Personalized Oral Care: Fluoride, Flossing, Tongue (Full Transcript)

[00:00:00] Speaker 1: If something that's almost entirely preventable is the most prevalent disease on the planet among adults and kids, maybe we should reconsider what we've been telling people, right? Millions of people brush their teeth still and floss their teeth and they still get cavities with fluoride, by the way. It's a pleasure to meet you. I've seen you obviously on TV a lot. So thanks so much for always doing such a wonderful job.

[00:00:26] Speaker 2: Oh, thank you, doctor. I appreciate that. I am curious, just for yourself personally, what is your oral health care routine like?

[00:00:33] Speaker 1: In the morning, before breakfast, not after, I start with a very safe and effective mouthwash. So it's before breakfast, BB, and before bedtime, BB. Why? Because every time you eat or drink, the pH of the saliva drops and mouth becomes very acidic. And if you brush your teeth in the first 30 to 60 minutes after meals, your teeth are very vulnerable to damage. And that's why you want to avoid brushing your teeth at least for an hour after you eat or drink anything. So in the mornings before breakfast, you want to get up, use a very safe and healthy mouthwash that doesn't have artificial colors. It's not acidic. It doesn't have antimicrobial agent that kills 99% of your germs. So it alkalizes your mouth, it loosens the plaque, it freshens the mouth, and it gets you ready for the next oral care products. The next thing after that is either you can floss in the morning or in the evening. And if you're going to take away one thing from this is to remember to clean your tongue because people, I think a lot of people are used to cleaning their teeth, but they leave all these microbes that lead to bad breath and changing taste. And, you know, your mouth is just a source of a ton of microbes in the mouth. And so you want to clean your tongue with a tongue cleaner. Now, there are three ways you can clean your tongue with a toothbrush, which is very, very minimal cleaning. It really doesn't do anything. Or you can use these U-shaped tongue cleaners. They're like metal ones, which is the next better version. Or the third one, which is my favorite, is a specialized tongue cleaner that has a tongue brush on one side, these longer brushes that go into the deep crevices of the tongue and a scooper on the other side that you can get out the microbes, the debris and the sulfur that causes bad breath. So mouthwash, tongue cleaner, toothbrush with toothpaste. Then you enjoy your breakfast and that's your morning routine. In the evening before bedtime, you do everything you did in the morning, but kind of backwards. You do the flossing first, if you haven't done it in the morning. The floss is such a critical thing. I know that's the one area that almost everybody lies about to their dentist about how much they floss. But truly, we actually get most of the cavities between the teeth. So floss, it's super important. It causes bad breath if you don't, and all sorts of things. So use a good floss and wrap it around your finger. If you can't do that because that's the best way, then use a water flosser. And the next thing is the floss, those little floss picks. But the best thing is actually a floss picker. You can get the cleaner part of the floss in between the teeth. And the flosses I like to use actually have the toothpaste ingredients right infused in the floss. Because as I always say, you don't brush without toothpaste. What would you floss without toothpaste? Because that's actually where we get most of the cavities. So you want to floss first, then you want to brush your teeth with a really, again, safe brush and toothpaste. And then the last thing you do at night is use the mouthwash and swish it around really vigorously and spit it out. Don't rinse anymore with water so the mouthwash protects your teeth overnight.

[00:03:31] Speaker 2: How do you sort of determine the evidence that makes this the right routine? Is this based on your patients? Because it's a very specific routine. How do you arrive at that?

[00:03:43] Speaker 1: So the model of brush your teeth with fluoride, floss, and see the dentist twice a year, this is the model that we've been following for 30 years. And what is the result? The number one disease is dental disease, cavities and gum disease. And so that model, we know it doesn't work. When I was in dental school like 30 years ago, the only discussion was fluoride versus non-fluoride, right? And what do we hear now? Fluoride versus non-fluoride. As if this one ingredient, it's either going to save the world or it's going to cause havoc. You know, you're a physician. It would be as if in medicine, the only thing we talked about for 30 years was the benefits of broccoli. One thing. So by just putting fluoride on a toothbrush and brushing our teeth, it's just such a simple solution to a complex problem.

