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Dr. Jonathan Levine:
Welcome to Think Oral.

Mariya Filipova:
Where we connect the unconnected between oral and physical health.

Dr. Jonathan Levine:
I’m your host, Dr. Jonathan Levine.

Mariya Filipova:
And I’m your host, Mariya Filipova.

Dr. Jonathan Levine:
Let’s get at it.

Mariya Filipova:
Welcome, everyone, to the Think Oral Health Podcast. I’m very pleased to meet our new guest today, and I have to say that this is the first time I have the pleasure of meeting her as well, and I’m already excited about the conversation and all the things that I personally will learn, and I know that our listeners would appreciate as well. Jonathan, another great guest to another great episode, and do you want to tee up the topic for the day?

Dr. Jonathan Levine:
Absolutely.

Mariya Filipova:
Guest of honor for the next couple of minutes here.

Dr. Jonathan Levine:
Yeah, our podcast is all about connecting the dots, right? We always talk about it, between dentistry and medicine. The mouth is well connected to the rest of the body, and we know that the body, as we always talk about, it’s an ecosystem, it’s a connected systems, it’s not these individualized systems. And so it’s exciting to have a physician and a researcher like Dana Orange. She’s a rheumatologist in New York; she received her medical degree from Weill Cornell. Cornell undergrad, which I hold very close and dear to my heart, my alma mater, and her master’s MSC from Rockefeller. She’s in practice for 15 years, and she specializes in rheumatoid arthritis and related, and her research that she’s currently doing is exactly, if I could say, at the heartbeat of what this podcast is all about, to really understand the molecular underpinnings of symptoms of rheumatoid arthritis. But what they found recently that has been published in a couple of key journals and articles is quite groundbreaking. So I’m excited to bring Dana Orange onto our podcast. Dana, welcome to Think Oral Podcast.

Dana Orange:
Thank you, thank you. I’m super excited to be here.

Dr. Jonathan Levine:
Amazing, I’m going to throw out the first question, if I could, Dana, tell us a little bit about what has preceded the research that has been, I’m going to call it, quite groundbreaking when we think about oral systemic medicine, the connection of the of what happens in the mouth and in the rest of the body, what preceded it, and what did you find that really got, when I spoke to you, you got me really excited, and I know the whole community is going to get excited.

Dana Orange:
As you said, I’m a rheumatologist, and I specialize in rheumatoid arthritis, that’s the disease that I study. And I just want to say a couple of things about rheumatoid arthritis, because maybe not everybody knows that much about rheumatoid arthritis that’s listening. There are many different types of arthritis. Arthritis is just a term that means inflammation of the joint. You can have osteoarthritis or rheumatoid arthritis, or there are about 100 different types of arthritis. Rheumatoid arthritis is super special and super interesting to me because it tends to develop earlier in life. It’s more common in women, it tends to be symmetric, so, you know, if a certain joint on the hand is involved on the right hand, that joint tends to also be involved on the left hand. It’s associated with having antibodies to your own human proteins, and it’s a real cause of disability and potentially deformity because the type of arthritis can eat away the bone and the joint. And it’s been thought for many years that there might be some relationship between oral health and rheumatoid arthritis. In fact, you know, to my reading, the first paper that was ever published on the connection was in 1918, and it’s one of the single-author journals who has this grand statement that it’s like concluded beyond the shadow of a doubt that periodontal disease is the cause of rheumatoid arthritis, but they don’t cite prior papers to know how they came up with that. And then, over the years, there are, people have tried treating rheumatoid arthritis with dental extraction, and it’s been the thing that people talk about for years. And I would say more recently, it sort of fell by, the connection fell by the wayside because there were some papers that showed that smoking is associated with a risk for rheumatoid arthritis, and that is, the data there is very strong. I think there are about 400 papers that note that there’s this relationship between smoking and periodontitis. And so I think people thought, well, since smoking is also a risk factor for periodontal disease, probably why periodontal disease is also associated with rheumatoid arthritis, and they forgot about the mouth. And the focus has really been on the lungs as a source of inflammation and rheumatoid arthritis. And then our study came along, where we have been monitoring patients with rheumatoid arthritis, trying to understand why they flare, because that’s another interesting aspect of rheumatoid arthritis is that patients can be doing okay, and then they might, their disease just acts up, and it becomes really hard for them to function, hard for them to get out of bed. And why that would happen in a person who hasn’t really changed their environment and no obvious trigger for it, that’s something that we’ve been interested in. And so we stumbled into this finding by monitoring these blood samples over time that patients with rheumatoid arthritis who had periodontal disease have leaky gum, and you were detecting a lot of oral bacterial products in their blood repeatedly, like many times over the course of a year, like every couple of weeks, we would detect these oral bacteria. And not only were we detecting the bacteria, but we could see that they were triggering an inflammatory response that can be seen in the joints of, the inflamed joints of patients who don’t respond to treatment. Yeah, that’s a long-winded answer.

