S6 E02: Fluoridation: Science and Facts

[00:00:00] Wright: Today we're tackling a timely topic, which is fluoridation. It's been getting a lot of press these days, so we're diving into an important conversation about recent developments in science behind fluoride and what it means for public health. What's being done to support our dental communities and how we can keep you informed.

I'm Dr. ArNelle Wright.

[00:00:20] Ioannidou: And I'm Dr. Effie Ioannidou, and yes, I'm so happy we are doing this because we need to dig deep into the issue and the science behind this, right? It's really important to discuss what we need to know, what resources we need to support us and our dental community, and how to talk to our patients.

So, let's get started and we have the best, best person for this.

[00:00:47] Wright: Yes, we do.

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[00:01:08] Wright: Hello, hello everyone! Thank you so much for joining us.

Fluoridation, as you've heard, has been making headlines lately and it's really brought up a lot of questions, a lot of concerns from our professional community and from our patients about what this really means for U.S. public health.

[00:01:25] Ioannidou: Joining us to today to talk about this important issue is Dr. Scott Tomar, professor and Associate Dean of Prevention and Public Health Sciences at the University of Illinois in Chicago. He's an amazing and vocal advocate on the topic of fluoridation for more than 30 years. We have a lot to talk about, so let's welcome Dr. Scott Tomar.

[00:01:50] Tomar: Thank you so much for having me. I appreciate the opportunity.

[00:01:53] Ioannidou: Thank you for joining us. It’s a pleasure, we have so many common friends, it's very nice to make new friendships.

[00:02:04] Wright: Right, and I was saying earlier, before we even started recording, it was really good to see you again, because you were a professor at UF when I was there as a dental student. So on that note, Dr. Tomar, why don't you tell our listeners a little bit about yourself?

[00:02:17] Tomar: Sure, so my current position, as you had mentioned, I'm professor and Associate Dean for Prevention and Public Health Sciences at University of Illinois Chicago College of Dentistry. Before that, I had been on faculty at University of Florida College of Dentistry for a long time, but my time in fluoridation really goes back really to when I was in graduate school.

In particular, earlier in my career I was an epidemiologist at Centers for Disease Control and Prevention for several years in the Division of Oral Health. Unfortunately, was just eliminated just a week or two ago, but we were heavily involved with water fluoridation then and I've really been involved with it throughout my career, both on the scientific side as well as on the advocacy side.

[00:03:06] Ioannidou: This is so important and you have, because of your background and your expertise, you have been speaking and advocating for fluoride for quite some time. Why this topic, this issue has been such an important, such a focal issue for you over the years and now I get it, like the epidemiological background, but what else?

[00:03:30] Tomar: You know, as a public health dentist, one of the things that's always just appealed to me so much about community water fluoridation is for one thing, it provides prevention that we learned from nature. I mean, we, you know, the early studies we just observed what was naturally happening in communities that had the right level of fluoride in the drinking water. So really, we're just mimicking what nature had already showed us more than a hundred years ago, you know, but compared to almost any other way of providing those preventive benefits this doesn't require any special equipment on the part of people. They don't need to do any special behavior, for communities, it's incredibly inexpensive, there's almost nothing we could do that is as inexpensive per person, per year as providing community water fluoridation and we really don't have great alternatives. It's one of incredibly few public health measures that not only prevents disease but actually saves money.

You know, we've got lots of other public health measures that we advocate for, you know, whether it's fluoridation or mammography and colorectal screening, lots of other things, but there's really almost nothing else that actually saves money. So, for communities, you know, and I learned this years ago from, from a health economist I was working with said, “well, you know, if you have evidence that it's effective at preventing disease even at relatively low levels of disease or lower levels than we have now compared to back in the 1940s. If you have something that prevents disease and saves money under almost every scenario, it's a no-brainer, of course you should be doing it.” And this was somebody that was an economist, was not somebody that had a dental background and so again, throughout my whole career as a public health dentist that to me has always been sort of our foundation for caries prevention, obviously for other folks that we may need to add other things, but as, you know, as sort of our base level preventive strategy, again there's nothing else that really comes close to the bang for the buck.

