Dental Health During COVID

July 13th 2020

Host Kimberly King joins Dr. Brian Davey to discuss Dental Health during Covid. Taking care of your teeth affects all parts of your body, and it's become a little more challenging these days. Learn how you can give yourself the best dental care and find out about a new treatment you may not have heard of. Dr. Davey is a fellow with the American Academy of Systemic Health and operates a dental practice in North San Diego, offering a comprehensive approach to patient healthcare. Tune in!

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00:00 Speaker 1: The advice and informational content does not necessarily represent the views of Mother's Market & Kitchen. Mother's recommends consulting your health professional for your personal medical condition.

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00:12 Kimberly King: Hello. I'm Kimberly King and welcome to the Mother's Market Podcast, a show dedicated to the truth, beauty, and goodness of the human condition. On today's show, taking care of your teeth affects all parts of your body, and it's become a little more challenging these days. We'll tell you how you can give yourself the best dental care, and share with you a new treatment you may not have heard of. And later we'll tell you what's going on around town. But first up, Dr. Brian Davey is a fellow with the American Academy of Systemic Health, and a Live Well San Diego partner. He operates a dental practice in north San Diego, and Dr. Davey is one of the first in the San Diego area to offer a comprehensive approach to patient healthcare, bridging the gap between medicine and dentistry. And I'm so excited to have you on today. We welcome to the Mother's Market Podcast. Dr. Davey, how are you?

01:00 Dr. Brian Davey: Thank you so much. I'm really excited to be here and get to share information with the community about the health of your mouth and how it affects the health of your body.

01:07 KK: Great. No time like the present. Today we're talking about getting back into dental safety, especially after COVID-19. So, that's one thing we're talking about, but I also wanna just be backing up, what is your mission and how did you get started?

01:24 DD: So my mission, along with my team, is to make San Diego the number one healthiest city in the US. And then we wanna accomplish that goal by educating the overall community, our dental colleagues, and even medicine, about the importance of the health of your mouth. And we know there's a lot of research that connects the health of your mouth, is directly connected to the health of your body. So a healthy mouth, especially now, supports a healthy immune system. And so that's what we're really just passionate about promoting good oral health in the community.

01:57 KK: Wonderful. I love that you're bridging this gap here and you're educating our community. So again, today we're talking about getting back into dental safety, and the health of going to the dentist, and really easing people's fears. So, let's talk a little bit about how you're doing this amid the Coronavirus, COVID-19 pandemic. It's made a lot of people afraid of going.

02:20 DD: Sure. And those concerns are really valid. And one of the reasons for being here today is I wanna help educate the community. The more information we have, the more we can start handling a lot of fears. So dentistry is now slowly re-opening, and it's definitely a safe place to be. Actually, MIT did a study and said, "Dentistry's the second safest place to go during the re-opening." And the reason for that is that we've put a lot of different steps in to help keep our patients safe, as well as our teams safe, 'cause that's our number one goal is safety. So, we've implemented pre-screening, so tele-dentistry. So, patients are gonna be getting a phone call two to three days before their appointment and going through a screening to make sure that they're healthy, and then when they arrive at the office, we're gonna go through the same screening as well. Every patient will come in and go through a hand-sanitizing protocol. They'll have their temperature taken, and assuming they are answering yes to all the proper questions, then they will be brought back to the room.

03:23 DD: And then we've reduced the capacity of the office to lessen the interaction. We've scheduled bigger gaps between patients so that the rooms can be thoroughly clean. You know, there's hand sanitizer at every turn in the whole office. Every left or right-hand turn, there's a hand-sanitizing station. Dental offices have also really upgraded their own personal protective equipment. Dentistry has always been at the forefront of universal precautions, so it wasn't a big jump for dentistry to move to this next level and so, we've upgraded. Obviously, everybody is wearing N95 masks. Anytime we're producing aerosols, face shields, head covers, disposable gowns, and all those are getting changed in between patients so that there's no cross-contamination.

04:12 KK: That is great. And you know, you told me a while ago that first and foremost, dentist offices have always been the cleanest, and now you're saying that with that MIT study that dentistry is the second healthiest place to go. But you're always aware and living in a clean environment.

