Cavities Are Not Just About Sugar - The Functional Dentistry Approach to the Oral Gut Brain Connection | Gut | E120

It's estimated that 250,000 children a year are undergoing general anesthesia to have their teeth fixed. Most parents do not realize this, but it is an epidemic, even with advancements in technology and pharmaceuticals and nutraceuticals and all of the things. And it's because of our food landscape.

Welcome back once again. I am super excited to be here today with Stacy Whitman. She is an amazing biologic dentist and if you don't know what that is, you're a about to find out. After giving a brief introduction about her, we're going to hop into a lot of great conversations about how your mouth is affected with your whole body. Your mouth actually might affect your hormones and we want to talk about airways a lot as well because that's something I'm really passionate about. Kids, sleep apnea, things like that. So we're going to talk about a lot of cool topics after the introduction. Dr. Stacy Whitman, a leading authority in functional dentistry, is on a mission to revolutionize oral health with unique blend of science, expertise and compassionate care. She's dedicated to creating a cavity free world which that'd be amazing if we could have a cavity free world. That'd be so awesome. Dr. Stacy is board certified in pediatrics, integrative dentistry and naturopathic dentistry and is one of the only dentists in the world have her functional medicine certification from the Institute of Functional Medicine. She founded one of the leading functional pediatric dental offices in the country where she takes a whole body and holistic approach to her care. She is the co founder of the Institute for Functional Dentistry launching summer of 2025 and lectures globally on functional dentistry and the oral systemic connection. She also is co founder of Feed your good guys Fig a microbiome friendly oral care which actually I use with patients. It's good stuff.

Oh, thank you.

Yeah. With a passion for optimizing the oral microbiome, hormone health, nutritional status and sleep and airway health, she's a sought after expert and educator with a heavy focus on preventive dentistry, cavity rest remineralization, which I actually want to talk about that a bit and the oral gut brain axis. Dr. Stacy passionately shares her knowledge and insights on creating happy teeth and healthy lives. Stacy, welcome to our podcast.

Thank you Dr. Hartman. It's a pleasure to be here.

We briefly talked before. So many topics we could talk about and so almost overwhelmed by all the topics we could talk about. I actually want to talk about cavity prevention, remineralization, reversing cavities because I feel like we actually did that with our daughter and people don't realize you can actually do that. So why don't you talk to us? Why do we get cavities? What's the reason we get cavities from a functional dentistry perspective? And how can you actually. Is it possible to reverse these things?

Yes, this is my passion. So thank you. It's a great way to start. Cavities are a pretty new phenomenon in human evolution, if you will, or dis evolution because it's not a great thing. It's a sign of disease in the body and imbalance. If you go back ancestrally 10 or 12,000 years ago, and I encourage everyone to do this, if you're ever at the Natural History Museum in New York city or Washington D.C. et cetera, go and look at ancestral skulls and you're going to see they have nice broad wide palates and dental arches and all the teeth line up beautifully straight. The wisdom teeth have room and there is no decay. So decay was very rare. Caries was very rare. And in our ancestral populations and you know, 10, 12,000 years ago was not that long ago in the course of our species timeline. So what changed? You know, we did see some decay in tribes that were close to maybe sources of honey or a lot of fruit density, et cetera, but it was pretty infrequent compared to today where it's the top chronic disease globally in all age groups. Many people don't realize that we went from a hunter gatherer society to an agrarian society. And then we had the industrial revolution hit. And this is when our food landscape changed a lot. We started milling and processing and adding sugar and flour to our foods. And now flash forward to current day where we have a ultra processed food diet and the majority of the population is consuming these hyper palatable foods that we over consume and that are filled in with essentially fermentable carbohydrates and oral microbiome disruptors. That includes all the preservatives, the food dyes, the flavorings, just all the additives that are in our food right now. And so not only are we eating a lot of sugar and a lot of flour, and flour acts like sugar in the mouth. These things feed pathogenic bacteria and so that we're getting a lot of dysbiosis and loss of diversity of our oral microbiome. This also impacts the gut microbiome and it's leading to decay. And it's actually when these pathogens consume and metabolize the sugars, they're fermentable carbohydrates, they release Acid. And it's actually the acid that's leaching minerals out of your teeth. And if it does this for a long enough period of time, you get a cavitation in your tooth or hole, and that's a cavity. And so this is primarily preventable. It's really dietarily leading. And it's not only what we're eating, but how frequently we're eating it. And so we tend to over consume foods and drinks. We're constantly sipping and snacking in the pantry, drive bys and sipping on the frappuccino. And that's altering the microbiome and it's lowering the PH of the mouth and it's creating this perfect habitat for these pathogenic bacteria to thrive and cause decay. And so, you know, in pediatrics I will tell you, it is overwhelming the amount of decay that we see. It's estimated that 250,000 thousand children a year undergoing general anesthesia to have their teeth fixed. Most parents do not realize this, but it is an epidemic. Even with advancements in technology and pharmaceuticals and nutraceuticals and all of the things. And it's because of our food landscape. Now regarding cavities, does every cavity need to be filled? My answer is no. And I do feel that especially, especially pediatric dentistry in the United States over treatment plans our children. It's like every little stain, an incipient lesion, which means at the very beginning of a cavitation, gets filled. And so this is probably why the anesthesia rates are so high too. I think we're over treatment planning. These are teeth that fall out. I'm very passionate about saving baby teeth. But you know, what if we just monitor things or what if we worked a patient up, talked about antecedents and triggers? What is causing this imbalance in your body? Are there strategies that we can make at home to then allow the body to innately heal? And this is where your saliva comes in. Saliva spit is the golden elixir of the body. And it is what allows our teeth to remineralize if we're optimized. So, so every time we eat our mouth I mentioned the pH lowers and you do lose some minerals from your teeth. Your teeth are constantly demineralizing and remineralizing throughout the day. And there's something called a Stefan curve that shows this visually if you wanted to show your patients. But what is necessary. It's just like we need our gut to rest. You know, we can't be over consuming food because of the migrating motor complex. And we just need to let your mouth rest too. And so it generally can take 30 minutes and up to two hours for full remineralization. So that's why we like patients to eat more on a schedule. And this includes children. So try to eat sequentially every two hours so that your saliva can naturally remineralize your teeth. So these are strategies that we use. If we catch a cavity early in a tooth, if it's still in the enamel especially that can remineralize, that can reverse. I would argue in baby teeth, the decay can be a little bit deeper and you can arrest the decay. That means freeze it in time until the tooth falls out. Now, not always. I still do plenty of traditional dentistry and this is where case selection matters. But then so you know, if the patient is properly hydrated, getting enough minerals, getting enough fat soluble vitamins, if they're nasal breathing, breathing, not mouth breathing. And there's different products you can use to help boost remineralization, like hydroxyapatite, theobromine, we can talk about fluoride if necessary and down the road, but there are things that you can do to help boost that remineralization process. And this is part of my specialty at my office, is that I am known for being the conservative dentist that is more comfortable watching things and trying to create strategies at home to arrest and reverse decay. And it's very successful in most families if they're motivated.