[00:05:46] Ioannidou: Low hanging fruit, right?

[00:05:48] Tomar: Yeah, yeah.

[00:05:49] Wright: Well, so Dr. Tomar, before we jump in too far, that was so good. You mentioned something that highlights or kind of eases me into my next question, which was the history. You mentioned, you know, we're following pretty much what nature has already shown us, so I want to go back to the basics for a moment.

Many of our listeners, as you already know, they're dental professionals and so we already know what fluoride is, we already understand what it does, but just for any of our listeners who may not be in the dental community as professionals and they may be hearing this for the first time. Can you please share a little bit of that history and provide some context of why fluoride is in our water, how it is there? Can you just kind of bring us all up to speed before we jump into the rest of the episode?

[00:06:37] Tomar: Sure. So, you know, the earliest studies really go back to, well, really before the 1930s, but I'd say the 1930s really was the starting point because that was around the time that they actually developed the technology to identify fluoride ion in water.

I mean, the story really begins before that with people noticing cases of severe, what we came to know as Fluorosis, but you know, with early days they called bottled enamel, going back really to the early part of the last century, they didn't really know what was. They sort of knew, there was something in the water, but they didn't know what was causing it. But really the, I'd say, the story of fluoridation really starts in the thirties with a dentist, an epidemiologist named Henry Klein, the same Henry Klein that developed the DMFT index that we all learned about in dental school and still using to this day.

Dr. Klein led a study of American Indian children, native American children, throughout the Midwest and Southwest scoring them for caries. Again, you know, he had just developed that DMFT index in the early 1930s and noticed that the severity and the prevalence of caries was much lower in parts of the Southwest U.S. than among children and reservations in other parts.

And he thought, you know, sort of speculated at that time, we wonder what might be causing these children to have lower caries experience than what we're seeing in children on other reservations and he speculated that maybe it's because this is an area that's known to have high levels of fluoride in the water, what they considered endemic fluorosis.

He actually took this to his colleagues in the public health service, ultimately led to an investigation by H. Trendley Dean, also well-known oral epidemiologist. Dr. Dean's primary interest to that point was really fluorosis, trying to understand what they could do to prevent fluorosis and Henry Klein presented this hypothesis, you know, “hey, I think that this fluoride level also could be reducing levels of caries in people, in communities with higher levels of fluoride.” So that led to, another observational study, this time among white children that Trendley Dean conducted in 21 different cities, mostly in the Midwest and sure enough found that there was this inverse relation between the level of fluoride in drinking water and the severity of caries as measured by Henry Klein's DMFT index.

He sort of charted both the prevalence and severity of fluorosis and the prevalence and severity of caries and said, “you know, it's somewhere around one part per million, there's substantially lower prevalence of caries and relatively low level of fluorosis, all of it, you know, pretty mild.” So it led to this hypothesis that if we could somehow adjust the level of fluoride in drinking water to this sort of, this sweet spot where we're getting relatively low levels of caries and also a little bit of fluorosis, but most of it, very low prevalence, most of it very mild. If we could somehow tweak the adjustment, the level of fluoride to that level, maybe we could reproduce what nature has just shown us in terms of this relationship between fluoride, fluorosis and caries. And so that led to the four sort of pioneering trials that started 80 years ago this year. 1945 Grand Rapids, Michigan, the first city to adjust its fluoride level for the purpose of preventing caries.

[00:10:42] Wright: Wow.

[00:10:43] Tomar: And they used Muskegon, Michigan as the comparison and then there were two, three other sets of cities and comparisons including here in Illinois. Evanston, Illinois, just north of where I'm sitting now in Chicago and Oak Park, just west of where I am, was the comparison and there's a couple cities in New York and a couple cities up in Ontario, all started around the same time. 1945, 1946, where they adjusted the level from negligible to about one part per million and then they kept the other city as the comparison and after about 10 years they saw a dramatic reduction in caries in the cities that were fluoridated. The effect on the sort of the early look at the data, was so significant that some of the cities that were supposed to be the controls, you know, went ahead and fluoridated, like Muskegon.