Dr. Jonathan Levine:
It’s not long-winded, but I’m jumping in. I’m jumping in deep. I don’t know if I told you, my background is microbiology and immunology from Cornell, Dana. And when Dana started telling me a little bit about this, I said, wait a minute, you check the bloods of these RA patients how often? And it was weekly.

Dana Orange:
A minimum of weekly for a minimum of a year.

Dr. Jonathan Levine:
And so weekly they’re checking the bloods, and P. gingivalis, which is, there’s seven pathogenic bugs of the mouth of the chronic inflammatory lesions periodontal disease. So when, look, let’s get some stats out there. One out of two Americans, from the CDC, has periodontal disease over the age of 65, 70%. Okay, so you’ve got a lot of chronic inflammation. And the thing is, you don’t know it a lot of times because it’s painless unless it gets very acute and the ligaments of the teeth get pressed from a food impaction, or something like that, so usually you don’t know about it. Maybe you get a little bleeding when you’re brushing. People don’t know about it. So that’s very important. And here she is testing the blood of these RA patients and P. gingivalis, this pathogenic bacteria. And the mouth is just like the gut, there is a bacterial balance of good versus bad bacteria. So here are these pathogens, and she’s finding them in these RA patients. So take us down the road. You find P. gingivalis, you’re testing the blood, and you’re finding what is P. gingivalis doing in the blood of these patients? How did it get there? And that’s the point. How did it get there? Because we got 58 systemic inflammatory diseases like RA that are now connected to periodontal disease. And I don’t know of any study that tested the blood on a weekly basis to test for these pathogens that are originated from the mouth. So take us down that road and tell us what did you find?

Dana Orange:
There’s an interesting thing about humans. I guess every organism, I don’t want to overstate this, but many have circadian rhythms because we have all evolved on planet Earth, and there’s a 24-hour cycle, and many of our responses, including immune responses, are circadian. And the way we were doing our analysis, we really wanted to minimize any noise. And so we had patients collect samples, their blood samples, at the same time every day. That was really important to us because another interesting thing about rheumatoid arthritis is that when the arthritis is active, it’s worse in the morning. When patients flare, they wake up, and they feel terrible, and it can, I’ve had patients tell me it took me one hour between waking up and me being able to get to the bathroom because I just could barely move. There was incapacitated in the morning. And then, as the day goes on, a couple hours later, they might feel better. So I was always really worried that if the patients collected some sample in the morning, but then when they flared, we couldn’t collect their sample until later in the day that it would mess up the data, that there would be noise in the data. So we had them collect their samples in the evening, and just to standardize that, I said, why don’t you just keep your collection supply in your bathroom? And then, after you brush your teeth every night, that’s when you collect your sample. So I really wasn’t looking for, I didn’t ask them to collect their sample after brushing their teeth because I thought, I didn’t go into the thinking we were going to find all these oral bacteria in the blood, but that is what we did. What I think probably happens is they brush their teeth, and as you say, it’s not uncommon to have a little bleeding when you brush your teeth, and I think when your gums are bleeding, the blood is going out, but also, some of the bacteria in the mouth are coming in, and that’s really what we found. And we, it wasn’t just one bacteria that we found. We basically replicated all of the bacteria that you see in the mouth. That is the order of abundance that we saw in the blood. And we can say that because we used the data from the Human Microbiome Project, which, you know, swabs various areas in many human bodies like the cheek and the gingiva and the tongue and the nose and the ear and the stool and …, and they made an encyclopedia of all the bacteria that you tend to find in just a normal human and how abundant they are in those places. And then, we use that encyclopedia to compare to our blood data to be able to infer that these bacteria that we were detecting in the blood were oral bacteria. And I can’t even say that it was just the gingiva, all three oral sites were represented in the blood, which I think also supports the fact that just, there was a leak in the barrier, and whatever was there was getting in, and so there’s like a two-way communication when your gums are bleeding.

