 Julia, what are the plans for questions? Were you wanting to take them from the chat box as we go along? Did you want me to use my common sense about it? Did you want to leave it till the end? We've lost our presenter now. And everybody else here and me at the moment? My rather tired voice. Thank you, Donna. Fine. Just bear with me just for a moment. I don't quite know what happened to our presenter then. She seemed to disappear. I should keep an eye on her popping back in again. And we can ask her to speak to us. That's strange. First time that's happened today. This is the 23rd presentation as well. So we've done very well. Does anybody want to start a short conversation in the chat box about something? Ah, she's back. Hi, Julia. Sorry about that. Hello, Julia. Can you hear me? I can hear you fine, yes. What happened there? You're a bit quiet. All of a sudden, the computer just shut itself off. I don't know what happened. Oh, it happens to us. Bear with me and bond in there. You're a little bit quiet, Julia. Could you possibly either get nearer to the mic or turn up the microphone next to the green thing at the top of the screen? I can do that. How do I sound now? Better? Still not as loud as you were before you disappeared. OK, so just my. How's that? Oh, that sounds good. That sounds good. Great. OK, so I can just advance the screens using the arrow at the bottom. Is that how that works? Yes, you can indeed. OK, very good. Great, thank you. So today, I wanted to talk to you about oral health during pregnancy at NYU. We were fortunate enough to get a rather large grant of $5 million to study oral health. And so we've been very involved in oral health and folding oral health into all of our curriculum. So for all of the midwifery students, as well as the nurse practitioner students that are at a graduate level in our university, each specialty has oral health and the discussion about how oral health is important and how it can affect pregnancy is really what I wanted to talk to you about today. So we know that there are oral systemic health problems that are very common to pregnant women. And what we might not know is that they have an incredible significance for the overall health of both the mother and the baby. And so today, I just want to talk to you, make sure that you're aware of the things that are significant about oral health and what we can do to help these moms and ultimately help the baby. So today, you're going to understand the importance of the oral systemic health during pregnancy. You're going to look at six oral health conditions and their effects on pregnancy and how to manage them. And hopefully, this will lead to improved outcomes for both the mothers and the babies. I'm also going to talk to you about things that you might do in your clinical setting that we found helpful here when we're thinking about oral health. So let me see if I can get this to come up. So in the United States, and I did not look at oral health in every country or anything else like that, we haven't looked at it internationally. But in the United States, we know that almost half of women who recently gave birth did not have a dental visit in the past year. So they're probably all missing at least one visit and maybe many more. Because we know out of those, half of those women, that 18% or one out of five have never had their teeth cleaned in their life ever, which means they probably have never been to a dentist. And that's not really acceptable for a pregnancy. It's not really the thing that we want to be part of a pregnant woman's health. So 40% of the women have some form of periodontal disease, and periodontal disease has a great number of sequela that I want to talk about today. So can I just stop for a moment and ask, if people have questions, that's perfectly fine with me. I guess if you put them in the chat box, I'll keep trying to check over and see if there's anything. Is that the way that you've been doing this in the past? You do it whichever way you wish it to be. So if you like, you concentrate on your presentation. And if I see a question that needs answered right then, I will interrupt you. How about that? That sounds great. Thank you, Linda. Actually, there's a question straight away that you perhaps need to add to the question. Oh, I see. There's a question about periodontal. So periodontal disease means gum disease. And gum disease, of course, is going to affect your teeth and cavities and that type of thing. That, Harry, do you understand the word now? Sure. So anytime. So please, that's exactly the right kind of question. If you don't understand what the word is, then the presentation is not going to help you very much. So please, don't hesitate to ask. So there are a number of different oral health problems during pregnancy that we're going to look at today. Gingivitis is one of them. Periodontitis, tooth decay, or caries, enamel erosion from vomiting or reflux, and pregnancy granuloma. So I'm going to explain each one of these to you and let you know what can be done during pregnancy. So we'll just go through these one at a time. So if you look up at the top here, you're going to see a nice little presentation of healthy gums. So we want gums to be pink and firm. We don't want them to bleed. When you have healthy gums, like that's pictured in the top, what you have is basically a barrier to your systemic system. So nothing is going to get into your bloodstream when your gums are healthy. It's there to protect the rest of your systemic system. And down at the bottom, we have something called gingivitis. So gingivitis, the gums are soft. They are swollen. They can be edematous. And they can