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Summary

This on-demand teaching session is relevant to medical professionals and provides an opportunity to learn about the importance of oral health in relation to non communicable diseases, such as diabetes, and the importance of establishing a healthy oral hygiene routine from birth. Jill from the Commonwealth Nurses and Midwives Federation will discuss the high prevalence of dental cavities in children, including the reasons for this, as well as the effects of toothache in children on physical and emotional wellbeing. Participation in this session provides access to a certificate which is of particular use for revalidation.
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Description

Learn With Nurses Founder,  Michaela Nuttall RGN MSc is joined by Jill Iliffe, Executive RGN BAS RM, MIntS, IDMHHRL, Executive Secretary from Commonwealth Nurses and Midwives Federation for the next part of the Diabetes and Oral Health In Conversation series 'What about the kids' to discuss:

Why do children have such a high incidence of dental caries?

Is the current emphasis on oral health just a clever advertising campaign to sell more oral health products?

A 40-minute live webinar that will be recorded and made available on demand.

Nurses and midwives are in a unique position to raise awareness about the importance of oral health and provide oral health education to individuals, families and communities. Implementing preventive measures early will alleviate individual pain, discomfort and disfigurement and reduce the economic burden of oral diseases on individuals and the health system.

A collaboration between C3 Collaborating for Health, the Commonwealth of Nurses and Midwifery Federation and Learn With Nurses.

Funded by Burdett Trust for Nursing.

Learning objectives

Learning Objectives: 1. Understand the importance of establishing healthy oral hygiene routines in children from birth to prevent dental cavities. 2. Recognize the relationship between poor oral hygiene and increased risk of developing non-communicable diseases. 3. Identify the dietary and behavioural risk factors which can lead to poor oral hygiene in children. 4. Appreciate the effects that toothache and other oral diseases can have on children in terms of sleep, concentration and learning. 5. Learn strategies to help children and parents develop good oral hygiene habits.
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Computer generated transcript

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The following transcript was generated automatically from the content and has not been checked or corrected manually.

Good morning, everyone. Well, I say good morning everyone. It's hello actually, because depending where you're joining from or how you're joining us defines on what time of day it is for you. But for me, it is good morning. But I'm joined today by Jill and Jill. I think it's good evening for you tonight. Yeah, it certainly is. Good evening. Six pm for me. Oh, and it's 8 a.m. for me over here. And this is the joy of doing things on the internet. So anyway, I will um introduce the session for us and then I will be handing over briefly to Jill. So welcome everybody to another of online with nurses sessions. And this is part of our really special group that we're doing together collaboratively with um C three collaborating for health and Jill's CN MF and Jill will tell us a little bit more about CNM F in a moment. Um And this whole project was uh funded by um funded by the Trust for Nursing. So remember everybody, if you're live now and joining us live, now, we will be able to see your questions as they come in for anybody who's joining us as on demand, then of course, you won't be able to ask any questions, but you also won't be able to read any of the questions. So if we do get questions that come in, we will read them out aloud. And that's where you'll know why we're answering something. Now, don't forget at the end of our session, remember to do your uh evaluation because that's really important for us. So whether you're watching live or on demand, it is really important. But also that allows you to get your certificate, which is really important for that is as part of, well, many people for our revalidation. So as I said, this is a joint initiative. It's a collaboration between all of the organizations and it really is looking about oral health and diabetes and it's been a very sort of interesting journey I think we've been on and we'll, we'll hear a little bit more from Jill in a moment because she's been quite, quite involved with oral health. Um, but we're really trying to leak it now into the, um, the emerging, um and rapidly emerging connection between oral health and diabetes and this sort of symbiotic, bidirectional response that's there. But this session is called, what about the kids? So, um, Jill, do you want to let us know a bit about you and, and CNM F and, and the topic and why this topic is important? Yeah, certainly. Thanks Mia. My name's Jill and I'm the Executive Secretary of the Commonwealth Nurses and Midwives Federation. As Michaela said I've been working with um C three and learned with nurses um on this particular project um linking um oral health with diabetes, but also with other non communicable