04:29 DD: Sure. So we're obviously, we're operating in people's mouths, and there's always, historically been diseases that are at risk of transmission, going back into the '80s with HIV concerns, and that's when the blood-born pathogens, universal precautions came into play. And dentistry is definitely at the forefront of that. And then when the aerosol transmission came in with COVID, it wasn't easy, but it was a logical jump that we were gonna be able to mitigate these risks by implementing different protocols, as well as increasing our HVAC in the office, improving ventilation. Most dental offices have also have medical air purifiers in the rooms that filter out any aerosolized virus, as well. So it's down to 0.1 microns. And so in our rooms, every five minutes you're breathing brand new air.

05:27 KK: Which is... Yeah, that's amazing. And that's great that you've made that turn around. And thank you for pointing that out about your aerosol as well. What about your instruments and reducing the aerosols, and just how are you cleaning your instruments and getting that...

05:43 DD: That's actually not changed. All our instruments go through an ultrasonic bath before they get put into bags, and then they go through a high heat autoclave. So, that actually hasn't changed as far as what we're doing with our instruments, 'cause the COVID virus actually is easier to kill than a lot of other scary viruses that are out there, hepatitis, HIV, or even tuberculosis, which isn't a virus, but our... And every dental office has that system in place, and that is a safe way to keep the instruments clean. It's more the protocols have changed with... First off, we're screening... We're only seeing healthy patients. That's the first layer. And then when patients come in to the dental office, we also...

06:30 DD: The next layer is we have them rinse with hydrogen peroxide. So, if they were asymptomatic and they had COVID in their saliva, the hydrogen peroxide is now reducing the level of virus in their saliva. And then we brush on a periodontal gel, which is from para protect company. It's a 1.7% hydrogen peroxide gel that's slow release. We brush that all over their teeth and on their tongue and we wait five minutes. And so, now we have just ratcheted down the number of virus that could be in the saliva. All these protocols in place are just to continually lower the risk.

07:07 KK: What about doing self-care at home before we go to the dentist? What would you recommend?

07:13 DD: Sure. So obviously, we want patients brushing two times a day for two minutes and flossing their teeth. At home, you can use the... There's some over the counter products, a hydrogen peroxide rinse. We do know that COVID is susceptible to oxygenation, so hydrogen peroxide is one way to do that. The hard part at home is it takes five minutes of contact time to actually kill the virus. So it's pretty tough to gargle with [chuckle] hydrogen peroxide for five minutes.

07:45 KK: Oh, yeah. It's unfounded.

[chuckle]

07:47 DD: You know, frothy mouth, [chuckle] but it does help to do that. So that's something that you can do at home and also nasal saline rinse like with a neti pot, with a 3% saline solution is another way to help protect our nasal membranes in the back of our throat to help fight the COVID virus as well.

08:06 KK: And that's... Those are... That's great advice on that. You have a unique approach to the field of dentistry and I'd love for you to explain, because it matches with your... Obviously it's your passion, but you're marrying into the field of the medical.

08:21 DD: Sure.

08:21 KK: And also... And I'll remind you, but I also wanna talk about your training that you keep up on as well.

08:28 DD: Okay. Yeah, so we believe a healthy body starts with a disease free mouth. There's a lot of research that connects the health of your mouth to the health of your body. We know that 80% of Americans have some form of gum disease and that's what we're fighting. So, the bacteria in our mouth can travel through our body and our blood vessels and go to organs increasing our risks for heart attack, stroke, dementia, certain cancers, even making you more predisposed to diabetes. So there's a lot of connections to the bacteria in our mouth, physically traveling to different parts of our body and setting up inflammation. So having periodontal disease, it's an inflammatory disease and having gum disease can create systemic inflammation and systemic inflammation is the root cause of so many of our chronic illnesses in the US and these are preventable. So, we really wanna work with medicine to prevent the preventable.

09:31 KK: And I love that, because you tell other dentists through your training and the training that you're here to practice that same type of thought process where you really wanna make sure that we're telling... We're working with you as a dentist, but then you wanna work together with the medical community as well.

09:48 DD: Yeah, absolutely. People are more than teeth and gums, it's the whole person. You know there is... We wanna help educate our patients about proper nutrition, exercise, stress reduction, the quality of sleep. We see a lot of sleep disorders can show signs in the mouth. And so these are some different ways that we can tie in the health of your body and the health of your mouth altogether.