Dr. Jonathan Levine:
Exactly, and that’s the point. We know with inflammation, there is increased permeability, and there’s basal dilation. And so this epithelium that is connected right next to that two surface, that gets inflamed like a balloon that gets blown up, that wall gets thinner, and permeability increases. If you have bleeding out, you got bleeding in, is really what we’re saying. So now that you know that these bacteria can now transmit and you prove that into the blood of these patients with a systemic inflammatory disease like rheumatoid arthritis, from this conclusion, how are you changing your thinking? What is the conclusion here from a standpoint of helping these people? Because we know from some of the cardiovascular studies that when they decrease periodontal disease, they would decrease cardiovascular disease. That came out of Moisi Devereaux’s group at Columbia, and a number of studies like that with other systemic inflammatory diseases. How are you thinking about, from this study, from a therapeutic standpoint, how you might be able to help these rheumatoid arthritis patients?

Dana Orange:
I think the onus is on us to prove that if you treat periodontal disease in patients with rheumatoid arthritis, that it will make them easier to treat or make their arthritis better. There have been a couple of small studies that have shown that in patients with severe rheumatoid arthritis who are starting some of our strongest therapies, if they have concurrent periodontal disease, they’re less likely to get better. So that’s like a smoking gun that suggests that there’s clinical relevance to this and that if you have inflammation in your gut and bacteria just keep getting into your bloodstream and triggering this inflammatory response. But it’s sort of an uphill battle for the drugs that we’re giving that are tamping down the inflammation if we’re just sending more continually fueling the fire. But I think we need to prove that because dental care is not free and to justify the cost, I think it’s worth proving beyond the shadow of a doubt that management of restoring that barrier actually improves symptoms, and, for people living with arthritis. And I’ll even go a step further, I’m interested to know whether, with rheumatoid arthritis, people develop antibodies, these antibodies to their own human antigens years before they actually developed arthritis, and so there’s this notion that there may be an opportunity to prevent rheumatoid arthritis. And I also wonder whether ongoing inflammation in the gums, if you could just intervene by removing that inflammatory trigger, maybe you can actually prevent rheumatoid arthritis, which would be really nice. And my, rheumatoid arthritis is manageable, but it’s not curable, and in some patients, it can be really hard to treat, and my impression is that periodontal disease is a little more straightforward to treat. So if that’s true, then let’s get on that.