Now, something you said used a word that I wanted to unpack. You said hyper palatable foods. Unpack that. Because I know what you mean by that, but I think that might have flown over most people's heads. Could you explain what that is? Because I think that's huge as far as why everybody eats what they eat and part of this whole process. Could you explain that word and how it plays into all this?

Sure thing. There's something called the bliss point. The bliss point is something that food scientists try to achieve and they're paid big bucks to do this in their labs. That hits all the right receptors in the brain, all those great dopamine receptors and serotonin, etc, and usually it involves the perfect blend of fat and salt and sugar. Okay. And so it's just that taste point that just makes it so that you can't stop eating it. And I will give you an example. I'm very aware of this and I like to live a very clean life. And if I am on a road trip and I'm starving and I'm in the middle of nowhere and we stop at a convenience store, My go to my Achilles heel are Doritos. I can grab a bag of Doritos, which I eat very frequently, maybe once a year, which is still, I would argue, too much. But it's okay. I can't eat just what? I just can't. I even will say to myself, just have a couple. I can't stop eating them because it is that trigger, that brain feed, that feedback loop between my palate and my brain, that it is hyper palatable. I just can't stop eating it. Because that bliss point. I once heard a speaker who used to work for maybe Frito lay's, it was Pringles. And she said they were being offered another multiple, multiple ten of millions of dollars to make Pringles even more, quote, unquote addictive. You know, once you pop, you can't stop. Like that is strategic. And so they're constantly trying to refine their ingredient formulas to make these foods. So you can't put them down. You eat the whole bag of chips and then you want more because they're non satiating. There's no protein, there's no nutrient value in it. And so that increases their sales. I mean, I'm not trying to be cynical, but it's this constant eating that's trashing our teeth and our oral health and then our gut health and our systemic health too, our blood sugar, all of it. So we're just overeating. And we're seeing this with the chronic health epidemic and the obesity epidemic as well.

So your point, you said before, part of the way our teeth remineralize is we need that time between eating in order for them to remineralize. If you're snacking, then you're basically blocking that natural process and making yourself more prone to, to cavities. You know, it's really interesting. When I was a kid growing up, I used to love Fritos, the barbecue ones. And I would actually sit down watching Kung Fu Action Theater on Saturday mornings and eat a whole bag and never stopped. So you're not the only person. I haven't done that in quite some time.

But yeah.

