Practical Pediatric Dentistry Tips for GPs

If they're in the room, I'm setting boundaries. So I always let them know, hey. um i'm going to be the one talking i'd love for you to be a silent observer so i've already kind of set the stage for i don't want them you know hovering over the child i tell them that this is your seat and you're more than welcome to be there if you want to be outside the room we usually have glass windows they can look inside but it's important to do all of that at the consult appointment so you don't sound you know upset or frustrated in the midst of the appointment where really all of your focus should be on the child and not on the parent Welcome to Austin, Texas, and welcome to the Dr. Phil Klein Dental Podcast. Have you ever had a moment that completely changed the direction of your career? Our guest did, and it almost came after walking away from dentistry altogether. Fortunately for her, and for the countless children she's cared for since, she chose a different path. She discovered that pediatric dentistry wasn't just a specialty, it was her calling. Our guest, Dr. Nidhi Kotak, has practiced dentistry in five different countries, but it was while treating a young patient in Kenya that everything clicked. That experience became the turning point that led her to specialize in pediatric dentistry, and she says it's the best professional decision she's ever made. In this episode, Dr. Kotak shares the inspiring story behind that journey, along with practical tips. clinical pearls, and a fresh perspective that can help any general dentist feel more confident and even enjoy treating children in everyday practice. Whether you're looking to improve behavior management, create better experiences for your youngest patients, or simply become more comfortable with pediatric care, I think you're going to enjoy this conversation. Before we get started, I'd like to thank all of you for tuning in. If you're enjoying the show, please follow us on Apple Podcasts and Spotify, and even better, leave a review. By doing so, you're not only showing support for what we do here, but your reviews are instrumental in getting more dental professionals to listen and benefit from our content. We really do appreciate it. Dr. Kotak, it's a pleasure to have you on the show. Thank you for having me, Phil. So it's a very interesting path you've taken. blows my mind is how many countries you've practiced in, in the last how many years, you look very young to me. So I don't know how long you spent in these countries. But to be a dentist in five countries is pretty cool. How did that all happen? You know, life just happened. And it was either education or love or cool work experiences that took me from one place to another. And it wasn't really the conventional journey, but it really has shaped who I am today and the way I look at things and the way I practice dentistry. So I'm really grateful that I had this path and I wouldn't have had it any other way. Yeah, no doubt having that experience working with different cultures, different populations in different countries as a professional dentist has certainly shaped your profession and your personal life. And most of us can't even imagine doing that. So quite remarkable. So as someone who practiced as a general dentist before specializing in pediatric dentistry, what are some things you would do differently now when treating children? And specifically, what mistakes or missed opportunities stand out in hindsight? Yes. So straight out of dental school for two years, I practiced at two very peds heavy offices. And one of the things I really wonder is why I was so afraid of the stainless steel crown. It almost felt like a molar retreatment to me. And the number of times that I did these massive... composite fillings, two surface, three surface, where really I, you know, I know now that a stainless steel crown would have been the treatment of choice. So once you've done maybe just 10 of these, you realize that in pediatric dentistry, it's probably one of the easiest procedures. So that's one of the, you know, if I had to think of a mistake that I wish I wouldn't have made. And just to give you some context, I worked at a federally qualified health center in Rockford, Illinois, incredible hospital. The motto was good people. good people. And I learned so much because there was a steep learning curve, you know, in dental school, I don't know of many dental schools that give you extensive pediatric dental experience. So there was a lot, you know, of learning ahead of me and Rockford had a huge refugee population at that time. And the only way they could see a pediatric dentist was if they were sent to UIC, which was at least a two hour bus ride and a six to eight month wait time. So oftentimes for these kids, we were not only the last resort, but maybe the only resort. And that was really tough straight out of dental school because a lot of these kids needed more than a general dentist at that time because they needed maybe oral sedation or general anesthesia that I didn't have the training for, I didn't have the skills for. And unfortunately, there were a lot of scenarios where I had to remind myself, no, this is what is best for this child right now. But I had to do treatment sometimes using protective stabilization. And I still remember the first time I did that, I went to the bathroom and cried because it is very difficult to work on kids in general. But working on a child screaming bloody murder in a language that you know, you don't speak and they don't understand your language, it really hits differently. So, you know, now I'm really glad that I practice very differently, but it took, you know, a lot of time to get to this stage in my life. Yeah. So you really love pediatric dentistry. And, you know, I've talked to other pediatric dentists before on the show, and