10:16 KK: Talk a little bit about those sleep disorders then. And I mean, everything that you're mentioning is that pathway. So you're talking about all these different diseases, you're talking about diabetes and Alzheimer's, but it can be discovered through your inflammation of your gums. Is that also discoverable for sleep apnea?

10:34 DD: Yeah. So there's a lot of signs that show up in your mouth. We spend most of my day in patients' mouths and after doing a lot of training in sleep apnea and sleep disorder breathing, certain signs just start to jump out at you, certain people, if you snore or you have sleep apnea at one point in the night, you're gonna be grinding your teeth. So when we see teeth grinding, that's one of the signs, tongue position. When we have people open their mouth and we see the position of their tongue or the size of their tongue and the amount of airway, 'cause you can look into the top part of somebody's airway. These are all signs that we see and then if we see those, it starts pointing us down a line of questioning to ask our patients about how they're sleeping, and their quality of sleep, their quantity of sleep. If their partner is elbowing them in the ribs all night long.

[chuckle]

11:29 KK: With snoring, right?

[chuckle]

11:30 DD: With snoring, but in America over 25 million Americans suffer from obstructive sleep apnea, and that's associated with...

11:37 KK: What?

11:41 DD: Diabetes, heart disease, high blood pressure, obesity, and even motor vehicle accidents. If you have untreated sleep apnea, you're four times more likely to be in a car crash.

11:50 KK: Wow. From falling asleep and not getting that quality.

11:52 DD: Yeah. So snoring is no laughing matter, everybody likes to joke or tease about their significant other and their snoring, but it's really no joke. It's a... It can be a deadly disease.

12:07 KK: And you know, I think that's an interesting point. I remember when my daughter had her wisdom teeth pulled and it was the first time in a line of questioning that he asked her about her sleeping patterns. And just for it to be discovered through the dentist, I never really thought about that, but that is your passion is to really look at all of these, whether it be sleep or diabetes. I know that you also ask your patients about their health history or their parents too. And I think that's so lost right now and it's so needed.

12:37 DD: Yeah. We're lucky in dentistry where we have the time that we can sit down with our patients and really go over their full medical history, asking them about anything they might have or had, or also has anybody in their family had these. 'Cause there's some genetic links to certain diseases and we wanna know about that as well. And we know that with Alzheimer's there's a genetic link, with heart disease there's a genetic link, about a third of the population actually has a gene that makes them increased risk for inflammation. So, in the same situations, they're gonna have more systemic inflammation. So, these are all important questions to be able to ask our patients so that we can prescribe appropriate care. So somebody might need more diligent hygiene visits on a more frequent basis and somebody who has no family history and squeaky clean and no history of any other systemic illness, they might be somebody that can go six months between their cleanings.

13:40 KK: Wow, I think that's great. What would you say to people who've been reluctant to go into the office setting and that have been really putting off their dental care?

13:48 DD: Sure. So first of all, just to validate their concerns, 'cause you know, we are in a pandemic and it's no joke. So their concerns about it are valid. It's more to reassure them, one, that dentistry isn't really elective. The health of your mouth, if you put off getting your routine cleanings, we see asymptomatic dental problems turn into dental emergencies. Right now, the last place you really wanna go in a pandemic is the emergency room. So the longer you put off asymptomatic problems, like you might know that you need some work done and people are afraid to come back to the dentist and they're pushing it off, you're actually increasing your risk for more significant health problems. And so, really educating the public that it is safe to go back to the dentist. We've put a lot of measures in to protect the patients and to protect our teams and that, you know, when... We wanna help prevent dental problems, especially periodontal disease. Right now, people haven't been in for a long time, we're seeing lots of patients coming back. Their gums are puffy and inflamed and they are bleeding when they're brushing or flossing, just 'cause they're so overdue for their hygiene.

15:01 KK: You know, and I was... So, I'm gonna ask you another question in a second, but of course, during the pandemic, so many people were at home or just trying to... Maybe just eating the wrong food, so you have a key role here [chuckle] to help us with our teeth, now can you help us lose weight too. How long can you go without a cleaning?

