David Reznik, DDS, shares his experience using Solmetex Sterisil SafeWater Solution with the host of Product Talk, Mike DiTolla, DDS.

Good evening. Tonight, we're looking at the Stericil safe water solution protocol for our dental unit water lines. And joining me is Doctor David Resnick. David is the director of the Oral Health Center of Grady's Infectious Disease Program, a clinic he founded more than 3 decades ago and serves as Chief of the Dental Medicine Service for the Grady Health System. He is president and founder of the HIV Dental Alliance, a nonprofit organization committed to access to high-quality oral healthcare for people living with HIV, and he helped develop Georgia's dental unit waterline rule. He speaks nationally on waterline safety and infection control. And served as president of the Georgia Board of Dentistry. David, welcome back. It's great to have us, have you with us again. How are you doing tonight? I'm doing great. Glad to see you. Glad to be here. I know you are more passionate, I think, than anybody in the United States, and that's why anytime I wanna talk waterlines, you're the only person that, that I turn to. And as I mentioned, you were instrumental in writing and advancing Georgia's dental unit waterline rule. What motivated you to champion that and what have you learned since it first took effect? So, it's been an interesting process. When I joined the Georgia board in, um, 2022, we didn't have an infection control committee. So, I thought that was something that we needed to have, especially since we had a history of problems with dental unit water lines and I've been to some offices that were, could have been better, done a better job of infection control. But we had a history. We had a problem in 20 And so 2022 was the first instance and we created continuing education as a part of the board and so to get your license, the 20 years for hygienist, the 40 years for dentist, 40 years, 40 CEs, 40 years would be a lot of CE. 40 CEs. It's not an addition, but you had to take one on infection control and one that focused on dental unit waterlines. Then regretfully, we had another case in 24. And my concern was that we were not, the education may, will work. There's no question, education works, but will it work to the degree and fast enough that I thought was necessary since now we had 3 documented cases, uh, going on in Georgia. So we created a dental unit waterline rule. And I think the thing that shocked me the most was, it was unanimous. There was no opposition. A very few things um would get through the board that I'm president of the board now. I, I, I wish other things would go through so smoothly, but this went very smoothly and it just set up I think a program where people could pay attention to an important part of infection control they weren't really paying attention to before. Why do you think there wasn't a single objection? Because it is, it sounds funny to say that, but by the same token, you can hardly ever get a group of people to agree on something so wholeheartedly. Do you think that there was just this underlying feeling that everybody knew, yeah, this is going on, we have to do something about it? Why do you think you got that unanimous vote? Well, I, I think partially, um, my partner in this was Doctor Jay Shirley, who worked at Children's Healthcare of Atlanta. So, he had been involved in some of the cases. I think Georgia was unique because we have Children's Healthcare of Atlanta, which does have dentistry, which does have infectious disease, which does have epidemiology. Cause the, the cases, the length of time between symptoms showing up could be anywhere between 14 days and 250 something days. And they were actually able to track it. And so, to me, Why do I think I'm very passionate and I could probably sell most things if I was in the sales business? Um, we do sell health. I think that's when actually I don't sell it, I give it away, but the whole concept was how to protect, uh, the children and how do we, now that I'm get, I'm considered elderly these days, how do I protect other elderly people? My patient population has always been medically complex and immunocompromised. How do I protect them? And so. Yeah, so. There are no opposition. Um, the only ones who spoke up a little bit was an oral surgeon. We don't use dental unit water lines. And I said, so, postop, you never sort of wrenched. You're always using, uh, sterile saline. You, you just have it hanging there. They finally agreed to, uh, drop any kind of opposition. So, it was, it was a remarkable experience. And I had help. I mean, there were a lot of people that were very proactively, uh, helping this along. Well, you mentioned the oral surgeons with the sterile water. I mean, a dentist might think I put cleaner distilled water into my bottle, so my water must be safe, but what, what happens between that bottle and the patient? It has to go through the water lines. These are very small tubes, as we know. That have a large surface area. And so it's very easy for bacteria to adhere to the dental unit, uh, water lines. And then if it adhere, they could actually cause a biofilm and then you have more particles, more bacteria in your water. So, uh, even if you think it's clean, there's a lot of