Now you mentioned oral ph, and that's something I actually check my own oral ph almost always alkaline. Could you talk about that a little bit? Because that's a topic that I'm passionate about as far as like not just systemic, not just oral health, but this might be a, you know, transition, but systemic health. Because if your mouth is acidic, not alkaline, that reflects other things. So could you talk about that briefly and Maybe we can use this as an interlude to kind of transition to how the mouth actually impacts the rest of your body.

Absolutely, yeah. So it's iphs. Every patient, when they come in, it's a moment in time. But we use it as a measure, but also an education tool to teach the parents and the kids. It's really about acidity. Everyone's taught that oral health issues are because of sugar. That's indirectly the issue. The real issue is the ph of the mouth and the PH of your saliva. So the fact that you're alkaline is excellent. When I see a child who has an alkaline level, we, you know, say bravo. And those kids generally eat a whole food diet. They're very well hydrated and the parents generally will add minerals into their diet, whether it's in their water or as a supplement. Supplement. And they also are nasal breathers. Important to note. And we can get to this down the road. But when you breathe through your mouth, you lose all your salivary health. You get dry mouth. We've all experienced this. And then the ph drops. Okay. So if you're a mouth breather, your mouth will be acidic. What loves acidity? Pathogenic bacteria. They're anaerobic generally, and they love acid. Okay. So they will thrive. You're creating this perfect environment for them to thrive if you're breathing through your mouth or if eating a lot. And I like to point out it's not just eating a lot, it's drinking too. So many of our issues are from our drinks. The coffee with the sugar and the creamer that you just sip on casually all morning, or that sparkling water that you're like, well, it's better than a soda. Yes, it is, but it has a low ph. So if you're sipping it constantly, you're just bombarding your mouth with acid. So we like to structure things. Like if you're going to drink something like that mineral water, sparkling water, try to just pour a serving and drink it in a fairly short amount of time and then just drink regular, ideally mineral rich water in between to allow your saliva to raise the PH to buffer. And so what can be some of the reasons? I mean, it's a lot of dietary related. So I do find that kids who are eating a more ultra processed food diet, they will have more acidic saliva and then also just deficiencies like you can. Mineral deficiencies certainly will cause a change in ph of the saliva along with the mouth breathing and gut health too. So if they have a dysbiotic gut, intestinal permeability do they have reflux, etc, that can all impact the oral health as well.

And the oral phone is something I watch closely to patients and really also urinary ph related to cell function and things. So it's something that is looked at but is almost never talked about in the traditional world and even the functional medicine world. I feel like we like it's mentioned once in your training and no one ever talks about it again. But it's critically important. It's a reflection of what? The redox potential literally of your cells, which is crazy. Now the transition I want to do here is your mouth and the rest of your body. You know, I learned in medical school that if you had bad dentition, that could be associated with an increased risk for heart disease, neurological issues. Could you like talk about some of the things that go in the mouth, bacteria and ph and things and how, how on God's green earth can your mouth actually be reflection or affect negatively your body's health?

Yeah, this is a passion of mine. So this is the oral microbiome. So we all are familiar with the gut microbiome in functional medicine and how profoundly important it is for immune function and just general health and wellness. And we tend to go there first. Like health starts in the gut. I would argue health starts in the mouth because the mouth is the gut. This is the way I want people to be thinking of it. It is the beginning of the gut, it's the beginning of the digestive system. It's one tube and they're very similar and they act bi directionally and they influence one another. There's a lot of data around this right now and I'm very passionate about salivary diagnostics and oral microbiome testing. I know more and more funct functional medicine providers are starting to offer this to their patients. I suggest everyone look into it. Like if you are doing gut mapping, you should be doing oral microbiome testing too because if you are cleaning up a patient's gut, but they have gum disease or periodontal disease or cavities or tonsil stones or some sort of oral dysbiosis. Please note your patient swallows about 2,000 times a day. So that's direct translocation of oral bacteria into the gut. And many of these pathogens will survive the environment of the gut and the ph and they can make it down into the intestinal area. So we do know very specific keystone pathogens and you should be aware of these. There's P. Gingivalis, which is linked to Alzheimer's and Dementia. It's also linked to pregnancy and fertility issues. F nucleate has been linked to colon cancer, pancreatic cancer, breast cancer. There are more, you know, and I'll save the details of that. You'll learn this when you start oral microbiome testing. But how does the bacteria in our mouth influence other organ systems? So these bacteria usually are associated with gum and periodontal disease. So if a patient comes in and you're examining them and their gums look puffy and red and inflamed. And if you ask them, when you brush and floss, your gums bleed. If you spit in the sink, do you see pink in the sink? That is a sign of inflammation. That inflammation doesn't just stay in the mouth. That is going to become systemic inflammation. So not only now you're having an inflammatory response, but also just like you have leaky gut, you have leaky gums. So if your gums are bleeding now, there is a way for the bacteria in the mouth to get into the lymphatic and circulatory system and, and end up in places they shouldn't be. And this is why we're doing biopsies. And how they're linking these things is that they're finding oral bacteria that has no business being in the colon and colon lesions and cancer or in the pancreas or in the brain, leading to amyloid plaques and neuroinflammation. So not only can the actual bacteria translocate, but also they are releasing endotoxins and lipopolysaccharides and these inflammatory cascade responses, like a cytokine storm, if you will. And so they're just causing a lot of downstream effects that way. And there's again more and more research, but specifically the ones that people should be aware of, I think that get patients motivated to take better care of their oral health include the brain health connection. So the oral brain access. So Alzheimer's, dementia, cancers, pregnancy and fertility complications and delay. So couples we know inflamed gums, infection in the mouth, gum disease. These pathogens can affect sperm motility, kidney dysfunction and challenges conceiving, as well as pre delivery, low birth weight, miscarriages, et cetera, rheumatoid arthritis, autoimmune diseases being linked back to the mouth, cardiovascular diseases, you know, and that's most people do know about because of the bacteremia. And so the list goes on and on. Gut health, you know, obviously we're swallowing so gut dysbiosis and resulting in potential mood disorders as well. I think because medicine went one way and dentistry went another, and the way dentistry began, you know, we were like the blacksmiths that just started extracting teeth out on the street. We never were taken seriously by our medical colleagues. And I think a lot of that is deserved because we don't tend to look at metrics or data. You know, we're considered carpenters, and I think some of that's justified. And there's a time and place. We need dental technicians. Absolutely. We need to fix teeth, but we also need to put all the pieces together and stop compartmentalizing and understand how the different systems all link together. And I believe we need dental physicians. This is where functional dentistry comes in. This is where understanding how all these different pathways connect to one another is really important.