diseases. And one of the reasons that we wanted to focus on Children is that it's just incredibly important for Children to start um a healthy oral hygiene hygiene routine as early as possible. Um So that they have a healthy mouth, healthy gums, healthy teeth and this will protect them from developing uh non communicable diseases, particularly diabetes later in life. So that's why we wanted a session focus particularly on Children. Yeah, lovely. And this is part of a whole series. We've got um some pretty much more taught sessions where people, you know where Jill does in a fantastic session on what to look for in mouth and, and with slides and everything. This is one of our in conversation ones where it's just gonna be me and Jill having a bit of a chat, some sort of questions backwards and forwards. So hopefully if you, if you've already seen some of the other sessions and if you haven't do, do hop onto them cos there's the usual small bite size, I wanna get you to learn more. So I'm gonna start by asking Jill a question really about, about Children and, and I think Jill was really pivotal in, in, in getting us to really think about the Children as part of one of our webinars. So I think, you know, Jill, why do Children have such a high incidence of dental cavities? Why is, why is it so why, why Jill, why there are, there are many reasons, unfortunately. Um I suppose the first is that there's a generally a very poor understanding um of a by adults of uh the importance of oral health. Uh don't forget that Children go live in isolation by themselves. They have parents, they have grandparents, they have teachers, aunts and uncles. And if adults don't have an understanding of the importance of oral health, they're not going to share that information with Children and make sure that Children have an established healthy oral hygiene uh routine, protecting children's teeth, which is something else that lots of adults aren't familiar with starts in utero. So it starts while they're a a fetus. Um and you know, pregnant women, um in my experience are not aware of the importance of their diet and their own oral health um on the developing um teeth of their, of their fetus, their baby, um teeth start developing from the sixth week of pregnancy. And it's really important the nutrition that a pregnant woman has uh for developing teeth. So that's something that, you know, maternal and child health nurses, midwives really need to be um aware of parents have shocking habits. I mean, how many times do you hear of uh of um, honey or jam being put on dummies or Michaela. Please don't, don't feel guilty, don't look guilty. I mean that sweetened, sweetened fruit juices, um, in, in bottles that you know, this means that sugar is in contact free sugar is in contact with, with baby's gums even before their teeth break through, um, their gums and, and this sugar turns it, bacteria turn this sugar into acids and then acids affect the, the primary or the secondary teeth. So sweetened foods, sweetened dummies, uh rubbing honey on someone. Uh, the baby's gums rubbing jam on their gums, giving them a bottle of orange juice with your sweetened orange juice. It's really very, very poor practice. Uh right from the time that a baby's born, they need to have their, their gums wiped with a soft damp cloth after each feed just to remove them. I'm making you feel like a bad mum, don't worry. I did some bad things too. Um And, and so we start right from then we start with really bad habits. Um, and Children, Children are given sweets as a reward, you know. So that's a reinforcement for them. Um It, that a sweet thing is good, but in actual fact, a sweet thing is bad and, but if Children do have, I mean, everybody likes something sweet but you really need, if you have a, a hunk of chocolate, um, you really need to rinse your mouth out after you've eaten it to get rid of the sweetness. So even adults, they need to, if you know, you, you're, you're busy and you don't have any time. And so you, you, we eat a Kit Kat or a, or whatever those things are called Mars Bars. I can't remember the name because I don't really like it very much, but you need to rinse your mouth afterwards. So that, that sugar isn't sitting around your teeth and your gums. And I guess the other thing is that adults don't have a real appreciation of the importance of primary teeth. So they don't think that primary teeth are important, so they don't look after them. Um And of course, your primary teeth are critically important if you, if they're, you've got cavities in your primary teeth or, or if you've got gum disease that can affect the permanent teeth developing beneath them in the gums and also primary teeth help with speech. Um they also help with nutrition and they also help by keeping a place in the gums for the permanent teeth coming through. So it's it's really important that primary teeth are looked after. So yeah, that's all, a lot of those are the reasons why uh there's a high incidence of dental caries in. Um Yeah, yeah. And, and, and if, and if I reflect back on some of those and you will have seen the shock on my face, but I was ii have to confess, I did I only put, I only put jam on a dummy a couple of times because my daughter never had a dummy. And then, and then I just wanted her to have a dummy because I think I