From Disease to Remission: A New Framework for Periodontal Care

We're all struggling with clinical attachment level, clinical attachment loss, and the AI shows you exactly what that clinical attachment loss is in numbers, in percentages, and wow, wow. In a couple of years, that's going to be standard, in my opinion, in every practice, and it's going to take that guesswork out. Welcome to Austin, Texas, and welcome to the Phil Klein Dental Podcast. Periodontal disease has traditionally been framed as something we control or maintain. But what if that mindset is already outdated? Today's conversation challenges the idea that stable is good enough. Instead, we're exploring a more precise, more proactive benchmark in periodontal care, remission. What does it really mean to move a patient out of active disease? And more importantly, how do we keep them there? In this episode, we'll dig into how precision assessment is reshaping periodontal diagnosis and monitoring, including the role of clinical attachment level, and how periodontists use this metric to assess disease progression and accurately record periodontal status over time. We'll also unpack the updated periodontal classifications, specifically staging and grading. and why these frameworks matter not just academically, but clinically in everyday decision-making. We'll explore how periodontal classifications should align more closely with the way medicine classifies and manages other chronic systemic diseases, and why that alignment is critical for interdisciplinary communication, risk assessment, and long-term patient care. And we'll also discuss how AI is helping clinicians better visualize and understand perio disease, enhancing classification, improving diagnostic consistency, and supporting more precise individualized treatment planning. Along the way, we'll examine why microbial balance, not bacterial eradication, is becoming central to treatment planning. and how personalized, patient-centered home care strategies often determine long-term success far beyond the operatory. So this is a forward-looking discussion about redefining periodontal outcomes, improving patient engagement, and elevating how we think about chronic disease management in everyday practice. Our guest today is Marianne Dryer. She is a registered dental hygienist with a master's in education, an international speaker, published author, and Program Director of Dental Hygiene at Cape Cod Community College in Massachusetts. 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. Marianne, it's great to have you on the show. Hi, Phil. I'm thrilled to be here. You know, you built one of the most trusted platforms in dental education. Very excited to be here to speak with you today. Certainly appreciate the nice words, Marianne. It's always nice to start an episode with that. But I do want to say that it's our guests that are making this show trustworthy and relevant. And the key thing is getting the right guests and talking about timely issues in dentistry. And we've tried to do that. And thank you again for the nice words. So to begin this episode, I want to ask you about something you talk about often. and that is periodontal remission. And you use that term as a new benchmark in periodontics. So tell us what remission actually looks like periodontally and why you think it's a more meaningful target today than just saying a patient is periodontally stable. I began speaking on the AAP classifications way back in 2019. I was asked to do some presentations. And I said, sure, sure. And I looked into the new classification system and I was very overwhelmed. And I think most clinicians, when it rolled out after the Chicago workshop, were overwhelmed. And I think sometimes we're not diving into it because of the depth of it, frankly. The system hadn't been updated in 20 years to that level. So I really enjoyed speaking on the classifications. I still do. It's one of my main subjects. And what most attracted me to it was the medical nomenclature. It was the sense that you are now going to be able to quantify risk factors and to talk about a prognosis, which in dental hygiene, we don't always speak about. And after a year or two, I just intuitively started using the term remission because we talk about stages. We talk about stage three periodontitis. And, you know, I think the patients get that. They understand it better. The medical community understands what we're talking about. So it was a natural phrase. I'm not sure I started that, but I think it's powerful. And I think that patients want to be in remission versus. They want to be stable. There's more concreteness to it. And really, it's about making sure that the patient is bleeding very little, that the pocket depths are controlled. There's no progressive attachment loss. And it's also about a patient that can maintain this over time. So it's not just a snapshot of that day. Are they slipping? Are the pockets getting deeper, per se? It's about quantifying and being able to measure. the fact that this patient is in fact in remission. And I think that's something for the patient to strive for. I think it's motivating for them too. Just curious, Marianne, when was the last time periodontal classifications were comprehensively updated for the dental community to abide by? The full classification update was 1999, which was well over 20 years ago. So when they got together in Chicago for that workshop, they had a lot of work to do. And they broke up into six groups and each group took, one took mucositis, one took gingivitis, which is very interesting. It really redefined the parameters