they kind of say you either love it or you don't. It's not like this gray area where, yeah, I don't mind treating kids. treat some kids in my practice and that's true gps do treat kiddos but some of them really don't like it it's partly because they just feel the kid's going to be disruptive in the office or difficult to deal with because they're afraid it's going to be time consuming the mother may be in the you know insist on being in the operatory which could also interfere with the flow of what's going on so With your experience, both as a GP, Dr. Kotak, and now a pediatric dentist, what do you attribute the preconceived notion that children are so difficult to work on and they would rather avoid it rather than actually embracing these patients into their practice? I think the issue is that we sometimes tend to overpromise and then we're just not able to deliver that level of care. And in pediatric dentistry, it's very important to have an out. when you're in a sticky situation but you don't want to have that come up when you're in the middle of a treatment and things aren't going well so you know even as pediatric dentists when we do a consult for a child i'm telling parents hey this is plan a and this is what i hope for this child and if we're doing general anesthesia for example i know that's possible but if it's plan b where you know we're trying our best to do it in office I tell them that, hey, I really hope we can achieve this. But if it doesn't, then here's plan B or plan C. In which case, if I'm able to achieve all of that, that I initially promised, then I'm the hero. But if not, then it's not something that, oh, this dentist doesn't know what she's doing. I've already prepared mom or dad as to the different ways this treatment could go. And, you know, have the different tricks up your sleeve. So, for example, if you've started freezing the child and you started prepping and then, you know you lose the child because they're starting to move around and you're not going to be able to get the good isolation to get good treatment done you know have things like fuji restorations in your clinic that you can you know put in that situation or have the knowledge to know when you need to stop and when you need to refer. And also, if you have that gut feeling or that instinct telling you that I really shouldn't be doing this, listen to that gut feeling because I feel like it's that voice in your head that you really should listen to because every time that I haven't listened to that voice, I've always regretted it. So as a general dentist, have an out. Don't let the parent pressurize you into treatment that you're not comfortable providing. And know when to refer would be the three ways that you can, you know, go in to work, see kids and not feel really stressed about it. So when you're in the operatory with the child, with the patient, do you allow the parent to be present in the operatory? So I've been in clinics that I've done both. I usually almost always liked when the parents were outside of the clinic because or outside of the operatory, because I feel like kids do so much better when parents are not in the room. But I've also practiced in countries or in cities where the parenting styles are very different and they absolutely want to be in the room. And a lot of the times I find that this is an advantage because if things aren't going well, the parents are able to witness that and they're also able to see how hard my team and I have tried to make it possible. But if they're in the room, I'm setting boundaries. So I always let them know, hey. I'm going to be the one talking. I'd love for you to be a silent observer. So I've already kind of set the stage for I don't want them, you know, hovering over the child. I tell them that this is your seat and you're more than welcome to be there if you want to be outside the room. We usually have glass windows. They can look inside. But it's important to do all of that at the consult appointment so you don't sound, you know, upset or frustrated in the midst of the appointment where really all of your focus should be on the child and not on the parent. So similar to adults. Amongst children, there are different levels of fear. When you have that patient who's so fearful and you pick up the syringe to give them local anesthesia and they carry on where it's almost impossible to get an injection in there, are you an advocate of removing the super infected decay, the real mush that's in the tooth, leaving the rest of it there? The affected carries the leathery dentin and using STF and then using glass ionomer. And that in many cases can be done with hand instruments precluding the use of local anesthesia. So the kiddo isn't set off in this crazy direction where it's hard to get through the rest of the procedure. I love using silver diamine fluoride and I love using glass ionomer restorations. I think case selection becomes very important. Until a few years ago, I used to think of silver diamine fluoride as a way to buy time until the child is ready to have that final restoration. And in a lot of cases, that still is applicable, but a lot of times I'm now seeing that it tends to be even the definitive restoration. So for example, if it's a really young child, three years old, and I was able to get bite-wing x-rays, and I'm seeing that there's no interproximal caries, but there's... large occlusal in which case i will apply silver diamine fluoride on that child i usually wait two weeks bring them back in make sure everything's nice and rested and then i put that glass ionomer like equia forte on top and that tends to be a great solution for this child sometimes silver diamine fluoride even for interproximal lesions that are starting i'll tend to use a super floss and floss it in between to you know, prevent it from growing. But we're also taking bite wings