, on the inside of the mouth. So between the cheek and the teeth down in the gum, in that neck of the woods, okay. Usually not painful. So like a canker sore, or a cold sore that's viral. We know what causes that, you know, that'll go away. Eventually those things that are painful in the mouth when it comes to the gums, usually not so much of a problem is the ones that cause pain. Once again at the gum line that are things that we need to be concerned about, because what happens is bacteria has gotten in there and bacteria are smart until they're stupid. They get to a certain point where they can't breed oxygen anymore. Right. They need to breathe oxygen. And so they're trying to find a track.
Dr. Joy (38:52):
They create their own trapped to out to the outside where they can get some oxygen again, so they can start breathing. And, and so they'll also create this, like this capsule around them. So to stay healthy, once again, you know, you, you are their living organ, you know, the organisms, they, they, they're very adaptive. And so they will create this bubble around themselves to protect them. And that bubble is your abscess. And if you burst it, it's going to potentially be smelly. It'd be paused to have ooze. You know, it could be yellow, it could be Brene, it could be great. It could be Brown. Um, and, and one might think, Oh, well, I'll just have them rinse and they're going to be fine. And the answer to that is a big note because unfortunately, if we pop that thing, just like if we popped a zit, you know, I mean, I'm sure you've heard the horror stories of, you know, someone had to be hospitalized because of bacteria went internally and then the face blew up or around the eyes or whatever.
Dr. Joy (39:44):
Literally the same thing can happen in the mouse and going to also happen to mouth as well as on the skin is sepsis, right. Which is the infection of the blood due to bacteria, which once again, be can a hundred percent prevented, um, if properly taken care of. And we, if you see one of those, you know, those, those bubbles are those, those zits are those white heads inside the mouth. You don't want to touch it. You definitely want to call a medical care provider. Um, ideally a dentist, because then we can re evaluate, put on antibiotics first to help make sure that the infection stays local. And then unfortunately, whatever tooth that's assigned to it, then we would have to take the two. Yeah. The good news is once the tooth is gone, once the source of the problem is gone, that thing's not coming back, that absence is not coming back.
Dr. Joy (40:34):
The source of the problem is the tooth. Okay. So a lot of times, if that thing has been there and, and, and this can change depending on the dentist, but usually for me, if I find out that this thing has been there for about, for 72 hours or longer, I want to make sure this person has been put on antibiotics. Um, also usually they have a compromised immune system, even more reason for that, but I want to make sure that if there's any additional bacteria that's going around, I want that shrunk. I want that localized. I want a compacted. I want to get rid of all the extraneous stuff so that when I actually go in there and I do take the tooth, we don't have any post-op problems, you know, you're down the road. Yeah. So that is a very serious issue that we definitely want to make sure that we don't have, um, uh, that we don't have, period.
Dr. Joy (41:20):
Another problem is loose teeth, you know, especially for those that can communicate with us, but you don't want them choking on them. I know that sounds absolutely horrible, but it's happened, you know? So we want to make sure all of, you know, they'll fall out eventually. Well, yes, potentially, but they're not children. Yeah. You know, they're not baby teeth, you know, when a baby tooth falls out, the root has completely shrunk. We're looking at a, maybe a three millimeter. I mean, you know, quarter of an inch to a quarter, I mean really tiny little he's that can't cause a problem to anybody. Right. They're meant to keep us integrate adult teeth. That is not the case. When an adult tooth is loose, you've got a full root there you're, you know, you're yeah. You're looking at something that's going to be, you know, it could be, it could be choked on let's put it that way.
Dr. Joy (42:06):
And so we don't want to wait and see on that. That is another situation where the dentist really needs to be called. Usually antibiotics don't even have to be involved, but those teeth have to be taken. Cause we wanna make sure that the airway stays. Right. We want to make sure that we don't have a choking hazard. And unfortunately that can be, and that's my edit, take those aides out on that other woman, because they were horribly loose. Um, she wasn't closing her mouth. Right. It was, yeah. It was a serious situation. She's great. Now she's much, much happier now, but yeah. At the time it was pretty bad.
Speaker 4 (42:39):
What about chip teeth? I mean like chips for some reason. Yeah.