[00:04:32] Speaker 3: I wanted to take a minute to explain how fluoride works. I think this is really important. Fluoride is a naturally occurring mineral that can help prevent tooth decay. Remember, prevent tooth decay. Here's how it works. When we eat foods, in particular sugary foods or highly refined carbohydrates, the bacteria living in our mouth that are already there get to work, breaking down that food. And in doing so, when the bacteria start doing their work, they are releasing acid. And that acid is what then corrodes the minerals that make up the outer layers of our teeth. That process is called demineralization. And that is the very start of tooth decay. Now fluoride, if it's already on your teeth, can help prevent this loss and even restore some of the minerals broken down by the acid released by those bacteria. Keep that in mind. You got food, you got bacteria, it releases these acids. Fluoride can help protect your teeth from those impacts and even restore some of the minerals. Okay, so keep this in mind during the next part of this conversation.

[00:05:43] Speaker 2: I realize that we've probably been pretty reductionist about this sort of thing. But I am curious, you know, we'll just stay on fluoride for a second. This idea that when you take in fluoride, when you ingest it through fluoridated water, for example, it's getting into your system, it's doing things to your teeth and to your bones. There's been this movement recently to try and reduce if not eliminate fluoride in the water or stop adding it at least. Obviously, some of it occurs naturally in water. What do you think of that based on the data? I mean, if you look at the CDC's website, they say this is one of the greatest public health achievements of the 20th century. And then there's other people who say, look, hey, it's associated with neurodevelopmental disorders and other things. Of course. Where do you land on this?

[00:06:28] Speaker 1: So fluoride, like you said, is a natural ingredient, natural mineral. It's present in water, in seafood, in tea. So fluoride works. It's not a controversial thing. We know that fluoride makes the teeth more acidic resistant. It does have one benefit and one downside. Because of the acid, you're saying? That's right. The one benefit is it makes the teeth stronger, especially against acidic erosion. Why all the controversy with fluoride? Because it also has some side effects. If it's ingested too much in childhood, it can lead to things like fluorosis, which is a discoloration or deformation of enamel. Or in very high doses and in serious side effects, it can actually cause neurotoxicity or other toxicity. So that's why there's a controversy. So my recommendation to people is only use fluoride when the benefit outweighs the risk. Like someone who's in braces, like teenagers, maybe an adult, and they're not brushing their teeth or whatever they're doing, they're still getting decalcifications, which are these white spots around their brackets, or they're getting cavities. Well, then add fluoride to the regimen because then the benefit of that outweighs the risks for that particular person. What are the situations that I wouldn't recommend fluoride? Well, on a baby or on a pregnant mother because the risk doesn't outweigh it. There's other ingredients that we can use to help remineralize enamel and help having better oral health without the potential risk of fluoride. But by obsessing over this one ingredient, it doesn't allow us to focus on the rest of the ingredients, on the rest of the mouth, on how the body works and how the mouth works. I don't think it's the only solution for all of the population.

[00:08:05] Speaker 2: Yeah, look, I mean, as you know, the famous adage in medicine is the dose makes the poison. A hundred percent. I think, you know, I just want to be careful because I think this idea that sometimes the benefits are underplayed and the harms are overplayed, I think is important as well. Certainly choice is important here, but the idea that inappropriate concentrations, some of the studies that we're talking about with the harm, you were looking at fluoride levels that were twice the concentration that is normally found in the U.S. water supply. In normal concentrations, it can be beneficial for a baseline of oral health, I think is something you agree with.

[00:08:49] Speaker 1: But it does come with some risks. So as a society, we have to decide if it's something that we want to do as a general thing.

[00:08:54] Speaker 2: Even at normal concentrations, you're talking about risks?

