The Functional Medicine Approach To Oral Health with Dr. Todd LePine

Coming up on this episode of the Doctor's Pharmacy.

There are a host of conditions including premature birth, obesity, diabetes, cardiovascular disease, rheumatoid arthritis, inflammatory bowel disease, and even dementia that are directly connected to poor oral health.

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Welcome to the Doctor's Pharmacy. I'm Dr. Mark Hyman, that's pharmacy with an FFAR MACY, a place for conversations that matter. and if you've ever struggled with dental issues or mouth issues or gum issues or teeth issues, you better listen up because we're gonna have a conversation today about how your mouth health and your oral health connects to your overall health and why it's so important to focus on oral health. And it's with none other than my colleague and friend, Dr. Todd Lapeen, who's been with me for 25 years working together at the Ultra Wellness Center before that at Canyon Ranch, and is one of the pioneers in functional medicine and brilliant man. And I'm so excited to be back.

Here with you on the Doctor's Pharmacy Todd to talk about The mouth.

All right.

Thanks, Mark, for having me. It looks like you're in the Castaway movie with the.

Yeah, Tom Hanks just walked up the beach. Okay, so most people who go to medical school, we don't really learn much about the mouth. We don't know you've got gum disease or you can have sores in your mouth. I mean, a few things here and there, but it's just amazing how much of a vacuum in our education oral health is. But as it turns out, it's been linked to everything from Alzheimer's to heart disease, to cancer, and to autoimmune diseases, and so on and on and on. And the question is, what is going on with the connection between our oral health and our overall health? So take us down that pathway, and then we'll talk about basically how to address dental health from a functional medicine perspective.

Yeah, so Mark, just a little bit of background. I probably have mentioned this before, but I come from a family of dentists. So my grandfather was a dentist. He went to the University of Maryland in the late 1800s, my father went to University of Maryland 1940, my brother went to UPenn dental school, and then his two sons are dentists and my two sisters are dental hygienists. So this is a topic that's near and dear to me, and I'm sort of the black sheep of the family. And we know that in functional medicine, the gut is sort of where everything starts, and it can either lead you down the path of health or it can lead you down the path of disease. And the beginning of the gut is the mouth. so as you mentioned, you know, in medical school, we didn't learn anything about the mouth. That was like, for the dentist, you know, we'll just ignore that. And the dentists just basically stay in the mouth and they don't really realize that there's a whole body connected to the mouth or some of the dentists don't. And this is where I think a lot of both, you know, even functional medicine physicians and dentists really miss the connection. So unless you're working with a a holistic smart dentist or a functional medicine doctor who's aware of the connection between the mouth and the gut and systemic immune system, you're gonna be missing a lot of things. And as you mentioned before, you know, there are a host of conditions including premature birth, obesity, diabetes, cardiovascular disease, rheumatoid arthritis, inflammatory bowel disease, and even dementia. that are directly connected to poor oral health.

It's incredible, yeah. I mean, dementia and they're finding that the microbes in the mouth get absorbed then go up into the brain and create inflammation in the brain. Pretty wild. We know that your risk of having heart attacks is higher if you have gum disease. We know that even weight and metabolism are related to what's going on in your mouth. So, you know, what's wrong with traditional dentistry and its overall approach? Because, you know, your dentist does your teeth cleaning, they might treat your disease, they'll fill your cavities, they'll thicken root canals. So tell us what is the problem with traditional approaches to dentistry?

Traditional dentistry and dentistry has gone a long way. The original dentists were actually barbers. You remember that the barbers used to pull the teeth out and the dentists have come a long way since being barbers. But a lot of dentists are what we call drill and fill. and then you can do root canals and then you can do implants and those kinds of things. A lot of that's related to structure function and cosmetics. People want to have white teeth and you don't realize, okay, you just have white teeth doesn't mean you have a healthy oral microbiome. And you really have to look at the whole picture because the beginning of digestion starts with your mouth, starts with healthy saliva. and all of those things are interrelated to being able to digest and absorb your nutrients from the get-go. You need to have a proper salivary pH, you need to have sufficient amylase. So there's a lot of happening in the mouth that is the beginning of digestion.

All right, so one of the challenges is traditional dentistry is they use certain techniques that we find problematic. For example, putting in silver fillings or mercury fillings. And recently you sent me a link to the FDA's new ruling that fillings were not acceptable for pregnant women and babies and kids. So why is it good for the rest of us? It's not good.