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Foreign.

Tonsil stones a bit ago, and I'm kind of curious about that because I used to get those when I was a kid. I don't get them anymore. I was always told they're just pockets in your tonsils to catch food and bacteria. Is there more to tonsil stones? Because I have. Patients routinely come in, they have the little white things in the back, their tonsils. What's the deal with those? Why do people get them? And what's a great way to make them go away?

Yeah, tonsil stones are tricky, and they're very common, interestingly. So it's a sign of oral dysbiosis. Absolutely. Generally, the first thing I think of when a patient has tonsil stones is I do wonder if they're chronic mouth breathers, if they're breathing through their mouth because that's going to change the ph, it's going to alter the type of bacteria and the diversity that is in the mouth. And then I always wanted to do they have sinus issues that post nasal drip? So the mucus is dripping down there, it's mixing with the bacteria. And then essentially you can get a bacterial colony that gets calcified. So it can also be a sign of mineral imbalances like in vitamin as well. So like K2 deficiency, we know K2 is really important to direct calcium in the body. If there's too much calcium in the saliva, it's going to deposit as tartar, as calculus and then also as potentially these tonsil stones. So it's definitely common but not normal. So it'd be nice if patients could work with their functional medicine or dental providers to try to triage and understand what the real issue is. Certainly addressing the main underlying issue is the key to all of this. But you can be gargling ozonated water is wonderful. That's one of the best ways. And then if they get really bad, a provider can go in and do a debridement for you too. And then I would say if you have chronic tonsilitis and infections, it is worthwhile to consider potential surgery too if it's leading to low grade chronic systemic inflammation. It's just a conversation to have. I personally had chronically inflamed tonsils for four decades of my life and I just kept blowing it off and I finally said I'm going to get them out. I had my tonsils out at the age of 43 and immediately after healing I felt so much better. I lost all of this inflammation in my body. You know, you just don't realize how much these low grade impacts can have on the body day after day. So just being open to that.

Yeah, you'd mentioned before about the airway and I see a lot of patients in adulthood who have sleep apnea. I'll see kids with pandas and pans, autism who have, you know, crunched the narrow dental arch, high arch palate, and they probably have some kind of upper airway resistance syndrome. And if you don't address that, that affects their entire health. Can you talk about that from a dental perspective? Because there are some options out there as well. If you catch these kids early enough, we can actually do something about that.