bleed bleeding. So they'll bleed when you brush. They may bleed when you floss. And that's not what we want to see happen. And it's very common in pregnant women. Of course, 25% to 75% of pregnant women will have bleeding gums. And for us, we used to say all the time, well, that's normal. There are some hormones that influence pregnancy that make your gums bleed a little bit. But they really should only bleed. I mean, I don't know that they should really bleed at all. We've always thought it was normal. But maybe it isn't. Maybe we should really question anymore whether that's normal or whether you have to have bleeding gums during pregnancy. So we know that gums bleed because they're not taken care of. We know that people don't brush enough, or they eat the wrong foods, or they don't brush as often as they should or floss. And we know that the hormones of pregnancy will actually exacerbate gingivitis. So enamel erosion is another thing that we want to think about because so many women are nauseous for so long. We hope that by 14 weeks, 16 weeks somewhere in there that they will stop vomiting. I mean, personally, I can just tell you my own. I was nauseous for nine months. So you can have nausea and vomiting for a very, very long time. And that acid in the vomit or the reflux can actually erode the enamel so that cavities can get into the teeth more easily. So the way that we can help pregnant women is to have them reduce that acid by rinsing with water or water and baking soda. I see that you get free dental care in the UK. Yes, we love that about you. And we get free dental care here in many states, in the United States, because we have federally funded health centers. And actually, in the United States, many of the women can get free dental care for two years. So we really encourage them to get in not only while they're pregnant, but to continue after they're pregnant. And I'll tell you why in a little bit. Another thing that pregnant women get that's very common is pregnancy granuloma. We know that 5% to 10% of women get this. Some women get it every single time that they have a pregnancy. It's benign. It's not a problem. It's a lesion on the gum that can be on the gum that lifts the tongue. And it's caused by irritation from poor dental hygiene. It usually resolves after delivery. It also can come from heart. It's hormonal. And you don't need to worry about it, but you can worry about it if it starts to bleed or if it gets in the way of chewing or mastication. You want to remove it or have it removed by a dentist. So this is something really that you don't need to worry about too much, unless it causes a problem for the mom. So caries, cavities, tooth decay, results from poor oral hygiene, high frequency of sugar intake. So what happens is that we have the bacteria from the carbohydrates metabolizes and then gets breaks through the enamel and causes the cavity, which can then go up to the root of the tooth. It also makes much bigger problems for the mom and the baby. I don't tell the story too, too often, but one of the midwives here at the states was telling me about one of her moms who was eight months pregnant. And she had obviously a tooth decay and a carry and developed into an abscess. And she went into the emergency room to be taken care of because her jaw was swollen and she was in a lot of pain. And no one would care for her. And so while she was there, they just sent her home and said, no, you're pregnant. You're too pregnant. We can't. We won't care for you. And the next day she came in and her baby was fine the night before, but her baby, she had a stillbirth. And they did an autopsy. And the cause was that the same bacteria that she had in her mouth from the abscess had gotten into her bloodstream and into her systemic system and caused the baby to die. And then subsequently, really a few days later, the mom also died, passed away. So just all from a toothache. So that's why I think it's so important. Really a very sad story. And that's why I want to bring this information to you. And I'm not sure if these are pregnant teeth or not. I see that question. But so teeth or teeth, whether they're pregnant or whether they're not, they still look like this if they have caries. Sometimes they look like this. And sometimes it just looks like a black spot or it can look like a shadow. So we talked a little bit earlier about gingivitis. And periodontitis is an even worse untreated gingivitis. So this is the thing we're really trying to avoid. So gingivitis, you can see, as I told you before, you're going to have some edematous gums. They're going to be swollen, tender, inflamed. They're likely to bleed. That's one part of it. And once you start bleeding, once you have that bleeding in the mouth, then you've got an opening right to the systemic system. So just think of it that way. So what happens with periodontitis is that the gingivitis goes even further and it destructs the gums and the bones that support the teeth. And we used to say, OK, so they're one, two, three each pregnancy. But this is totally preventable and really preventable just by getting some good dental care and some oral health care. So you can see in the bottom photograph that there's advanced periodontitis. And that periodontitis is really exposing caries that were created. And we used to say people got long of tooth. Well, that was really periodontal disease that was exacerbated. And we want to really truly avoid this if we can. So there are some other sequela that I'm going to bring to you. And yes, I do have links for further resources to share with mothers to be. But let me go on with the rest of this first and then I'll give you