and allowed us to speak to disease in a whole different way. When were those revisions made to perioclassifications that you're talking about where they broke up into groups? What year was that? it was completed in 2017 in chicago and and i also want to say that this is not just aap this was the efp um very much involved the european federation of appario because it is a global system if you will it's made for portability and for um statistics etc so it was a global incentive and and we can now say to our patients This is evidence-based. You are a stage three, and we know that from 20 years of research. And, you know, they looked at meta-analysis, systematic reviews. It was a very in-depth project that was put together. I just hope more people start using it. The graduates are certainly coming out speaking staging and grading. So the seasoned clinicians need to get on board. So do you think that this new classification is simplified to the point where communication with the patient is a lot more reasonable, where they will understand what's going on? Because when anything is too complicated, the process kind of gets held up. in complexity. And when you simplify something, and it doesn't matter what vertical you're in, then the information could be transferred to the patient so that something could happen. You know, a meaningful result could come out of classifying, because again, it's not a diagnosis, and it's not implementation, it's just a classification. So by simplifying that classification, that's a good start, right? Yes, I think you're spot on, very well put. And I often say to the audience, if you look at the 1999 system, which I put up on the screen, it looks like a menu from the Cheesecake Factory. There are so many choices. You can see why clinicians weren't even using that rendition. They were using classifications from the insurance companies. So this is an absolutely simplified, streamlined. get to the decision quicker, and the communication comes out of it so much better. So for clinicians trained in the traditional periodontal classifications, whether they adhere to it or not, maybe they use the insurance classifications like you mentioned, what kind of mindset shift has to happen to move from simply managing disease to actually measuring and maintaining what you're now calling periodontal remission? It's a great question. And again, I speak to audiences that have very seasoned clinicians. And I think it's important to note that the graduates over the past two years are coming out talking, staging, and grading. And that doesn't necessarily mean everyone has to conform. But at the end of the day, it's the direction that we need to go in. And I'll use this as an example. Dr. William Giannobel, I'm sure you're familiar with him now. over at harvard he pointed out back in 2012 that right now we are diagnosing periodontal disease with a metal stick and 2d imaging and at that point we're down the pike and so the brilliance of of his statement back then was you know let's use salivary diagnostics let's use different technologies biomarkers etc So we can start diagnosing this before it becomes periodontitis, pre-diabetes, pre-heart disease, pre-cancer. We need that in dentistry. And what that pre is in dentistry is gingivitis. Gingivitis is the pre. to the periodontitis. And we need to diagnose that with more seriousness and more mindfulness so that we can not slide into that periodontitis. Right. Because obviously gingivitis is going to come first. But one of the issues, and we'll get to this later, is that when you see a loss of periodontium, you immediately assume there's periodontitis involved. When in fact, that loss of periodontium could be a history of... periodontal surgery from 15 years ago and the patient didn't even really know what was being done to them so they can't really communicate that to the hygienist and say yeah they did an apically positioned flapped and they did some bone reed contouring and they don't they don't know so the new hygienist who's who's relatively young doesn't may not have a ton of experience or even maybe an experienced one might look at the bone loss and then match that up with the bleeding and saying this person is actively involved with periodontitis when in fact they're not. It's very important to make that distinction because you treat these patients differently because treating patients for gingivitis with bone loss or attachment that's in remission is different than treating active periodontitis. So I hope that made sense and I just didn't confuse everyone. No, you're absolutely spot on. And I think that was a real light bulb. And that's part of the light bulb that comes out in these presentations that, you know, when somebody comes back for their maintenance appointment and you are probing and you're seeing bleeding or even an increase in the pocket depth. does not mean that the clinical attachment level has gotten worse. It could mean that the tissue is simply inflamed and you're dealing with gingivitis on a reduced periodontum. And as you said, we can have reduced periodontium from occlusal trauma. There can be reasons why that periodontium is reduced, but we don't just automatically go back in in SRP. And, you know, that's being mindful of using the correct treatment plan. And that's what this system really helps with, because we certainly don't want to over-treat. But frankly, what we're doing right now is under-treating. And we often hear about the bloody pro fees and... We need more. So these are two different entities, certainly. But you want to treat what the patient presents with. And that's, you