Clear Aligners in General Dentistry: Opportunities and Challenges

If I see somebody with a periapical radiolucency, I'm going to send them to endo. If I see somebody that has a fractured amalgam and they fractured their tooth as well, then we're going to talk about how we're going to protect that tooth. And same thing with ortho. They may not go for it right away, but it is a conversation. I say, hey, I don't know if this is something you've ever considered, but because of XYZ, I would highly recommend for you to give some thought to clear aligners. Welcome to the Phil Klein Dental Podcast. Today we're talking about clear aligner therapy, and not from the orthodontist's perspective, but through the eyes of a general dentist. Our guest is Dr. Sheila Samaddar, one of the very first dentists to adopt Invisalign when it first came out. And since then, she's become internationally recognized and published by Invisalign for top case results year after year, and even landed a top 10 case with the American Academy of Clear Aligners. In fact, she's the most decorated clear aligner GP provider in the Washington, D.C. metro area. In our conversation, Dr. Samaddar shares how aligners have been a huge benefit to her practice, but she's also candid about the challenges, like getting patients to stay compliant and what to do when they don't. She also walks us through the key things every GP should know before diving into clear aligner therapy. Plus, some of her favorite products and tools that help her get the best results. So if you've been thinking about offering aligners in your practice, or you just want to pick up some real-world insights from one of the most experienced providers out there, you're going to love this episode. Before we bring in our guest, I do want to say that if you're enjoying these episodes and want to support the show, please follow us on Apple Podcasts or Spotify. You'll be the first to know about our new releases, and our entire production team will really appreciate it. Dr. Samaddar, welcome to the show. Thank you so much. Yeah, we really appreciate you being here and congratulations on being selected by your peers as a Washingtonian magazine top dentist for 2021. And I know you were selected several years. That's quite an accolade, especially coming from your peers. So I'm sure you're pretty happy about that. I am. It was quite the honor. Absolutely. Yeah. And this is interesting because we're talking to you about clear aligner therapy, which is obviously getting very popular. It continues to grow. It's certainly a boon for orthodontics for the simple reason that now there's so many more potential patients that are going to be in that chair, including patients in their 70s, which is just something we would never think was a possibility 20 years ago. So to begin this podcast episode, I want to ask you as a general dentist, from your perspective, what are some common misperceptions that dentists typically have when recommending clear aligner therapy to their patients? Well, I think the first thing is to back up a little bit because a lot of dentists don't even recommend clear liner therapy because I don't think they think it works. And there's a lot of reasons they probably think that. And we've all seen all kinds of failed cases regardless of the specialty. And the main thing is compliance. So when they're talking about ortho to their patients, they could think that potentially the patient isn't concerned about the function. They might just be concerned about aesthetics and they don't think that. they have any problem with aesthetics. Think about all the people that are like, oh, my top teeth look great. Nobody sees my bottom teeth. What you look like at the end is icing on the cake because what you're doing is you're lining your teeth up so you can access them to clean. You're lining your teeth up so you're not getting wear facets and infractions and all these incisal wear and chipping restorations in teeth. And I always tell people, that it's much less invasive to shift your teeth into a better position than to cut them down to fix them. And that's the whole thing with shifting your teeth is that if you do need substantial restorative work on the back end, you can actually prep a lot more conservatively because you are not having to create some sort of massive reduction in order to have porcelain that's not too, you know, you don't want to look like Bucky the beaver. You want to make things look aesthetic. Yeah. And I was going to ask you about the patient communication that goes on between you and the patient. Now, the first part of the question is, when you see some form of misalignment, do you recommend clear aligners to every patient that has pretty much under 70 or even a little bit over 70 that has crowding where you see that periodontal issues are either going on because they're having difficulty cleaning, the occlusion is not... ideal by any means and that's causing like you said where facets and fractions is that communication where you just talk to them alone or Do you use the scan and then show them what Invisalign will actually produce? Absolutely the visual as you know is worth a gazillion words and some people just have no idea How bad their bite is or how bad their crowding is and when you can show them on the scan that it's got the red markings where they're hitting really heavy or they can see from year to year. We scan people every year where they've had soft tissue loss or they've had incisal loss or they've had chipping, things that they didn't have prior or their shifting has gotten substantially worse. So I talk about... ortho, just like I talk about any other specialty. If I see somebody with a periapical radiolucency, I'm going to send them to endo. If I see somebody