[00:11:43] Wright: I was going to ask that, it makes sense.

[00:11:46] Ioannidou: Yeah.

[00:11:46] Tomar: So in fact, you know, in a couple of the areas they lost their control city. You won't find data for Muskegon after the baseline because two years into the trial they said, “well, wait, what about us?” So that they went ahead and fluoridated, but luckily, we actually did have comparisons in Bradford and Sarnia, in Ontario and in New York, but actually, similar findings to the two communities that only had sort of a pre and post, but again, consistently, you know, somewhere between 40 to 70% reduction, not only in the severity of caries as measured by the DMFT index, but also in the percentage of kids that were caries free.

Thinking back to those days, mostly what they could offer at that time, to some extent fillings, but to a large extent extraction. So there was also a dramatic reduction in the number of teeth missing due to caries. So really, it was just such powerful data, by the late fifties, early sixties we saw just a rapid uptake of fluoridation starting in the major cities in this country.

[00:13:06] Ioannidou: So the evidence is clear and loud, right? It's clear and loud. We have everything we need, we have long-term trials, we have the well-controlled studies that show safety of this dose. There's a concentration in the water, so when did disinformation about this started and why do you think this happened? Like when did this start and why?

[00:13:33] Tomar: To some extent the misinformation is as old as fluoridation itself. The earliest opposition to fluoridation started, in fact, before they even started to add the fluoride to Grand Rapid system. There were people that were already calling and saying, “oh, I'm having an allergic reaction.” They hadn't even added the fluoride yet, but people were already reporting supposed adverse events. You know, I've been involved in this again for more than 30 years and over the course of my career I've seen the supposed adverse effects change over time.

Early days we heard lots of accusations of it causing various forms of cancer, osteosarcoma and then we went through a phase, actually going back to when I was in graduate school at University of Michigan, people looking at things like hip and bone fracture.

There were accusations that it had increased, the brittleness and fragility of bones and all of that was subsequently refuted by more and better studies that we went through. Late eighties, early nineties, people claiming that it caused problems with immune function and that in increased the risk for HIV aids. You know, over the course of my career I have seen and heard all of it, even before I was in dental public health, going back to the fifties and early sixties that claims that this was a communist plot and it's a way for the military industrial complex to get rid of byproducts of nuclear material.

[00:15:21] Wright: You have seen and heard it all?

[00:15:24] Tomar: Yeah, I just said it's, I mean there's, you know, people literally have written textbooks on the history. I'd say what has changed in recent years, probably several things, for one thing, the internet has certainly made it much easier and much faster to spread misinformation and I'd say in many cases, disinformation around the globe. So, we've always had a small but vocal minority, but you know, the days where all they could do is put out newsletters or mimeographed flyers, it never really caught on, people really recognized them for the fringe group that they were. But I'd say, the internet, just the widespread ability to spread this stuff at the click of a button has really transformed things and I'd say certainly in this post-Covid world I think that really has, I think at least for a large segment of the population, has increased their skepticism around health and public health. Probably to levels that we didn't see before that. So I mean, just all the skepticism, not just around fluoride and fluoridation, but you know, vaccinations and other public health messages.

So I think that it created an environment where people were perhaps more receptive to some of these, you know, what in years past was really a fringe voice, those things that have really had a synergistic effect in the past several years.

[00:17:10] Ioannidou: Yeah, absolutely true. The graduates of the Facebook medical school and dental school have been really very prominent in social media, so you are absolutely right.

[00:17:23] Wright: Seems like it's always been a little bit of a political thing, or there's just been skepticism around it. Maybe just not as loud and in front of our faces as it is now. Which honestly, at the time when I was in dental school learning about fluoridation, I would've never thought that this would be such a big…I don't know, you know what I mean? I had no idea how big of a thing and how much weight this has held, but learning the history now I can see and I'm just informed even more, just even by hearing you speak about it.