Dr. Jonathan Levine:
Well, and look, it’s been proven in some other systemic inflammatory diseases. And if we can change the thinking of going downstream to wait till a patient gets to rheumatoid arthritis and try to treat to reversing, flipping the switch and going upstream and saying, hey, you have some early symptoms, we know there’s a relationship between periodontal disease and systemic inflammatory disease, specifically in this conversation, rheumatoid arthritis. What do we do upstream? And potentially saying that could be the root cause of rheumatoid arthritis or could, it could be one of the risk factors, so that needs to be determined. But what happens if we treat it? How do we prevent the cytokine storm in the inflammatory cascade that causes that, that RA, a great statistic came out of COVID where people were treated with perio and who had perio. First of all, the ones who had perio were five times more likely to end up on a ventilator, and that’s a classic inflammatory response in the body and a cytokine storm, and as they look at long COVID, they’re pointing to those this type of processes. So the question is, how do we jumpstart? How do we jump into that, where the next level of testing could be taking these patients, curing them of periodontal disease because it is manageable? We can treat that. A lot of it has to do with having these management periodontal programs locally and then improving the way people control the bacteria in their own mouth on a daily basis, an oral hygiene regimen. As you think about this, are you thinking about those type of collaborative studies? Maybe it’s with a dental school or a foundation, or how do we move the needle on that? Because that would be such an interesting proof point. Incredible.

Dana Orange:
We’re very interested in doing that kind of study. And maybe there’s somebody listening to this podcast, … who wants to work with us because I think there are so many cool ways to approach a research project like that, be able to prove that an intervention can actually change somebody’s life. The other interventional study that I would be interested in is thinking about rheumatoid arthritis patients who are in remission because a fair number of our patients can achieve remission with our therapy. And then the question is, do you have a young person, 40 years old, and they have rheumatoid arthritis, they are in remission, they’re on an expensive drug that suppresses your immune system, and right now, our guidelines say, lifelong therapy for you. You have to stay on your therapy for the rest of your life. And they’re like, but I have no symptoms, and now you’re telling me that I have to stay on this very strong immunosuppressive medication forever? There’s a lot of interest in trying to figure out, like, are there certain people that could maybe come off therapy? And I really wonder whether, if you have a leaky gum and active periodontal disease with this ongoing trigger for your inflammation, then maybe those people are not going to do well when they stop their therapy. So maybe knowing about periodontal disease and people who are in remission could help guide who can actually come off therapy. Maybe periodontal disease is not the only trigger, maybe there’ll be like a checkbox of things that. Are you still smoking? Okay, then, probably you’re still going to need your immunosuppression. And do you still have periodontal disease? Then you probably still need it. And that’s a pretty tractable study because about half of patients who taper or discontinue their therapy who are in remission will flare within a year. There’s an achievable endpoint in a reasonable time, which is nice for a study design.

Dr. Jonathan Levine:
And it would be a very interesting baseline study if you literally just started with two groups and you didn’t treat the periodontal disease, and you test it, and you did treat the periodontal disease, and you test it, and that would be, that probably wouldn’t take that many subjects. I know a prosthodontist and periodontist who would be very interested to run those studies through their foundation. That person is staring at you right now. So that could be something that we can have some really something very interesting together, but that’s a very interesting baseline study. And then I’d love to connect you with the people at Forsyth Dental up at Harvard, who is the number one clinical perio-testing center in the world, yeah.

Dana Orange:
The other baseline, you just, very step back, study that I would love to do is how bad does periodontal disease have to be for us to be able to detect the bacteria in the blood the way we did. Because we didn’t really go into the study or design our study looking for oral bacteria, which it was a secondary endpoint, and I think it would be worth knowing.

Dr. Jonathan Levine:
There’s the aha, the P. gingivalis, the number one pathogenic bacteria that has been found in the carotid artery of cardiovascular patients has been found in the interstitial cells of leaky gut patients, of colon cancer, and pancreatic cancer, and I’m just leaving out 54 more of the inflammatory diseases of the body, they found P. gingivalis in the blood. I think this is a story that’s just getting unfolded and amazing research that you did, Dana, and excited to hear what the future holds for further research. A big question, Mariya Filipova, I’d love to hear your thoughts on how this can impact the health of our overall population and how upstream diagnosis and getting to root cause. And excuse me if I use the expression more of a systems-focused medicine or functional medicine versus the downstream wait for the symptoms to occur and try to treat with drugs, how does this change some of the Western medicine? And I love, Dana, for you to answer that question also, of how can we be more efficient in our healthcare system and to get a little more upstream to look at root causes and not to wait till the symptoms and the severity of diseases hit?