[00:08:57] Speaker 1: Yeah. I mean, so it's just you're a hundred percent right. Obviously, the dose has a lot to do. It's like vitamin D. At the right dose is an incredible bright vitamin, but at high doses could be toxic. But again, it works. It's cheap. In fact, in Canada, in one of the provinces, they removed fluoride from the water and they saw an uptick in the amount of cavities, so they brought it back. So I know it works. Again, I'm not really, you know, crazy against fluoride, so I don't do really anything. I don't put fluoride on top of it in my toothpaste and mouthwash because I don't need it. Because with all the other ways that I'm preventing cavities and have a healthy oral health, same thing with my own family and same thing with thousands of my patients. By the way, in my offices, in some patients we use fluoride and some patients we don't use fluoride. In some patients we use hydroxyapatite, sometimes we don't. Again, it depends on the patient. And I think in our society, we just got to customize things a little bit more. I always give this example. When you're a dad, let's imagine a family comes in my practice or in your practice and they have a pregnant mother, the dad has gum disease, they have a one-year-old with no cavities, a 10-year-old with a ton of cavities, a teen in braces, and a grandma, you know, with some lost teeth and some bone loss. They have different needs. And so that's what I try to teach, even in the dental profession, that make sure that we learn more about just fluoride, we learn about how the microbes work. During pregnancy, according to CDC, up to 74% to 75% of pregnant women get gingivitis for hormonal changes, changes in their diet, etc. Seventy-five percent. And that inflammation, the gum disease, can impact the health of pregnancy. You know, it can increase the risk of many complications like preeclampsia, diabetes, etc. It can impact the timing of birth. That's just one example. If my own wife was pregnant, I wouldn't recommend fluoride for her because it's an unnecessary risk. So I would recommend nanohydroxyapatite because nanohydroxyapatite as an ingredient, just so you know what it is, this ingredient has been around for decades. By the way, it's been tested in every country. Unfortunately, in the U.S., FDA has only so far approved fluoride for anti-cavity, but in many countries it's already been approved for that purpose. But I can just tell you what science says and what it does. It does remineralize enamel. Basically, it's a biomimetic version of your own enamel. It's a calcium phosphate. NASA invented it decades ago in the early 1970s in the micro size and then in the 1980s, the nano size. So it remineralizes enamel. It buffers enamel against acidic attacks. That's why you want to brush your teeth before breakfast or before eating, not afterwards. The third one is it reduces plaque as effectively as some of the most potent antimicrobial agents. But the way it works, it doesn't decimate the oral microbes. It's so small, it sticks to the teeth and sticks to the microbes, and it doesn't allow the adhesion of the microbes to the teeth. It also naturally whitens teeth and it naturally reduces sensitivity because it's literally liquid enamel, basically kind of resurfacing the enamel. But for someone who's got braces and they're not brushing their teeth and they're starting to get this decalcification out of their teeth, I would then add fluoride to nanohydroxyapatite. Should you see how if we customize products and the ingredients, we can get better results at the same time, mitigate risks. So by just putting fluoride in a toothbrush and brushing our teeth, it's just such a simple solution to a complex problem.

[00:12:39] Speaker 3: Okay, let me pop in again here for a second, because there's obviously a lot of nuance in what we're talking about. So let me just reemphasize a few of the points. Here in the United States, most communities have fluoridated water. So truth is, you're probably going to be getting fluoride from your drinking water. And yes, there's been some recent debate whether we should move away from that. But the American Dental Association does continue to support this practice, the practice of fluoridating water, and also the use of fluoride toothpaste for most people. And that goes for pregnant women as well. Both the ADA and the American College of Obstetricians consider fluoride safe for pregnant women. And they recommend that pregnant women continue to use fluoride toothpaste. I just want to make that point very clear here so there's no confusion. But the nuance comes down to the fact that we are able to get fluoride protection from different sources. So yes, like Haas said, dental care can be individualized. But you have to remember at the same time, not everyone's going to have access to good dental care. With that in mind, let's get back to the conversation.

[00:13:49] Speaker 1: If something that's almost entirely preventable is the most prevalent disease on the planet among adults and kids, maybe we should reconsider what we've been telling people, right? Millions of people brush their teeth still and floss their teeth and go to the dentist, and they still get cavities with fluoride, by the way. Because again, remember, your mouth is not just enamel. Fluoride works on enamel, right? That's all it does. It just makes the teeth a little bit more acidic resistant. What about the oral microbiome? What about the nutrients that the teeth need to strengthen itself from inside, like vitamin D, vitamin K2, like calcium? What about prebiotics to help the oral microbiome? What about the alkaline pH of the toothpaste and mouthwash? And on and on and on. So my message to everybody is like, let's stop arguing over one ingredient. If you want to use it in circumstances that are necessary, with the known benefits and risks, I'm all for it. Again, as I said, I recommend it to many patients. We have it in many of our products. But for people that don't need it, why take the risk when there are all these other alternatives to have a really healthy mouth?