So we all know that there's been so much chatter in the news, you see states that have changed fluoridation policies, communities, cities, I mean, I'm here in Florida, as you all know. I can think of a few cities even like my hometown, that has changed fluoridation policies. So, can you talk to us about what is happening right now, like in real time? What's happening?

[00:18:24] Tomar: I mean, as I see it, I think there's really two things that seem to be driving it. At least as it is coming up in city council and county commission meetings regularly. I'd tell even in the state level this came up, with Utah in their recent ban.

Most of the public doesn't really have the time or the skillset to really get into, you know, to dig deep into the scientific literature. What they see is, “oh, there's some concern around this substance called fluoride.” Many people don't realize this is a natural mineral found in some level and almost every body of water and soil rocks. I think it's like the seventh most common mineral in the environment, so it's out there. It's not something that we came up with in a laboratory, but again, many people don't know the background of that and I've had reported people say, “well, what is fluoride? Why is it in our water? You know? Because people really don't know.

[00:19:36] Wright: Yeah. They genuinely don't know.

[00:19:37] Tomar: Again, you know, if you don't have the time ability, you know, the skillset to, to get into, well, you know, what was that study? What did they really find? Is that, was that really a valid study in both how they measured the exposure and how they measured IQ? And I can tell you that there's many, many questions around most of those studies that have made headlines, the evidence is nowhere near, uh, as strong as some folks would, would have the public believe.

So that's part of it, people are just saying this, this background noise of, oh, something's wrong with fluoride. The bad news make headlines, you know, the refutation, the critique of those studies, you know, probably gets buried, you know, somewhere on, page 20 at least. When, when people actually read, you know, real newspapers. So, I'd say that that's a big part of it.

The other is this issue of freedom of choice, that this really came up in Utah. To some of it is represented in the really unfortunate bill that they ultimately passed. So there were certainly, uh, you know, a, a strong political agenda that ultimately led to that being passed. But, what we were hearing was, um, not so much about the health effects, but this, you know, the sense of, well, it's should be people's individual right.

We hear this in many areas of public health, but then, you know, the nature of public health is we try to balance. The good of the public with, you know, that individual, you know, individual liberty. And there are many, many examples where, you know, we do things for the good of the public, especially those who are most vulnerable.

That may be somewhat, um, you know, maybe infringes to some extent on individual choice. But, you know, let me give you an example that almost every state in this country has seatbelt laws that requires the driver. It's one thing for the child in the backseat, but the driver, you know, they have all these, you know, click it or ticket laws. So as an individual shouldn't I have the right to go head first through the windshield? Is it that my, my personal liberty? But at some level, you know, society said no, because if a person is permanently disabled or killed, that is a real cost to society. So, no, you know, it's in the best interest of the public for you to wear your seatbelt.

[00:22:08] Wright: That's a good analogy.

[00:22:09] Tomar: Why do we put vitamin D in milk? You know, why do we add iodine to salt? So all these things are, are things where we have good science, that these prevent adverse events. And it's, it's the absolute same thing with, with fluoride. We're, we're just adjusting the level of a mineral that naturally occurs in bodies of water.

That's how we learned about it. We're just adjusting that level to a level that is optimal for preventing tooth decay with minimal risk for, for fluorosis and virtually no risk for, for any other, uh, adverse effect. It's the same as we do for many, many other things in the realm of public health. Um, but again, this, this has become, you know, a buzzword in this environment that, well, it's my, you know, it's my personal freedom.

[00:23:01] Wright: Very true.

[00:23:02] Ioannidou: No, of course.

[00:23:03] Wright: We'll be right back.

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[00:23:54] Wright: Welcome back to Dental Sound Bites. Today we're having an important conversation with Dr. Scott Tomar about water fluoridation and its impacts on public health.