Mariya Filipova:
To me, there’s multiple pieces to the puzzle, and you know how closely I work when it comes to systemic health and connecting the dots. We do talk about root cause analysis and diagnosing and treating gingivitis early. That’s step one, right? 75 to 85% of Americans, that’s 200 million Americans have periodontal disease, period. So let’s get better at diagnosing and treating it. I’m not the clinician in the room, but even I know that P. gingivalis returns seven days after you’re cleaning, and up to 30 days, it’s already fully restored, so this is not a one-and-done. It requires a dynamic change of lifestyle and dynamic adjustment of the treatment regimen. You can’t just say, well, I have, I’m diagnosed, I have periodontal disease, went in, got my cleaning, I’m done. So there’s a kind of a much more of an iterative approach to diagnosing and treatment that involves changing your lifestyle and changing your way of thinking as a patient and frankly, as a decision-maker of an organization. I spent a lot of my time talking to the head of benefits in large organizations and asking them how are they offering dental and oral hygiene education to their employees. Because, yes, it’s the right thing to do. But also, frankly, it’s good business because from what you and Dr. Orange are describing is, it’s treating those oral health issues that help in reducing total cost of care at a systemic whole-person health level. So that’s where my mind goes. And I’d love to think about, in a day-to-day care delivery level, what would you like if you had a magic wand, right, if you could change how we train physicians and dentists today or how dentists and physicians practice today, what would you like to see different, right? Do you want specialists who are treating rheumatoid patients with rheumatoid arthritis to have the right connection to the dental team? What does that look like? That’s where I want to know.

Dr. Jonathan Levine:
That’s where I want to go too, Dana to talk about it. How did dentists and medicine, and dentists and medical professionals work together?

Dana Orange:
I don’t know. It’s such a problem because you think about it, medicine and dentistry have been separate, like too separated. In medical school and dental school, we don’t even go to the same school. If there’s any other organ system in the body that’s a problem, becomes a problem, the eye, the ear, the gut, the whatever, I have friends that I trained with that I know that I can quote, but the mouth I don’t. I didn’t train with any dentists. There’s such a separation between dentistry and medicine, and it’s pretty artificial if you think about it, because like, of course, they’re connected. And even health insurance, it’s so interesting that my health insurance covers everything, but not, but had to have a special insurance for my dental care.

Dr. Jonathan Levine:
Yeah, you have to blame the way, yeah, you have to go back to 1840 to understand why it’s separate. When the dentists wanted to be a division of medicine at the first medical college, and they got rebuked, and they said, go open up your own school because it was a barber profession back then. But there is one dental school, Harvard, that it’s connected medicine and dental. I went to Boston University, first two years I went was two years of medical school, and we were all together with the PhDs, and that was interesting, but we got to break down the walls. And I love talking about this because this is one of my favorite subjects. We’ve got to break down the walls of medicine and dentistry and like sleep like salivary diagnostics, like cone beams and CBCTs that we’re taking as standard of care in dentistry today, this is an area where medicine and dentistry is going to be able to connect the dots. When you diagnose a rheumatoid arthritis patient, you’re going to start saying to yourself, what is the health of the mouth? And you need to bring in the dental professionals and work collaboratively based on your new research. Now, the next step is to prove what we talked about, is how to solve rheumatoid arthritis or decrease the severity of disease by controlling periodontal disease. That’s the hypothesis that is going to need to get tested. That’s an … future because it’s one more way of breaking down these walls between the professions. Mariya, how do we do that, Mariya Filipova?