15:20 DD: So that's really case by case. So, the bacteria that cause gum disease, I always make the analogy of, it's kind of like an onion. 'Cause gum disease, the bacteria that cause it, create what's called biofilm. So, different layers of the onion start to be built up and after about three to four months, the bad bacteria start to invade and that's when you start having inflammation, systemic inflammation and bleeding and swelling of the gums. So, for people with the history of gum disease, they need to get their teeth and gums cleaned about every three to four months. If you're healthy and your gums are... You're not having any inflammation or bleeding then you can stretch it to six months. So, it's really case by case basis.

16:03 KK: What about... Again, going back to self-care, being home, flossing, and do you have any recommendations about how we can best floss to get rid of that gum build-up?

16:13 DD: Yeah, so a lot of times brushing and flossing is good, but it's not enough. There's some other... There's something called interdental picks. They look like little miniature Christmas trees, you can clean around your teeth. Most hygienists can help educate patients about different types and different over-the-counter products. There's another product called Perio Protect trays with a Perio Protect gel. It's probably one of the most effective ways of keeping a healthy mouth between hygiene visits.

16:39 KK: Yeah, that's interesting. And I wanna ask you when we come back about that Perio Protect... [chuckle] Anyway...

16:46 DD: Say that 10 times fast, [laughter] Perio Protect trays.

[laughter]

16:48 KK: The trays. When we come back. So, stay with us. This is great information. We'll have more. Stay tuned.

16:53 DD: Thank you very much.

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16:55 KK: Why not shop online and let Mother's have your order ready for you when you get to the store. Go online to mothersmarket.com and place your order today.

17:05 KK: Welcome back to the Mother's Market podcast. And we wanna remind you that if you missed any portion of today's show, you can find us on iTunes by searching Mother's Market or download this show from our website, mothersmarket.com. Click the link for podcast and listen to past shows, plus download our healthy recipes and money saving coupons. All available at mothersmarket.com.

17:27 KK: And now back to our interview with Dr. Brian Davey. And we're talking about going back to the dentist safely after COVID-19, Coronavirus, and you've been giving us some amazing information really about the health of your mouth, it starts with your health of your mouth. We just left off talking about those Perio Protect trays and gel that's... [chuckle] I still can't say it. But that protective trays what... Tell me about those.

17:49 DD: So, there's something called Perio Protect trays, they're a custom fit tray, people are pretty familiar with bleaching trays. So it's very similar to a bleaching tray except it's matched to your periodontal pocketing. So when you go to the hygienist and they measure the numbers and you hear them say two, three, four. I always call them golf scores, you want the numbers to be low.

18:08 KK: They're low, right.

18:09 DD: You don't want a lot of double bogies [chuckle] seeking in there. So these trays are custom fabricated and they match your gum pockets. And what you do is, we talked about the periodontal gel, it's a slow release hydrogen peroxide gel that you put in the trays and when you put the trays in, it pushes the hydrogen peroxide below your gums and what it does is, hydrogen peroxide breaks down to oxygen and water. Bad bacteria, the Gram-negative anaerobes and the spirochetes that are associated with disease, they're anaerobic. They don't like oxygen. So, we're oxygenating the pockets. The bad bacteria don't like it. Our normal healthy bacteria like it. And so, we're keeping a healthy population of the good bacteria and so that's... This is probably one of the only products that you can use between your hygiene visits that's gonna keep you as clean as the day you walked out of your dental visit to the next time you come in, so.

19:04 KK: And so just like 15 minutes a day or something that can...

19:06 DD: Yeah. Actually, thank you for saying that. It's not something you have to wear all night like a night guard and it's 15 minutes a day.

19:13 KK: And I heard there's a side effect but it's a good side effect.

19:16 DD: It has. Yeah. Unfortunately, all medicines have a side effect. This one, it does have a side effect. Your teeth are actually gonna get whiter.

19:23 KK: Oh, darn. [chuckle]

19:23 DD: You kinda about joke about it like... It does have a side effect. Your teeth are gonna get whiter. It's definitely noticeable and it's just really great to see patients come back from hygiene visits three or four months later and they have very little bleeding when we're examining their mouth and their gums are nice and pink and firm and patients just feel better.

19:48 KK: How much does something like that cost?

19:50 DD: The prices right now are a little bit lower because the company actually has a COVID relief pricing. So it's anywhere from $600 to $800 depending on where you are in the country or the state, and right now it's around $450.

20:04 KK: That in and of itself should get you back to the dentist because again, that's something you can do at home.

20:08 DD: Sure.

20:09 KK: And that's great.