Dr. Joy (42:45):
Yeah. And you know, and that happens. That happens a lot, especially for those that are clenching and grinding. And for those that are on dementia medications, like the, um, government, um, yeah. Uh, you know, you have that horrible grinding that can occur. And the, and, um, you know, eventually teeth will chip, you know, I'll be honest with you. If it's not bothering them, I kinda leave alone. I can use a, um, a drum role-based, you know, drill bit just to smooth them down. And there's also handheld air driven, you know, um, high-speed hand pieces or drills to help smooth those teeth down. I don't like to take a tooth unless I really have to. Um, especially because it's so traumatic for the body and so traumatic for the system, uh, I'd rather be able to work with what we have and if it's, you know, based on a situation where, um, you know, I'll be perfectly Frank, if it was my own mother, she chipped a tooth. It's not sharp. She's still leading fine. She's smiling. She doesn't even know that it's occurred. Um, I'll leave it alone. You know, sometimes less is more, you know, if the patient is not aware where it's not affecting their, you know, their, um, self-confidence right. Um, and it's not really bothering the mouth or causing any problems or, or, you know, potential health hazard or a source of infection.
Dr. Joy (44:05):
I leave it. Yeah.
Roy - AGEUcational - How Your Oral Hygiene Relates to Your Future Brain, Heart, and Lung Health (44:08):
A lot of things that we've talked about revolve around bacteria in the mouth. I think it's also, I'll let you reiterate the fact of that morning brush. You know, a lot of times we have the misconception or what I've been told anyway, is that, you know, our morning brush is not to really remove a lot of food particles. It's more to remove that bacteria that's built up overnight in our mouth is that
Dr. Joy (44:29):
I preferred after breakfast, after breakfast. Yeah. What we're trying to get rid of the junk that we haven't swallowed after a meal period. So if we can brush after breakfast and after dinner or slash before bedtime, you know, as per our lifestyle, that that's really the best thing, you know, if someone wants to their mouth out now, we'll see, this were those that have have dry mouth, right. What I'd recommend is, is an and I please understand, I am not sponsored by anybody by anybody, but, but Biotene B as in boy, I O T E N E Biotene. Wonderful, wonderful, wonderful product. Y number one over the counter. So it's economical. Number two. It is swallowable all Biotene products are swallowable from the toothpaste to the mouthwash, to the gel, to the spray. I think they have lozenges. Now. They're all swallowable, they're meant to be swallowed why it's pH neutral.
Dr. Joy (45:26):
So I want to fit the tummy. Number two, it will help coat, not only the mouth, but the back of the throat, where if someone wakes up with chronic, um, dry throat, a sore throat, because they're not producing enough saliva, then the Biotene is a great product. Cause the way I tell people to do is to put it on their bedside table. And so they will have it on their bedside table and yes, water is important, but then you got pee 20 minutes later, let's be honest, you do a swig, right? And you just swig up the Biotene. That's not going to happen because the majority of it won't even reach her guides. It's coating the back of our throats and it, and it stays, it lasts longer than water. Water will evaporate, but this won't. And so I tell them to do a swig of it before they go to bed and do a sweep of that in the morning. So yeah. So when they first wake up and the great thing about it is it's got an additive effect. So the more often you're using it, the better it works. Okay. So, yeah, so that is something that I truly recommend. First thing in the morning, if someone has, you know, um, chronic bad breath or usually due to dry mouth, um, then doing a speak a bat is, is perfectly safe. Absolutely wonderful. Clear as the pallet, have some water, have your breakfast rush out here.
Roy - AGEUcational - How Your Oral Hygiene Relates to Your Future Brain, Heart, and Lung Health (46:36):
Okay. Awesome. So let's get back for just a minute. I know we need to wrap up, we're running long on time, but I have a couple of questions about the, um, well the, I guess the timing of care, if there is nothing wrong, do we still keep that on the same six months or as we get to a certain age, do we need to shorten that or LinkedIn?
Dr. Joy (46:59):
That's a great question. The American diabetes association recommends that, that patients get oral care oral exams three times a year, not just twice a year. And the reason why is because those that are diabetic, um, are more prone to oral health issues and they happen a lot faster. So, so those that are diabetic, it is strongly encouraged. And I see all my diabetic patients, regardless of how stable they are, whether they're taking insulin or not. Um, they are all being seen three times a year period. Okay. And, but other than that, for those that have teeth, even if they just have one tooth, there's still a source of a problem. I will see them every six months. Unless of course they need to be seen more frequently because it's too difficult for the loved ones and the caregivers to, uh, provide proper oral care. Yeah.