that has a fractured amalgam and they fractured their tooth as well, then we're going to talk about how we're going to protect that tooth. And same thing with ortho. They may not go for it right away, but it is a conversation. I say, hey, I don't know if this is something you've ever considered, but because of XYZ, I would highly recommend for you to give some thought to clear aligners. When you got into this in the beginning, and you got in very early, we talked about this offline, what drove you to clear aligner therapy versus other specialties that you could have, like sleep disorder, sleep apnea, or pediatric sleep obstruction is now becoming more and more popular? And there's a lot of things you could do as kind of like a subspecialty of general dentistry. But you really, you were very attracted to the clear aligner category. Tell us why. Well, that was very early in my career when I was two years out of school and one year out of my residency. That's when they first offered in this line training to GPs. And I took the very first class that you could take in Washington, D.C. And that was in 2002. So I'm aging myself a little bit. But I had done a ton of surgery. My residency, I showed up and they said that they didn't have a GPR anymore. We were all going to be surgery interns. And so I was forced into doing oral surgery for a year. And that was exciting. And I'm being very facetious about that. And then I went from there to a maxi course in implant training. And I got into it. And then I was like, you know what? I don't really like this. So as much education as I had in that area, I don't do implants at all anymore. I do some surgery. And I'm really good at it. But I started really started looking at the other areas and was just really trying to find my way and see what I liked and see what stuck. And I loved the minimally invasive nature of the ortho. And you know how it is. dental school, you don't really learn a lot. Like I think I took one tooth out that was periodontally involved and another tooth I took out, my instructor pushed my hand while I was, you know, elevating. And so you don't really learn a lot. So if you want to dive into an area outside of dental school and really increase your knowledge, you've got to do a lot more classes. So that is the way to really see what you like and you're going to make mistakes, right? But I think that's what did it for me. I loved the cosmetic. But also just knowing that I could help somebody, even if they didn't do anything restoratively after ortho, that they could. really make a difference with how their teeth would last them and hopefully last them for life. Now, when you do this orthodontic treatment on these patients, do you find that you're moving right into whitening? Because they say, wow, my teeth are so much straighter now. I really like my smile, but they're yellow or they're discolored. So now you're moving into the whitening. That should almost be part of the deal when you do the... Clear aligner therapy. I actually throw that in. Yeah, you're probably right. So they're whitening their teeth as they have the trays in. And the other thing is on top of the whitening, do you find yourself doing more restorative work post-orthotherapy? So once those teeth are aligned, the patient sees, you know, that they're not 100% perfect as far as the way they look, although they're aligned. Maybe I can get some cosmetic dentistry done on top of this. Well, the interesting thing is with digital dentistry, there's things you can do. while the ortho's in progress. Because sometimes they've got broken teeth, but they also want to start ortho. So we can sort of do things in conjunction. I do a lot of digital dentistry. Most of my crowns are CERAX, except for anteriors. I do like to send that to a really highly specialized lab. But we will do things. so that we can actually mimic the shape of the tooth and so they can be doing things while we're moving along. But yes, depending on what they need or what their aspirations are for their smiles, then yes, it does lead to restorative and cosmetic options on the back end. Yeah. And we'll talk more about some of the compliance issues with clear aligners later on in this episode. But I do want to ask you about your favorite products and tools when doing clear aligners. Tell us about that. probably five bread and butter tools that I like. I have one handpiece that is an IPR handpiece, an interproximal reduction handpiece. that I don't even think is on the market anymore. So I was telling somebody the other day, you better look on eBay and snap it up. But Dentsply makes a great IPR handpiece. I have no idea why they stopped making it. I love my NSK electric handpiece. 799L just came out. It's super lightweight. And depending on how many rounds of ortho you have, there's a lot of on and off with the attachments. And pushing on that, you know, anytime we're using our hands, you know, right? So I really am trying to protect. my hands. So the electric hand pieces just give so much power and they're lightweight and they just really help me zip off these attachments and buff the teeth so that we can scan for new trays or retainers when we're ready. I also love pull tools. There are little hooks with circles on them and there's a bite tab so you can actually tap down and bite and really lock your aligners into place. And that's very, very important because if the aligners aren't properly engaged with the teeth and with the then you're not being as efficient as you could be with your movement. And what I also love is a product that works so that I don't have to worry about my attachments coming off, and that's the All Bond from Bisco. And I can't tell you how crucial that is because when I first started doing aligners, The