20:11 DD: You mentioned patients... We talked a little bit about people are afraid to go back. Patients who... There's just a spectrum of fears out there. Some people are very, very low fear, and we call it the 10. So somebody who's very little fear about the virus and running around, going to everything that they can, they would be like a zero or a one. And somebody who's a 10 is somebody who's really just doesn't wanna come out of their house because they might have pre-existing conditions or they're just [20:42] ____. And wherever people are at, that's where they're at, and... But there are still ways that we can help those people. So, patients who are just not ready to come back to the office, we can actually mail them the Periogel, and they can brush that on at home, and that can help reduce the oral bacteria that causes a lot of problems until they're ready to come back to dentistry.

21:05 KK: And I think that's so great too, Doctor, because you are very upfront about how that Periogel is helping, or just ways to help at home, and you tell patients that aren't even your patients, or people that you're kind of... You're giving this great free information, to other dentists too and in the medical community.

21:25 DD: Yeah, absolutely. The more people that know how to keep their mouths healthy, it helps our community. And our community mission is to make San Diego the number one healthiest city. I can't do it by myself. And so I wanna share this information with as many dentists and patients and medical doctors, and it's gonna benefit the health of our community. We all know that health care costs are rising and that chronic illnesses, diabetes, heart disease, are on the rise. And they're the most debilitating of diseases as we get older. And people wanna enjoy their older years. You wanna have a healthy brain and a healthy heart so you can enjoy your grandkids and enjoy being in retirement. And so by preventing the preventable and lowering systemic inflammation, we're helping to support people's overall health so they can have a great life.

22:22 KK: I love that. We were just talking about some stats. Can you talk about diabetes and heart disease and how that relates to dentistry?

22:30 DD: Sure, so most of the research that we have the strongest connections with is in diabetes and gum disease. So we know that 95% of patients that have diabetes have some form of gum disease, and it's a vicious circle. So when your blood sugar is out of control with diabetes, it makes your gum disease worse. And when your gum disease is worse, it makes it harder to control your diabetes. But we have the ability to manage both diabetes and gum disease. But left unchecked, patients with diabetes and heart disease are two times more likely to die from a heart attack and four times more likely to die from a stroke. So it's pretty serious. And then even just like we were talking about health care costs in the US, one in five health care dollars are spent on caring people that have diabetes, and patients that have gum disease and diabetes... Untreated gum disease... Spend about $2,800 more dollars on health care than patients that have their gum disease controlled.

23:38 KK: Wow. And those are incredible numbers as well. It is true, it seems like everything's going up these days. What about... You mentioned it earlier about how that can also prevent hospital admissions as well.

23:51 DD: Right. So, there's been a number of studies that show periodontal treatment and heart disease lowers hospital admissions as well as patients with diabetes. In diabetes, it's like a 40% reduction in hospital admissions with diabetes-related complications when patients aren't controlling their gum disease.

24:12 KK: And again, people just don't normally think about that. It starts in your mouth and if you see that inflammation and then...

24:18 DD: It's one of the unfortunate, fortunate things about dental disease is that typically, it's to a patient, it's not painful till it gets to the end-stage disease. Also similar to high blood pressure, and heart attack or stroke, most of the time, people don't feel anything until they have an event. And so typically gum disease, if they're not visiting a dentist on a regular basis, they might not even know that they have gum disease. And for some reason, and just our culture, it's just, "Oh, I just have a little bit of bleeding when I brush or floss and that's okay." And it's the only part of our body that bleeds when we wash it and it's okay.

24:58 KK: That's really true. You really are flipping the script on what's out there about dentist... How we take care of our mouth. And I think what you're doing is amazing. You also keep in touch with the medical... The doctors of your patients, right? Do you just kinda let them know that you have opened that conversation?

25:17 DD: Right. Earlier, we talked about medical history. We do a very thorough medical history, and then we wanna know who their doctor is. And when we find something in their mouth, maybe we're concerned that they might have sleep apnea, we wanna communicate with their primary care doctor and let them know that. Or they're coming in and they've checked off that they have diabetes, and then we have a finding that they might have gum disease, we want to let their physician know that, "Hey, this patient also has gum disease and you've let us know that they have diabetes. We need to work together with this patient to inspire and motivate them to a healthier state."