pitting that you have in dental units, uh, water lines. And also you have to remember the reservoir. The water lines and the reservoir are not meant to last a lifetime. Um, the dental chairs, hopefully, well, they'll, well, they don't last a lifetime either, but they last a really long time, and I have high, I was, uh, blessed with an enormous grant when I built the last clinic, and so I have top of the line, um, dental chairs. But we wanted to put in a protocol that would work for us, that was simple, and that was easy to maintain. If, if dental water uh unit water lines were all clear, you know, like somehow they were completely transparent, would we be able to see this visually, be able to see this biofilm on the inside and realize that there was an issue? In some really bad cases, the answer is yes, and I hate showing those slides, but I mean it literally can grow to a point where it looks similar to having worms in your waterlines. It's just not nice. And I think the other point that because the, the cases where I saw that were in Cabatrons that were single unit, they weren't attached to the dental unit waterlines. You have to treat those too. And people sometimes forget that you have to treat the water lines inside the cavitrons. So I have one hygienist who loves cavitrons and two that love piezzos, so we have one that's special and we treat that room specially. Yeah, that's a good point. So even if they, even if the tubing was clear. You wouldn't be able to see the biofilm until it just got absolutely grotesque. I mean, so the fact that visually you didn't see any biofilm would not even be, oh, my lines are safe because I can't see it. You won't be able to see it until it gets insanely bad is what you're saying. You won't be able to see it until it gets to a ridiculous level, like something that just has been sitting there forever. Um, no, you remember we're trying to get less than 500 colony forming units per mL. Uh, that's hard to see. So that's why we test it and that's why we have fast check. You can test it in 15 minutes and see if you're passing or not. We're not looking for specific organisms. We're just looking for the total number of organisms, and this is not new. This has been around since the 2003 CDC infection control guidelines. It says you must maintain less than 500, uh, CFUs. Uh, per mL and that recently showed up in a case in Colorado where they don't have a rule, but they use the highly publicized case, uh, gentleman, uh, took out some wisdom teeth but didn't have a pan, and so they went into the office and did an infection control look and dental unit water lines showed up. Because it's part of CDC guidelines. So whether you have a rule like I thought was necessary in Georgia and I do think it's necessary in several other states, it already is a part of, of 32 states' professional guidelines. So why just 32 states, not all of them yet, huh? 32 follow CDC guidelines, not all of them, no. Well, they might have a few. I mean, Washington State has a very comprehensive, um, set of guidelines, and I'll be honest, the Georgia rule that I put together came directly from the Washington state rule. I'm one who doesn't believe that you need to reinvent the wheel. If there's a model out there. Use it and just change it to make it work for your state. Um, and it was a matter of just changing a few little words. Like for instance, the Washington rule says the dentist shall test. No. Um, not in Georgia. The dentist isn't going to test the dental assistant or infection control coordinator, which I do have one of those, um, who is just a, uh, if you're going to have somebody who you want to hang on to, say, a dental assistant, and you want to give them a little bit more money and be in charge of, like, infection control, that worked for me. Um, and I got it done through the Association for Dental Safety, my. A D S.org. Which I've been a member of for a long time, so it's a little plug there, but um that's how I got her credential through Dan B. Dale and ADS. Yeah, that's if, if the dentist is in charge of it, it's just not gonna happen. There's too many other things that the dentist has to concentrate on and be primarily responsible for, that's certainly something that should, should be delegated and frankly, yeah, in my own office, it's, it's my lead dental assistant who, who does all of that and um yeah, thankfully I'm not, I'm not the one who's in charge of it. What would you say to a dentist who says um but I've never had a patient get sick from our water, what would you, what would you want them to understand? Uh, first thing I would say is, how do you know? I mean, that that's the #1 thing that I would say. The #2 thing because they say, well, we've never had an outbreak. I think that there California, um, Georgia. And then there's been some issues with some other states around the country. Uh, I think part of it is, one, we're looking at one organism, Mycobacterium abscessus, a non-TV form of, of, uh, Mycobacterium. And two, it basically, with that long period where symptoms are showing up, you don't know if it's failed dental work. Or is it due to an infection? And so, uh, I, I, I do think that that should be the standard of care around the country. And that's why I agree. I'm working with, uh, I'm