Latest / Pharmacy Podcast Network / Why Dental Care During Pregnancy Is Critical; Dr. Michael Duboff | MaternalRx

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Why Dental Care During Pregnancy Is Critical; Dr. Michael Duboff | MaternalRx · Pharmacy Podcast Network

• 0:05
  Speaker 1: You are listening to the global network of podcasters dedicated
• 0:09
  Speaker 1: to the pharmacy profession. Welcome to the Pharmacy podcast Network.
• 0:31
  Speaker 1: Welcome to the Maternal RX podcast, where we challenge the
• 0:35
  Speaker 1: status quo in pregnancy care and highlight how pharmacists can
• 0:38
  Speaker 1: play a pivotal role in improving outcomes and help reverse
• 0:41
  Speaker 1: the trajectory of preventable maternal morbidity and mortality. I'm your host,
• 0:47
  Speaker 1: doctor Danielle Plumber, pharmacist and antipartum doula. Today we're addressing
• 0:51
  Speaker 1: a part of pregnancy care that rarely makes it into
• 0:54
  Speaker 1: routine counseling, but should. Oral health. We counsel on full
• 0:59
  Speaker 1: of acid antiemetics and avoiding teratogens, but do we counsel
• 1:03
  Speaker 1: on protecting enamel from repeated gastric exposure. Pregnancy can heighten
• 1:08
  Speaker 1: gum inflammation and bleeding, and with persistent vomiting, repeated acid
• 1:12
  Speaker 1: exposure can silently weaken enamel. Yet many women postpone dental
• 1:17
  Speaker 1: care believing it's unsafe or are told that bleeding gums
• 1:20
  Speaker 1: are simply part of pregnancy due to hormonal changes. In
• 1:24
  Speaker 1: my work with women experiencing hyperremasis graviderum, I've witnessed the
• 1:29
  Speaker 1: devastating consequences of that gap and awareness, significant enamel loss,
• 1:34
  Speaker 1: advanced decay, and in severe cases, tooth loss. For most,
• 1:38
  Speaker 1: it's completely unexpected, and in many cases it may have
• 1:42
  Speaker 1: been preventable with earlier counseling and collaborative care. So what
• 1:46
  Speaker 1: role should pharmacists play in that prevention? Today I'm joined
• 1:50
  Speaker 1: by doctor Michael Duboff, who earned his dental degree known
• 1:54
  Speaker 1: as a d MD from Boston University Dental School in
• 1:57
  Speaker 1: two thousand. As twenty five years of clinical practice in dentistry,
• 2:01
  Speaker 1: with five years in Boston and twenty in Las Vegas
• 2:05
  Speaker 1: and as an associate Clinical instructor at the University of Nevada,
• 2:08
  Speaker 1: Las Vegas known as UNLV. Doctor Dubof will help us
• 2:12
  Speaker 1: unpack what's happening in the mouth during pregnancy, what's normal,
• 2:16
  Speaker 1: what isn't, and how pharmacists can better support patients through
• 2:19
  Speaker 1: collaborative care. Welcome, doctor Dubov, Thank you so much for
• 2:23
  Speaker 1: joining us today.
• 2:25
  Speaker 2: Thank you for having me.
• 2:26
  Speaker 1: That was some introduction, you know, Unfortunately it's the truth.
• 2:30
  Speaker 1: Women reach out to me from around the world after
• 2:33
  Speaker 1: having very difficult pregnancies with extreme vomiting and the toll
• 2:37
  Speaker 1: on their mouth is horrendous, and as I've done with
• 2:40
  Speaker 1: so many things throughout my career as a pharmacist, said,
• 2:42
  Speaker 1: why are we not talking about this? So I am
• 2:44
  Speaker 1: so grateful for you to be here today and take
• 2:46
  Speaker 1: time out of your busy schedule to answer some questions
• 2:49
  Speaker 1: and help us learn what's normal, what's not, and what
• 2:52
  Speaker 1: can pharmacists do and what can patients do to prevent
• 2:55
  Speaker 1: this tooth decay and other hormonal changes that affect oral
• 2:59
  Speaker 1: care in the mouth through their pregnancies. If it's okay,
• 3:03
  Speaker 1: I would like to start with my expertise. Unfortunately, from
• 3:07
  Speaker 1: personal experience, hyperemesis and acid exposure. So what happens to
• 3:12
  Speaker 1: the teeth when they're repeatedly exposed to gastric acid and
• 3:16
  Speaker 1: at what point does damage become irreversible?