attachments would come off if somebody bit into something, if they're eating candy or crunchy or something they shouldn't be doing, if they are really rough on the way they're taking their aligners in and out and they're just, instead of using an actual technique, they're just sort of jamming things up and down or they're biting into their trays. So the Bisco bond is the best bond that I have found for aligners to stay. intact with the attachments really adhering to the teeth. And, you know, it's a typical, what we do, you know, you etch and then you bond and you have to make sure you scrub your bond in so that it really, you know, has that chemical engagement and then light cure it before you put your attachments on. And I have been so thrilled actually that I've been using that because nobody wants to have their patients come in with four lost attachments two days after you did it or the same day that you did it. And I haven't lost any attachments. So the last tool that I really like, Invisalign, the company, sells detail pliers on their website. And they're little, they're just, I mean, they're pliers like you've seen, but they've got little dots in them. So you can actually put indentations in the trays and rotate the teeth. I'll put something on the mesiofacial and on the distal lingual to try to give a little extra push. Because one of the big misconceptions with Invisalign or any clear aligners is that you can just put them in tray after tray after tray. I have found that if you don't intervene and start doing a little direction, yourself in the tray you could just be ordering set after set after set and it just gets old and i don't think the patient or we are really that excited about just indefinite trays yeah for sure i do want to ask you about the interproximal the ipr handpiece how is that handpiece different than any other handpiece that you mentioned you may have to buy on ebay and what about strips diamond strips where they're already pre-calibrated let's say you want to remove 0.03 millimeters at tray seven. So the patient comes in after the seventh week or whatever, the assistant could do it, the dentist can do it, and they can just use these strips. And then when those strips are finished, they know they just reduced according to plan. Is that more precise than a handpiece? Well, I don't know what you're allowed to do in your state, but nobody can touch the patient like that in our state. Only the licensed dentist can do the... the reduction, anything that's potentially irreversible. But what fits into this IPR handpiece are the space files, the dent supply cells. It's a little case and it comes with in specific order how you start. And they are numbered so that you know what your millimeter measurements are. And I like the handpiece much better because I've tried everything. Um, I've seen people use the discs. I've seen people use the little ones where you're, you know, and the thing is, is like there's strips and there's the little like quick strips though, this little oval one with the little. friction on the side to reduce but I started using those and I thought my hand was going to fall off and it goes back to again protecting my hands because I would like to practice dentistry as long as I'm able to and as long as I want to and stay on my terms not being forced out because of a hand injury or a neck or a back injury. And I found that those manual ones really just do so much wear and tear. And it's great that they're pre-measured, but perhaps if you're just getting in for like a quick thing, that's fine. But I wouldn't do all my IPR for a case with something. like that and then with the discs and some people use burrs i mean the the chance of gouging teeth is so high and then what are you going to do what are you telling your patient when they got looks like huge nick in their tooth oops sorry yeah absolutely ipr ipr is a sensitive technique and yes yeah using a tapered diamond burrs is scary oh yeah um agree so what are some of the biggest challenges you face during treatment and how do you overcome them typically as a GP? Well... A lot of people think that they can wear their aligners, finish treatment, and then take them off and never have to wear them again. So you really have to set up the expectations from the very beginning. I tell people that when you did ortho as a kid, your orthodontist told you that you had to wear retainers for a year or two, and then you're gone. You're out of there. The problem is that these orthodontists never saw anybody again. So now we're seeing everybody that has all this relapse and the subsequent damage from the relapsed teeth. So I tell people from the very beginning, if you are not planning to wear retainers for the rest of your life, I would not even waste your time to start the ortho because it's just like doing bariatric surgery. You can't lose 90 pounds and then go back to eating Cheetos and cheesecake. You have to make some changes about what you're going to do. So that is a misconception. The amount of time that you need to wear the trays is a misconception. I had a patient who wore them five hours a night. I guess that's all she slept. And she was like, I'm just really upset. My teeth aren't shifting. And I'm like, you're not wearing your aligners. It's like telling you you ate one extra carrot or something. What are we looking at? 20 to 22 hours a day is what's expected? It is expected, but I do even feel that if you're getting 16 or 17 hours, you know, and I'm talking every minute that you can, as soon as you're done with dinner, pop those babies in and then leave them, you know, brush your teeth in the morning, put them right back in until you have your coffee, brush your teeth, put them back in. You know, I just, even if you're getting