know, not to sidetrack here, but that's why we really need to start using more ICD codes. You know, we're using treatment codes across the board, and we need to define and understand what is bringing our patients to this point. And if it is gingivitis, let's work with the patient to get that under control. And they need to do that at home, but we need to teach it well. And Marianne, just to clarify to our audience, you mentioned ICD codes versus CDT. ICD codes basically say what the patient has. It's a diagnostic code. Yes. A CDT code is the procedural code, what you actually did. And the reason why that's important these days is because ICD supports medical necessity and it's essential for medical-dental integration. It's critical in areas like dental sleep medicine, diabetes management, which we're talking about today, or we will be, and airway-centric care as well. So that's why ICD codes are becoming more and more relevant. So the bottom line is, no matter what vertical you're in, we need to come up with a diagnosis. That's the goal, right? Yes. So let's talk about what you call precision assessment. which means we have tools, we have technologies that we use to track periodontal health. How do they change your clinical decisions, Marianne, compared to relying on probing alone so that we can get to a definitive diagnosis so we can go down the right treatment path? Well, again, I think this staging and grading is incredibly helpful, especially for the grading piece. The grading helps us with the prognosis. If somebody has a history of smoking, currently smoking, for example, or their diabetes is not in check, things like that, they're going to have a different prognosis as somebody else. And so I consider the AAP a tool in trying to get periodontal disease under control. it the third revolution in dentistry is AI. And two years into speaking on this AAP, I was introduced to AI and wow, wow, we're all struggling with clinical attachment level, clinical attachment loss. That's another pet project I have going on with some other faculty. And the AI shows you exactly what that clinical attachment loss is in numbers, in percentages. And, you know, in a couple of years, that's going to be standard, in my opinion, in every practice. And it's going to take that guesswork out. It's absolutely phenomenal, Marianne. As you say, AI is a game changer in a way we just couldn't even imagine a few years ago, really showing us what the periodontum looks like. And this applies to all verticals of dentistry, endodontics, orthodontics with clear aligners, bringing CBCT into it as well. tools that go along with this advanced imaging equipment, these AI tools, the software-based AI tools are just phenomenally revealing and helpful in where the patient is and how to proceed forward in our treatment planning. Yeah, and I think that I'm sure you've interviewed many people on this AI subject, but, you know, these all have FDA clearances. They're considered medical devices. These get 5, 10 clearances on them. And so every single day something new comes out and the technology is just getting better and better and the accuracy is phenomenal. So it's going to help the clinician see actual clinical attachment loss. It'll help the patient see. as you said, direct evidence of bone loss that they can see on the radiographs with these different overjet. video, different programs that are out there. They're fantastic. But let me just say this. It still depends on the clinician's input. So you still have to be an accurate prober. You still have to not get overlap or elongation or foreshortening. A bad x-ray at the end of the day is a bad x-ray. So we still need that piece. And I actually helped develop technology to measure subgingival pressure according to how somebody is holding the periodontal probe. And I feel like it's 2026 and we still don't know how much pressure someone's applying. Yeah, probing is a very subjective process. It is, it is. Yeah. Right. And, you know, myself, my generation, certainly all the way back to probably close to 30 years ago, we lived in the world of pocket depths. And yes, those are very subjective periodontists. I've always kind of quantified things as far as clinical attachment loss. And that's the CEJ to the JE. They're very fixed landmarks, if you will. And that's where we're moving towards. AAP classification system relies on using that clinical attachment level or loss to make the correct classification. And I feel like over the past year or two, that's really where clinicians have gotten stumped. And Katrina Sanders and I have put together a three-part series helping clinicians understand the CAL and understand it from an assessment standpoint, from a recording standpoint. But as I said, the probings have to be accurate. The radiographs have to be in good shape to utilize that for the bone loss. So I think we're getting a little... It's almost like a revolution, if you will, that we need to break this down and help clinicians and students and faculty, for that matter, understand the best way to teach clinical attachment loss, because that's the indicator. That's the indicator of true progression of the disease, because pocket depths are a snapshot in time. You know, you can have increased bleeding for a variety of reasons. And we need to do a better baseline assessment, which is that clinical attachment level. And it's mysterious to a lot of clinicians, unfortunately. Yeah, it seems like to me the CAL is more of an encompassing assessment of what's going on health-wise in the periodontium versus... a single, like you said, a single snapshot