• 3:19
  Speaker 3: Well, what's going on in the mouth As a constant
• 3:22
  Speaker 3: demonoralilation remanieralization of your enavel from your saliva.
• 3:27
  Speaker 2: Salive is your best friend.
• 3:30
  Speaker 3: So with the gastric acid, it's going to eat away
• 3:35
  Speaker 3: at the outer layer, which is the enabl So you
• 3:38
  Speaker 3: want to do things to re establish the remontalizations as
• 3:43
  Speaker 3: soon as possible. Oh, you asked when does it get
• 3:46
  Speaker 3: to the point where you know the damages is too far?
• 3:50
  Speaker 3: Absolutely so, if you lose the enamel of the two,
• 3:56
  Speaker 3: then your dentin is exposed, which is much more susceptible
• 4:01
  Speaker 3: to where and decay. Your teeth should feel smooth, so
• 4:05
  Speaker 3: if it's starting to feel gritty or rough, you know
• 4:09
  Speaker 3: you might have done damage to the enamel.
• 4:12
  Speaker 1: Thank you for sharing that. It gives a very clear
• 4:14
  Speaker 1: picture of what's going on with the teeth and when
• 4:17
  Speaker 1: it gets to the point that's too far. You know,
• 4:19
  Speaker 1: as farms as we have a lot about the physiology,
• 4:21
  Speaker 1: but dentin is not a word I'm familiar with. Where
• 4:24
  Speaker 1: does denton fall into this picture?
• 4:27
  Speaker 3: So basically, there's three layers to the tooth when it's forming.
• 4:32
  Speaker 3: It starts with the pulp, which is the nerve and
• 4:35
  Speaker 3: the blood vessels inside. Then it formed so the shape
• 4:38
  Speaker 3: of the tooth, which is the dentin, which is hard
• 4:41
  Speaker 3: but not fully protected. And then the outer layer, which
• 4:45
  Speaker 3: is the hard shell is the enamel.
• 4:48
  Speaker 1: And that's the word that we hear about most right,
• 4:51
  Speaker 1: protecting that enamel. But I love that it gives a
• 4:54
  Speaker 1: nice visual and we can picture what's happening with our
• 4:57
  Speaker 1: teeth when that acid comes in repeatedly. At what point
• 5:00
  Speaker 1: then have we gone too far and we can't reverse that?
• 5:05
  Speaker 1: For patients with severe nausea, is brushing immediately after vomiting
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  Speaker 1: helpful because that's the intuitive thing, right vomit. We want
• 5:12
  Speaker 1: to get that taste out of our mouth, protect our teeth.
• 5:15
  Speaker 1: What sequence of oral care actually should be recommended?
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  Speaker 3: That's actually the worst thing you could do. Do not
• 5:22
  Speaker 3: brush immediately after vomiting. You want to rinse out with water,
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  Speaker 3: get the taste out, get the asset out, give about
• 5:30
  Speaker 3: thirty minutes to help remmorization, and then you can brush.
• 5:36
  Speaker 3: Because if you brush right away, you have the weakened teeth,
• 5:40
  Speaker 3: and then you're scrubbing away, you're an outlet.
• 5:43
  Speaker 1: Such a frightening thing, and I think that happens with
• 5:46
  Speaker 1: so many of these women, just to get that taste
• 5:49
  Speaker 1: out of their mouth.