25:55 KK: That's fantastic. And I think it's time to open up that relationship. Not every dentist does that but you do, you talk about it. You're a Live Well San Diego partner, and I think you're one of the only dentist...

26:07 DD: I think I'm the only private dental office, I know there's other dentist in the Live Well San Diego community, but I was the, I think, the first private dentist to partner with the county. Live Well San Diego's working to make San Diego a healthy, safe, thriving community, and it just tied into our mission to make San Diego the healthiest city. I'm hoping that Live Well San Diego adopts our goal to make San Diego the healthiest city in America.

26:35 KK: I hope so too. Give us some basic tips on brushing and flossing, how long, what type of tooth brush, how often? [26:42] ____ rinsing?

26:43 DD: Sure. So two minutes twice a day, and flossing once a day, that's the minimum. A lot of times people speed brush, and two minutes doesn't seem like a very long time. There's all kinds of apps on your phone, you can set a timer if you have, just in my opinion, the best brush that you can get is a Sonicare or any kind of ultrasonic toothbrush. So patients that come in that have that, typically, we see them cleaner and healthier than manual toothbrush. You can use a manual toothbrush as long as you're getting all the plaque off of your teeth every day, you could use pretty much anything. It's about disrupting the bacterial colonies in our mouth, and so whatever you can do to effectively remove it, that's what you should use. But a lot of us who are busy, maybe some of us think we're not the best brushers or flossers, so something like a Sonicare it's timed, and so you're kinda stuck there for two minutes once you hit the button, so...

27:47 KK: You gotta do it, yeah.

27:47 DD: You gotta do it. And then, of course flossing, if you're brushing your teeth and not flossing, it's like washing the roof of your car and the trunk of your car and the hood of your car, and you're leaving the doors dirty.

28:00 KK: I like that analogy, that's good. What about eating certain foods, or not eating certain foods, sodas? What about...

28:09 DD: Sure. Well in the US or pretty much everywhere these days, our food supply has so many hidden processed sugars in there. So if it comes in a box, a can or a bag, there's a good chance that somebody's added of some type of sugar. So we're getting exposed to a lot more sugars than we ever were, any type of sugar or they call it fermentable carbohydrates, so the people don't think of crackers or chips as something that has sugar. Your saliva actually has an enzyme that turn starch into sugar in your mouth before you even swallow it, so we call it fermentable carbohydrates, so we wanna limit that. It doesn't mean that you can't have a piece of candy or you can't have a cookie or a cracker from time to time, you just can't have them all day long. And sodas are also high in sugar and any carbonated beverage that breaks down to carbonic acid that's acidic, and so once again, it's not saying that you can't have a soda or you can't have a carbonated beverage, you just really should try and avoid having them all day long. If you're thirsty, drink water.

29:17 KK: Water, yeah.

29:18 DD: Most of us don't drink enough water as it is anyway.

29:22 KK: I was just gonna ask you about teas and coffees, the same thing...

29:24 DD: Yeah, same thing. It's everything in life in moderation, and sometimes including moderation.

29:34 KK: But your number one tip today on what we're talking about is don't be afraid to go back to the dentist, do all of the cleaning, everything. You're good to go, you're giving everyone a green light.

29:43 DD: Yeah, you know what? It's time to go back to the dentist. So if you've been putting it off, it's actually time to go back. Your oral health is very, very important. And like I said before is, during the pandemic, you want your immune system to be as robust as possible, if you encounter the virus, you have a robust immune system, you're gonna have the best chance of having a good outcome, and so a healthy mouth help support a healthy immune system.

30:08 KK: Perfect, this has been so interesting. Thank you so much for your time and some great advice, we really appreciate your knowledge and we look forward to having you on again. In the mean time, you can get more information on Dr. Davey, the website is dr.davey, it's D-A-V-E-Y, by the way.com. We look forward to your next visit.

30:25 DD: Thanks, Kimberly. Bye.

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30:28 KK: If you wanna learn more health information, please check out our Mother's in store guest speakers at mothersmarket.com. All seminars start at 6:30, and please be sure to go online to our events page and reserve your spot. Thanks for listening to the Mother's Market podcast, and for shopping at Mother's Market.

30:45 S1: The advice and informational content does not necessarily represent the views of Mother's Market and kitchen. Mother's recommends consulting your health professional for your personal medical condition.

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