[00:14:57] Speaker 2: There was a study, I think, that came out on flossing a few years ago. And I don't have it in front of me, but I remember it caused quite a bit of a stir in the dental community. And I don't want to oversimplify it, but basically it was really questioning the benefits of flossing at that point, saying if you look at the data, maybe it didn't hold up in terms of actually reducing cavities and improving oral health. Do you remember that?

[00:15:21] Speaker 1: What did you think of that? I remember that. Most of us who've been practicing for 30 years or plus, we know that floss works. But not every floss works. And I try to avoid flosses that have PTFE, which is a forever chemical, or petroleum-based waxes, like microcrystalline wax. These are forever chemicals that stain your body, stain the environment.

[00:15:43] Speaker 2: And you talked about a very specific sequence of events, using the mouthwash, doing the tongue cleaning, doing the flossing, doing the brushing of the teeth. Do you have any sense, Doctor, what percentage of the country is doing this right, doing this in a proper way?

[00:15:58] Speaker 1: Very small percent. Let me ask you a question that may really shock you. How many hours of dental education do you think in dental school or hygiene school we get on toothpaste, mouthwash, toothbrushes, flosses, basically the oral care products? Very little is my guess. That's right. Zero. I went to UCLA Dental School, not a bad school, probably one of the top schools in the country. And we had one hour on oral care products. And all I remember, they said, use something with fluoride. That was it. So I think it's shocking. So we've taken the responsibility to educate. So our company, we now teach at almost all the major dental conferences. We provide CE courses online. Because this is not taught in dental schools. This is not taught in hygiene schools. And this is, so we provide those courses. We provide educational content. We provide CE courses. We provide webinars, live courses, recorded courses. We go to now dental schools. Some hygiene schools have done that. Because they also realize that this is not working. So to answer your question, because we're not educated in dental school and because we're not educated in our hygiene school, of course, not a lot of people are following the way they should be doing their oral care. And the result is a disaster. So one of the things we're doing, and the responsibility, I feel like we do have the responsibility. Since nobody else is doing this, we've taken the responsibility to actually go out there and not only teach the public through these interviews and through all sorts of ways, but also teach the profession as well.

[00:17:34] Speaker 2: Yeah, and I want to make clear again, for people who may be listening, this is what you do for a living. You oversee many practices around the country. So as a result of that, my guess is, doctor, you can collect a lot of data. That's right. Because this is one of those things where, again, like with the floss, does it work, doesn't it work? How long should you floss? How long should you brush? All that. You've been collecting this data. For over 30 years. Over 30 years. And the book is called If Your Mouth Could Talk. That's right. That's why you decided to write the book, my guess is.

[00:18:07] Speaker 1: Well, actually, I'll tell you a story about why I decided to write the book. Now, I'm an expert. I'm a dentist. I'm an orthodontist. I'm a pediatric dentist. We run this huge group dental practice with all the specialists. I've gone to one of the best schools in the country. And before my son was born, when patients would ask, Dr. Haas, what toothpaste do you recommend? I would say anything with fluoride, because that's what I was taught. And so when my own son was born, I went to my wife. I'm like, what toothpaste should we give Aiden? And my wife said, I don't know. Because now it was our own child that was on the line. So that was the beginning of me. I actually panicked. I'm like, I don't understand. I know all these areas about sleep and breastfeeding and all these other things. But the area that I'm supposed to be the expert in, none of us know what to give my own child. And so I ended up reading over 600 research articles and books over the next few years. And that's really what led me to write my book. Because once I had the knowledge, I figured, oh my God, really, we need to spread this information about why oral health is important, how it's connected to pregnancy, to childhood, to airway, to sleep, to mental health, to systemic health longevity. And then once I did that, and I wrote the book, and I would do interviews and talk to media and conferences and professional meetings, then the first question out of everybody when they would read my book or talk about it or I would discuss why oral health is important, they would say, what toothpaste do you recommend, Dr. Haas? And I would say, well, it really depends on your situation. How old are you? What are your risk factors?

[00:19:37] Speaker 2: So if people are listening, and you may have a pregnant woman, you may have an older person, a younger person who are all listening, the idea of customization of their oral care routine is something that you talk a lot about in this book. I mean, it's probably, there may be too many details to get into in one podcast. But I think the point that you're making is that it's not a one-size-fits-all approach.