• 5:50
  Speaker 3: Yes, it's very common, and yeah, you do not want
• 5:54
  Speaker 3: to brush directly after rent through your water is your
• 5:58
  Speaker 3: best bet?
• 6:00
  Speaker 1: Heard baking soda in a water mix. Is that something
• 6:03
  Speaker 1: you'd recommend or is that not necessary?
• 6:05
  Speaker 2: Absolutely?
• 6:06
  Speaker 3: That would neutralize the acid allow the mineralization process.
• 6:13
  Speaker 1: Is that something you can make at home? I know
• 6:15
  Speaker 1: they do sell baking soda toothpaste. Would you recommend that?
• 6:20
  Speaker 3: You can definitely make it at home. It's a very
• 6:22
  Speaker 3: simple baking soda and water. Most people can't stay in
• 6:27
  Speaker 3: that paste, so the storeboard products have some flavor to it.
• 6:33
  Speaker 1: If a patient can't tolerate brushing because it triggers nausea,
• 6:36
  Speaker 1: what alternatives might help protect that enamel?
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  Speaker 2: Now?
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  Speaker 3: Is it the brushing itself or the taste of the
• 6:44
  Speaker 3: toothpaste or the phoniness?
• 6:47
  Speaker 1: What is causing the any and all of the above.
• 6:51
  Speaker 1: We could break that down.
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  Speaker 3: You could actually brush with just a wet toothbrush and
• 6:58
  Speaker 3: not use any toothpaste. If it's a specific area, then
• 7:03
  Speaker 3: now I mean you won't be doing the best job,
• 7:06
  Speaker 3: but you.
• 7:07
  Speaker 2: Could avoid that area.
• 7:09
  Speaker 3: If you can't brush at all, I would say go
• 7:14
  Speaker 3: to your rinses, flossing, and maybe more often getting a
• 7:20
  Speaker 3: dental cleaning. I actually recommend every three months for pregnancy.
• 7:26
  Speaker 1: You recommend every three months. I've never heard anyone say that,
• 7:29
  Speaker 1: and in fact we see the opposite happen. Women while
• 7:32
  Speaker 1: they're pregnants avoid going when really they should be going
• 7:36
  Speaker 1: more often. I hope that message gets across.
• 7:40
  Speaker 3: Dental treatment during pregnancy is very safe recommend especially the
• 7:45
  Speaker 3: preventative of the cleaning. Some work can be put off
• 7:50
  Speaker 3: after that's fine, but you definitely want to take care
• 7:54
  Speaker 3: of the gingivitis and any kind of infection that could
• 7:59
  Speaker 3: be going on.
• 8:00
  Speaker 1: And that's extremely important as well, because what I've learned
• 8:03
  Speaker 1: through my pharmacy training and working with cardiologists and in
• 8:07
  Speaker 1: the hospital that dental care ties in so directly to
• 8:11
  Speaker 1: our heart. There's bacteria infections that we can get in
• 8:15
  Speaker 1: our mouth that if they're not taking care of, it
• 8:17
  Speaker 1: can lead to other infections systemic throughout the body. Very scary.
• 8:23
  Speaker 1: What are you saying if women delay care and then
• 8:25
  Speaker 1: come into your office, what type of things are you
• 8:28
  Speaker 1: finding that could potentially have been prevented?
• 8:31
  Speaker 3: Well, Breando, women are susceptible to what's called pregnancy gingividis,
• 8:37
  Speaker 3: so oral care is very important.
• 8:40
  Speaker 1: Pregnancy gingervitis again a phrase not commonly talked about. Can
• 8:45
  Speaker 1: we break that down a little bit more as well?
• 8:47
  Speaker 1: What is gingervitis?
• 8:50
  Speaker 2: Well, that is gun information, you know, bleeding gums and
• 8:54
  Speaker 2: what causes that bacteria?