every six months to check on that. So those would be situations. And when I was practicing in Canada, the code would be called caries control, where we did silver diamine fluoride. And then weeks later, we would follow it up with a glass ionomer restoration. And when I first started doing it, I always thought, okay, well, I'm going to replace these with either a composite or a stainless steel crown later. But I often realized that if the decay didn't extend in approximately, there was no need to do that because You know, Fuji fillings work really great even as a permanent restoration. No, no, absolutely. Now, what about the young kiddo who you don't think will come back? Can you use SDF after removing the infected dentin the best you can without anesthesia and then go straight in with the glass ionomer in one procedure? So I think as long as we're not... close to the pulp. I'm comfortable placing the silver dimming fluoride, but I don't tend to excavate at the same appointment. I want that silver dimming fluoride to seep in. If I am trying to do it a same day treatment, I have used something else called Papa Carry Duo to remove some of that infected dentin and then put a glass ionomer filling on top of that. I think that's a great approach. And I think that over time serves the patient, the kiddos very well. I do want to get back to the GP again. I would love you to convey your experience, wisdom, and some really good recommendations for those GPs who are very exasperated when they treat kiddos. They feel stress and anxiety, some of them, before even going into the operatory, knowing that they're going to be treating a child. Is there something you can say to them, something you can recommend about being more open-minded? And perhaps if they follow some of your recommendations, they can actually eventually enjoy treating kiddos. So I'll tell you what worked for me. When I was in Chicago practicing as a general dentist, I started taking classes at the Second City and I started going for improv classes. And if you've ever been to an improv show, you're basically on stage and the audience is giving you suggestions and you're coming up with things on the spot. And I feel like with children, this is so important because they're often the best improvisers because they're not thinking before they're speaking but as adults we can put so much extra thought um so i i found that doing um a lot of this improv training ai it brought out a side of me that i didn't even know and i enjoyed it so much but i just started applying all of those improv games into what i did at work and could you give us an example give us an example of what you're talking about Okay, well, I'll give you an example. Feel free to act it out right now. We're all listening. We're all ears here. I remember there was a child and I was talking to mom about, you know, how I'm going to freeze the tooth. But obviously I do the anesthetic and the needle part, you know, never in front of the child. And then when I was talking to the child and I said, hey, you know, we're going to put your tooth to sleep. And, you know, I talked about whether it was sleepy juice or Elsa's frozen juice. But when I said, we're going to put your tooth to sleep. And immediately the child replies, is my tooth going to have dreams? And I still remember that moment. I was like, wow, this is basically yes and where you say something, you know, that's so ridiculous, but somebody just takes it on and keeps growing on that. And it suddenly felt like a game. And then I just kept growing on those dreams. What was your response? Not quite really remember because I feel like I say something different every single day, but we just went into, you know. It's a phenomenal interaction that you're having between the kid. They're actually drifting off into this, you know, fantasy land where their tooth is going to sleep and it's going to have dreams. But I'd be afraid to say to the kid, yeah, it's going to have dreams. And then the kid's going to say, I never remember what the dreams are. So I don't know. Then it gets deeper and deeper. But that's just a fantastic way of communicating with the kids. Honestly, if you feel like things are going south, just don't stop talking. Change the topic. I'm always talking about their little sister or their dog or my imaginary cat named Luna and how she has, you know, she loves jumping across the room and just anything. I look around and I just pick up something and my assistants are always rolling their eyes because, you know, they've heard that story 50 times before. But you just don't stop talking. If you run out of ideas about cats, just go to Instagram and you'll see hundreds of them in your feed. I love those. Yeah. Do you have a cat? I used to a very long time ago. And I think that she had such an impact on us that she always comes up at all of my appointments. That's amazing. That's amazing. Yeah, we have four cats. We moved them to Texas. They all passed away. And now we just take care of our kids' cats. We cat sit when they travel. And they each have two. So there's plenty of stories to come out of that. Now, did this improv that you did, did that change your approach to kids? Or did you have that approach already and you just took it to another level after the improv? I think that I had it somewhere deep down, but I needed a little bit of a push. And I think that's what Second City did for me. But I do think that, you know, how you said that some people are just cut out for pediatric dentistry and some aren't. I think that most of us who get into pediatric dentistry have a little bit of weird in us. And we just get to be weird at work every day. And, you know, you don't have to hold it back. And I think that's what's so special about... being in this profession. Yeah, absolutely. I've heard that before. Brian Novy, I don't know if you know that