or a single locality where we're talking about a probing depth, which is subjective. Let me ask you about microbiome because oral microbiome keeps coming up more and more in conversations about how it relates to period disease. How has thinking about microbial balance, not just bacterial load, but microbial balance, how has that changed the way you approach treatment planning? Well, you know, it's about dysbiosis and it's about looking at the oral environment and understanding, for example, the non-responders. Why are they not responding to the treatment that, you know, we provide everyone else? Certainly a piece of that can be systemic, but many times it can be their oral environment. And that's where, you know, we really need to look harder at. probiotics at the microflora and what's going on in that mouth not just eliminating bacteria which which we could never totally make that type of environment but it's about getting a better balance within the oral environment and on top of that it's about reducing the inflammatory load. And the patient has got to be a partner in that. That's just not going to work by coming to see us. But at the end of the day, we have to be more like physical therapists. We have to be more like coaches as far as treating that aspect more seriously, maybe at the beginning of the appointment versus the end. I'm a firm believer in that. If we don't get the inflammation under control, we're never going to get the dysbiosis to return to health. Right. And if you can get the inflammation under control, in most cases, if you get it early enough, it's not going to proceed and progress to periodontitis. And talking about implant periodontitis, that's a whole nother topic, which is very much related to all of this, but a whole other topic. So let me ask you this, and you just mentioned it, that I think all of us who deliver perio care for our patients agree that long-term remission essentially lives or dies. outside of the operatory, right? Because what have you found to be the most effective ways to personalize home care so patients actually stick with it? I think you said the word and that's personalizing it. And I think we sometimes get into that circle of recommending the same thing for everyone. We really need to assess our patients and understand what they need. You know, flossing is great, but not if they don't do it. So I'm a firm believer in the go-betweens, the interproximal aids. I love them. I always have them in my purse. you know if we can get excited about it and show the patients how to do that um that's a win and i think it's critical to only introduce one thing and then give them you know a couple of visits to make sure that they are in fact doing it and you mentioned go betweens that's a sunstar product uh and for our audience if you are interested just visit sunstargum.com you'll see a ton of home care products that are very innovative, soft picks, and you can just browse through them and see which ones work for you and your patient. Sunstar just rolled out a intro level sonic brush, and it's $9.99. I don't know what you would charge in the office, but at least you're getting your patients introduced to the whole concept. Yeah, you know, I've tried that brush. Do you know what I use it for? What? I actually am finishing up Invisalign, and I use it. You're not supposed to use toothpaste on your trays. Right. So I have to have a separate toothbrush for my trays, and Sunstar sent me that brush. It's fantastic for cleaning. Isn't it? Yes, for cleaning. And look at that price. Clean a clear liner tray. And get them used to that. Yeah, I didn't know what it cost. You're saying it's $10 retail? Yes, yes, yes. Amazon, Walmart, that type of thing. Yeah, I had no idea it was $10. That's amazing. Everybody listening to this podcast, go out and get one. You can travel with it. You know, I'm not here to promote Sunstar's power toothbrush, but for $10, the thing works amazing. My wife has one and she uses it actually as a primary toothbrush. And it is called the Gum Sonic Powered Toothbrush by Sunstar. Yeah, that's a steal. And I think it takes... AA batteries. Yeah, it's very lightweight. It's got a lovely, clean feeling after using it. And I think that if somebody gets used to that, you can then step them up if that's what they want. But even with the interproximal aids, the go-betweens, you've got to provide a plan that is doable. And that word doable, I think, is very, very important. Yeah, I need to ask this one question before you go on, and that is... What do you have in the operatory that typically you can give to the patient? Because it makes it much more convenient for the patient to get it in the operatory. And some dentists don't have the products. I had rotator cuff surgery and I went to the physical therapist and she recommended these bands. And I travel a lot with work. I'm a super busy person. And I was like, hey, do you sell those here? And she said, yeah, we have them in the back. I would never have taken the time to go down to Walmart or Target or buy it because having things in the office. to sell to your patients gets a bad rap. You know, we don't want to sell things in the office, but you're really doing a patient service to provide it there. You don't have to push it. You can offer it. But I think it's ease, you know, and we're all about ease. We're all about DoorDash and, you know. I mean, I don't want to compare us to a hair salon, but because we're not a hair salon. But, you know, when I get a haircut, I don't buy any of the stuff, the product that they sell there because I don't need that. But I do see