Absolutely. Until we get children and humans in general breathing better, it's going to be an uphill battle. There's so many pillars of health that are critical, but to me, airway is the most important, it's foundational. What can we not live without for just a few minutes? It's oxygen. So if you are every day struggling to breathe, you're having dysregulated breathing, you're not becoming properly oxygenated, you're not getting into your proper sleep cycles, your restorative sleep, the proper hormones aren't kicking in, the glymphatic system isn't working optimally. You're going to not thrive essentially, and it can shorten your lifespan as well. Let me go back ancestrally again. So there's a book called Breath by James Nestor, which if people are interested in airway health, this is a must read. It will change your life personally and also the way you look at your patients. Just like I spoke about ancestrally, we used to have big, wide, broad palates and the teeth were all lined up and everything was hunky dory. What has happened, anthropologists theorize, has a lot to do with our lack of chewing. So when we were hunters and gatherers, we used to chew for three, four hours a day. There was a lot of foraging of food, it was harder to get nutrients, we had to chew a lot. Now these hyper palatable foods are for all intents and purposes pre digested. They're already so soft they just melt in the mouth. You just mash them and swallow. And now we just chew a few minutes a day. So depending on what your diet is, but this is the standard American diet, so it's the act of mastication and chewing that grows the face, okay, along with breastfeeding. And so this has been generation after generation after generation. So we are dis. Evolving is what James Nestor has coined. Our faces are shrinking, they're getting more narrow, our jaws are getting more narrow. As a result, if I were to take your face and just kind of smush it and make it more narrow, what's going to happen to your palate? It's going to vault up like this. What's going to happen to your septum? It's going to deviate. And then also the surface area of your dental arch is smaller. So now your teeth have no room to come in. So they come in crooked and now you don't have room for wisdom teeth. And so your wisdom teeth get pulled and then you wait too late to address this. And now the dentist says you need your premolars extracted. And then you take a small mouth and you pull everything back with braces and you make a small mouth smaller. And what happens with that? Well, now your tongue has nowhere to live. Your tongue can't fit in your mouth, so it falls back into the throat or it sticks out and you become a mouth breather. And this is on a continuum. You have open mouth posture, mouth breathing, sleep disorder, breathing, upper airway resistance syndrome, and eventually potentially sleep apnea too. And so what we do as a functional dentist and an airway trained dentist is that we do airway assessments on children the minute we see them. You know, I see infants. We like to see kids by the age of one. That's the American Academy of Pediatric Dentistry's recommendation. National guideline is bring your children in by the age of one. A lot of this is for education, but also airway screening. And so we can off the bat. If a child is narrow, you really can. Do they have low tone, maybe? Do they have a tongue tie, tongue thrust? Do they seem like they're going to be crowded? That narrow palate, that high vault? And there are things that we can do even in these early ages, such as myofunctional therapy, these silicone type appliances that can help train the lips to be closed, the tongue to be up, breathing through your nose to help get them ready for what is potential early functional orthodontics, which is when we start extending, expanding the jaws. And so newer philosophies with orthodontics is fixed by six, at six years old. Now, it doesn't mean everything's done, but it means we need to start addressing these issues while a child is still growing. So most facial development in a human is done around the age of 10, almost 80 to 90% is. So if we're waiting beyond that, like traditional orthodontics does, we're not changing the structure of the jaws in the face, we're just moving teeth around. And so we're not addressing airway issues, which is really the skeletal discrepancies that we see. And so we do really love to talk about early expansion. And it can be so easy in young children because at their palate, there's a suture. It's filled with cartilage. It's very easy and malleable, easy to manipulate. And retainers are usually all that it takes to grow that arch bigger and wider. Now you have room for the tongue, now the teeth have room to come in. And now essentially, your child's face is how it should have been had we been growing optimally all to begin with. And you are setting your child up for a lifetime of health because now their airway will be improved.

So what Are the for just for clarity and simplicity. What are the ages for each, like, you know, you mentioned the face stops growing about tennis, seeing the pediatrician, the pediatric dentist at age 1, like for each step, like let's say kids that got crooked teeth and narrow dental arch. Like, what age would you expect to if you're going to completely do this? Each one of those. And what's the latest stage at which you could do anything because of them?