some resources. So here I talked a little bit about this. So there's gram-negative bacteria, endotoxins from that, inflammatory products in your mouth. And there's hundreds of bacteria in your mouth all the time. And so what we really want to do is when we get gingivitis or periodontitis, we have all these gram-negative bacteria. And they can go to semically disseminate from the mouth into the fetus. So we know that gram-negative bacteria is what's in bacterial vaginosis. And so that bacterial vaginosis is definitely linked with preterm labor. Well, this is same gram-negative bacteria. I mean, some of the information that we have now says there is a link to preterm labor and preterm birth. The evidence isn't really strong yet, so I'm going to just let me put that disclaimer out there. But if you have gram-negative bacteria in your system, why would you want that at all when we can prevent it? So we get the gram-negative bacteria that leads to increased prostaglandins. We know that high prostaglandins lead to preterm labor and preterm birth. And that we get cytokines are also produced from the endotoxins. And that this is associated with spontaneous rupture of membranes, preterm birth, and possible infection. So just to keep these things in mind as a possibility and why it's important to keep a pregnant mother's mouth healthy. So preterm labor, the other thing about periodontitis is that there's definitely really good evidence for the association with poor glycemic control. And so the control of diabetes and the control of gestational diabetes becomes more difficult when we have a mom with periodontitis. So they affect each other, blood glucose control. So one asked me the other day I was showing this picture. And they said, well, what is that? A pregnant mom testing her finger to check her blood sugar. So we certainly want them to do that. And we want them to stay under good control by not having periodontitis. So I think one of the most important messages that I want you to take home from this today is that it's essential to have dental care during pregnancy. Ultimately, we like them to have it before they even get pregnant. But if you get a mom in and she has not had any dental care, we want to get her in for dental care and a cleaning and an evaluation right away. We don't want her to be afraid of the dentist. We don't want the dentist to be afraid of her. And sometimes it is because of the dentist. It's not always that the, I'm sorry, I was reading the questions on the side. I'm going to stop doing that. I'll let Linda, you'll interrupt me. So what I was trying to say is that sometimes it's a dentist that is the problem. Some dentists won't care for pregnant women. And that needs to, we need to really think about that a little bit too. And we'll talk about that in a minute. So consistent and regular dental visits are key, especially during pregnancy, more so during pregnancy than any other time. It's not only safe to see the dentist. It's the right choice for the mother and the baby. And it's important that we get to know the dentist in our area so that we can refer our pregnant moms to them. We are, as midwives, perfectly positioned to be frontline educators for pregnant women and about the importance of their oral health. We may see them four times. We may see them 14 times during a pregnancy. But we can be asking the question each time about their oral health and documenting the oral health of their moms. So let's just think a little bit about this. When you examine the mouth, instead of thinking H-E-E-N-T, let's change that. Let's do chin up. Head, eyes, ears, nose, oral cavity, and throat. So think of the whole entire head, all right? And let's make sure that we do not use H-E-N-T so that you don't forget the oral cavity. We want to encourage regular brushing and flossing. We want to refer all our pregnant women for dental care. Every single one of them should go for dental care. And we want to make sure that we discuss a healthy diet. Because, yes, eating lots of sweets and everybody wants to eat whatever they want during pregnancy. But the reality is that it's more important to be careful about your diet during pregnancy than any other time in your life. So the other thing, the other time that we can talk to moms, and we're going to go a little bit back and forth here, but I want to just think about this a little bit, is after birth. So when your mom is chewing the food and then giving it to the baby, and she has a carry in her mouth, or she has that bacteria in her mouth, she is transferring it right from her mouth into the baby's mouth. If that pacifier falls on the ground and she picks it up and she puts it in her mouth first, before she puts it in the baby's mouth, she is transferring that bacteria. So mothers, what we know is that mothers with high rates of carries are more likely to have children with high rates of carry. And this is such a preventable disease. Children don't have to have high rates of carries either. But you definitely don't want to chew their food. You don't want to be passing that pacifier. And you want to make sure, we like to say that we want those babies to get in. By the time they're a year old, they should have a dental home, a place where they can go, where they can call, where the mom can take them to the dentist. Now, how many teeth do they have? Not that many at one year. But what they do have is the potential to get carries. And then they can also learn from the dentist how to take care of their children's teeth. And so that they can help prevent carries. So we can tell them, make sure you see a dentist. They should be wiping out the baby's mouth. Even before teeth