[00:24:03] Ioannidou: You very nicely analyzed the, uh, scientific evidence and the limitations of certain studies, and it requires that people have them the skills, uh, and expertise to be able to assess the evidence and, and maybe their evidence validity. Right? And, and when they don't have the skills, they interpret studies the way they want. And I have to be fair, I think also we as, uh, scientists have failed to communicate in plain terms sometimes, uh, science and make it really, really accessible.

That's why I think it's really important for us here, when the patients come to us and they, uh, come up with a question of, you know, but I heard fluoride is poison, I heard fluoride is toxic. I heard that my kids IQ will be compromised. I think it's important for us to be able to explain and reinforce the good, the credible and the strong evidence that, uh, we have available to reassure people.

So, Scott, what do you think? And how, you know, if you wanted in, in a plain terms without, uh, jargon to speak to a patient and say, here is the summary of 80 years. Right? And, and this is why. So how would you do this?

[00:25:31] Tomar: Yeah, I, you know, I would say, and again, the, I can only speak for myself, but, uh, but I think it's true of many of us in, in the dental, public health community, we're dentists on the one hand, um, you know, oral healthcare providers, but we're also public health professionals. And on top of that, I'm also a parent and now a grandparent. If my reading of the literature suggested that there was any, any risk, not just, not just oral health, but you know, to my granddaughter's, uh, neurodevelopment.

You know what, again, I think I have the ability to, to, to read and comprehend these studies and, and advise people, uh, on our, what does this really mean. If those of us that are involved in promoting community water fluoridation, you know, truly had questions about the safety of this, uh, you know, we would probably change our tunes.

But again, we have read not, not just the systematic reviews that have come out and made lots of, you know, I think unwarranted, headlines and created tremendous fear and actually led to, you know, I think a really, um, ill-advised, uh, legal judgment in Northern California. I think, you know, we, we've actually read the studies behind that, the individual studies, and I can tell you that there is, um, you know, many of those studies that have been included in those reviews are, you know, I'll use the word garbage.

Um, 'cause one, one of the reviews I've actually read of that, of that systematic review. They use the term, you know, garbage in, garbage out. A meta-analysis, a systematic review can only be as good as this quality of the studies that go into that. You know, that the National Toxicology Program report by the author's own admission, three quarters of those studies were poor quality studies, that any credible systematic review would've just excluded them. It artificially makes it look like we have this robust body of literature when we don't. And then even of those that were included, most of them were not, at levels of fluoride exposure that we have in the United States.

The studies that really are relevant to the levels we have here have found no association whatsoever. There's actually been some really good studies done in places like New Zealand and Australia, and even Canada, uh, levels of exposure comparable to what we have in the United States that found no association. Those, those don't make the kinds of headlines that some of the ones that are generating fear have made.

And again, what I try to do is, you know, both a dentist and as a, and as a public author. So I try to break it down in simple terms for people. It's like, well, listen, we've looked at this, know the evidence does not show any association between the levels that we use in this country for fluoridation and any adverse event. Including any effect on your child's IQ or brain development. There's just no association.

[00:28:46] Ioannidou: I like the garbage in, garbage out. It's my favorite. That was so good. My fav. My fav.

[00:28:52] Wright: Yeah. I use that for impressions in the office. Oh man. You said so many things. Uh, Dr. Tomar and I just can't bring myself to call you by your first name because you were my professor in dental school. So I don't know.

[00:29:07] Tomar: Please feel free, but we're colleagues in it.

[00:29:09] Wright: Okay. I know.

[00:29:11] Ioannidou: ArNelle be cool.

[00:29:11] Wright: I know, I know. I'm just.

[00:29:13] Ioannidou: Be cool.

[00:29:13] Wright: Okay. I know, I know, I know, I know. And I need to relax. I'm learning, I'm learning from you, but there were so many things that you said, and, and I was over here writing down the first thing as far as misinformation goes.