people. walking over to the shelves with the person who, their hairstylist, and they'd say, yeah, I'll take a bottle of that and a bottle of that. And I'm thinking it's very convenient. They don't have to look for it. They trust the hair salon that the product is actually good quality. Same thing kind of applies to a dental office in that respect. So getting back to microbiome guided care, are there certain types of patients? where microbiome-guided care is especially valuable. And from a practical standpoint, Marianne, how realistic is it for the average general practice to integrate microbiome-guided care into everyday workflows? Well, I mean, I think that you can do all varying levels of that. I mean, there are docs out there, like we know, doing ozone therapy, which the more I learn about that, the more I think, hmm. So you can graduate yourself into that as a practice. But I think that the mindset needs to be, let's look at the whole situation here. And let's look at that medical model. And let me break that down. How do you diagnose a disease in medicine? You draw blood. And that's that saliva piece. 2026 CDT codes now offers a more encompassing code for salivary diagnostics that doesn't have to mean it's going to a lab. And that's a long time coming because I think the major problem has been. cost. And I don't think it's time, but we need to know, especially for those people that have dysbiosis, people that are non-responders, what's going on in their mouth that's causing this to not function? We owe them that. We owe them a better answer. And I think that... making your practice shift towards becoming an anti-inflammatory precision assessments. And I'll add something else into that is the furcation probe. We have to get that out and dust it off and start measuring furcations more accurately because, you know, as hygienists, we're charging thousands of dollars with the doctor as well, of course, for quadrant treatments. I find sometimes when I go over furcation anatomy that clinicians forget how to access, for example, that mesial furcation on 3 or 14. You've got to get that mesial furcation. You've got to access it from the lingual. You're not going to be able to get that with a straight probe. What's the name of that instrument called? The neighbor's probe. The neighbor's probe or the furcation probe. Okay. And they can get that at any major dental dealer? Yeah. Yeah. And you don't want your diabetes pretty close to being diagnosed. You want it accurately. And a straight probe is not going to be able to give you an accurate furcation involvement. And truly, Phil, that's why people slip out of remission is because those furcation areas is what houses the biofilm and the deposit that We might not even have known that it was there. And that's on us as clinicians. If we don't remember how to access certain parts of that anatomy, we have to go down memory lane and really remember that. Now, if you take CBCT, you should pick that up, right? But a typical 2D film, you probably will not. Is that correct? That's a very good point. And I think that we're pretty far away from your routine. assessments if you will to to use a CBCT I don't know though I mean the prices are coming down the radiation is coming down and I think that will go in that direction I also think that probing is going to be a thing of the past at some point they're talking about squid ink and and retainers that can give you an ultrasound type probing assessment. I mean, let's face it. It's, again, 2026, and we're taking 900 little measurements that are very subjective, that depend on people's angulation, people's pressure. We've got to find a new way to understand the topography, navigate those furcations and convexities, concavities. I think we're getting there. I think this is all very exciting because I think we're just on the brink with AI and 3D, et cetera. really understanding what lays beneath the tissue because, you know, we are working in the dark and we're down there feeling around and hoping for the best, but we need to really navigate that anatomy. Now, you teach at a hygiene school. Right. I'm the director at Cape Cod Community College, the Harvard of the Cape, I like to call it. And I do a lot of CE speaking on ultrasonic, advanced ultrasonic technique, along with period diagnosis. And we use an app called Bonebox, and it's free on iPhone and Android. And it allows the clinician, our students use it for dental anatomy learning, to really rotate that tooth and look at all the... specifics of the anatomy and we really tie it to instrumentation. So I recommend these practicing clinicians that are out there when I do these presentations and I show that mesial purcation on 3 or 14 and I say to them, you know, you can't access that from the buckle because of the width of that, you know, of the mesial. And they kind of look at me and it's not anything to feel guilty about that you forgot the anatomy, but we need to correct it, right? I don't know if they forgot the anatomy or never really fully grasped, you know, and understood the anatomy. Endodontists have a good anatomy of these roots inside the bone and periodontists do too. Oral surgeons should. General dentists. Yes and no. Some do, some don't. How much are you teaching or how much is being taught in hygiene about the oral systemic link? And again, not only will oral disease contribute towards systemic disease, and we know it does. That's been proved many times now. It's not anecdotal. But how much do you think dental hygienists and dentists are missing the fact that the patient has a systemic disease? that's contributing