Mariya Filipova:
I mean, from my perspective, obviously, incentives, aligning incentives is step number one, and because you get what you measure and you get what you incentivize. And when we start as patients, first of all, being more engaged and educated and aware of the interconnections, I hate to put the burden on the patient because we have all experienced it, right? It’s so complicated to keep all these moving pieces of care coordination and taking and digesting your diagnoses and just dealing with your own health. You’re not feeling great when you have to all of a sudden manage all of these complex things, and now all of a sudden we’re saying, oh, the patient needs to ask. It’s just a lot to put in the shoulders of a patient, but patients do have a role to play, and we have a role to play to raise awareness and educate them. That said, I still recall the days when I was in one of the largest health insurance companies, and when I asked for a simple question, I asked, what is the total cost that one of our largest self-insured employers spends total between medical and dental claims? That turned out to be a six-week project, right? We don’t even know because the data lived in two different organizations. The databases were different, the tech stack was different, the teams running the numbers were different, let alone doing the analysis. We, going back to, we get what we measure, and currently, we measure dental costs, medical costs, very differently, in very different models. And so that’s number one, and the incentives are very different. I would argue dental insurance is a misnomer. Medical insurance is, acts like an insurance model. However, on the dental insurance side, I think it’s a defined benefit, discounted set of services, right? If all of a sudden you have a severe accident and you require dental surgery or something more invasive, your dental coverage is not going to cover that because you have a defined set of cleanings and procedures that’s maybe going to be covered by your medical insurance, but most likely out of pocket. And so we have to also think differently about what dental coverage is, as said, defined set of discounted set of services. And is that the right model to incentivize preventative behaviors, preventative care? And unfortunately, I hate to be the Debbie Downer in this conversation. We were going so, we’re being so optimistic when we talked about the breakthroughs in science and technology, but the reality is technology is never the rate-limiting factor. Science is never the limiting factor in integrating care. It’s the people, the decisions, the, that we make around measuring and incentivizing.

Dr. Jonathan Levine:
But, Mariya, let’s take this specific case. And Dana, please weigh in here. If rheumatoid arthritis costs insurance companies, let’s just pick a number, I’m going to say $4 billion. And we can say that if you take an upstream, a preventative, proactive approach of really going after one of the root causes of rheumatoid and you could prove financially to the insurance companies, run a pilot test, and we can treat the periodontal disease of these RA patients, and we could prove that your, the cost downstream is going to be 40% less or 50% less, wouldn’t they sign on for the, a major reimbursement of, from a medical standpoint of treating that periodontal disease? Could we talk about this for cardiovascular disease? We talk about these the other systemic inflammatory disease. You having lived in the insurance world, the medical and healthcare insurance world, the dental healthcare insurance world, how do we navigate the system for the good of the patient and to really create a more efficient healthcare system where our runaway train of healthcare expense being 20% of our GDP goes down, not doesn’t go up over the course of time? How does that happen? Dana, what do you think?

Mariya Filipova:
… Easy questions.

Dana Orange:
I think it would be great to prove it, to show that it made rheumatoid arthritis easier to treat and cheaper to treat, that would be the Holy Grail. Because then, I do think maybe you could incentivize insurance to want to take this on, too. I just want to say, to Mariya’s point about the difference between insurance and benefits and the separate ways of measuring. Another way that reminded me that medical care and dental care is separated in this country is that now more and more, with the digitization of health records, when I look in the medical record of one of my patients, I can see so much information about all the other doctors that they’ve seen but I still don’t see anything about their dental care. So I might, it might be on my radar that, oh, wow, look, they had a follow-up on their most recent colon cancer screening or whatever, but if they had a tooth extracted because they have periodontal disease, there’s no way that I would know about that unless they tell me specifically about it. And it would be great to get the medical records with the dental records do to …

Mariya Filipova:
That’s the easiest thing we could do, that’s right, and that’s why there’s such glimmers of hope with large dental service organizations like Pacific Dental who just invested millions, tens of millions of dollars adopting Epic as their record system. And I think it has all its limitations as well, but it’s definitely step one to even think about, These are the data fields that dentist needs to know as well as members of your medical team need to know. This conversation has got me thinking about, so, Dana, for you, the question I’d like to know is rheumatoid arthritis, is the burden of rheumatoid arthritis equally distributed across different demographic areas by gender, by ethnicity, zip code? Talk to us a little bit about that equity angle.