• 8:57
  Speaker 3: That's your body trying to fight the bacteria you get inflammation.
• 9:04
  Speaker 1: What is the evidence on fluoride varnish and high fluoride
• 9:07
  Speaker 1: products during pregnancy. Are they safe and effective?
• 9:10
  Speaker 2: Yes?
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  Speaker 3: I can say enough good things about fluoride. I believe
• 9:15
  Speaker 3: it's very safe, especially topically.
• 9:18
  Speaker 2: You're just going to have it in your mouth, spit
• 9:20
  Speaker 2: it out.
• 9:21
  Speaker 3: Florida and Ricky water is a different conversation because that's systemic.
• 9:26
  Speaker 1: I am so glad you brought that up. I grew
• 9:28
  Speaker 1: up in New Jersey where we had fluoride in our water.
• 9:31
  Speaker 1: I have the strongest teeth of anybody I know, and
• 9:35
  Speaker 1: when you google that, it would terrify anybody from ever
• 9:39
  Speaker 1: touching fluoride at all. It's at trace elements. It's been
• 9:43
  Speaker 1: proven safe through our water system. That varnish that they
• 9:47
  Speaker 1: just brush onto your teeth. It then gets rinsed off
• 9:50
  Speaker 1: and it's going to protect that enamel layer. Is that correct?
• 9:54
  Speaker 2: Correct?
• 9:55
  Speaker 1: We can save systemic fluoride in the water for another conversation.
• 10:00
  Speaker 3: But you know, I know it's a big debate and
• 10:05
  Speaker 3: some people are antifluoride and that's your option or preference,
• 10:13
  Speaker 3: but just know that's your best defense against the decay.
• 10:18
  Speaker 1: For patients who's enamel appears more porous or vulnerable after nausea,
• 10:24
  Speaker 1: are there long term strategies preventative that can be implemented.
• 10:28
  Speaker 3: Again, I'm going to go with the fluoride rinse your mouth,
• 10:33
  Speaker 3: then get some high fluoride, possibly prescription toothpaste. You ought
• 10:38
  Speaker 3: to be hydrated or Rince's excellent.
• 10:42
  Speaker 1: I think that's the biggest problem, especially when we talk
• 10:44
  Speaker 1: about women with hypermesis hydration slain right. We're constantly dehydrated.
• 10:51
  Speaker 1: It's quite torture because we're thirsty. We drink water, but
• 10:55
  Speaker 1: it doesn't stay down. There's so many changes in the
• 10:58
  Speaker 1: mouth during pregnancy, dute those hormones and the fluctuations, anything
• 11:02
  Speaker 1: from this dry mouth all the way to excess saliva
• 11:07
  Speaker 1: which has many different names. Tallicism, am I saying that correctly? Yes,
• 11:13
  Speaker 1: very good, pyt Alim, I.
• 11:17
  Speaker 2: Think I think you got it, Okay.
• 11:20
  Speaker 1: That excess saliva alone, it could trigger vomiting. I actually
• 11:24
  Speaker 1: once wrote a whole blog on things that might help,
• 11:28
  Speaker 1: and there's a lot of dental tools that might help.
• 11:30
  Speaker 1: You have these pads that you could put in your
• 11:33
  Speaker 1: mouth to soak. You have a lot of women that
• 11:35
  Speaker 1: will just be spitting to get it out, so you're.
• 11:40
  Speaker 2: You're going to be doing a lot of spitting. It's
• 11:42
  Speaker 2: just the part of the deal.
• 11:44
  Speaker 1: And what's not talked about what happens to a lot
• 11:47
  Speaker 1: of women. It actually affects their social life because if
• 11:49
  Speaker 1: you're out, if you're at work with friends, with loved ones,
• 11:53
  Speaker 1: you don't want to constantly be spitting. But unfortunately it
• 11:57
  Speaker 1: is probably the best option. There's really not much you
• 12:00
  Speaker 1: don't want to keep swallowing. That is that correct?