working with Salmetic, Stericil, um, we're partnering trying to make this happen. Um, so I joined the American Association of Dental Boards and Examiners. Um, as president of the board, I wanna see what other states are doing and see if I can help influence or help other states get something into process. So I've never had a case. I, I, I find that hard to believe, but if your patients are healthy and they're adults and they're between. Uh, 20 and 45, you probably haven't. But most of us have family practices. You're seeing, you're treating children, which is where this mostly shows up. But it shows up in heart patients. They were. Um-hum. Women's Hospital. Uh, they had 4 patients, had the same OR, same surgeon, were in different towers, 2 developed mycobacterium, Abscesses in, in the heart area and it was due to an ice machine. And so we have an ice machine in what we call our acute care center and, yes, we test. We, we melt the ice and we go in there and we test. So, uh, I think it's more, much more widespread than we're aware of. And I think that being proactive, having this a part of your normal infection control will ensure the safety of your patients and that's what it's all about. Well, walk us through the steroce safe water approach. I think it's test, shock, and maintain. What does each of those steps accomplish? So test lets you know where, well, first thing is the installation. When you put the straws in, and these are use silver ion technology, Um, it comes with shock. So, it literally is going to help clean out your lines to start with and then you only, you put this in once a year. It's not like I have to add tablets all the time or whatever else I'm going to do. It's noncorrosive. It's not going to smell. It's not going to change the taste of your water like some other products might do. Um, so that's the first step. The second is testing. You wanna make sure even a new equipment, you really wanna make sure that you have less than 500 CFUs and you can do that in 15 minutes. And it's not like you have to test every little thing in your dental operatory. You can do pool testing. So you literally can get water, equal amounts of water samples from the dental unit water line, from the air water syringe, etc. And then get equal amounts into a container and then get your 5 mL, stick it in a little tube, stick a little, I can do it, OK? If I can do it, anybody can do it. You put a fast check in there and 15 minutes later you know whether or not you have a problem and then shocking to help make sure that you keep the bacterial counts low. So shocking is, is something that we do on a Friday. And then, um, it has, have a color and these products all work together. So, you have the Sterisil straws and then you have Citrucel shock. And so it is orange. So we know when you run it out that you're going to, when you get clear water, it's fine. You can use it on patients. And then we wait till, and we test monthly. We're one of those more proactive states where testing monthly is, is, is, actually more proactive clinics. Testing monthly is what we do. Our law, our rule requires quarterly testing. But we test every month. It doesn't take that long. It's sort of simple. So, you, the whole sterile solution is, you're right, it's, it's test, shock, maintain. And so, you look at it the other way, you have the sterile straws in there first place, you're shocking. Then you can test to make sure that your water is good. Um, you have constant maintenance because it's going to last a year, which always, we put a ticker in a month before and two weeks before to make sure we're set up to get the new straws in. And then you have the shock that works with the other equipment. It's not corrosive either. Color coded so you know when you can flush it out and then testing. And so you have one system all made together that works smoothly, that is easy to create a standard operating procedure for. And so I, I really strongly believe in, um, having recently semi-retired, I didn't create standard operating procedures for everything that I did in my job as, as a service that I started. So now I have to go back a couple of days a week and, and help out, which is fine because I love the program. But there, there are certain things that are just simple and this is simple. It's effective. It doesn't hurt your equipment. It's noncorrosive. It's easy to maintain and it just becomes a reflex. I, with our infection control coordinator, I did, never had to tell her, OK, it's time to test. If we had a failure, which we didn't have very often, then we would reshock and then we wait a few days and we would test again. And so you have to look, if you're having issues with failures, call up your tech, call up the company, they will help you out. It could be an issue like total dissolvable solids, it could be an issue um that you're not performing something correctly. You know, people will come out and help you get through this, and there are some great expertise and great trainers around the country actually. I thought you were gonna tell me that you've never had a failure, you know, because you guys are so on top of it. That's interesting that it sounds like just kind of randomly something, one of the rooms, one of the water lines, something, maybe