are wrapped, we want to have them wipe out with either a piece of clean gauze or a clean washcloth. So another goal is that we want to promote, again, oral hygiene for all pregnant mothers and encourage regular dental visits during pregnancy. Some of the things that we do, when OBs we know, obstetricians generally do not refer to dental care. And that's why I think it's so important for midwives and nurse practitioners to be doing that. We like to create a list in the neighborhood of the dentist. And then we call them and ask them if they accept Medicaid. That's our insurance, our health insurance here. So I think if you can create a list for your patients, that is really, really helpful for them so that they don't have to go through the phone list of dentists and try to get in and see who to call and who will take them. So we find out whether they accept the insurance and also whether they'll see pregnant patients. And then we reassure the patients. I think that the pregnant moms, we want to let them know that it's safe to see the dentist, that prevention, diagnosis, and treatment of oral conditions is safe, and that you can have x-rays if you have abdominal shielding. So if you have the steel apron, then you'll be fine. If you can use local anesthesia during pregnancy, it's safe during pregnancy. The other thing is that we want to make sure we talk about oral hygiene about the newborn, because we know that early prevention leads to lifelong prevention of childhood caries. And we want to make sure that moms know not to check that food before she puts it in the baby's mouth. I mean, she can check the heat of it, but she shouldn't put the same food that's been in her mouth in the baby's mouth or the pacifier. So a healthy mouth leads to a healthy mother, which equals a healthy baby. And so it's just one other part, I think, of prenatal care, of postpartum care that we need to make sure that we bring this to our midwifery practice so that we can help prevent unnecessary sequela to both mom and baby. So in terms of, let me just answer one of the questions that was asked before. And this is the end of my presentation. One of the moms before, or one of the midwives before, asked about a reference. And I'd like to refer you to smilesforlife.org. And I put that in the chat room because it's a fantastic website that you can go to. And it's free. It's totally free. And you can do the modules, and they give you free CEUs. And you can take advantage of their modules that are really well done, have great questions, and great CEUs for you to have for your midwifery. And you're very, very welcome. I'm glad that you like the reference. Let me just see if I can see if there's any other questions here. Do any other education programs in the UK include oral health? If you're asking me, I'm not sure. And do NHS dentists look after pregnant women, or do they get turned away here? Yeah, I don't know that. Listen, I was speaking to a dentist the other day, and I asked him, he's a retired dentist. And I said, did you take care of pregnant women? And he said, absolutely not. I told him they could come back when they were done being pregnant. So I think the younger dentists now are thinking more about doing this. And I think you might want to refer to a dental school because the dental schools are going to have, of course, you're sending them for a cleaning and an evaluation. They don't have to have the work done there if they need work. But I think that it's a great place to go for a beginning visit. I know your student knows. Hi, Julia. You're welcome. We just see if there's any other questions. Julia, can you hear me? It's clear. Pardon me? Julia. Yeah. Julia? Yeah, hi. It's clear. It's a delicacy term. Hi, how are you? Hello, I'm fine. Thank you. How are you? Good, thank you. I'm very sorry about the technical issues at the start. But that was an excellent presentation. And I'm sure everybody enjoyed that. I think a lot of the questions that are coming through are more about the UK, which obviously you're not able to kind of answer for, but really inform us of an excellent presentation that you gave for Thank you very much. Well, thank you. Thank you. It was a pleasure to do it. Miles, for live or for healthy. Oh, the question we didn't answer, and that was from one of the students who asked whether or not diet had an effect on teeth. Maybe you should answer that one more for me. Yeah, so of course, diet does have, of course, an effect. And the thing is, is this. So a lot of us, and we like to encourage, are pregnant women to snack every couple of hours, right? That's the way they're going to get rid of their nausea and vomiting. But the problem is, is that we keep introducing those carbohydrates over and over and over again. And so we're just introducing the potential for the endotoxins to get started, and then the cytokines. So it does make a difference. It makes a difference how often. I mean, I think if I were a pregnant woman and she was going to eat every couple of hours, I'd say, listen, if you can carry a soft toothbrush around with you, it doesn't have to be a hard toothbrush, a soft toothbrush, and try to brush as often as you can throughout the day. Because we want you to eat every two hours or three hours. But we, and we want you to have good, healthy snacks. But even a good, healthy snack, even an apple, can create a cavity. So certainly the things that are going to have a higher carbohydrate, like candy or chocolate or something like that, it's going to have even more potential to create caries. The other thing that they like to recommend here in the state, the dentists like to recommend, and I'm not a huge fan of