[00:19:59] Speaker 1: The problem is, if I ask the next 100 people I'm going to see today, how do you get cavities? They're all going to tell me, of course, if you don't brush your teeth enough and eat a lot of sugar. Because that's the message we've been given. But if cavities were this simple, then cavities wouldn't be the number one disease in the world. It's not that simple. It's more complex. Your mouth is more complex. It's an organ with multiple things that are functioning with a whole world of oral microbes, with saliva, with soft tissues, with gingival tissues, with the bones, especially in children, that the mouth is growing. We have the airway. We have the tongue. And so we need to broaden our approach about oral health. And people like me, dentists, and like you, physicians, we need to join forces. And we need to, even from educational thing, it's absolutely nuts that dental schools have been separate than medical schools. It's probably one of the reasons why oral disease is the number one disease in the world. So maybe we should have a different approach. We need to customize them for different ages and stages and preferences and risk factors. And hopefully we can get the results that we haven't been able to achieve in the last decade.

[00:21:06] Speaker 2: What are the other consequences of poor oral health? Like my dad had a cardiac procedure recently. And the doctor, I think very appropriately, asked about oral health during that, concerned about potential infections and the impact that might have on the cardiac procedure. So we're talking about mouth affecting heart. But it goes way deeper than that, doesn't it?

[00:21:30] Speaker 1: It goes way deeper. For some reason, and probably the disconnection between medicine and dentistry, people forget that the mouth is not a separate entity. It's the opening to your body. So if you have microbes in your mouth, if you have toxins that those microbes produce, if you have inflammatory cells, because of the reaction to the unhealthy imbalance or microbes that have you in the mouth, if you have oxidative stress molecules, all of these things, when you have bleeding gums, which is a very common sign of gum disease, all of those molecules and the chemicals and the microbes and the toxins, they can't get into the blood vessels. They can only damage the blood vessels. But like you mentioned, they can travel to the heart and cause infections or inflammation. They can go to the brain. They can go to the joints. They can go to an unborn baby and cause complications. So because blood goes everywhere, right? So that's how one of the ways how oral health impacts every part of your body. There's other ways. During COVID, for example, we knew that people with gum disease had a high risk of complications from COVID because the oral cavity, the surfaces of the mouth are contiguous with those of the trachea and the lower airway. So we've always known that oral health can impact respiratory health. Like you can aspirate oral microbes, et cetera. Like for example, I've seen studies that show that in nursing homes, if the residents clean their tongue with a tongue cleaner, it reduces the pneumonia by a certain percentage. I forget exactly.

[00:23:03] Speaker 2: Hmm, interesting.

[00:23:05] Speaker 1: Just by cleaning the tongue. Just by cleaning the tongue because they're not going to aspirate their microbes into the lungs as often. There's also, of course, your mouth is the opening to the GI tract. So the mouth, we all need to remember, is not just connected to our body. It's the body. It's the opening to it. So whatever happens in the mouth, it can impact everywhere else and vice versa, right? When I go to dental conferences or medical conferences, sometimes I'm on a panel with my physician friends and they're talking about the importance of the gut microbes. And then I always have to remind them, like, where do you think your gut microbes come from? It's not like they go through your belly button. You know, it's when you swallow over the years, you know, you collect the gut microbes. So we cannot think of your mouth as a separate entity. And so we need to think of it as just part of the body. It is one of the most important organs in your body, right? The good news is it's so much easier to, I think, fix oral health, which impacts all of these areas of our mouth, systemic health, mental health, personal successes, professional successes, our dating life, how much money we make. By the way, all of these are impacted by oral health. Why don't we at least have an open mind to look at alternative new ways of taking care of oral health?

[00:24:14] Speaker 2: Yeah, look, I've learned a lot. And I just want to emphasize this point. You do this for a living, number one. And number two, you've been doing it a long time and been collecting data. So there are people who are going to hear some of this and it's going to be surprising for them. But I just want to keep making this. We're having you on the podcast for that reason, that this is what you do. And, you know, people really do care, I think, about their oral health, despite the fact that they have not, sounds like, from your data, have not been doing it well. And, you know, we don't have great oral health. Part of the problem, I think, as well, is the lack of parity when it comes to insurance. Well, look, I really appreciate you writing the book, because I know it's hard to do. When you write a book, it forces you to constantly evaluate your thinking. It forces you to reexamine the data and to put something out that's going to be for the ages, because books last for forever, you know, or at least a long time. It sounds like a lot of people within the dental community are, as you say, getting on board. I guess most importantly is your wife, because she's also a dentist. Do you guys have disagreements on things, or are you pretty much lost?