• 12:02
  Speaker 3: I mean you could swallow it. There's nothing wrong with it.
• 12:07
  Speaker 2: Just live them.
• 12:08
  Speaker 3: Have you ever tried clonidine to help with salb ary flow?
• 12:12
  Speaker 1: I love that you brought this up, because this is
• 12:14
  Speaker 1: a pharmacy podcast, right. Clonatine has also been recommended in
• 12:19
  Speaker 1: past clinical studies for hypermesis graviderums. I had not heard
• 12:23
  Speaker 1: it brought up for this case. There are other medications
• 12:27
  Speaker 1: that are used in the OAR for patients with surgery
• 12:31
  Speaker 1: that might have a benefit, and clonagine is not one
• 12:34
  Speaker 1: of them. Let's look into that and see if it
• 12:36
  Speaker 1: would help. From what I've seen, some of the excess
• 12:40
  Speaker 1: saliva that women are producing during their pregnancy, it does
• 12:45
  Speaker 1: not last the whole nine months. It seems to taper
• 12:48
  Speaker 1: off by mid pregnancy. Is that what you've noticed as well?
• 12:51
  Speaker 3: Yes, they say second trimester usually gets better.
• 12:56
  Speaker 1: So even if you are on that clonidine earlier on,
• 13:00
  Speaker 1: pay attention to your blood pressure. But sector you boff,
• 13:03
  Speaker 1: as you said, it's a low dose and I'm gonna
• 13:05
  Speaker 1: I'm gonna start investigating this one because we wouldout be
• 13:08
  Speaker 1: a life saver. So I'm gonna flip topics. If a
• 13:13
  Speaker 1: woman knows she wants to become pregnant and is doing
• 13:16
  Speaker 1: what she can to prepare her body, any thoughts on
• 13:19
  Speaker 1: what can be done. We talked about getting in to
• 13:21
  Speaker 1: see your dentists, getting a regular checkup if you are
• 13:25
  Speaker 1: do for one. Are there any other recommendations while woman's
• 13:29
  Speaker 1: preparing to become pregnant.
• 13:31
  Speaker 3: Well, I would advise regular dental visits anyway. But if
• 13:37
  Speaker 3: you are trying to become pregnant and you have been
• 13:41
  Speaker 3: neglecting in your mouth, I'd say that is the time
• 13:44
  Speaker 3: to get in and get that taken. There's some studies
• 13:48
  Speaker 3: about low birth rate free term pregnancies with ginger vitis periodontitis.
• 13:54
  Speaker 1: Can you talk about those studies. What's the evidence that's
• 13:57
  Speaker 1: linking periodontal disease and those adverse outcomes like preterm birth.
• 14:03
  Speaker 3: Just like we spoke before, How the bacteria gets into
• 14:07
  Speaker 3: blood streaming can attack the heart.
• 14:09
  Speaker 2: Just imagine what we would do to developing fetus.
• 14:13
  Speaker 1: Try not to imagine that. Yeah, no, it's quite scary. Honestly,
• 14:18
  Speaker 1: it's something no one ever spoke to me about. All
• 14:21
  Speaker 1: my discussions on pregnancy, no one's ever brought this up.
• 14:24
  Speaker 1: It shows how important it is to get that dental
• 14:27
  Speaker 1: care preventative if possible, if treatments needed, get into see
• 14:31
  Speaker 1: your dentists, get that taken care of before becoming pregnant.
• 14:36
  Speaker 1: If you do become pregnant, it's okay. It is safe
• 14:39
  Speaker 1: to go see your dentists and get procedures done.
• 14:42
  Speaker 2: Right.
• 14:42
  Speaker 3: If we've treated millions of pregnant women, it's very safe.
• 14:47
  Speaker 1: I love it when we can put numbers to this.