It's not good for the rest of us. And, and, you know, the thing is, is the interesting thing about that is that, you know, I think, you know, as, as you said before, there's no safe level of mercury. You know, the mercury is a known neurotoxin, and some people are better able to detoxify it. My father is an example of that. My father, he practiced Dentistry up until his 80s, and he used to literally handle amalgam in his hands. and he'd be throwing it on the floor and every, I can remember going to his office and playing with the mercury in his office. And lo and behold, there are some people who are better at detoxifying mercury, and there are others that don't detoxify mercury as well. But mercury is definitely, for some people, a real problematic issue, I think, is you experience that yourself. And there's testing that we do for mercury. You can check for mercury body burden, and you can check for both organic and inorganic mercury. one of the labs, quick silver that we use, does that test, and it can tell you how you're excreting both organic and inorganic mercury, and the one from fillings is the inorganic mercury, which is the more toxic to the brain.

Right.

And so we've got the filling problem, which really nobody should ever have silver fillings, and if you have them, it's tricky. You get them out, you not get them out, how do you determine when I think you need to know that there are biological dentists who do it safely and there's a website called I-A-O-M-T.org and we'll put in the show notes, I-A-O-M-T.org, which is a resource of learning more about biological dentistry and finding a biological dentist in your area who knows how to practice safe removal and other dental techniques that actually help to rejuvenate your mouth. One of the other challenges is root canals and I think, you know, people are getting a lot of root canals. I certainly had one and I had to take it out. But tell me, what is the problem with root canals? Why should we be concerned? And should everybody with root canals have their teeth pulled or what do we do?

All right. So, okay, so I'm not an endodontist who does root canals. And I spoke with my family members about this. And if somebody is really, really skilled at doing a root canal, you can do a root canal. The real, I think the key thing about root canal doing a root canal is to make sure that you're dealing with a sterile environment, which very, very difficult in the mouth. Because when you're doing a root canal, my sister Gail, she made a comment that a root canal is basically a dead tooth. And if you had a dead spleen, would you leave a dead spleen in your body?

No.

You want to remove a dead organ. And a tooth that's devitalized doesn't have nerves. So if you get an infection, you oftentimes won't get pain unless it starts surrounding to the other area. you don't have a lymphatic system to drain infections, you don't have a blood supply, arterial and venous supply. So you can really get these stealth infections. And by that, we typically think of an infection as someone who's got a fever, there's swelling, et cetera. But you can have these smoldering infections. And I've seen, just this past week, I've had two patients who had a history of root canal issues. that were manifesting as systemic issues. And they really didn't have a whole lot of oral issues. They were having peripheral issues.

Yeah, that's interesting.

Exactly, yeah. And then when they open those root canals up, if it's a bad root canal, root canal gone bad, they often find these anaerobic infections. And they are foul smelling. The anaerobic bacteria produce things like putrescine and cadaverine, and you don't want a lot of cadaverine in your body unless you're a cadaver. and putrescine is very, very, very good.

It doesn't sound good either.

And there's a lot of yeah, you're right. And there's a lot of organisms that are in the mouth. In fact, the oral organisms, and we have hundreds of oral organisms, there's about a 45% concordance between the bacteria that we find in the mouth and the bacteria that we find in the digestive tract. And you can think of the the whole body as being like a tube. And the opening of the tube starts at the mouth, and then it goes all the way down into the stomach, the small intestine, large intestine, and out the anus. And those bacteria that are in the mouth get swallowed by the body. I mean, you will swallow about 10 billion bacteria per day. And some of those bacteria, when you swallow them, can actually cause systemic inflammation and those systemic inflammation can manifest in the joints, in the heart or in the brain. It can also promote systemic inflammatory diobesity as you well know. So it's a real, you know, important issue and it's not just, you know, just having, okay, my teeth look white, everything's fine. You can't see the types of bacteria that you have in your mouth and not only that, but your individual immune response to the bacteria is really critical. We know that in terms of, say for example, COVID, COVID is a virus, and as a virus, for the vast majority of people, it's not going to kill you. You get it and you may be totally asymptomatic, you may have a mild cold, or you may die from it. The same thing with certain types of bacteria. Everybody's immune system is unique, and when certain people are exposed to certain organisms at critical levels, it provokes a low-grade inflammatory response, or in some cases actually even more acute, and that can lead to a whole host of systemic issues.

Yeah, I think that's true. And I think both of us have seen patients who, when addressing their dental issues, often resolve other systemic issues. So maybe you could share a little bit about some of the patients you might have seen that have links to their systemic health from their oral health.