one of the cavatrons had a failure, and, um, you might have never known. Did you ever like pinpoint what it was, or do you, is that not as big of a concern as just to shock it and move on from there? What it was is, um, I have 12 operatories. One is actually a negative pressure operatory in case something nastier than COVID comes around. And, um, that is a room we're using for research. So, the water lines weren't really being used on a regular basis. It was, it's a perio HPV HIV study. So, that was almost a dead end for us and that room was, uh, uh, failing. So, now that room goes through everything that every other room does, flushing a little bit 20 to 30 seconds in the morning. Um, you know, flushing after lunch, making sure the sterosol straw is in place, which it is, making sure we shock appropriately. So it was our, it was an oversight based on lack of real clinical use. Our research team, which are different people, were actually using that operatory. Interesting. I, I think so the it it it does that mean that the more a um unit sits without being used on a daily basis, the more likely it is to build up these biofilms, or is that not necessarily true? I think it can be necessarily true, especially if you have what's called a dead end where you, you plumbed out for 12 terrors and you only have 9. I think that can be an issue, um, but for the most part, um, Treat every room, even say that you have a hygienist two days a week and that chair is empty three days a week. That chair still needs to be maintained during the course of the week and make sure that it's in, that makes sure that you, but it's so easy because the whole issue and, and now these straws are different. I've had these straws. When my clinic was 8 chairs and it was in a different location, and now the straws have better technology. They are based on whether the total dissolvable solids are. We sort of expected that my building is old, that the water lines would have high levels of total dissolvable solids, and well, that wasn't quite the case, so we had to make a change. No one, no one is perfect. No one knows all the answers except the, the, the really the people that work for the company that can help you if you end up with a problem. And so, yes, I picked up the phone. I said I have a problem. My rooms are failing. And so when they looked at our total dissolvable solids, we had the wrong thing installed. They came out and installed the right thing. So I think other, other places that people don't pay attention to are the reservoirs. Um, for those that have them, I've run into a lot of offices that don't have reservoirs that are using direct feed from the city water, um, but reservoirs can pit, uh, we change them every five years now. We change the tubing out when their problems start to show up. We're not, uh, like I said, it's an infectious disease program. My patients are medically complex. We also have oncology patients. I'm not putting them at risk. That that's the whole goal. So a simple solution, a simple product line that actually works together, um, that is not difficult to manage that even I can manage, and I, and I say that because, yes, I set everything up, but I have people helping me and as you said, there's other issues that I'm concerned with. You know, where are the grant funds? You know, Bob, you know, financial issues, uh, staffing issues. Um, it took me 8 months to hire a dental hygienist issues, and I got blessed. We have, uh, the last person I hired worked out to be fabulous, so I'm looking forward to seeing her in action. So you're having the same, uh, dental hygienist, uh, shortage in, in Georgia that we're having in California, sounds like. Yes, except, um, the dental hygienists in Georgia basically say it's not a shortage. Um, and we are producing more dental hygienists than are retiring. But for some, but for some reason hiring a dental hygienist becomes very difficult and it becomes um a cost issue. So, you know, can you afford, if you're, if you're on a, uh, we're really off topic, but if you're on a dental plan like my nephew, And he's paying 10 number of dollars for the hygienist per hour and the, what he's getting reimbursed for the profit is half of that. It's a loss lead into his program. Yeah. But he's still doing it because it's the right thing to do. Well, talk to me, uh, the Fast Check 15 for a dentist who hasn't used it yet. Um, how does it compare with, uh, waiting for a culture-based test result, for example? Well, culture base is going to take some time. Um, you get an immediate answer. You will know in 15 minutes whether or not you have more than 500, uh, CFU per mL. And that is actually very important. Um, we're not testing for certain bacteria, like we're not testing for mycobacterium, but we know at the higher, The bacterial counts go, the more likely you're going to have some kind of nasty organisms. It could be Legionella. It could be Pseudomonas. It could be Staph aureus. I mean, there's certain bacteria that if you get to a certain level, they're going to cause a problem. So, here, 15 minutes, I know. So 15 minutes I have something that maybe fails we shock the room. The room immediately immediately, yeah, why wait? Well we might do it at the end of the day, but we're not gonna