Dana Orange:
Like every disease, socioeconomic status is a very important determinant of the … activity in rheumatoid arthritis. And why that is, I’m not exactly sure, but my recent data does have me thinking that maybe access to dental care could be playing a role in all of that.

Mariya Filipova:
It’s a proxy for so many things, right? Socioeconomic status is a proxy for lifestyle, proxy for access to care, proxy for perhaps awareness, education opportunities. And so it’s just, it’s, adds on top of the other and is probably the same corollary on periodontal disease. Would you say, Jonathan, that patients in a lower socioeconomic status are more likely to be at risk of developing periodontal disease?

Dr. Jonathan Levine:
Of course, we see it very prevalent when we have our GLO Good foundation mission down in Eleuthera. And there’s, it’s a microcosm of what happens in the rest of the world, but it’s where there’s an inequality of healthcare, no access to care both on the health on the medical side and the dental side. So if the children in the schools aren’t getting trained how to brush properly and as they age and they’re on a modern diet of sugary drinks and foods and the modern diet issues, you’re dealing with runaway decay and runaway periodontal disease. We’ve been there now on six missions, and we’re into the schools with the public health team at BU, and we can see the changes we’re making, and we’ll be running some studies on that. It’s just an example of what happens in these poor areas throughout the country, and I think there’s a correlation of the systemic inflammatory diseases when people don’t have access to care, and there is an inequality of healthcare. That is correct.

Mariya Filipova:
That’s right. I just, you don’t want to lose the angle around the socioeconomic factors and the equity component because we talk about patients in this monolithic sense. All patients are suffering from periodontal disease or rheumatoid arthritis, but every patient is very different in the way they present and the environment and the resources they have to treatment or support network for that matter. Again, those of our listeners listening and looking to getting involved and being part of the solution, there’s plenty of work to be done in that angle in that area as well.

Dr. Jonathan Levine:
That’s right. I think that’s the message. We all have work to be done, and I think we’re up for the test, and it takes a village, it takes every, people from every category working together to improve the health of people and to create better equality across healthcare and making the system much more efficient than it is today.

Mariya Filipova:
That’s right.

Dr. Jonathan Levine:
Yeah, wonderful. I think that it’s really amazing research. I’m so excited, Dana, that you and your team at Rocky has proven what you’ve done. I look forward to continuing the conversation and how maybe we can muster up some partners to continue the fight and to create some interesting answers to the research, to look for improvements for the patients, for the …

Mariya Filipova:
Can’t wait to have you back in the program to talk about the findings of that research when you do find them and how we can action that because that’s really important. Any key resources or future appearances where folks who are on, who are listening could get more information about your research or conferences that you’re speaking at, Dana, coming up? Anything you might want to leave as a parting gift to our listeners?

Dana Orange:
The paper that we’ve been discussing is published. That can be found in this journal called Science Translational Medicine. And my next speaking engagement on that is going to be at this conference called ELAR, which is the European League Against Rheumatism. That’s in Milan in June, yes.

Mariya Filipova:
Great, so we’ll look we’ll keep an eye out for that. And thank you again for all the important work you do.

Dana Orange:
Okay, thank you, guys. It was great to meet you.

Mariya Filipova:
Great.

Dr. Jonathan Levine:
Thank you.

Dr. Jonathan Levine:
Thanks for listening to the Think Oral podcast.

Mariya Filipova:
For the show notes and resources from today’s podcast.

Dr. Jonathan Levine:
Visit us at www.OutcomesRocket.Health/ThinkOral.

Mariya Filipova:
Or start a conversation with us on social media.

Dr. Jonathan Levine:
Until then, keep smiling.

Mariya Filipova:
And connecting care.

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