name, Dr. Novy. He's a brilliant dentist, cariologist. He does research on everything. He's on the show a lot. He does webinars for Viva Learning. He's a goofy guy. I mean, that guy has a peculiar personality. I love him, but he's definitely not your average dude. I mean, no way about it. But he'll go into an operatory and he'll connect so well with the kids. They love them. So you do have to have as an adult a personality that connects with the children. I mean, that's and that's something that can be taught to some extent, I think. But apparently you have it. It's innate for you, Dr. Kotak. It's just by talking to you and knowing how you've evolved into, you know, a superb pediatric dentist. It's in your blood. You have a passion for it. And you look forward to seeing the next patient who's a kid. Now, I remember when I was in my fourth year of dental school and I had to rotate through pedo and I knew I wanted to be an endodontist, but I had to rotate through pedo and it was very difficult. I love children. I was a counselor at a camp, but doing dentistry on a child was very difficult because they just, you know, just for obvious reasons, they don't sit still. And, you know, when you're in a fourth year dental school position, you're not a good dentist. You don't know very much and you're pretty. uncertain about, you know, pushing a pedal down where you get 200,000 revolutions per minute on a handpiece with the tongue there and the cheek. And I was always afraid about hitting the tongue and hitting the cheek. And that's actually something I want to talk to you about. You talk a lot about isolation. Yes. And you, you know, recommend to general dentists and mentor them about isolation. So tell us where you are with isolation. What do you use? What are our options? And how does that help you? So when I started residency, which was at Temple University Hospital in Philadelphia, we were almost exclusively an ISOVAC only residency. And I had never used ISOVAC before that. Until then, I was a general dentist and I used, you know, rubber dam when I was doing endo or cotton rolls and dry angles. But when I started using the ISOVAC, it really opened up a new world for me. And I think it was so much more important in residency because You know, you are never overstaffed there. Oftentimes you're on your own and you're trying to do dentistry on a child. And it really helped to have the ISOVAC, which not only, you know, provided the isolation and retracted the tongue and the cheek and the lips and all of that, but so much more important provided a barrier to the throat or airway safety. Because when you're working on kids, kids can move really fast and accidents can happen before you know it. And it's so important that nothing goes down that airway because you never want to be left guessing, did that child swallow it? Did they aspirate it? And if you have been in that situation, it's really, really stressful for the child, for the parents, and for you. So if there's anything that you could do to avoid it, you absolutely must. And for the first few years of my practice, I believe that... using Isovac was the only way. And I still use it for, I would say, majority of my procedures. But I've worked at so many practices and, you know, adapted their ways. And I think there are certain procedures for which I absolutely love the rubber dam, which is the gold standard of care. And there are a few procedures where I might even consider a cotton roll and dry angle like silver diamine fluoride that we touched upon earlier. But for majority of my procedures, I love using especially the posterior teeth. Isovac or if you have the elevator isolite, it just works like a dream. Now, what are the cases where the rubber dam is more indicated? So for me, in my hands, when I'm doing any anterior restorations which have, you know, subgingival caries or crowded teeth with interproximal caries, those are cases where having those floss ligatures makes the treatment just so much, you know, elevated. And for those cases, rubber dam is something I almost always use now. Sometimes I've also used OptraGate for anterior restorations. I also use the Isolite occasionally for anterior, especially if it's like a lingual pit, for example. But if it's anything subgingival, especially if there's decal wrapping around even the labial surface of the teeth, the floss ligature really does wonders. Typically, how does the pedo patient tolerate the Isovac? Are there any techniques to help implement that device? I think for the most part, I figured out the words to use, making sure that you're using the right size attachment and mouthpiece for the child with the Isovac. And oftentimes based on the age of the child using nitrous oxide, the combination of these three. uh makes the acceptance rate really really high um and very very rarely if the child has a severe gag reflex and using nitrous oxide and blocking the child still doesn't work with the gag reflex then uh maybe i'll pull out the rubber dam in which case the the gag reflex is still an issue. But for the most part, if you've tackled those issues, the gag reflex with your inferior alveolar nerve block and a good dose of nitrous, I feel like you're able to get away with pretty much anything with Isovac. Do you suggest every GP to look into using nitrous or consider nitrous on pediatric patients? Not on every patient, but I think every GP, if they're seeing kids in their practice, it's such a great tool. I mean, there are kids who just do so much better with nitrous but i also feel like it's important to know the limitations of nitrous nitrous is not going to make a really anxious patient be an excellent patient in your office but it's going to make those kids who are a little bit nervous but really want to try hard to do well for you those are the cases where nitrous works wonders if you have a child who's