Oh, absolutely. I have three cases real briefly. The first case is a patient who actually was a friend of mine. and I remember we were talking over a beer and he was telling me, you know, some of his health issues and, you know, he was bemoaning the fact that he was having all these symptoms and nobody could figure it out.

And.

And I said, well, why don't you come see me? I'll, you know, I'll do a consult on you. We'll take a look at it. That's what sort of what I do. And he told me, you know, in going over his history, that he had a Cadillac in his mouth. and I said, you, don't even have a Cadillac in your mouth. Yeah, I got about $40,000 worth of dental work in my mouth. And he goes, you know, the dentist said, I have weak enamel. And I said, well, what do you mean weak enamel? And I said, you know, weak enamel is not normal. I said, did he tell you why you have weak enamel? And the first thing that popped into my head is that he probably had undiagnosed celiac disease, which we cause weak enamel. And lo and behold, I tested him and sure enough, he had celiac disease. marked a response to gluten. And when he got off of it, I mean, all of it, a lot of his symptoms, they didn't affect his teeth because, you know, the horse was already out of the barn, but he also was having sort of unexplained fatigue and malaise and all that kind of stuff. And, and actually just getting off of gluten cleared up those other conditions. And we all, you know, you and, you and I well know that there are multiple autoimmune conditions that are associated with gluten sensitivity, but weak enamel is one of those things. and I also, I try to get my patients and the dentists who I see, either as patients or dentists who I meet in social circles, to really be aware of that because I just think it's below everybody's radar. Yeah, that was, yeah, it was really, and it was very life-changing for him. Another case is a patient who I saw who was diagnosed as having rheumatoid arthritis. And this is a woman over from Europe. and she wasn't getting anywhere in the European system. Not that the European system is better or worse, it's just different than our system. But she was not getting any significant help over there and they wanted to use the disease modifying anti-rheumatologic drugs for the DMARDs. And when I did a workup on her, I did a deep dive in her and she had a seropositive rheumatoid arthritis and my seropositive meaning that when you check for rheumatoid arthritis, you can have a positive rheumatoid factor or you can have a positive CCP antibody or both of them, one or the other, or both of them. You can also have seronegative rheumatoid arthritis. And as we talked about earlier, rheumatoid arthritis is just a label that we put on things and lots of different things can cause rheumatoid arthritis. The most virulent, aggressive type of rheumatoid arthritis is the one that has both RA positive and CCP antibody positive. Now, if you go into the medical literature, CCP antibodies are associated with periodontal disease. So anytime I see a rheumatoid patient who's got a positive CCP, there are other things that can do that. Epstein-Barr virus can do it also, but it's strongly associated with the periodontal disease. And then they have to start doing a deep dive. So what I did with her, I did a deep dive, and lo and behold, she had a lot of dental issues. She had old root canals. She had silent infections. And I did as much as I could, and then I also referred her to a very good colleague of mine, Doug Thompson, who runs the Wellness Dentistry Network out of Michigan. And he helps to teach other physicians about integrative dentistry. So I referred my patient to see him. and he did all the different things that he did. In addition to having rheumatoid arthritis, she also had undiagnosed Lyme disease. Exactly. So she had two things going against that can affect the joints. So I basically treated her Lyme disease, did that successfully over a period of time, had her see an integrative dentist. We did testing on her oral microbiome. He did his thing. and she had a dramatic Improvement. She also really changed her diet. And all of those factors really, really made a huge difference in her life. She was basically not able to function. And when we treated, you know, the underlying causes, the root causes, she had a dramatic Improvement in her health. And then one other case, and this is a really anecdotal case, and I really like this case. And, Mark, you probably have seen some patients or, you know, and certain in your career that you've seen a lot is a patient who has frontal temporal dementia. Yeah, right. That's a bad, it's a bad thing. And it's like Lewy body, you know, we don't really understand, you know, these kinds of conditions. And I saw the, the lady, and she was actually quite Advanced with her frontal temporal dementia when I saw her. And I did a big workup, did the ion test, nutritional metabolic testing, testing for leaky gut, testing for heavy metals. and I did, and actually at the time, I did relatively new tests, which is the my perio path test, which is looking at the DNA of the oral microbiome. And she had one of the worst oral bacterial microbiome analysis that I've ever seen. And my hypothesis was, is that I think her frontotemporal dementia was really being driven by undiagnosed severe periodontal disease that was spreading up to her brain.

Well, you just said a mouthful there. Because I just, I just want to highlight a couple of things. One, there is an oral microbiome.

Yes.