use the room until it gets under 500 CFUs. So yeah, let's say an operatory fails its uh water test before the first patient arrives. Kind of walk us through what the team should do and how they establish that it's ready to use again. So, that is a great question. So, you, you test in the morning, the first thing and you find out that room one out of your 86 operatories is, for some reason, is failing. Uh, the first thing I would do is retest to make sure that you've done the test appropriately. That, that would be the first thing. I would look at the history of the room to see if there had ever been failures there before. Because you have to determine what is the cause of the failure. Are we not doing the procedure right? Um, have we not used the room, etc. etc. So, um, we take the room out of service. And we shocked the room. So, that's what would happen. That room would be down for the day. The shock doesn't need to be in there, uh, 24 hours. You shock the room. At the end of the day, you can rinse it out or before the next morning, rinse it out and then retest and you should pass. I always say never don't, don't shock and then test because that's cheating, uh, but, but in a case where you had a, a failure and you wanna make sure you can get the room back open, then that's what I would do. Is it incredibly expensive to, let's say you decided I'm, I think I have disgusting water lines. Like somebody says, OK, we're gonna test for the first time and every room fails, for example, which I think is possible, correct? Wouldn't that, that could possibly happen? OK. What if they decided they wanted to just replace all their dental unit water lines, start from scratch, use the stero cell program. And, and go on from there. Is it incredibly expensive to have a technician come in and replace all those water lines, and is it essentially impractical to do? Well, that is the, uh, that is a step of, I won't say last resort, but that is if, if you're constantly failing in a room, there has to be a cause and so the most likely cause are going to be the dental unit water lines. So I, I, I, I would not recommend somebody who is starting use the products first. Products are incredible. And so you, you get that shock, you get that maintenance, and then hopefully by using this product you will begin to pass more tests. Um, some dental unit water lines actually have some silver embedded in them, which is helpful. So it just it it really. The cost of it is not going to be cheap if you're going to take out all your water lines and have them put back in. Um, even adding a reservoir, what I found was some of my colleagues who might be around my age or, or a tad older, they've never had a reservoir. They've always used city water, and that can cost you up to $1000 or so. It, it's a range, you know, $500 it depends on where you live. Um, hopefully in the South, it's a little cheaper, but I, uh, than it is in California. But, um, We have a little bit less tax, but the whole, but the whole issue is I wouldn't immediately go to that. I would like, well, in other words, my point was kind of like there's, there's not gonna be if a dentist is worried that by testing their water it's gonna open up a can of worms that could cost $15,000 to replace all your water lines, that's not how it works 99% of the time. You're going to be able to just implement. The stero cell program and be able to get your numbers acceptable and safe and not have to worry about it. Like it's not gonna uncover some awful retrofit that you have to do on all your opportunities, no, not at all. You're the assumption that you're making or the statement you're making is 100% correct that 99.5% of the time it's not that you. Uh, have, uh, uh, dealing with water lines that you're going to have to replace and reservoirs that you're going to have to replace. But when you buy a practice, you're not testing the water lines when you buy that practice. So, you might run into some issues. What were they using before? You might need to add the steroidal system, which is to me the easiest. If I have to only put something in once a year and then shock on a monthly basis and test on a monthly basis, then I'm happy. It makes it easy. That is funny. I, I had never thought about considering purchasing a den like I purchased a dental practice four years ago, and as part of my due diligence, I did not test the water, but it kind of makes, I mean it, it kind of makes sense that you would want to do that, and at least from the day you own it and are now the responsible party that you, yeah, that from day one you do it, but. I didn't do that because like most dentists, I just I don't know. I didn't think about it. I just didn't do it. And then I interviewed you for the first time and I'm like, OK, guess what we're doing tomorrow. Well, the whole, the whole goal is you wanna make sure that your entire practice is safe. We don't wanna cause any harm, and literally it's been tied to phlebotomies in children. Um, we don't want that to happen. You don't want the risk if you're a practice or a DSO if you know that you can eliminate the possibility of it happening. Of having what happened in California, having what happened in Georgia a few times. You don't want that on your practice, cause then you have