And you can address this however you want. How much of this do you think is, um, is associated with just like lack of education on the importance of dental care altogether. I feel like, you know, in dentistry, some of the other professions, they don't even recognize us as doctors or, you know, they just think that, oh, it's just like cleaning a tooth or something like that.

So how much of this information is associated maybe with just not even putting in, uh, putting a premium on oral care altogether. And then, um, speaking of the misinformation from a public health and like the future of public health perspective, maybe can you share like what your opinion is? For the future of public health, um, if we can't combat this misinformation that's out there.

And then thirdly, sorry I'm loading you up here. Tell our listeners that are dentists, how they can advocate for fluoride in their communities?

[00:30:26] Tomar: I think you've touched on, you know, a very real point that when you think about who's making the decisions, whether that's, you know, at the state level, even at the county level, the people that, that serve in those elected positions, you know, they probably are not the ones that were up all night with their child suffering from a toothache or an abscess. Um, you know, they've never had a problem being able to access dental care for their, for their kids.

And, and this has come up. I mean, you know, they're in, uh, in, in many policymakers mind, you know, well, dentist, yeah, my kid needed braces and, yeah, I think they had sealants maybe had a filling. You know, so they, they don't recognize, um, the impact that oral health has.

Dr. Wright, you are in Florida, I spent 20 years there. Um, Florida unfortunately leads the nation in emergency department visits for children for non-traumatic dental problems. Um, so tremendous problems with access to dental care. They wind up at the most expensive, least effective place that they should go, uh, is the hospital emergency department.

Well, Florida leads the nation in that it's got one of the worst rates of dental care utilization for children covered by Medicaid in the United States, and here they're, they're taking fluoride out of the drinking water. What we're going to see, unfortunately, is an increase in dental emergencies.

So we're gonna be using more of our limited public dollars resources. I mean, you know, kids are gonna wind up at an emergency department, you know, and we know from the data that you know, about half of that is actually paid for by Medicaid. The other half is not reimbursed. So ultimately the healthcare system, you know, eats that cost.

And here we took out one of the evidence-based effective measures that we had that could have helped to control that. Uh, what I haven't heard from, from Florida's leaders is what they're going to do, you know, to try to, to stem this tide of, of pending public health crisis.

Uh, 'cause I think that they don't recognize that it's not just about, you know, oh, you know, kid gets one cavity. Children wind up, you know, with emergencies. They miss school, they wind up in the hospital. Uh, I think that much of the public.

[00:32:53] Wright: It compounds.

[00:32:55] Tomar: Much of the public does not recognize, you know, oral health is more than just, you know, uh, an additional filling of course. So that, that's a big part of it.

I'd say that we as a dental community, as a public health community have not been nearly as active on, or should say, as proactive as we, we should have been and could have been in telling people, well, yes, we do fluoridate your community, this is why this is the benefit.

I mean, when, when, have you ever seen a public service announcement on why you should be drinking tap water? The benefits of Fluor data tap order. It just.

[00:33:32] Wright: Yeah, it doesn't, I haven't seen it.

[00:33:33] Tomar: I've never seen it. Um, so again, it's things that we probably, you know, should have been doing and maybe, uh, maybe it's not too late that we should be starting to be more proactive, uh, on that.

And again, what we should tell our, you know, our patients again, to, you know, assure them that we're, yeah, we're, we're dentists, but we're also healthcare providers. The mouth is part of the body. So of course we care about not just your teeth, but the whole patient's body. And you know, uh, or again, oral health is not just, it's not just about that one tooth, it's about the person that's attached to that tooth. The mouth is an integral part of their body. So of course we're concerned about more than just their teeth.

[00:34:18] Ioannidou: Put the mouth back to the, in the body. I was thinking where do the, our colleagues at the American Academy of Pediatrics stand on this? Are we united with the physicians, the pediatricians? And what do you think the other major public health groups say about fluoride?