So let's just start with infancy. So obviously if a dyad, if a mother and an infant are having challenges with breasts feeding, work with an ibclc. But then you can go see an airway focused dentist. And sometimes they do need a tongue release. Okay. Or maybe they need some intraoral work with a cranial sacral or chiropractor. You know, is there torticollis? Is there just low tone? So that's the first step. You know, we do either body work or sometimes they do need a minor surgery. It just depends. There's an appliance called a Myo munchie. This is a very early myofunctional appliance that can be used as young as eight months old. And it looks like a little silicone mouth guard with a long strap. And believe it or not, 8, 9, 10 month olds, they love it. You put it in and what it's teaching is them to close their lips, keep their tongue up and breathe through their nose and they just keep it in for a few minutes. So it's, it's an oral motor function tool and that can be used indefinitely. I have a myo munchy that I use in my car during my commutes because it does help tone the face. I that's why I use it. So that's like the first step when they're very, very young. I would say expansion, like little retainers and expansion really can't start until a child's like three or four. And that's just mostly a behavioral issue. And there are different philosophies about this. There are so many different appliances out there and they all will tell you they're the only one. They are the best one. I will just like everything, we are bio individuals. Nothing is one size fits all. So if someone is marketing to you just one appliance, I'd be very cautious. We should have a lot of tools in our toolkit because someone's needs are different. So this can range from a series of silicone appliances to a removable retainer that starts to expand the jaws to a fixed Retainer that moves more quickly. Then there's fixed retainers that move more slowly. And this is where, you know, working with a knowledgeable, airway focused dentist would work. So if I have a child that's really struggling, like, failure to thrive, they're starting to develop ADHD type, you know, behaviors, and they're struggling, and they're getting in trouble in school. And, like, the family is desperate. We will start expansion as young as, like, three and a half or four. Okay. Now, if we just see an issue, but the child's doing okay, sometimes we may suggest myofunctional therapy first around the age of four or five, and then around five or six, six, we will start the expansion. So it just depends on the age of the child, the maturity of the child, what is the family dynamic like? This is a big commitment for the whole family too. Okay. But most often I am referring my kids to my functional orthodontist between 4 and 6 years old to start the conversation, to get things started. And I like to see most everything completed, at least the first phase. And the first phase means skeletal changes. Okay. Phase one is skeletal hard tissue. I like to see that definitely going and almost done by eight, eight and a half, nine years old. So then oftentimes we'll take a break, and then we might have to tweak and line up teeth with Invisalign. We usually are trying to avoid braces at this point, but kind of like a last retainer series, and that can be around 11, 12, 13 years old because the skeletal issues been addressed. Now we're just lining all the teeth up. I do like most of this to happen by 10, you know, now after 10, all hope isn't lost. It just gets harder. Because that suture that I said was filled with cartilage, it does start to calcify. We used to think it completely calcifies. We now know that's not true, that even adults can pop their suture open and get expansion. And I'll get into that. But most of the time, if it's after the age of 10, it does get trickier. It gets more uncomfortable for the patient to do expansion. And this is where sometimes we now have to do jaw surgery. All right, now, there are different appliances that are out there now. One is called the marpi, which is less invasive than true jaw surgery, but it involves little tiny mini screws that go into the palate. I think it sounds worse than it is based on patient report. Obviously, it's a commitment, but it just creates anchors to really help open the palate and ride in the jaws more. And sometimes we do have to do those in 11, 12 and 13 year old year olds. And now adults can have marpies too. And there's other appliances like the homeo block and the ALF appliance and. But I will tell you, all of this is much more successful when you're working with a myofunctional therapist also. And myofunctional therapists are essentially physical therapists for the muscles, for the tongue, for the muscles of the lips, for all the muscles that are needed to help promote nasal breathing. Traditional orthodontics tends to just focus on bone and teeth. And we really are ignoring muscles. And in a battle between muscle and bone, muscle will always win. So if you're imbalanced skeletal muscularly or fat, your fascial, you know, planes are off, you're going to have relapse. And how many of us have had orthodontics? And then we said, I didn't, I didn't wear my retainer in college or whatever and my teeth shifted back. That is because the underlying muscular balance was never addressed in you. And we are trying to make a movement in functional orthodontist to say we need to be addressing both together for the best patient outcomes.

It's all super interesting and to your point, like, I had to go through three different devices. I have mild sleep apnea and it was the third one that actually I was able to tolerate. I wasn't breaking it, my mouth wasn't hurting at night. So you do need different options. You're 100% correct about that. I haven't heard anybody actually say that, but that was my own personal experience. I want to just say briefly about tongue tying because a lot of people are like, don't worry about it, ignore it, or they often be done when they're born. It sounds like your approach is a little more nuanced to that.