• 14:50
  Speaker 1: Stop to hear say the things on TikTok and see
• 14:53
  Speaker 1: your dentists, get that care done, and if there is
• 14:56
  Speaker 1: more extensive work that's necessary, have that conversation to say,
• 15:00
  Speaker 1: can we do this now, should we do this now
• 15:03
  Speaker 1: or is this something that can wait until postpartum.
• 15:06
  Speaker 2: Absolutely?
• 15:08
  Speaker 1: Yes, there's still hesitation around dental X rays. Is there
• 15:12
  Speaker 1: a rule as far as what's considered safe or the
• 15:16
  Speaker 1: timing anything we should know in those regards.
• 15:19
  Speaker 3: As far as I'm concerned, Dell X rays one hundred percent,
• 15:23
  Speaker 3: say it's a low dose and you're shielded, so I'd
• 15:28
  Speaker 3: say it's zero effect of the fetus. Best time for
• 15:33
  Speaker 3: dental treatment is usually in the second trimester. Usually we
• 15:39
  Speaker 3: will ask for a medical release from the obgyn. Although
• 15:44
  Speaker 3: we know dental's treatments, say we know how much anesthetic
• 15:47
  Speaker 3: to give.
• 15:48
  Speaker 2: We do like to coordinate with the obgyn.
• 15:51
  Speaker 1: Music to my ears right collaborative teamwork. And I think
• 15:55
  Speaker 1: for so many years practitioners have practiced in silos. Pregnant
• 16:00
  Speaker 1: see is not a time in life where you can
• 16:02
  Speaker 1: be in a silo. Even though the experts are your obstetricians.
• 16:07
  Speaker 1: This pregnant woman has so many other conditions going on,
• 16:10
  Speaker 1: and we just touched upon how important dental care is
• 16:13
  Speaker 1: during this time to prevent things like preterm birds and
• 16:17
  Speaker 1: hearing that you can work with your obs, you can
• 16:19
  Speaker 1: work with your pharmacists and all the other healthcare providers
• 16:23
  Speaker 1: that are out there. That's what's going to lead to
• 16:25
  Speaker 1: best outcomes for that mom. Let's talk about postpartum. Do
• 16:31
  Speaker 1: dental issues often emerge postpartum that may have started during
• 16:34
  Speaker 1: pregnancy and if so, how should they be addressed.
• 16:38
  Speaker 2: Yes, I mean if you do have HG.
• 16:41
  Speaker 3: Obviously you've had the asset attack going on, so you
• 16:45
  Speaker 3: want to keep up with your datil nygiene visits. Also
• 16:49
  Speaker 3: the pregnancy jijivitis that we talked about, you'd want to
• 16:52
  Speaker 3: come in post pregnancy, make sure all that has been resolved.
• 16:57
  Speaker 1: Very important to get that message across. And women, do
• 17:01
  Speaker 1: you keep in mind that you're going to have a
• 17:02
  Speaker 1: newborn with you, So if you're going to see your
• 17:04
  Speaker 1: dentist postpartum, or if you're debating should I do something
• 17:07
  Speaker 1: during this pregnancy here wait till after the baby's born,
• 17:10
  Speaker 1: keep that in mind as well. Just strictly for logistics,
• 17:13
  Speaker 1: I would bring my little one and go can they
• 17:15
  Speaker 1: be here? Can they be in this room? I'm in
• 17:17
  Speaker 1: the chair, or I just hope that they would be
• 17:19
  Speaker 1: sleeping through that procedure. But you know, if they need
• 17:22
  Speaker 1: diaper changes, if they're nursing or bottle feeding, you timing,
• 17:26
  Speaker 1: timing to get anything done when you have a newborn
• 17:29
  Speaker 1: may always be complicated.
• 17:31
  Speaker 3: Keep that in your mom have brought babies. We can
• 17:35
  Speaker 3: work around that. Hopefully.
• 17:38
  Speaker 1: I love that if enamel erosion or periodontal damage has
• 17:43
  Speaker 1: already occurred. With our resortive options that are effective to
• 17:47
  Speaker 1: help improve that decay.