[00:34:40] Tomar: Sure. The, so the American Academy of Pediatrics, uh, has been and continues to be a very strong supporter of community water fluoridation. They have issued, um, you know, very strong statements and supported it. And again, they're, you know, they are physicians, uh, and many of them also have, you know, advanced degrees in things like epidemiology.

They read the same studies that we read and, and they've actually reached the same conclusion that the American Dental Association has reached, uh, that community water fluoridation remains safe and effective for caries prevention. Uh, the America Public Health Association continues to have, uh, formal policy, uh, supporting community water fluoridation.

Uh, the World Health Organization continues to strongly support it, and I say most of our, uh, you know, most of the, uh, the public health agencies. In, in, uh, other wealthy industrialized countries. Um, again, they've read the same studies including the National Toxicology Programs report.

[00:35:44] Ioannidou: Yeah, yeah.

[00:35:44] Tomar: Not only do they continue to support community water fluoridation, uh, in the case of, um, of the United Kingdom, uh, they're expanding fluoridation in parts of northeast things.

So again, they've reached the same conclusions we have looking at the same studies that we're looking at. No other country has changed its fluoridation policy as a result of this. Australia continues to have, you know, well over 90% of their population that's on public water systems is receiving Fluoridated water. There was no change at all in their practice. And as I said, the, the UK will soon expand fluoridation.

[00:36:26] Ioannidou: So let me add here also that the, the American Association of Dental Oral and Craniofacial Research, the ADOCR, has also statement for water fluoridation, supporting water fluoridation, obviously.

So just because, you know, I have to speak about my house, my home.

[00:36:45] Tomar: Which is, and again, it's very important 'cause again, this is really the scientific arm of the oral health community, the ADOCR. Um, and so these are the people that really do have the skillset to critically read that. And, and again, I think it's very telling that they've actually come out with a, uh, a new really evidence-based position statement, uh, complete, you know, totally supporting community water fluoridation.

[00:37:10] Ioannidou: Great. That's so great. I love this conversation.

[00:37:13] Wright: This has been so good.

[00:37:14] Ioannidou: Yeah.

[00:37:16] Announcer: On the next dental Sound Bites.

[00:37:18] Wright: We'll be talking about imposter syndrome and how to build confidence as well as thrive in the face of self-doubt.

[00:37:27] Ioannidou: This is really helpful and it, it has been amazing to have you here with us on Dental Sound Bites today. And, uh, so, I mean, we know where to find you, but tell our listener, we will come and get you, tell our listeners where they can learn more about you and where they can find you online.

[00:37:45] Tomar: Sure. Uh, well, you can always reach me by email at s tomar S-T-O-M-A-R, at uic dot edu certainly welcome your, your questions I, I could, uh, help point you to, uh, to the literature if, if you have problems finding it and,

[00:38:01] Wright: Oh yeah, you can.

[00:38:03] Tomar: And chances are, if there's a study you come across that, uh, you need help interpreting, chances are either I or one of my colleagues has probably looked at that study and, and could give you our, uh, our, our 2 cents on it. So please feel free to reach out.

[00:38:18] Ioannidou: That's perfect.

[00:38:19] Wright: Yeah. We appreciate it.

[00:38:20] Ioannidou: Thank you so much. Thank you. Thank you. This was, this was great. And to all our listeners, we are going to link the resources and the information mentioned in this, uh, discussion on the episode notes, and you can find them on ada.org/podcast.

[00:38:38] Wright: If you like this episode, please share it with a friend. Then be sure to subscribe wherever you're listening so that you can get the latest episodes. Uh, Dr. Tomar, we are so excited that we had you here, so thank you so much for being on the show.

[00:38:49] Tomar: It was my pleasure. My pleasure. Thank you both so much for the opportunity to be here.

[00:38:57] Ioannidou: Thank you so much. It was great. Thank you. Thank you.

[00:38:59] Wright: Bye everyone.

[00:39:01] Announcer: Thank you for joining us. Dental Sound Bites is an American Dental Association podcast. You can also find this show resources and more on the ADA member app and online at ada.org/podcast.