can't remember. I thought, oh, she needs a dummy because she needs to, you know, she didn't cry much, but after a jab she needed to. So I remember I used to put the dummy in and she would go and it would pop out and I'd put the dummy back in. I'd try and hold it in. It would. Oh, so I thought I'll try. So I only did it to dry and put some, put some, I think it was some jam on it or something to think. Would that entice her to keep the dummy in? But now it popped out. So I never did it again. But I'm quite surprised by that, you know, the, the, I mean, I'm not surprised but the, but the rubbing gums after food, that was something II never knew then. And, and until now I didn't know now and I'm guessing a lot of us don't know to um, to clean gums. I mean, we used to give her in Venice, we did, used to give her a toothbrush to chew on and to play with when she, when she just had gums. And I was very good at taking her to the dentist when she had gums and that was something I didn't realize, but it was my dentist that told me, oh, bring her in. It's never, it's never too early to start. So um yeah, yeah, so brilliant. And um and I think primary teeth, I always think of them as called like a as baby teeth, but maybe we should be less calling them like baby teeth because that baby teeth makes it sound less important though. It really doesn't matter. They're just the baby teeth and they will be gone and then you'll get your, your, your, you know, your adult teeth, your big teeth. So II think I'm liking the name primary teeth. So, so do I have another question for you? Now, I wanna, I wanna know about this. Um the because there seems to be this massive, there's massive surge from all over the place on oral health and why it's important. But is it, is it just those people that make oral health products that are just trying to get us to buy more toothbrushes and toothpaste and, and mouthwashes and stuff? Is it, is it just clever advertising, Jill? Hm. Well, certainly that's, that's got something to do with it. But for all the clever advertising, it is really important. The message is really important for us to um establish a healthy oral hygiene routine right from birth before birth, as I said before, um you know, toothache and and oral diseases have a a shocking effect on Children, you know, toothache affects children's sleep. It, uh, it makes them cranky and miserable. It affects their, um, concentration, it affects their learning. They have, uh, increased absenteeism from school. Um, and apart from that they're very conscious, Children are very conscious of, um, decayed teeth. Uh, and, and the, and the smelly breath, um, much more than you would, that you would realize. Um, just recently, one of my grandchildren had an accident in a swimming pool and snapped his two front teeth. Um one was snapped right up near the gum and the other was snapped off at a diagonal. Someone knocked his feet out from under him and he smashed down onto the di onto a diving board, uh permanent teeth, which is really tragic because you can't replace permanent teeth. And so the dentist built these teeth up, but they were a slightly different color um to the other teeth. And my daughter noticed that he wasn't, he wasn't smiling. Um And she took him back to the dentist. She said he's not smiling. Is there something wrong with those teeth? And he said, oh, no, he's just conscious of the color, different color. I'll change the color. And she said it made such a difference to this child because now he's smiling, you know, he's, he's uh he's really lost that self consciousness. And you don't think that Children are conscious, self conscious about dental caries, about bad breath, about teeth falling out. But they are, they're very cautious of it. Um, quite apart from that untreated caries, as I said to you, with it, particularly in primary teeth can lead to gum disease. Um, and, and it's severe gum disease, like a mild gum disease, like gingivitis or a severe gum disease like periodontitis. And that's where you get, um, periodontitis is not reversible gingivitis is, um, that's where you get, then links to um, non communicable diseases, um, diabetes, heart disease, respiratory disease, cerebrovascular disease and some cancers, it's not good um to leave your Children teeth um to get to that point. Um it, and it's uh even when teeth are falling out, you know, that affects a child's nutrition. Um One of the things, the interesting things that um that we've come across while we've been doing this um series is that um the, the, the um frequency that uh parents will pull out a loose tooth. Um, you know, in, in my childhood, uh they used to tie a, a string, they might have done this with you as well. Tie a string around your tooth and then tie that onto the open door and then close the door. And of course, that pulled your tooth out. But this is really something that you shouldn't do. Even though loose tooth are teeth are annoying, they should be left to fall out by themselves because as I said, they're holding a place for the permanent tooth, but also you've got an open wound there and if you add an open wound to bacteria from touching things like kids do, putting things in their mouth or, you know, sugar and bacteria acting on sugar and getting into that cavity, you can get all sorts of problems. So it's