really carefree They can probably get away without nitrous anyway. But if you're also trying to do full mouth dentistry or, you know, one-sided dentistry and those are longer procedures, then yes, nitrous works really well for those cases as well. Yeah. Just out of curiosity, you mentioned the conversation you had with the patient. What would be a typical conversation with a new patient on Isolite or Isovac? And just for the audience to know, Isolite is the same thing as Isovac, but it has a light on it. Is that correct? Yes, that is correct. So what's the conversation? I'm your new patient. I'm a little kid and you're going to use Isovac on me. How do you present that to the patient? Okay. So usually, I guess, are we just going to go straight into it? Straight into it. Any way you want to do it, I'm good. Okay. All right. So here we have this little dolphin tail. And this dolphin tail is really going to help us today because when I put it in, and when I do put it in, it might feel a little bit silly, it might feel a little bit big, but once I put it in and I turn it on... it's going to sound like the ocean waves. And as soon as we turn it on, you might feel like you're at the beach. And if you want to close your eyes for a little bit and just relax, that's totally fine. So it's just about the way you introduce it. And then as I'm introducing it, I'm constantly talking again about Luna, my cat, and distracting them. And usually they're just fine. And if they're moving, I'll be like, oh, remember I told you it's going to feel a little silly. And then I have them bite down. And then by then they're comfortable. And then we get straight into it. Wow, that's amazing. That was very, very good. So your chairs are filled with kids. I mean, I can imagine that word of mouth. I mean, once the kid comes out and the mother says, if she's in the waiting room and not in the operatory, she's going to say, so how'd it go, Johnny? And the kid says, it was great. You're going to just fill that practice with kids with that kind of approach. I mean, that's really phenomenal. And it sounds like you're having as much fun as, well, I wouldn't say as they are, because maybe they're not having that much fun, but you're having a lot of fun doing what you're doing. I am. And oftentimes, you know, I still remember there are times that I was I was doing an extraction and there was a song Golden that was really. popping uh i think about a year ago um and i was literally doing extractions and this kid is you know through the nitrous through the extraction singing a song and i'm singing a song and my assistant's just looking at me like you're so crazy but we were just having so much fun and i i think it really shows when you you know you love something that you do it comes through and i didn't always feel this way when i was a general dentist i you know i knew that there was something missing in my life or my career i i almost quit dentistry at one point until I went to Kenya and I realized, okay, no, it wasn't the dentistry. So what experience, did you have a specific experience with a child? Was there some watershed moment that occurred that made you realize that pediatric dentistry was your calling? I specifically remember this one patient, but it's not like I was able to get that instant gratification. It was quite the opposite. i was at the the federally qualified health center this child four-year-old boy um you know he had just moved to the united states very medically compromised uh had had plenty of surgeries lots of medications and he opened his mouth and i remember seeing 20 root stumps and i i didn't even know how to respond i didn't even know that was possible on a four-year-old child and that was just so shocking to me it was such a wake-up call and it's very easy to you know blame the parents and think of it as dental neglect but these parents love this kid um in their country dentistry wasn't a priority plus these parents had been doing everything for this trial from a medical standpoint and teeth had taken kind of the the back seat um and at that point i did everything to make sure that this child could get the treatment. And, you know, we couldn't wait for UIC. We couldn't wait for that, you know, six to eight month period to get the consult. And luckily I was able to find a pediatric dentist who was able to see them pro bono to get this child out of pain because he just wasn't able to eat. It was still awful, you know, being a four-year-old with 20 extractions. But I think that instance made me realize I really want to help this child and I'm limited in what I can do and in my training. And I felt like a middleman and I wanted to do so much more. And I think that was the point where I realized, you know, there's something more I need to do in my life to get to that point. And that was the beginning of when I realized I wanted to be a pediatric dentist. Yeah, it's amazing. Amazing story. Very inspiring. For dentists who may be wondering about expanding their care for children or any other discipline of dentistry, not necessarily pediatrics, what advice would you give them about pursuing? their own professional passion. Okay. So if you're a general dentist, and I'll speak to you from a pediatric standpoint, I think there's two ways to do it. One would be the path that I followed, which is, you know, I was general dentist for about almost nine years before I decided to go back. So I did it a lot later in my career. But as soon as I started residency, it just... widened my horizon so much because I didn't know how much I didn't know until I knew it. And it was astonishing. There were suddenly so many options that I just couldn't present before to my patients. And my treatment planning style changed significantly. My knowledge of techniques and materials and everything. So I'll always say that residency gave me the wings