It's like anything anyone that's saying anything's black and white in the human body. The side of caution. So restricted oral tissues or tongue tie or lip tie or buccal ties, etc. They're not an issue unless they're an issue. So are they impairing function? There are people that have a tongue tie that seem to acclimate and adjust and compensate just well. Now the concern is if you are compensating, if you're using muscles and things that ideally you shouldn't be, will that catch up to you in decades and decades of life? And now you have chronic neck Pain or headaches, et cetera, that's always hard to predict. So a lot of times this is a monitor and wait situation. Unless the patient's struggling, they need a full assessment. And we always start with myofunctional therapy. Unless they're an infant. The gauge with an infant is, are they working with an ibclc? Have we tried to utilize other strategies? They're not working. The mother's still struggling, the mother still wants to breastfeed. And then we proceed with the procedure. And many times it's very helpful. It may not be perfect, but it helps get the mother through a phase that's challenging, so she continue on her breastfeeding journey. Okay, but anyone that's just doing surgery on every little baby out there, I mean, unfortunately, this is why it gets a bad reputation. There's a joke like you buy a laser and now all of a sudden everybody needs a tongue release. And I don't disagree with that. Like, it's unfortun. And it really bothers me that my colleagues are behaving this way, and certainly not all are as we age. And so now let's say we miss the infancy window. There is a no man's land of like age one to, I would say four, where you just monitor, because otherwise you're having to do a sedation. And it's very hard to justify the risk of sedation for something like this. So then if the child's a bit older and we're seeing speech issues, do they have. Are they picky eaters? Picky eating can be a sign of oral motor imbalance. Your tongue does so much when you are chewing and swallowing and masticating. Like, think about how your tongue pushes your food back. If it's restricted to the floor of the mouth, you may be more fearful about foods you have to chew a lot. What are those? Like carrots and apples and meat? What are safe foods? Saltine crackers and goldfish and chicken nuggets. You see how easily a child can get pegged a chicken picky eater, when actually maybe they have a tongue tie. Oral motor dysfunction. So these are things we ask the parent. How are they eating? Are they a picky eater? How's their digestion? You know, are they not chewing enough? So now they have digestive issues? Are they nutrient deficient? Are they mouth breathing? Are they snoring? Are they getting behavioral issues? Is the family struggling? Because every night this child's up all night and just like looking sickly. And there's things that we can see in the face Venous pooling. That's those dark circles. They call them allergic rhinitis. It's inflammation, and it can be allergies, too. Do they have the long, narrow face, the forward head posture, the open mouth, like the Napoleon Dynamite look, essentially, is what it is. Those kids are not thriving, and that will catch up to them. And you hear people say they're going to outgrow it. They do not outgrow it. They don't. It tends to get worse. It's a continuum. And what we're trying to avoid is that adult patient that's on a cpap. It's nuanced, it's complicated, but certainly every tongue does not need to be released. But if we have a concern, we send them to myofunctional therapy first. Can we, you know, strengthen the muscles and do these exercises to create balance? And if we can't get to where we need to be, that's when we go to surgery. So we try so many other things before we jump to surgery. But I will tell you, my own daughter, she had a missed tongue tie. This is why I do what I do now. We had a very hard time breastfeeding. She had a posterior tongue tie, which many people think it means. Back here, it's kind of misnamed. It just means it's still under the tongue, but it's buried under the mucosa. So you really have to palpate for it. You can't visualize it like a guitar string. It's kind of hidden. She had a posterior tongue tie. She started mouth breathing, grinding. Just a lot of sleep disturbances and issues. And then around the age of three or four, I felt like she was just more sensitive, reactive to sound, to tags, loud noises, more ADHD type symptoms. And this is when I went into my airway journey. And so it is. It's case by case, you know, and eventually we did. We tried everything. We did myofunctional therapy, craniosacral therapy, all of it. We ended up getting her tongue released, and it was profoundly beneficial for her. And she started to actually eat better, too, and chew and masticate and digest better.

That's an interesting story. My second daughter had something with hers where she had to get hers released. And it was interesting to see what happened after that. She was at 12 or 13 when that happened. Something you mentioned earlier on, before we even started talking about. We're coming to the end of the time, and I want to respect your time, but you mentioned association with oral health and hormones. Could you briefly tell us, like, that's the first time I've actually heard anybody say anywhere, talk about how's your mouth health affect your hormones?

Like, could you talk about that and vice versa? So, well, it's inflammation, number one. But I will just say, so what are the key moments where there are fluctuations in hormones that can be seen in the mouth and vice versa? You know, puberty, pregnancy, perimenopause and menopause. So very commonly 11, 12, 13 year olds are known to have terrible hygiene and they come in and they get shamed and blamed because they have inflamed gums and their gums bleed. But there are those handful of kids that come in and their teeth are really clean, but their gums are still puffy and inflamed. And then typically dentists will be kind of like, we don't believe you. You're not brushing and flossing, you have gum disease, get on it. And the kids will say, I really am, doc, you know, and I used to be guilty of this too. And I just, I had to take a step back and think, and then what is this child going through Right now? They're going through puberty. And so there are estrogen receptors in our gum tissue, in our oral tissues, and they're significantly influenced by fluctuations in estrogen and progesterone and testosterone, et cetera. So just be mindful of that. And this also happens in pregnancy. So many women experience something called pregnancy gingivitis. Up to 75% of women will experience this. These are due to hormone fluctuations. It usually self resolves post birth and after we've been breastfeeding for a while and hormones start to normalize and regulate a little bit. It also, like when relaxing kicks in to help us prepare for our birth journey. It helps loosen the ligaments, if you will. We have ligaments around our teeth, we have the periodontal ligament. And so that can also be influenced. You hear many pregnant women say, gosh, my bite shifted, my teeth shifted. There's a phrase that says, I lost one tooth for every child. It has a lot to do with this. Okay. And so we tend to be dismissive of women when they're coming in, like saying, no, my bites different, you know. And so then perimenopause and menopause, you know, estrogen and progesterone fluctuations can impact a lot. We see a decrease in salivary flow. So many women report dry mouth, they report a metallic taste in their mouth or burning sensation. They may get more TMD or TMJ type symptoms. This has to do with, you know, decreases or changes in progesterone influence, collagen synthesis and how we're responding that way. There tends to be more clenching and grinding and again, gum disease and bone loss too. So think about how we're recommending DEXA scans now. There's bone around your teeth and we can start losing alveolar bone and it will look like periodontal disease. But actually these could be changes in a woman's hormones. And this is why I'm so happy women's health is getting more attention because if we can stay ahead of it, we can prevent some of these long term chronic issues as well. And, you know, we can tie it into pregnancy and fertility as well, you know, the oral microbiome. And, and so if there is a couple or a patient that's really struggling with conceiving or maybe even they're just struggling during perimenopause and menopause and they're trying to get their hormones in check, I highly encourage oral microbiome testing because there may be a keystone pathogen hanging out at an unoptimal, you know, a suboptimal or too high of a ratio level that's creating dysbiosis and issues. And if we could do targeted strategies and protocols to help you don't completely eradicate it, but get it back into a more balanced ratio that is more typical, we can get the patient healthy again.