much more important for primary teeth to be left to fall out by themselves because that means that the primary, the permanent tooth is pushing them up and you don't get that open wound in the mouth. So even though there is clever advertising to get back to your question a and, and to sell products, it is important that you do have a healthy regular oral hygiene routine twice a day. First thing in the morning, last thing before you go to sleep, brush your teeth for two minutes, tiny dob of toothpaste, only a pea size dob of toothpaste, um fluoride toothpaste if you can because it adds uh protection for your teeth. Um Two minutes, spit it out, don't rinse. That's um that's the trick right from and it's adults, adults responsibility to look after the kids. It is. And now you're making me feeling even worse as a mother of all of those teeth that were pulled out. But um and I'm having flashbacks to my daughter had a really wobbly teeth and, and we were trying to, there was her first one and we were trying to get it out and I remember saying this is the worst day of my life and then when it came out, she was skipping around the garden with it. My little tooth it was. And actually now I know that it, it, she didn't ii should have just left them. I should have just left them. But, but actually my teeth, if I and I, and I'm now thinking back so when I was little, um my baby teeth, my primary teeth and I'm thinking back of the being conscious bit. Um I don't know why, but the dentist took out the fore front ones very early and he said, yeah, but this was 1970 dentistry, you know, they pulled them out and they put big fillings in. So I had the front fall taken out and they said it was, they told my mum it was so they would grow straight. So my other ones would, there wasn't a problem with my primary, my baby teeth, my primary teeth, but I was really conscious of it and I would talk with my, with my, you know, and I've got one photograph when I was little, uh a school photograph and you can just see it. But I just, I was, I was very young and they took them all out and then as these first two started to grow, they took the next two out. So they were really just removing rapidly. But um, yeah, I mean, they must have thought it was the right thing to do at the time. But, um, yeah, Thank goodness, we've moved on from there. I know. I know. But talking about that you've, you've focused a lot in your career on preventive care. So, two questions. Is it ever too early to focus on preventive care? And what are the key issues in preventing oral disease for Children in your, in your experience, or in your opinion? Yeah. So, so, yes, you're right with the prevention and I II fell into prevention, I would say over about 20 about, well, probably about 25 years ago now, which is, which is quite a while. Um, but I certainly didn't think about, um, oral health at that point in time. But, uh, you know, it is never too early to invest in prevention. And a lot of the time when I, when I, when I talk about prevention, I think about, you know, we talk about, uh, mine is about preventing heart attacks and preventing strokes and trying to stop people getting diabetes and trying to reduce the chances of somebody developing hypertension or, you know, or further down the line and thinking about, you know, we can prevent some Alzheimer's, um, about a third of Alzheimer's could be prevented. So I really have invested quite heavily. So it's never, never, never too early. And one of the things we do talk about particularly in prevention is thinking about for, for women and when, when they're, when they're pregnant is thinking about their unborn child. Now, I've never thought about it in the context of teeth. That, that's, that's another bit to think about. Is it not in the context of teeth? But how, how important it is to invest in your own health and how it is important to invest in your child's health or your children's health. So never too early. And II, and I'm just imagining um nurses and other healthcare professionals listening to this one today and starting to think about what uh having the shots like I've been having on, oh my gosh, I've done this as a parent. I've done this and I think one other thing is if you've done it, you've done it, you can't go back and undo it. But, but um but, you know, you might be a grandparent at some point and then you can think about that or relatives but also patients friends. I think this is, you know, this is something that gets really shocking. And I think, you know, most parents love their kids, pretty much, all the parents love their kids and they don't, they sometimes think we do things without, without meaning to be bad. You know, like I see kids sometimes in cars without seatbelts on and I think how the hell can parents do that? And I think this, I just don't know. And I think there's a lot of, lot of that that comes through here is we just don't know. And if we don't know what we don't know, then, then we don't do it. And I think that's why it's a great topic here to have it. And I really thinking about, II didn't realize those teeth started to form so early in pregnancy. That's six weeks. Is it very early on? And I guess when I, you know, when I think about it, yes, they do start, you know. But I really didn't realize it was that early and I heard