to close down and I imagine it would be an absolute nightmare. So, if you're proactive and it's a part of your daily and monthly infection control protocols, just like you, we spore test daily in office and, and in my clinic because I'm, A little bit obsessive compulsive when it comes to infection control. I don't want to cause a problem, and I think that states where they, you say, well, we don't have cases, I've never had a case of this, you don't want to have the first case in a child. It definitely makes the news. I can tell you here in California, it absolutely makes the news, especially when it happens to a child that it happened in a dental office. It will, it's, it's all over the news. You don't want that to happen, and I know we, It's, it's just this weird thing where we sterilize everything in our office and for some reason we just don't think about the water for whatever reason. It's this weird, weird kind of mindset that we have. What, what's your experience been integrating testing and maintenance into everyday workflows for the dentists who you've worked with or seen or friends with or? It, it's really simple. I mean, the, the whole, the biggest issue was uh getting the, the, the, uh, the older dental chairs retrofitted. I mean. Um-hum. That was probably the biggest issue. When I tell people that you don't have to do something every day, you, say your infection control coordinator is not there and you really don't have a great backup and you're using some other kind of product that you need to add on, um, almost a daily basis, you could miss days. So, this, you have continuous maintenance, which is important. Um, I, I, I'd like it, and I've always liked it because, well, the once a year thing was very attractive way back when. Um, I started treating water lines before there was, uh, we had the cases in Georgia, I think, but I think we had put water lines in when Sterosol products first became, first came out. We've been using that for, I would say decades now, a couple of decades, and now I think the products are better. So, and that's another thing, cause it can adjust to whatever kind of water that's, that's the point I was making. It can be specific enough to deal with the kind of water you're dealing with. The state rule, easy. And one of the things I want to say about our rule is, yes, you can get in trouble if you're not doing this. We're not going to dental offices and checking your water lines. Uh, if we get an infection control complaint, that, then that's fair game. If, if there's a, a practice complaint, uh, failed endo molars, whatever, or whatever the complaints are, and Lord knows we get enough complaints, um, to keep us, uh, busy all the time, uh, I, I, I feel like I'm punishing people that I put on the, uh, Investigation committee, so you're gonna be working because there are a bunch of things that come in. You, um, but if it's an infection control complaint or part of that complaint, um, literally our, uh, people that go out now have the ability to test the dental unit water lines in 15 minutes. And so if that was a complaint, and that complaint showed up on the news in Colorado when they had that recent outbreak. Um, but like, like I said, we don't wanna be on the news unless we do something fabulous. Um, you know, you, you wanna, you, you want to show people that you're taking every step possible to ensure the safest dental visit. I think that's key. It's really hard to get on the news for doing something fabulous. It's much easier to get on there for, uh, doing something awful, as it turns out, which is unfortunate, but it's the way it is. Um, which sampling or maintenance or record keeping mistakes do you see the most often from, from offices? Like where are there, are there typical mistakes that, uh, that they tend to make? I'm not putting who did the test, not putting, you know, which, uh, units that they were testing. Um, it, it's a simple, Ceresyll has a simple online form. Um-hum. They have, for those who don't like online forms, they have a paper form, which is also really easy to use. And it lists everything that you need to have on there. So, uh, it's incomplete record keeping. Um, so, uh, for instance, people, uh, clues, uh, of not autoclaving. Well, if you don't keep records of the fact that you tested your autoclave on, say, a monthly basis, um, we actually have daily logs. We actually. Oh, OK. Can test. If, if we have a failed log, we can actually, one, pull the equipment, but also if it's been something that's been sitting, we can, we can track it back to the patient it was used on. And so putting systems that provide safety, and that includes dental unit water, um, we don't wanna have uh patients developing any kind of, of post-op complication that could happen. Dry sockets, are they always due to smoking? Are they always due to blah blah blah? Do dry sockets sometimes have something to do with the water quality? It's an interesting question. Especially if you start getting an infection, you know, a month down the road. What's going on there? So I, I, I think that, as I said, we're blessed that we have the resources that we do in Atlanta to be able to check on these, uh, areas. Other parts of the country do not have these resources. It doesn't mean they don't