And just like there's an intestinal microbiome, and that has implications for your health. And there's ways that now we can test this. And this is not something you're gonna get at your traditional doctor. It's what we do here at the Ultra Wellness Center. That's so unique. We, we do to dig down below the layers to see what's really going on. there's also genomic variations in our own DNA that affect our risk of periodontal disease. And, there's also tests we can look at to look at the heavy metals in the mouth and see if the mercury in your fillings is getting off-gassed and if you're absorbing it and detoxifying it or not. So, there's a lot of tests that we do in functional medicine that can be very helpful to identify whether the issues you're having are oral.

So.

The other thing is, you know, what do we do to change our diet to keep our gums healthy and keep our teeth healthy? And what do we know about food and nutrition and oral health? And then of course, basic lifestyle hygiene stuff that we should all be paying attention to.

Yeah.

So I actually, Mark, when I prepared for this, I made a couple of slides which should be available as an add-on for the podcast for those who want to look at it. But the big thing is the introduction in the diet in the modern day diet, the standard American modern day diet, is the introduction of a cellular starchy fiber or foods. And when you think of this, it's very simple to think of it. These are the things like, you know, rice crackers and pretzels. They basically have very little nutritional value and then sugars. And the modern American diet is very high in these types of foods. And these types of foods are basically instant sugar. and they feed the oral bacteria. And those bacteria also will multiply in the body. We obviously know that you can have bacteria that can cause dental caries and tooth decay, but it can also feed some of these other pathogenic bacteria. And you mentioned the role of the various types of bacteria. There's a couple of bacteria which I like to see on my perio path test, which is Fusobacterium nucleatum, and then another one which is a real bad actor, which is the Porphyromonas gingivalis. And these organisms are in the mouth and you're swallowing them. So the diet that you eat will feed both the bacteria in the mouth and then also the bacteria in the gut. So some simple things that you can do is avoid snacking, drink water after you've had a meal, watch for processed carbs, sort of fake food, if you will, in your diet. Chewing xylitol gum is actually something that is a simple thing to do that can actually have an anti-dental carries type of an effect. And then using electric toothbrush, that's another thing that is a simple thing to do. I pretty much recommend that for all my patients. And you can, you know, use that right after you eat. And then also having lots of fiber in your diet when you eat or eating fiber, it basically is cleaning the teeth. And we all know we've all woken up in the morning with that film over our mouth. Well, you know, that film is actually a biofilm. And unless you're actually keeping your oral hygiene clean, you're going to get, you know, some slime on your teeth. And that's really where the bacteria really sort of take hold in the mouth. And good integrative dentists will actually work on oral biofilms also.

It's great. And you know, it's often there's a lot of things we can do to improve our oral health through supplementation. Things like CoQ10 is very important, proanthocyanidins from colorful plant foods, vitamin C for gum disease, even things like vitamin D to help the bone structure and prevent osteoporosis in the jaw, which can cause gum, you know, weak teeth and so forth. So there's a lot of things you can do to actually help improve your overall oral health. One of the things that I loved was developed by a friend of mine who was a dentist in Lenox years ago. It's called the Dental Tooth and Herb Gum Tonic. And essentially it's a series of herbs. And it was amazing. He basically showed me, he would scrape my mouth and he would put it on a slide and he'd show all the little bugs swimming around. Then I'd do the dental swish with this dental tooth and gum tonic. this herbal tooth and gum tonic, and it was just totally different. And all the bad spirochetes and things that are causes of gum disease would improve. So there's a lot of simple things you can do from, you know, obviously electric toothbrush to water picks and flossing to, you know, using these different kinds of herbal tonics that can really help to keep your teeth and gums healthy. And it is really important because your oral health is so connected to your overall health.

That'S interesting that you mentioned that, Mark, because I, there, there's probably knew him, remember?

He was in Lennox years ago.

I don't remember, but you know what? There's, there's a, there's a company, I believe it's up in New Hampshire. I don't know if it's the same company or, are they, there's a, there's another company that uses, it's a, like an, a tooth tonic, if you will, which is an antimicrobial. So, yeah, that's, that's actually, uh, quite interesting. Um, the other thing is, is, uh, which I'll mention because this is, it sounds, uh, sort of hokey, but it's actually, it's in the medical literature. In fact, I, i, Preparing for the talk, I actually looked on PubMed and there's an article from 2020 about oil pulling and the benefits of oil pulling on oral microbiome and oral hygiene. You can do that with a variety of different oils. You can do it with coconut oil. I don't know if you've ever done it, Mark, but it also leaves the mouth with a very clean taste, a very clean feeling in the body. Then that also comes out to the other aspect of oral hygiene is halitosis. so somebody has really bad breath.