some, I was at a session recently and they were talking about um they were talking about oral health in the context of vascular disease, in the context of, you know, blockages in the arteries that were causing heart attacks and stuff. And it is down to that inflammation and that inflammation really. And II describe it to people as you know, if you've got a splinter and you've got the angry bit around it, that's kind of what happens inside your bodies with, with inflammation. You know, whether that's because we've got, we smoke or because uh we're overweight and our fat cells cause inflammation. But um, but now we're thinking our gums cause inflammation. So for me, I would say um the key issues, the real big key issues in, in um in preventing oral health. Uh well, oral disease in Children, it is, as you've said, I would say, is that, well, one is to know, I would say, first of all, you've got to know. So, so watching and taking part in some of our sessions is really good. Um, that, that having a damp cloth, that's a, that's a revelation for me, an absolute revelation. And I'm just thinking you could, you know, you just pop it on your finger and rub it round. Why, why didn't we do that? Well, we didn't do it because we didn't know to do it. But if you know, to do it that, you know, it would take seconds, you know, just to do um to be able to have that and, and I would say that, you know, um, well, I used to get her to play with a toothbrush and chew on a toothbrush. So it was so she was used to a toothbrush. So I think that really getting, getting the Children into a very good oral hygiene as soon as we start seeing those teeth come through. Um And so that is turning it into something probably quite nice rather than a chore you've got to do. Um, you know, something quite nice and part of a routine. I find Children love a bit of a routine as well. Love a little bit of a routine. And that as parents, we do have a, a duty, we do have a duty and that just because a child can clean their teeth by themselves doesn't mean we should leave them alone by themselves to clean their teeth because they'll do it. You know, they might not do the full timer they might be swallowing it, they might do all sorts. So, I think being there with the child till I probably about a good till at least eight I would say. And that what they recommend. Yeah. Yeah. Just to, just because, you know, kids go, yeah, I've done that, you know, they never wash their hands, all of that sort of stuff. So I would say that's there and it was only, and I like the pea size. I like the pea size. I think that's really important because often, you know, you see the adverts and they do do a lovely, big, a lovely, big bit and we don't need that much. That's there. And I only recently learned that we, we, we, we, we don't rinse, we don't rinse. I II would say that was only in the last couple of years. I've learned that from my dentist. Make sure that you don't rinse. And we do have those fluoride toothpaste. I get the prescription fluoride toothpaste now because I don't know if you can say my teeth II, I've lost a lot of enamel. So they kind of um so the color is changing and every time I go to the dentist, she says, oh, your teeth are getting thinner, I think, oh, I wish my hips were, you know, but um so, but my mum did invest in my teeth. She gave us fluoride treatment and all of that. So it was what I did as an adult. That was, that was pretty bad. And that um, yeah, if we see anything, if we see anything in our Children, we should make sure we act upon it and it's not just that your teeth look a bit bad nowadays, we really need to, to act upon it. And again, feeling guilty about the apple juice. I used to give her after she cleaned her teeth before bedtime. She just would like a little bit of apple juice. I thought I was doing good weaning she loved her bottle, she loved her milk till it was till I and I thought, you know, she was down to just having an ounce of milk at the end of the night. And she even, and then we put it in a cup and then we were trying to get her up and we thought, oh give her a little bit of apple juice. Then that's fruit. The dentist was like Michaella. What are you doing? So, um, so for me, there's so many multiple things, but actually it's about getting into those little routines, isn't it? And changing our behaviors as parents and as adults um as, as well as thinking, thinking about the Children. That's, that's kind of where I would come at it. I think one of the things that um you often see um parents do, they might be out and the child's got a dummy and the dummy spit, child, spits the dummy out and the, the parent picks it up, wipes the dust off, sucks it themselves and then gives it to the child because they say they feel they've cleaned it with their mouth. That is the worst thing they could possibly do because they're transferring bacteria from the own mouth to their child's mouth. So it's a terrible, terrible thing for people to do. But you see it all the time and I guess parents are doing it because they think it's a good thing that they're doing, they're not doing because it's a bad thing they're doing it because they think it's a good thing. So, my daughter, my sister had a dummy till she was very, very old and very old. I mean, she'd come home from school and put her dummy