like a half an hour and squeezing a little time here and here and. Um, I think just every little bit that you can get makes a difference. Yeah. And a lot of people are worried about, you know, in DC, a lot of people are on TV and a lot of people are on zoom calls and doing, you know, a lot of face forward. um, interviews and whatnot. And so they're always concerned about if somebody is going to be able to see their, or the lisp, the sound. Exactly. Exactly. But I don't have a problem if somebody has got a 20 minute call and they pop their stuff out and then they just put them right back in. It's just when you pop them out and you forget for five hours, then that's a problem. Right. And when that happens, the teeth are actually moving back to the position. Well, exactly. They're just relapsing. They want to go back to where they were moved from. Absolutely. And that's terrible, right? Because now you've got this big wiggle space where nothing is stable and you're just destroying bone. So when you have a really good patient who's very compliant and they're tracking, then... you're you're like free sailing through this whole case right you take a look whenever they come in what is it every five to six weeks and then you just what do you do with those evaluation let's talk about the perfect patient and then we'll i'm going to ask you about the patient that isn't so compliant okay it depends on the patient a lot of my folks travel all the time internationally and sometimes they can't get in so sometimes we'll do stuff over zoom or facetime and Sometimes they'll send me photos, but what we'll do is I'll look at the spacing. If there's areas that are in need of rotation, I want to make sure that I can floss in there and I'm not getting any friction with the contact area. I want to see how they're seating. I want to make sure that the teeth are all the way to the bottom of the trays. Because again, if they are gapping a little bit, then yes, you'll be moving, but it may not be efficient. And if you're not walking in with the attachments, then again, the trays aren't gripping properly and they're not really able to grab the teeth. I've definitely made my mistakes. I have done cases where I have not put attachments on people. I mean, that was many years ago at this point, 10, 15, who knows how many years, but they worked, but it just took a long time. So if you do all the little rules that you're supposed to do, then it works. You can take a few shortcuts, but again, if you're trying to get out of your aligners, you gotta, you gotta do the work, you know, just like you gotta, you know, you can't have nice biceps without doing any pushups or curls, right? You gotta, you gotta, you gotta go to the gym. So let's talk about the patient who is on tray nine, for instance, and they can't get it in their mouth. And they come to you and they say, oh, I've been wearing it. I've been wearing it. But you know very well that they're not wearing it the way they're supposed to. How do you manage that patient? I really have a come to Jesus moment with them. I'm like, look, we can stop right here. We can keep going. You have to decide. I can't come home with you every night and put this thing in your mouth. No wonder you're a dentist. You're the top dentist in Washington, D.C., and people fly all over the country. They love that. Yeah, go ahead. You'd be my dentist any day. I'm very charming when I'm berating people. Yeah, I love it. No, keep going. I didn't mean to interrupt you. No, not at all. I mean, I'm just very clear with them. I'm like, look, I want you to be successful. You want something. I want something. But I cannot want it more than you want it for yourself, right? And so if you're not doing the work, I can't help you with your results. And I just really try to be very clear with them. a lot of people I have a lot of people stopping and starting and it's frustrating and I think I mean do you lose patients when you have that approach which I absolutely admire I think that approach is very candid and genuine and you're their doctor this is the way it is this is the reality um you know you're fibbing to me you're telling me you're wearing them but I know you're not wearing them so when you how many literally stop and and that's the end of it they don't continue and how many come to a real understanding that, okay, I need to buckle down here and I need to be compliant because otherwise we're both wasting our time. I mean, I think 98% of the people really want to do it. So they keep going. I mean, sometimes people will get deployed or they'll go, you know, have like a foreign service situation where they're gone. And when they're in town, they'll come and they'll check in. There are people that start and stop. And I do tell them, I'm like, look, you're potentially really doing damage because you're not doing this. You should just do it and get done with it. And then we retain it. And sometimes when I just really verbalize it, they understand. And they're like, OK, let's do this because I don't want to keep doing this until I'm 99 years old. So I think just being you can you can say these things and be kind, but be very clear. Because you want them to succeed. And honestly, if you're doing an Invisalign case for six years, you've paid the patient to do Invisalign or whatever clear aligner product at this point. Because the chair time that you've wasted, the number of times you've sent off scans to get new sets of trays and then you fit them in and then you're checking them. I mean, it's time consuming. It can be a great product. The clear aligner therapy can be a great product. everybody stays on track. The more appointments you have, then your expenses just go up because you're using more composite and the chair time and the