Bad breath. Bad breath.

Exactly. So bad breath is not just, you know, an embarrassment. It's telling you that you've got some bugs in there that are producing chemicals that are not very good for your body. And these are usually the, some of the bacteria that can actually reside in the tongue and the tongue fissures. And they're what we call sulfite or sulfur reducing bacteria. And there's a, there's a dentist who came up with a product. which is a very effective one. It's called TheraBreath, which I oftentimes will have patients use. And that's a very effective way of dealing with halitosis, but then also then looking at, okay, how can we actually improve the oral microbiome in addition? And there are some products that are out there, you know, with some lactobacillus salivarius and such that are oral probiotics to also help balance out the microbiome.

Yeah.

So probiotics for your mouth as well.

Is what you're saying?

Yes, exactly. Yep.

Yeah.

So from a functional medicine perspective, we really deal very differently through diet, through nutritional supplementation, through various herbal therapies and other things that can actually help us. And we also focus on the big issues that are somewhat controversial, which is heavy metals in the mouth and mercury and even root canals can be a problem. I don't think all root canals problem for everybody. But they can become infected and it's often missed. And I personally had a root canal that I knew wasn't quite right. The dentist thought it was fine. The endodontist, she didn't have a problem with it. The x-rays looked fine. And I ended up having a cone beam x-ray, which is a special type of CT scan of your tooth. It's much more accurate in determining whether there is some pathology there. And I definitely did have an infection, a low-grade inflammation infection at the top of my tooth. so I had it pulled and it was really, we sent the tooth off to the lab and it was frightening to see what was growing in there. So, this is really a new frontier of oral health and systemic health and I think we really don't pay enough attention to it in medicine.

Absolutely, yeah. And, there's an interesting, when I was first made aware of this, I went into the medical literature just to see if there's anything in the literature and in PubMed, there's a case of one. of a patient who had quote unquote rheumatoid arthritis. And when the patient had a tooth removed, they had a closed dental infection. And the patient's rheumatoid arthritis went into complete remission. Interestingly, my brother Eric, who's a dentist, he actually had an anecdotal case of himself because he had this patient and he took the patient's bad tooth out. I think it was, I think was a old root canal. And the patient came up to him afterwards and said, you know, Doc, after you took care of my tooth, I feel so much better. I can move now. I'm not in pain. And sort of a light bulb went off in my brother's head to say, yeah, there's really a connection here. So it's good. And I think we just have to raise the awareness of it for both doctors and dentists and also patients.

Yeah, it's not to say that all root canals cause a problem, but it's important to identify the fact that for some it can be and for not all people dental fillings are a problem, but for some it can be. So, I think we have to be very personalized our approach and I'm really thrilled that we got a chance to talk about oral health. It's not something that doctors really talk about and there are a lot of great resources out there. I've learned a lot from the holistic dentists out there. I've learned a lot from some of my colleagues like Mark Breiner who has written books called I think it's called Whole Health Dentistry. And I think we can learn a lot about how to improve our overall health by keeping our oral health in check.

Absolutely. And one other thing, which I'll mention, because we talked about the testing that we do, which really is helpful to sort of, I always, my motto is test, don't guess. Because when you have objective information from the labs, it helps to really direct what to do. and one of the new tests that I that I'm using now is a test called DNA smile, which is a really interesting test is looking at genetic variations. And, you know, at the Ultra Wellness, we do a lot of genetic testing to look at a person's variations in their genes. None of these genes are related to disease. And this is a fascinating profile because it looks and sort of can risk stratify a person's risk for developing periodontal disease. so it looks at markers related to the immune system, innate immunity, acquired immunity, whether or not a person tends to want to have sweet foods, sort of have that sweet tooth, how they can detoxify, and then also whether or not they have issues with the APOE4 genotype, which is related to lipids and Alzheimer's disease. So I've been using this test to really sort of preempt, just, you know, see, okay, does this person have the genetic profile that can push them in the direction of someone who's going to be getting a periodontal disease?

Exactly.

Well, I'm so thrilled about this conversation and I think people need to pay more attention to oral health and understand as a functional medicine perspective, there's ways we can diagnose problems and help people. Todd, it's been great having you back on the Doctor's Pharmacy. If you love this podcast, please share with your friends and family. Leave a comment. Tell us about how you tackle your oral health issues. Subscribe wherever you get your podcast and we'll see you next week on the Doctor's Pharmacy.

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