in. I mean, she won't be watching this so I can tell her, but she was quite old. She just didn't want to get rid of that dummy. And, you know, and I'm not just talking about nursery school, I'm talking about a little bit older. Well, this, this, um, this, uh, series is, is trying to educate, um, nurses and midwives so that, um, they can, they've got the, the, uh, necessary knowledge to be able to pass on to um, their patients and their clients. So, what do you consider as far as Children are concerned and getting a message to parents and Children? What do you think is the key roles for nurses and midwives. Yeah. And that's, and you're right, that is what we're, that is our, our, that is the aim of the, of the whole, the whole sort of program of work that we're doing here. And I think there's a bit to really, sort of think, think more about oral health. We kind of don't think about it. We think, well, that's all to do with the dentists, you know, and we have got a session coming up on that one. We have got a session and it's not, you know, oral health is just as important as any other bit of health, you know, that we've got in our bodies and, and I think we often think, oh, I'm a, I'm a stoma nurse or I'm a, I'm a diabetes nurse or I'm a general, you know, we don't, and, and there's, there's no, we don't have a, oh, I'm an oral health nurse, you know, and, but it's because it should be part of all of our roles. I think. So, whether we're nurses, whether we're midwives and we know we, we've got a lot of healthcare assistants that watch us pharmacists joining doctors, med students, we have all different ones. And I think first of it, so I think it's a bit about, you know, being aware, being aware and, and, and, and, and igniting that fire to think. Well, one about our own practice and what we do, but also thinking about our patients that we come a lot, we get involved with or service users as well as friends and relatives and stuff and particularly if you are involved with, um, if your role expands over, you know, into pediatrics somehow. So whether you're a children's nurse, whether you're particularly with midwives, and we're thinking about, you know, the antenatal care and the postnatal care. Are you a school nurse? Are you a general nurse in, in primary care where you do come across much more Children in your day to day world? It's really start thinking about those mouths. And I, and I do think about with the sessions I've done with Judy and she would say so, Judy is a diabetes nurse specialist that's been heavily involved in all of these sessions. And she would often say that she remembers seeing a lot of patients with really bad teeth. So when she was doing her diabetes, annual reviews, they'd have really bad teeth, but she never connected the bad teeth with the diabetes. Um So, and I think there's something about let's look after our own teeth better. We can, we can all look after our teeth better by not spitting out and only, you know, by, by those bits. And if I tried to say to my husband, right, you've just had your bit of chocolate because he always, I don't do sweet things. So, you know, ii much prefer savory. But after he's had his little sweet thing, if I went and said, right, go and rinse your mouth out. Now, I think he'd be horrified at the thought of it, but I'm gonna start doing it and see if that happens. And so we just to think, let's just see because I think that could be a really difficult one for people to get. So really let's take care of our own teeth and the teeth of our Children or grandchildren because many nurses are and many healthcare professionals are women. And so, you know, we'll have nurses joining in um who are yet to have their babies. So maybe there's something they can really take across this and they'd really be an advocate I would say across um across there are workplaces and where are um and, and where our communities are and really think about how nurses can contribute to the, the wider system. And I know that we have at the moment, you know, we are probably the same for you, but the cost of living crisis is really, really bad at the moment. So is there a way that we can make sure that the products that we need to, to buy because we have to buy them? Is there a way that we can um lobby to make them more cost effective? Is there a way that we, you know, we give a lot of stuff to food banks and we're always, you always see like, you know, very sugary things in food banks, but should we also be putting toothpaste and toothbrushes in food banks and stuff? Is that something that should be coming through? Oh, yeah. Well, that's a jolly want to end on thinking cost of living. And I didn't, we're not quite, but we have to acknowledge that's where we are. You know, that's, that's where we are today. They're so Jill, yeah. The cost of living though, Michaela, it's, it's really um ineffective, cost ineffective to not look after your teeth because it costs so much less to clean your teeth twice a day for two minutes than it does to have. Go to the dentist have teeth pulled or have root canal therapy or have treatment for gingivitis or to have, uh, fillings, um, root canal therapy. No, it's, it's, it's very expensive. It's much more cost effective to investing preventive care. And that's prevention for you all over, isn't it? You