have mycobacterium, um. Abscesses in their water. So that's why it's important whether you live in Montana, you live in uh Washington State, which has that rule, you live in Florida, Maryland, I believe, is beginning to look at something. California is beginning to look at something again as well. I think it's important that states do what's best and do what they think will, will Lead to, uh, compliance, making sure that dental unit water is safe. So the rule process, easy, easier is a legislative process. Have a legislate, we actually have a wonderful dentist who helps carry some things for us, um, in Georgia's legislature. Uh, we have a very active Georgia Dental Association that helps us as well. Um, board, we don't, uh, advocate for things, but we do come up with language for legislatures and we do come up with the rules. So, um, I think different things will work for different states and literally that's why I'm here today. I really want to talk about the fact that more states need to do what Washington and Georgia are doing, what California. And Maryland are considering doing or have put in place, um, and, and that's a reason I'm going to this uh dental board meeting is to see if I can influence some people, if people have questions they wanna ask me about why I do a particular product, um, I did a non, uh, I did a CE course where I didn't mention any products, just the reason why we need to do this. Here I actually get to talk about what it is I use and why I chose what I. Well, And that's all Dennis wanted anyway. It cracks me up because it's like, even if you were giving that CE program live and you wouldn't mention it, a million hands would go up and say, what product are you using? They, they want to know what David has chosen to use, uh, in his practice. And so I'm glad you can come on and, and sing the praises of Stairsil and how easy to use it. And let's close with kind of a call to action, David. So if a dentist watching this has no organized waterline protocol as of today, what are the 1st 3 things that you want them to do tomorrow morning? Call up their dealer, whoever is the, they're buying their equipment from. Every major dealer, every state or regional dealer has Sterisal products. Tell them you, you heard this. Let's get this installed. Even on new equipment, you have to do this because new equipment might be sitting around for a really long period of time. So, what I would want them to do, get the people on the phone, get the sterile cell system, Installed because as I said, the first load, it shocks and then you have maintenance. It doesn't affect the odor. It's non-corrosive like some of the iodine based products can be. Um, so there's really no negative to using it. You get great results and that you can test in office and it takes 15 minutes. It takes a little bit longer because you have to pull the samples. But still, you're not, if you have 10 waterline things in a, in a unit, you're testing once. Um, and that literally came from HIV testing where we were doing pooled PCR and if we had a failure, then we go further into it. Here, if we have, doing a pooled water sample, we can find out that your CFUs, choliforming units are too high. We can address it and we can address it simply. And it's easy, it, put it this way, if I can do it, anybody can do it. Um, and, and, and I did do it so I could go in here and say that I have done it before. Um, and, and thank God I have that infection control coordinator or that point person. Cause that's really important to have somebody who is responsible and a backup should that point person be out ill or should that point person decide that grass is greener on a different side. We need the standard operating procedure to last. So, if you've never done water lines, this is a great product, a great way to shock, a great once a year installation. I can't say that enough. Once a year installation cause it maintains the water. You can shock on a monthly basis as a preventive measure. If you have a, Failure, you can shock, then wait a few days and retest because the shock will help get rid of some of the biofilm and that's what's. Right. Really, truly important. And this is one family of products. So, you know they're going to work together. You don't have to worry about cross reactivity. It's just simple. It's. A, B, C and at my age, that works. Well, I love, I, I've taken the once a year installation to heart, David, and that's why I have you on the show once a year to remind everybody and get the word out until all 50 states have a protocol for this and, uh, until everybody's, until everybody's doing this, uh, it's just the right thing to do. We decontaminate the inside of our crowns now before we cement them. I never did that 30 years ago either. I mean, it just all. It makes sense now that we need to be a little bit cleaner about everything we're doing in whichever way we can. So David, thank you again for being so generous with your time tonight. I appreciate you coming on the show. An absolute, always talking to you. It was a pleasure. So I hope people enjoy. Well, that'll wrap it up for tonight. So on behalf of David, myself, and all of us here at Inside Dentistry, I wanna thank you for your time and your continued commitment to quality dentistry.