it myself, but they like to recommend xylitol gum. So gum that has xylitol in it, it kills the gram-negative bacteria. And so they say, if you can't brush, chew gum with xylitol. So let's see. Somebody was going off to floss. Good for you. I think Ella has a question about the gram-negative bacteria. Is it present in the mouth naturally? Yeah, well, there's hundreds of different types of bacteria in the mouth. So if someone were to swab your mouth right now, or even swab it after you get done brushing, there's bacteria there. So the problem is when you have the gingivitis, or enamel erosion, or periodontitis, that you have an opening to the systemic system. So if your gums are bleeding, then that's an opening to the systemic system. Just like if you can get gonorrhea through your system by orally. So I think that you have that opening to the system. And the gram-negative bacteria might be there, but it can't get into your system unless you have these oral conditions. That's the take-home message. So if we can get those gums healthy, then we can prevent the bacteria from going systemic. And xylitol, yes. Xylitol is a good product for some people. I think that too much xylitol has been associated with, if you're going to do tons of it, with memory loss and with, I think, one of the other side effects might be GI upset, those kinds of things. You know, anything that you put any kind of chemical you put into your body, I always worry about that. So I'm not so crazy about it. But let me see. Someone else is asking about the hormones of pregnancy. Well, that's a very good question. So the question is the hormones of pregnancy only cause problems if they are already dental problems or experiencing excessive nausea. Right, we keep telling pregnant women that bleeding gums are normal. And I would say to you that I think we need to challenge that. Is it normal? Are the hormones the things that are making gums bleed? If your gums were really healthy in the beginning and you're taking your prenatal vitamins and have a good diet, would your gums bleed? I just don't know that it's normal. I'm actually starting to really question whether it's normal or not. That is another great topic for research. I think some of the students are asking whether educators in the UK include dental health in their programmes. I mean, certainly, it's my university. I don't recall anything being taught, but Linda may correct me there. She may have been in first year. But it's really interesting to get it brought back into the limelight again. Is there anyone over in the UK who know if they all have had sustaining and dental care? The only thing that we teach, Claire, is that you shouldn't have dental work if you've got a cardiac condition or even a suspicion of a cardiac condition because of the risk of septic throughout the system. But no, I don't think we teach it. I can't remember ever seeing it on the timetable at all. It's really interesting as well. We're a bit out of date, obviously. Yes, absolutely. Does anyone else have any other questions for Julia? Lots of chat going on. Obviously, you don't teach it in Australia either. Yes, thank you. Michelle, thank you for correcting the website. I appreciate that. I'm sorry I had it a little shortened there. Oh, sorry, New Zealand. Can I ask Julia for the sake of the students if there are certain foods that are particularly good for suggesting to these women who suffer from nausea to keep that at bay that won't damage their teeth? Well, every single food that you put in your mouth has the potential to damage your teeth. So even the healthiest foods can damage your teeth like fresh fruit has carbohydrates. So in terms of pregnant moms with nausea and vomiting, our recommendations are to do small meals frequently, of course. And then the other things that we like to recommend are B vitamins, B6, 50 milligrams of B6, once in the morning and once at night. I think temperament oil is very helpful to carry around. I think anything mint is good. I like there's a, and I'm sorry I don't know the name of it, but the Chinese make a little ginger candy. Like it's a hard candy, which is fabulous also. So we do like small amounts of ginger or small amounts of mint can be very helpful for some women. And I think just a lot of small meals of whatever you can keep down. I mean, basically, we don't want them to go without eating. They're growing a baby. So to do as much as they can and then try to brush or carry a toothbrush around with them and just to try to keep their, if they eat, if they can brush. I mean, listen, I can remember gagging when I was pregnant also. Even the toothbrush would make me gag. So it's a difficult problem to approach, but it's one that we need to pay attention and just do the very best that we can with. Of course, everything that a pregnant woman puts in her mouth is making a baby. So of course you want the freshest, you want the most organic, you want fresh fruits and vegetables, good high quality proteins, whole grains. Those, I mean, that's really what we wanna promote as much as we can. And quite honestly, I'm gonna tell you if my pregnant mom comes to me and she says the only thing I can eat is potato chips, everything else makes me throw up. I'm gonna say, okay, enjoy the potato chips, but as soon as you can, switch off of those chips and get into something else. I hope that helps. Yeah, that was great, Julia. I think as well, in terms of education, probably getting in young. If people are more about mental hygiene from a young age as well, then hopefully it'll travel through their life. But unfortunately, I'm saying that sometimes you can save. More than healthy things. Good to