The testing you've referred to is up there.

Oral DNA is only going to test for the top 12 or 13 keystone pathogens and periodontal disease. So it's a great one if you're dealing with a periodontal patient. But I right now really love bristle. It's like toothbrush bristle. It's a direct to consumer, but it uses shotgun metagenomics and so it's sequencing the entire DNA sequence and it will also let you know is there yeast overgrowth. It will pick up H. Pylori and some gut biology too, if you will. And so I think it's a much more comprehensive test and it is direct to consumer, which is really nice. You know, many dentists are offering it in their office, but if you don't have a dentist close to you, which so many of us don't, that think this way and practices this way, you can order it. You literally just spit in a tube first thing in the morning. When you wake up, you ship it off and usually three weeks later you'll get your results. The interface and platform is so user friendly. It does give protocols and you Know, I will say that oral microbiome is essentially in its infancy. So we are continuing to refine some of these protocols. And you know, it's a blend of like diet and hygiene nutraceuticals. But there are some that require pharmaceuticals too, antibiotics because they're like the spirochetes and the really virulent pathogens just like if you had parasites. And you know, sometimes we have to use the heavy hitters to create homeostasis again. But yeah, so bristles the test that I like.

I could keep on talking to you I think for a couple of hours. But I need to respect your time because every time you say something I have three questions I write down. So people want to hear more about what you do, learn from you. Because I know you're active on social media. Tell us some where people could hear more about you, follow you, all that kind of stuff.

Yeah, I'm happy to come back on. I mean I'm actually working on a book all about the oral microbiome. So maybe when that comes out we could come back on and do do a round two. Yes, I am on social media so I spend a lot of time on Instagram. It's doctorstacey. We can put this in the show notes but doctor spelled out and it's Stacy with an I. I have a website, DrStacy.com the same spelling. I do a weekly newsletter. Because so many of these conversations and the education I provide on social media, it's just surface level. So I try to take a topic every week and really dive deep and go into the science and the why. But the protocols, because that's what's missing from so many of these conversations is you hear all about the what. But then it's like then what do I do? That's really what people want, right? So low cost, no cost strategies and protocols. So I try to be very mindful of that and help patients understand what they can do to help their health. I see patients in person in Portland, Oregon at Bloom Kids, you know, so if you have a child 13 or under, I do online consultations too. That's on my website. And then we have the Institute for Functional Dentistry. The bio is a little off. Clearly that's all that. We were supposed to launch in summer, but it's gotten delayed and now it's in January. But we're allied partners with the Institute for Functional Medicine which just means we're incorporating IFM curriculum. We are a separate entity. But what's missing from Functional Dentistry is the medicine. This is what Dentists are missing. And so we know to really be a functional dentist, you need to understand human biology a bit better. Hormone pathways, immune health, gut health, et cetera. So the dentist will come and get trained in functional medicine, and then everything is applied to a dental model, and they will actually become certified. So when you're listening to these podcasts and you're like, this is so interesting. I want to work with a dentist like this, but there's no one to go to. We're trying to change that. And so once the first cohort graduates, we really hope to have a little army of dentists out there practicing and thinking this way. So if you know someone who might be interested in joining that. It's for assistants and hygienists and dentists and even physicians, please, you know, share that with them, because that's how we're going to change the industry.

That's 100% how you do it. You do from the bottom up. You start training people, educating education, education. I've been so much enjoying my time with you here. I want to respect your time, and this is a great conversation. I encourage everybody to go visit Dr. Stacy, check her stuff out. If health begins in the bowels, but your mouth is apart, you really got to get that squared away. So thank you so much for your time.

Thank you. It was really fun. I appreciate it.

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