disposables and all that. So being as efficient as possible is good for everybody. When you figure out that the patient that you're trying to do clear aligners on and you're trying to sell them this case, you realize during that conversation that they're not going to be compliant. prefer not to go forward with it right then and there and maybe just refer them to an orthodontist to get typical brackets and wire because you don't need much compliance with that no not at all but when you're an adult you know you don't want to wear brackets and wire so how do you handle that do you rather just punt and not treat that person at all or try to work through it at least in the beginning to see if they can get compliant i have no problem referring to an orthodontist i have several that i work with in town that are just tops and I do present that as an option. And yes, you're correct. Nobody wants to wear brackets and wires, especially if they've got a job where they're in the public. And a lot of them will choose to stay and go through it. And if they tell me they're going to do it, I can't say, I don't believe you. Right. But no, but if you detect that, if they say I'm really not the compliant type, my personality, I'm traveling, I do things, I'm haphazard, I lose my keys all the time, I'm sure I'm going to leave my trays in the restaurant. When you have that discussion with those patients, do you try to talk them into doing it? Because it does require a lot of compliance for this to work. What I usually will say is when your schedule changes or when you're not traveling as much, then we can consider doing it then. Or if you are moving or whatever it is, I can find names of people that I would recommend in whatever town, especially if you're going to be gone for two years, then you find somebody in Prague. Who's going to do your Invisalign? I mean... Prague is a beautiful city. I mean, I joke about this, but I mean... It's cheaper. Prague is cheaper. To do this. And I'm just like, well, I'm sorry you're in Bulgaria. What do you want me to do? Let me ask you about the impact on practice growth and revenue. Talk about a dentist who's out five years. They're busy getting their practice going. It's starting to grow. They're thinking about Invisalign. They don't have the confidence on the ortho side. So they take the CE courses, they get the training. And then over time, they start integrating clear line of therapy services into their practice. Will this become a major revenue center for that practice? Generally speaking, what's the impact? Of course, it's all individual. It depends on how many cases. They do, but through your experience as a GP, what are you finding your colleagues seeing as far as revenue growth from adding clear aligner services to their practice? Doing clear aligners can be a huge, huge, huge contribution to your bottom line. But the thing is, though, as we just spoke about, if... you are treating people that either you're not capable of treating, your expertise is not there yet, or they're not going to be compliant, you're going to be spending a lot of money working with them and not necessarily reaping the benefits. So I would make sure that they're picking cases that are adequate for their skill level until they do more and they really understand the nuts and bolts of how everything works or not doing them at all, like you said. If done properly, and again, all these classes, whether you're taking surgery or endo or perio or whatever you're doing, you're going to learn more the more you take continuing education. And you cannot expect to take one class and be a clear aligner guru. You're going to have to take many, many classes. And it can be a huge, huge, huge. I mean, I think people are fooled because, oh, I can make six grand. seven grand, whatever it is, on whatever you're charging for your clear aligner cases. And it sounds really great, but the lab work is $2,000. And then you're talking about each appointment where you're using all these components. We talked about the bond and we're using flowable or packable composite and retractors and all these things. And the IPR and the burrs get dull and all these different things. And staff, just the staff costs. Exactly, exactly. And if you're really thinking about that chunk of money versus what it's going to cost you if you don't finish the case in a timely manner, then it's not going to be as... financially successful as it seems that it would be. And with that education, I think the general dentist needs to understand and learn how much intervention is necessary to keep that case successful. So the misconception of like, okay, I scan this thing, Invisalign sends me, you know, the first 26 trays or whatever, how it works. And then they start putting these trays in and I just come in and say hello to the patient and ask them how their kid did at Little League and I'm so happy they won their football game or whatever and sent them on home. It's not quite like that. There's intervention involved. So tell us about like to what extent should a GP expect to be actually doing things during that whole aligner therapy process? At the very beginning, it is pretty easy because you're just making sure they've got enough space, that you've either created enough space or they had enough space to start with, that their trays are seeding, that it looks like they're wearing, that the teeth are actually shifting, that there's not a gap between the incisals and the end of the tray. And then as you go along, you might start to see a few teeth that aren't tracking. Or believe it or not, I've had somebody come in and the tray was half out of the mouth. And I thought to myself, at what point would you think that you should come see me if your tray is not even in your