be prepared for the information for all our ladies. Does anyone have any other questions for Julia? I'm just talking about the use of Popolis Insta. Are you a leader of that, Julia? It's a great comment, actually. I don't have much experience with Popolis tincture. It sounds like something to investigate for sure. And I appreciate that this can be different in different circumstances, different countries, different access to food. How many was asking Julia just about using coconut oil and slushing it around the mouth? Yeah, that's something that... I've never heard of that, but that's so interesting. That seems like an interesting approach. Which we're going to share what you teach at MidWife. Oh, yes. So let me... Yeah, I can tell you a little bit how we've incorporated it into the curriculum. So we start with that he-not. So right in health assessment, they learn how to do an oral health exam, and we also do an interprofessional education day where we'll have a dentist and a midwife and a doctor together in a room. And they're all doing, taking care of a different body system. And the dentist student will teach the midwifery student and the doctor how to do an oral exam and what they're looking for. So that's part of our health assessment. So you do that he-not as part of... Right from the very beginning when you're doing a head-to-toe assessment. Yeah, the he-not is really cool, right? I thought that's a very good... My dean came up with that, it's a great idea. And then we do... So we talk about oral health right from the very beginning in our gynecology courses and talking about adding questions about oral health to every... Even GYN visit. So you're asking questions about, well, diabetes and your kidneys and everything else. Why not ask? When was the last time you went to the dentist? So we want to just keep bringing it into people's minds. It's important to get your teeth cleaned too. That's another part of your health. The mouth is like a window to your health, right? So let's think about that a little bit. And then the other thing is during antipartum care, of course, again, we start to talk about oral care and making sure that all of our patients are going to see the dentist. So that's part of what our students have to do. When they write a note about seeing a patient, we look to make sure that each note includes either questions about oral health or that they've done an oral health exam. And you can learn how to do the oral health exam on the smilesforlifeforhealth.org. They will teach you right there in those modules. And they also have some great brochures that you can hand out that you can give out for adult health and for pregnancy care, oral health. So please explore that website a little bit. It's gonna be very helpful to you. And then the other thing that we do in terms of for the patients, when we're, or for the midwifery students, is that we fold it into the postpartum course also, because we want them to really, that's the time when you're sitting with a mother, you're talking to her about nursing, she's nursing the baby. You can, you have a few minutes then to inform her about how to take really good care of her baby's mouth, so that she can wipe the mouth out when she's done nursing, that she can make sure the baby gets to a dentist by year one, by the end of the first year, that she doesn't do the pacifier and food thing back and forth with the baby, that she doesn't chew the food for the baby. Some, I know in some cultures that moms wanna chew the food up and then give it to the baby, that's not a great thing to do. It's not a good thing for your baby. And so just incorporating that into our postpartum, our antipartum and our GYN courses, they really are the places where we bring it in the most. And we also have the students do, they also talk about it in primary care, in their primary care course, but we also have the students do make a brochure, and they make a brochure that's a health, pardon me, a health literacy oral health brochure to give out to their patients. So, and it has to be on a really health literate. They have to make sure it's on a fourth or fifth grade level and that it's not too complex and that they can give it out to all moms and they have to do it in two languages. So it really helps for them to be thinking about, we give them little assignments so that they're thinking about oral health. And I'm happy to, I'm gonna give you my address right now and you can, if any educators would like to contact me or ask me about curriculum, I'm happy to share any hints that I can give you. That's great, Celia. Fantastic. I'm just about to say we could share the knowledge with the educators that they think that the students would really enjoy and benefit from finding out about oral health and pregnancy. That's great. Does anyone else have any further questions for Julia as we come to a close? It's been, I don't think there's any more. So, can I just? Sorry, Julia. I'd just like to say to you that it's been my honor and a pleasure to be with you today. Thank you so much for this opportunity. Thank you, Julia. It's been a great presentation and we appreciate you coming to speak to us today. Thank you very much for all the useful information that you've given us. You're very welcome. You're very welcome. And happy International Lid-Wides Day, everyone. Oh, and you, Julia. Okay, Claire, are you done? I think that's springing. Oh, yep. Great. Can I go through the photo? Great mind, Glinda. Yeah, I'll go through the final in slides. So, thank you, Julia, again, for coming to speak today. It's been really great. I'm just going to turn off the record now if I can get any other comments.