Dr. Joy (47:46):
And that happens even with the best of intentions that does happen. Um, and then, um, I also, for those that are completely edentulous, that are completely without teeth and that have dentures, I do strongly encourage for me to take a look at them once a year. Um, once again, it is a lot easier to realign a denture when it just starts to get loose. Yeah. Then in a situation like, like for example, for this particular stroke patient that I saw yesterday, he had this stroke in September, he's been slowly dropping the weight. It's only within the last month that they've noticed that he can't wear the denture perfect time for me to come in and help and help to, uh, you know, change that, change that outcome for them. Yeah. Um, but yeah, so those that have dentures, I still recommend having them looked at checked once a year to make sure there's nothing. And once again, not to get too gross, but nothing's growing inside the denture plastic was porous. Um, as well as, you know, there's nothing going on in the mouse. Uh, we want to make sure there's no where for sets. We want to make sure there's no, um, potential wounds because of the denture, just because it might be rubbing too hard on the mouth, the one that's. Okay.
Roy - AGEUcational - How Your Oral Hygiene Relates to Your Future Brain, Heart, and Lung Health (48:54):
And then the other question would be, so somebody that may be non-communicative, or that may not be totally with it, you know, if a caregiver is brushing their teeth, is there something that they can do they need to look in, or maybe even get one of those little mirrors? Or what do you recommend for those in the in-between in-between visits
Dr. Joy (49:15):
And in between visits? No, absolutely. You use the best you do the best that you can with what you got. Quite honestly, if you can, only, if they, you know, the first is punching and the only law this, then your brush, you only brush the front of the teeth. Yeah. If you can't get the inside, you can't get the inside. The, the effort has been made. So if you can, you know, a, a very common thing that we can do is that we're, if you run, if the person does, if they got curious slips, if you lift up the left and then good as your hand around, you can try all day right. On me or you can't. So if your hand is out like this or out like this, and now you can get the toothbrush in there and rush away. Right. Fantastic. And if it's 30 seconds over two minutes, if you've got 30 seconds, then that's a win, that's a win.
Dr. Joy (50:02):
So you do the best you can with what you got Waterpiks are very, are very nice too. Especially the, the, um, the handheld ones are waterproof. So if they're in, you know, uh, some kind of like a shower, you know, you know, being taken care of that way, or they can be brought in, so they're not creating too much of a mess. Um, water, Waterpiks the professional water, flour, oil flossers from water. Um, yeah. Water, fantastic products. Fantastic. To get in there as well. It can make some, a mess. Sometimes they don't really like it, but, um, that's another really great way to try to get in there. Uh, but once again, to be, do the best that we can just want to be consistent about it. We're trying twice a day.
Roy - AGEUcational - How Your Oral Hygiene Relates to Your Future Brain, Heart, and Lung Health (50:41):
Is it just water or is it one of their products that you use?
Dr. Joy (50:46):
Ray question. I really liked the one part hydrogen, one part hydrogen peroxide, two parts water. It's safe. It's effective. It's cheap. Okay. Gums, love it. Not anymore. Any, not any stronger than that though. Becomes too much of a good thing. So yeah. So one, one to two, one to two, one to two. Yeah. One part, two parts.
Roy - AGEUcational - How Your Oral Hygiene Relates to Your Future Brain, Heart, and Lung Health (51:06):
All right. One last question. And we're going to let you go. I promise. But two toothbrushes. I know there's been a big move to, uh, the battery and now they have a lot of rechargeables, uh, better. I mean, I know anything's better than nothing, but if we have, if, if we have the choice of getting the electric better, worse about the same.
Dr. Joy (51:26):
Great question. So, yeah. So 85. Um, so there was a huge study that went out, um, suffice to say toothbrushing with a manual toothbrush. We're not, we're usually brushing for a full two minutes, even over as opposed to, it only gets rid of the 70% of the Gunther in your mouth. So now you got to floss the other 30% dependent on floss, the electric toothbrushes it's been proven time and time again, since the late nineties that it gets rid of 85% of the Duncan. So yeah, so that is a significant difference. It's still a reliant on our flaws at 15%, I will say, however, that those that do have dementia and it doesn't really matter in this situation, what type of dementia they have maybe excluding Parkinson's. They, um, really don't like the feel of the vibrations in their mouth. They don't, you know, they're beginning to not even like being, having feeling water on their skin.
Dr. Joy (52:14):
Right. I mean, they're very temperature sensitive. There is, there's a, um, there's a, an avoidance and aversion to that. So as much as we would try to want to use the electric toothbrush, because it's so much more efficient and because it does such a thorough job, there's a really good chance that they're not going to want it, especially if they've never used one before. Right. They'll have nothing to be able to compare it to. They're not going to understand, unfortunately, so sometimes you're better off using something that they're familiar with, which is a soft regular toothbrush. Okay.