that I really needed. Having said that, I know that it isn't for everybody. Not everyone wants to only see kids in their practice and say you love being a general dentist, but you also like seeing kids. But you feel like there's something lacking or I wish I knew more or I wish I had, you know, a little bit more training in that. I think there's some wonderful CE courses that are geared towards general dentists who see kids in their practice. When I was in Canada, there's often a lot of provinces where there are parts where there's just no pediatric dentist. the load is on those gp dentists um and so i used to teach a course i don't anymore because i'm in dubai now but i talked with a um you know a group of people it was called little smiles learning um and basically it was a two-day hands-on course where we went over pretty much everything that you know was in the scope of pediatric dentistry for a general dentist so um obviously oral sedation and general anesthesia may not always be uh an option but you know how to treatment plan how you know case selection all of that we really went into depth for that so find a ce course you know close to you that works for you but I think that's one way to really push yourself if you want to really provide you know high quality care for those kids because with kids you often you don't get a second chance if you lose that child it's done then you probably have to refer them so if you do everything right the first time the satisfaction you get the professional satisfaction you get is really unmatchable no it's very well said do you did you have a mentor that took you under their wing and said you know needy This is really something you have a passion for. You've been doing general dentistry for nine years. Why don't you apply for a pediatric residency? Did someone push you towards that? Or was that something you did totally on your own? I think I've had some wonderful mentors along the way. But I think for me, what pushed me over was I was in Dubai at that time practicing as a general dentist. And I realized very quickly that I wasn't cut out for the cosmetic dentistry world. I wasn't cut out for... know, the full mouth rehabs, the veneers. And there were people who are excellent at doing that. It was just not me. To the point where I almost felt like I wasn't cut out for dentistry. And that's when I signed up for this, you know. outreach dental camp in Masai Mara in Kenya. And that's when I realized, you know, I absolutely love dentistry. What I missed was being able to see kids and be silly at work and, you know, not have to, you know, worry about impressions and my margins and doing work that really didn't give me joy. So I think that was what the final push was. And I applied. Got into residency and moved back to Philadelphia. And it's the best decision of my life I've made. Yeah. You left Philly after your residency? I left Philly and then I moved to Canada and worked there for almost four years. I had two kids there. And then I recently moved to Dubai again. My family's here. So my husband and I moved our two little ones. And I just recently started practicing. Today was day two of my practice in Dubai. Congratulations. Congratulations. You mentioned you practice in Kenya. What was it like practicing dentistry in Kenya? It was magical. And it was actually way better than I'd expected. They were actually initially funded by University of Pacific. It's called World Health Dental Organization. And it's a really well-run clinic. Sterilization is great. You know, equipment is not bad. at all i mean i remember having a rubber dam and doing endo even though i hate doing endo but it's all there um i remember doing an extraction on this man and There's just like deer walking by and then I can see elephants in the distance and then suddenly I heard a noise and I looked at my manager and he was like, oh yeah, I hear the lion roaring and like this. Wow, that's an experience. Every dentist should be doing this because it was just- Every dentist should be practicing in five different countries, yeah. Well, Kenya, you have to go to Saimara to practice because it will change. All right, so if anybody wants to practice in Kenya that's listening to this podcast, you can reach out to Dr. Kotak. I'm sure she'll be happy to connect you. with the right people to make that trip happen. Yeah. What is your email? Do you want to give your email or is there a place? Go for it. Two ways to contact me. My email is nkotak, K-O-T-A-K at gmail .com. And an easier way to find me would be on Instagram. I'm babytoothdentist and I tend to post a lot of, you know, just tips and tricks for general dentists who like to see kids in their practice. Amazing. Amazing. Yeah, we have a lot of listeners. We have over 500,000 active accounts on Viva Learning, not subscribers. These are active accounts, people that have given their name, address, emails, and everything else. And we're getting in the range of... depending on the episode, eight to 10,000 listens on these episodes. So the podcast show is really ascending. And it's because I'm interviewing people like you who have just such great experiences in dentistry to share. And I think there's a lot to learn from dentists that make decisions where they shift their direction in what they will essentially give them satisfaction, career satisfaction. And I think that's so important that can't be underestimated that what you do every day. You need to make money. It's a business. You're helping people, but you need internal satisfaction because that's all that it's about. If you're not happy internally, the money ain't going to, it's not, it's going to pay the bills, but you'll still be unhappy. And happiness is a pretty important thing. So I think you did a great job in this discussion, Dr. Kotak. Thank you so much for your time. Thank you so much, Dr. Klein.