• 17:49
  Speaker 2: Well.
• 17:50
  Speaker 3: Luckily, gum disease is pretty much reversible unless it's gone
• 17:56
  Speaker 3: so far where the tooth is lose. Luckily, you can
• 18:01
  Speaker 3: get that under control. If you have had an animal
• 18:05
  Speaker 3: damage where the tooth needs treatment, we could do composite
• 18:10
  Speaker 3: bonding or tooth m I need a crown to cover it.
• 18:15
  Speaker 1: And I know financial stress can add to dental care.
• 18:20
  Speaker 1: Is there any advice you have on working with insurances
• 18:23
  Speaker 1: to get things covered, like I know most insurances cover
• 18:27
  Speaker 1: preventative dental cleanings twice a year. Is that correct? I
• 18:31
  Speaker 1: guess you'd have to work with your insurance to add
• 18:34
  Speaker 1: a dental plan if you know you're going to need care.
• 18:36
  Speaker 1: Any advice on that, I know it varies by state.
• 18:39
  Speaker 1: It's a very broad question, but if you can add
• 18:41
  Speaker 1: any tidbits that might help these women, it'd be greatly appreciated.
• 18:46
  Speaker 3: Some dental plans are actually catching up with the times
• 18:51
  Speaker 3: and allowing more cleanings more preventative while pregnant. And I
• 18:57
  Speaker 3: don't know about other states, but about of Medicaid, pregnant
• 19:00
  Speaker 3: women get full coverage.
• 19:02
  Speaker 1: What exactly does that mean full coverage for the cleanings or.
• 19:05
  Speaker 2: For tu.
• 19:07
  Speaker 3: Adults still get any coverage for dental under Medicaid, Oh
• 19:11
  Speaker 3: my god, pregnant women get pretty much so you can
• 19:17
  Speaker 3: get all your treatment done while you're pregnant.
• 19:20
  Speaker 1: This is huge. I know this is a podcast, people
• 19:22
  Speaker 1: are listening. You can't see my face when you just
• 19:24
  Speaker 1: said that, my jaw dropped. There's normally not dental care
• 19:28
  Speaker 1: on Medicaid, but while you're pregnant, you have one hundred
• 19:32
  Speaker 1: percent care. This is powerful. So for those women that
• 19:36
  Speaker 1: are afraid to get dental work done while they're pregnant,
• 19:40
  Speaker 1: these are things to keep in mind. Prevent potential problems
• 19:44
  Speaker 1: like preach and verves, long term problems like infections in
• 19:48
  Speaker 1: your teeth, that gingovitis that can become systemic if it's
• 19:52
  Speaker 1: not taken care of. This is your opportunity think about
• 19:56
  Speaker 1: what's best for baby. Let's think about what's best for
• 19:58
  Speaker 1: mom too. And for those pharmacists that are seeing these
• 20:01
  Speaker 1: women at the counter, it is so easy for you
• 20:04
  Speaker 1: just to say, hey, if you haven't thought about a
• 20:07
  Speaker 1: dental cleaning, go ahead and talk to your dentists. Get
• 20:10
  Speaker 1: that done now. It's more important than you realize. If
• 20:13
  Speaker 1: somebody wanted to learn more from you or reach out
• 20:16
  Speaker 1: to you, what's the best way to connect.
• 20:19
  Speaker 2: My email is good some vile designers lv at Yahu.
• 20:23
  Speaker 1: I'm so grateful you joined us today. Thank you for
• 20:27
  Speaker 1: listening to the Maternal RX podcast again. I'm Danielle Plumber,
• 20:30
  Speaker 1: advocating for better maternal outcome through pharmacists led collaboration and
• 20:35
  Speaker 1: being my first interview with a dentist. I cannot thank
• 20:38
  Speaker 1: you enough. Thank you everybody,