mouth? Like it's, it's seating. Did they laugh? Did they laugh when you said that? They were so serious. And I thought, holy cow. I mean, like this person is running the government. Like I'm kind of freaking out here. Did your staff laugh when you said that? I mean, look, we've been in dentistry a long time. Oh, they've heard these lines from you, so they're used to it. I mean, I think we just shake our heads sometimes. Like, are you trying to, you know, are you trying to be successful or are you just really trying to shoot yourself? Yeah, and just for our audience, I want to make it clear that Dr. Samaddar works in D.C., the metro area, so she treats a lot of government personnel. So that's why she mentioned is the government. But we know all about how the government's being run. yeah so we we all know about that but i'm glad you threw that in there um so uh what we you i lost the train of thought what was what was the actual question i asked oh how much intervention right so much intervention so when the so in the in that extreme example where the tray was half out of the mouth That's obvious. But in general, GPs have to understand that it's not like scan, get the trays and put them in and then collect the money. Like you're saying, unless you really understand all the ramifications of what we're doing here with a procedure that is so compliant, dependent in order to have successful clinical outcomes, you're going to be in for a lot of surprises when these things aren't going to track well. potentially unpleasant ones because people are going to be upset and you're going to be upset. And I think. One mistake that I learned that we did talk about prior was that I found out very quickly that you can't just order set after set after set of trays and just expect, okay, we're going to go through one through 26 and then I'll see you and then we'll see what happens. And the trays are not going to be fitting. There's going to be a lot I can guarantee if you're not staying on top of these folks, you're going to be seeing some issues. And that's why I had mentioned the detail pliers. I love to really be on top of the treatment, if you will, because I don't. The more things go off track, the longer it's going to take us to get done with the case. What do you do with the pliers exactly? There are detail pliers that you can buy for ortho. And if a tooth, for example, needs to be brought out facially or pushed in lingually or rotated, sometimes I'll put a button mesiofacial and distal lingual and try to give some torque to the tooth, just a little extra pressure, just to help move things along. Because, again, some of those teeth, if they don't have attachments, the trays are not going to have anything to grip. And then you're sort of just hoping you're just waving a magic wand or some unicorn is going to come and flip that tooth around for you. And that's not very often. But again, you have to make sure you've got the space. Otherwise, you're just putting pressure on the teeth and they're just going to hurt for no reason. So as we approach the bottom of this podcast, I do want to ask you, what do you see in the future regarding the growth of clear aligner therapy among GPs? I think it's going to continue to grow. It's such a nice... minimally invasive way to achieve a lot of different things and I think if we have the compliance from folks I mean you know adults who won't be compliant you know kids who will be so it depends on the individual and I think there's a lot of room for the growth of clear aligners because a lot of people have malocclusions. I mean, I think they said, what, 65, 70% of Americans, for example, have malocclusions. So it's not going to be for everybody. It's not going to correct everything. There are some things that surgery or traditional ortho are going to be better suited for, but many things can be done with clear aligners. And I think it's very exciting that we have an option that we can put in our pocket to further benefit our patients. So as a final question before we wrap up this podcast, and it's been very enlightening, I do want to ask you about the age range of patients that you're treating with Invisalign. What's the general range from the youngest to oldest? I prefer not to see... Kids that are too young, I won't see kids younger than 12 for clear aligners. I know some people do expansion with aligners, and I would prefer the orthodontist do that. But again, I have kids that are young teens all the way up to, I've had multiple ladies over the age of 70 do Invisalign. it's for every age. Folks that are in their 70s don't think that they're going to die tomorrow. You know, back when we were kids, when you're 55, you're like, oh my God, you're so old. How are you even like alive? But now people are living well into their 80s and 90s. And if you're 70 and you think you've got another good 20, 25 years and you feel great, you're going to do what you need to do for your health because you want to keep your teeth. Yeah, no, absolutely. I think it's a great thing. Hats off to the 70-year-olds that are doing that, especially for their perio, for their self-esteem. Absolutely. They socialize and people 70 socialize more than people that are 30 sometimes. They do. They have organizations they're members of. They smile and they want to feel good. And they're very fortunate to have a dentist like you, Dr. Samaddar, to give them that opportunity to have that beautiful smile. Thank you very much. I hope you continue to be the dentist of the year in D.C. Thank you so much. Yeah, I really hope you come on the show again and talk to us about how you're doing over there because it's great input, really great input. Thank you so much. Have a great evening. Thank you so much. Appreciate you having me.