know, it's, it's very often we don't, we don't do something until there if I think about heart attacks, you know, we should be, you know, and we are getting better at trying to invest in prevention, but we're really good at managing it once you had your event. But actually there's, and I remember when I first moved from the, from the hospital out into a prevention job and the cardiologist said to me, oh, so it's not real cardiology then. And I think that's a, that's a bit and actually it is, it's like you know if I do my job right, then we don't need you. And that's what the, I mean, we still need dentists, but that's what we need to invest. So, Jill, I want to say a huge thank you for today. Um I, I've really enjoyed this session as well as, you know, making me feel, um, feel like not quite like a bad mom. And I think as nurses were often bad moms, you know, you have to almost have a limb. Misting, don't you? Before we, we, we, we, we intervene with a child, you know, go you'll be fine, you know, you'll be fine. But as you've got your key messages and a bit of a summary for, for people watching now and, and, and, and for people who are are joining on demand, any sort of key messages for us. Oh, I think um taking from from what you've said and, and the things, the questions that you asked the first is that it is cost effective to um look after your teeth. It's important that uh people realize that you need to start uh looking after your child's teeth when it's just in utero before it's born. Wiping, just gently wiping AAA baby's gums after a a feed with a, just a gentle little dab with a damp cloth. Um looking after primary teeth because they're critically important. Don't yank them out, don't neglect them. Um One of the things you said, I think is important, supervise Children cleaning their teeth until age eight. for two reasons, one is that if you're using fluoride toothpaste, you don't want the Children swallowing the toothpaste, uh spit out the saliva and the excess toothpaste and but then leave the toothpaste there. What's there? Because that helps to protect the teeth but you don't want them swallowing it. Um and also a pea size amount. You know, you, you do see almost every advertisement for toothbrushes has a long strip of toothpaste on the toothbrush. You only need a pea size amount and twice a day for two minutes morning. First thing, nighttime. Last thing no apple juice after you've cleaned your teeth. No, no bit of chocolate. I'll give plenty of tea after you have that chocolate. Give your mouth a bit of a rinse even if your Children, you know, have, have a lolly kids like sweet things. Try not to give lollies as rewards or sweet things as rewards, but get them just to rinse their mouth out to get rid of some of the sugar and the acid that's there. Yeah, I think they'd probably be the key messages and for nurses and wives to take every opportunity to talk about um oral health for patients and clients know how important it is because of the link to general health and also look after their own teeth and those of their families, their own mouths. Yeah, brilliant. Thank you. Thank you. Well, I'm going to wrap this up now and say, thank you to everybody that's joined us online. We haven't had any questions come in, but I know that often people listen to us as we are, as they're going about their jobs. So sometimes they're on the train, sometimes they're driving in the car. In fact, we have nurses and we have well healthcare professionals join us from all over. Um We did a quick session the other the other day, we did a survey the other week and we have people, we have nurses lying in that hospital bed recovering from surgery themselves who join us. Um We have people in the bath that join us. We have, there was even one lady who was in Scotland and had to climb up a tree because the wifi signal was so bad. So um yeah, we get people who join us from all over. So wherever you are joining us from, I hope you have enjoyed this session. So whether you're joining us live or you're joining us on demand, I hope you found it useful. Remember, please do that evaluation. It is really important for us. Um Partly because that's how we, that's how we develop, that's how we grow. But also we've got to let our funders bat know that uh that you've enjoyed our sessions and that is how you get your certificate. So we do have some more that are gonna run live. In fact, Jill's doing another one probably about this time tomorrow with the amazing Christie Hancock and then we have one at the end of the month um with um it's like, shouldn't we leave it off to the dentists? So they're the two more. So, hopefully you will have seen these. Oh, I can see something's coming to the chat. Um Oh, so somebody's just said, thank you so much. It's been really interesting, especially being a mum of two who are four and one. So there you go. Never too early, Jenny. Never too early, that's there. So, um for those you that are running live that are watching us live, I will um oops, hang on, I meant to send the feedback form and now I've sent it instead of setting up the feedback so you can start putting that in and remember for those people who are on demand. Um Please do it when you finish the thing. So it's just for me to say thank you very much to Jill and um yeah, thank you. You guys for what?