Roy - AGEUcational - How Your Oral Hygiene Relates to Your Future Brain, Heart, and Lung Health (52:42):
Well, awesome. Well, uh, before we go, any last parting words or anything else that you'd like the audience to keep in mind as we close up on that?
Dr. Joy (52:53):
Yeah. Um, if you have a loved one or you are a loved one yourself, and you are noticing, uh, an oral issue, chances are, um, it is a pretty common one. You're not the only one. So please feel free to reach out to me. I hope that you'll be, provide my information so that they can reach out to me the best way of email. The best way of getting ahold of me is by email. Um, and I welcome questions and concerns. I want it to be a resource. We'll give you a
Roy - AGEUcational - How Your Oral Hygiene Relates to Your Future Brain, Heart, and Lung Health (53:26):
Chance to put all your, uh, your information out there. So what is a tool, um, something that you use may not be, uh, or related, but a tool or a habit. What is something that you do that really adds value to your day? Either professional, personal, um, like journaling or an app. Yeah. Sorry. Sorry.
Dr. Joy (53:52):
That's okay. My that's a really broad question. Why do I, well, now that the weather's getting better up here in Chicago, we are my husband and I are trying to walk more. Okay. Um, yeah, so I, I really, I miss walking. I lived in New York. I lived in Milwaukee, you know, never had a car walked everywhere, was forced to walk everywhere, loved it. My body loved it. Um, now that we live in the burbs and you know, I drive everywhere now and, and it's not, it doesn't feel good on me. You know, walking is so much better. So, uh, walking is, is something that helps, um, clear my mind and, and being, you know, being on a nature, we're looking forward to going camping. We love to go camping. So that's something that was the we're looking forward to doing. And I, you know, now that we're both getting, you know, I've been fully vaccinated and my husband will be vaccinated. Um, we're looking forward to doing that. And, um, this being one with nature. Yeah,
Roy - AGEUcational - How Your Oral Hygiene Relates to Your Future Brain, Heart, and Lung Health (54:48):
That's good. We love, you know, taking that walk for me. It just, it really clears my head and it scares Terry when I come home, because I usually have a whole page full of ideas or things that, you know, I've thought about when I, when I've had a chance to really think and get, Oh my God
Dr. Joy (55:05):
Cameras. So I can take more. I take more pictures for my Instagram posts. And the last time I took my camera out, it was still too buried out here. I'm like, no, I want to spring. This is not spring. I'm hoping today. Maybe I'll see some green.
Roy - AGEUcational - How Your Oral Hygiene Relates to Your Future Brain, Heart, and Lung Health (55:19):
We have got some green starting to come up here. So it's not too far away. Not far away. Yeah. Well, Dr. Joy, thank you so much for taking time. And I know we ran way over, but it's been such an awesome talk and we appreciate it. So tell everybody not only, you know, kind of who you can help, how you can help them, but what you can do for them. And then of course, how that they can reach out and get ahold of you. Yeah.
Dr. Joy (55:44):
Fantastic. So yeah, Dr. Joy post goes in joyful dental care. I'm based in Chicago and I go all over the Chicago land area. However, if you need a resource and you're having a difficult time finding one, please feel free to reach out to [email protected]. That's joyful with one L [email protected]. Feel free to reach us at the office to at (773) 736-7767. But yes, email is the best way of getting ahold of me directly, even though it says office, that sounds very professional, but the email, the goes to me directly. So feel free. No, that'll be safe. You'll know that there'll be HIPAA-compliant and, and there will not be any, uh, problems with privacy. Yeah.
Roy - AGEUcational - How Your Oral Hygiene Relates to Your Future Brain, Heart, and Lung Health (56:31):
And we'll be sure and put all that in the show notes as well for you. Excellent. All right. Well, thanks a lot. So y'all give Dr. Joy a call, especially if you're in the Chicago land area. If you have a loved one that can't get out, let's get everybody really need to start thinking about oral care. Um, it's so, so important for us to live. You know, one of our new phrases that we use as we don't want to outlive our wellness. And so, uh, getting the proper oral oral care will certainly help with that too. So that's going to do it for another episode of educational. Uh, I'm Roy I'm Terry. I need to go brush my teeth. Yeah. We're both going in there and brush our teeth. Now. I was just sitting here feeling bad hope you can find us, of course, at www.educational.com. We're on all the major, uh, social media platforms as well. And we are on all the major podcast platforms, iTunes, Google, Stitcher, Spotify. If we're not on one that you listened to, please reach out. We'd be glad to get it added. So until next time y'all take care of yourself.
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