[00:25:23] Speaker 1: Yeah, of course. We have some disagreements. I mean, I'm talking about oral health, not the rest of your life. No, no. No, I mean, our oral health is pretty much on the same page. And the reason is that, again, we've been practicing, and then we have dozens of doctors in our practices, and we all have the similar philosophy because we've been practicing for a while, and we've seen the results, what works and what doesn't work. And so after 30 years of doing these things and seeing the results, I think we've kind of come to the same conclusions.

[00:25:51] Speaker 2: Finally, just breath, bad breath. A lot of people come to you, I'm sure, talking about that, complaining about that. Is that coming from the mouth? Is it coming from lower down in the airways?

[00:26:01] Speaker 1: Yes, it can be caused by many things, like your throat, you know, the food you ate, but primarily comes from your mouth. And it's not primarily from your teeth. It's primarily from your tongue. So that's one, clean your tongue. And it should be part of your routine, just like you brush your teeth, you should be cleaning your tongue. At least once a day, you should be cleaning your tongue, or maybe twice a day. So that's one thing. Teeth are also critical. And one of the areas that is also extremely common to have bad breath is between your teeth. If you have gum disease, just like what happens when you have gum disease, you get inflammation, you get swelling, food gets stuck. And so flossing, I gotta tell you, after 30 years of doing this, when I talk to someone, I can, just being in the distance of talking, I can smell if there are types of person that flosses their teeth or not.

[00:26:47] Speaker 2: Huh, interesting. Do you want to say a couple sentences on teeth whitening?

[00:26:50] Speaker 1: Absolutely. So who doesn't white teeth, right? I live in California. Everybody's obsessed with white teeth, right? So I want white teeth too. And so there are a couple of ways that you can whiten your teeth. One is through chemicals, like through bleaches, basically, right? Hydrogen peroxide, it does whiten your teeth. It really whitens it. But it also causes sensitivity. So you have to make sure that you use the right concentration. Don't overuse it, because then you're gonna literally damage your teeth. Over time, your teeth are gonna actually look more dull. You're gonna cause permanent damage to your teeth. So that's with hydrogen peroxide. Do you know any ingredient that can naturally whiten your teeth, but at the same time, reduce sensitivity, and at the same time, remineralize enamel, buffer enamel, and reduce plaque? Nanohydroxyapatite. I'm married, so I'm not, I'm just, this is a joke, but I always say that if I wasn't married, I would marry nanohydroxyapatite, just because it has so many benefits. And so my wife, I hope she doesn't listen to this podcast. So nanohydroxyapatite, it naturally whitens your teeth, because it's like liquid enamel. At the same time, it reduces sensitivity. So it works the opposite of bleach. Bleach whitens your teeth more. It bleaches your teeth. But over time, it can damage your teeth. So maybe once in a while, you can bleach your teeth, but your daily uses, if you want to have white teeth, you're a coffee drinker like I am, if you're a tea drinker, which I also am, you want nanohydroxyapatite, ideally with vitamin D3 and K2 in your toothpaste and mouthwash and floss. It naturally whitens it and reduces sensitivity and it reduces plaque and it remineralizes enamel and it buffers your enamel. So you can see why I'm obsessed, in a way, with this one ingredient.

[00:28:35] Speaker 2: Well, I wish you and nanohydroxyapatite a long and successful life together. We don't endorse any products on this podcast, but the products that you're talking about, are they readily available? Can you find these toothpastes that have fluoride and nanohydroxyapatite and some vitamin D and K2 and all that? Do they exist?

[00:28:54] Speaker 1: Of course, there are other oral care product companies that also have nanohydroxyapatite. It's an upcoming ingredient, and I think a dozen brands have it.

[00:29:03] Speaker 2: Doctor, what a fascinating discussion. Thank you very much. I got to be honest, I read the book, so I knew that it was going to be interesting, but you're a fascinating guy, and you've been at this for a long time. You literally married another dentist, and so this is your life. So I really appreciate you sharing your wisdom with us.

[00:29:22] Speaker 1: Thank you. That's very kind of you to say. Thank you very much.