towards the perio problem, and they just can't get it under control. They can't get the patient into remission because of the systemic issue that's going on, like diabetes, for instance. I think that's another very important reason to start staging and grading patients because you can have a better discussion with an endocrinologist or a GP, for that matter, if you're saying, you know what, we have a stage three perio patient here. that doctor, that MD is going to get, okay, that's not good. And the way that we're talking now with the medical community is just not sinking. It's not gelling. And, you know, in the hygiene programs with accreditation, we have to show that we're doing interdisciplinary aspects. So my dream would be that, you know, that they learn certain courses with the nursing students. And that works both ways. You can't get somebody off a respirator if their oral environment is not seen to. So we have to help each other with that. I think they know a lot about it. But I think that the curriculum is so full. It's so packed. It's hard to get all these pieces in. But I'm actually working with BioGaia a little bit about. creating some educational modules to bring that whole piece into the schools a little bit more so. And it's a lot for the faculty to all take on. I mean, if you can't understand the systemic contribution toward perio disease, then you can't put together a treatment plan and a recall basis that's appropriate for that patient. It's just impossible. That's right. Not an effective one. I mean, you're swimming upstream if you don't. And the same thing with smoking. For whatever reason, we have been so afraid to talk to our patients about smoking. We don't want to offend them. We don't want to get into that conversation. And actually, Dentaltown did a survey. I think they came out with about 16% were talking about smoking cessation. And if we don't get them off... no matter what you're smoking. In these days, it's a variety of things. You're not going to turn around. So to be able to grade someone a C and say, you know, Mr. Jones, you're stage two, grade C, you will not have the same prognosis as somebody that's not smoking. So we can finally talk about it with a little more comfort. we have to start talking about it in general because if we don't get on those things then we're swimming upstream and we will not get to remission Right. And it seems like your approach and what you're teaching, Marianne, which I'm totally in agreement with, is that you're looking at all of this as a medical disease. Because even the classifications are very similar. Yeah, that applies to, unfortunately, applies a lot to in the oncology world. But generally, that was the only thing about the remission part that I was concerned about when you talked about it in your lecture on VivaLearning.com. And if those of you who want to listen to... Marianne's lecture. Just look up Dryer on VivaLearning.com, D-R-Y-E-R, and you'll find her lectures. She has several of them. The most recent one is about, covers at least, periodontal remission. The only thing I was concerned about, Marianne, with that was that that term remission does have a connotation of cancer because that's when you most... Most hear that word is when someone is temporarily, hopefully long-term, but at least temporarily out of harm's way when it comes to cancer, they're in remission. Is it your coin term? Maybe. I don't know. I've been speaking about this for several years now. Is it catching on? Every time I say that, people will say, wow, it's powerful. It is powerful. Over 50% of the country is walking around with periodontal disease. So something is lacking with our delivery. We're not putting enough seriousness on it. And that's why the classification system changed the way we talk about gingivitis. And now we say you have a case of gingivitis, not you have a little bit of bleeding here or a little bit of inflammation. We say you have a case of gingivitis. And another thing hygienists tend to say is, you know, the good news is, Mr. Jones, you have gingivitis. We haven't had any. attachment loss yet there's no good news there's no good news to gingivitis and we have to start putting more seriousness on it because it's a very slippery slope right even more so mucositis to implantitis and we've got to get the inflammatory situation under control we just have to we have to have you on the show to talk about implants we we have one uh if you want to look up suzuki Dr. Suzuki, he had on VivaLearning.com, go to Apple or Spotify or VivaLearning.com. It was on peri-implantitis and Dr. Suzuki covers it very, very well. He talks about how implants can be doomed if you're not aware of these things and he covers it very well. I want to thank you very much for an excellent conversation. You've covered quite a bit of territory here. Any closing thoughts before we wrap it up? I just want to say one more thing about Sunstar. You know, I received the Sunstar Award of Distinction for 2025 for academia. What a thrill. And boy, they really support hygienists and they honor hygienists. And it's a very hard job that we do. And to have a company do that is just amazing. So I can't say enough about them, but I just want the whole profession to move towards that medical model. My dream would be, I'll end with this, my dream would be there's one insurance, not a dental insurance and medical. There's one insurance, and we're treating this whole thing as one. So I appreciate you having me on. Yeah, our pleasure, Marianne. It was a pleasure to have you, and have a very nice evening. Thank you so much. Thank you very much.