The Mouth is the Gateway to Your Health - Dentistry Uncensored with Howard Farran

Foreign for Me to Be Podcast interviewing Sonda Moldovan, all the way from Beverly Hills, California. For almost a decade, she has lectured at the UCLA School of Dentistry, teaching other dentists how to perform optimum implant surgery. In 2006, she became interested in helping her patients heal better through natural techniques such as diets, supplements, water, and bioenergetic devices. Dr. Sonda received her nutritional certification through the Certification Board of nutritional specialists three years ago. As a certified nutritionist and periodontist, Dr. Sonda educates her patients that the mouth is a gateway to their health. Her new book, Heal up, comes out in July. She practices in both Beverly Hills and Manhattan, New York, using minimally invasive oral surgery techniques and integrative nutrition. She is a frequent contributor to national television shows such as the Doctor on cbs, NBC News radio podcasts, and she has quoted in numerous publications and blogs. She is a contributor to the Huffing Post and Inside Dentistry and hopefully someday Dental Town magazine. How are you doing?

I'm great, Dr. Howard. How are you?

I'm doing really good. And I think it's so neat that you're combining nutrition and periodontal disease, because, you know, when I got out of school 30 years ago, all the older redneck dentists thought anything to do with holistic or nutrition or anything natural, that you were just a whack. But then when you watch those dentists, they're all like that. They when a dentist gets high blood pressure, he doesn't want to take a blue pill every day. He wants to lose weight and start exercising. So when you look at dentists, they're all naturopaths. They all try to exercise and eat right to avoid the pharmaceutical pill and the surgery. So congratulations to you for combining those two. So how closely related is nutrition to periodontal disease?

Well, I don't think we could separate one from the other. I do believe the mouth is the gateway to one's health. So if we. The mouth shows a lot of signs of inflammation in the body. So, for example, if we're lacking iron, you're gonna get a red, glossy tongue. If you're lacking vitamin C, we're gonna get red bloody gums. We know that scurvy is associated, so I think we've stepped away from that as we've gotten more and more scientifically oriented. We lost a little bit track of just the signs that we get from nutritional deficiencies. So periodontal disease is an inflammatory condition that's not just local, it's a systemic condition. So when the immune system is triggered like it is in periodontal disease, it's not just triggered in the mouth. We see inflammation all over the body. And I work with quite a few integrative medical doctors here in Beverly Hills, and whenever they have somebody with high inflammatory markers, I check them for periodontal disease and inflammatory signs in the mouth. Because if we're going to treat the person, we have to look at the whole the mouth and the body.

You said you work with a lot of integrated doctors.

Yes. Integrative medicine, or functional medicine is a newer branch of medicine. And we have a lot of MDs or DOs that are taking extra step with functional medicine, who's been around for more than 30 years to actually connect the different organ systems. For example, now, just like with a periodontist, you go to a periodontist, they just look at the gums. You go to a cardiologist, they just look at the heart. Then you go to a GI specialist, they just look at the intestines. But really, when the intestines are not functioning properly, we see problems with the heart, problems with the brain. So it's all connected. So functional medicine takes in consideration all those organs and connects them together. So we had great results.

You know, I like the Soviet Union model better, where dentists were a stomatology, just a branch of all the MDs had the same undergrad the first two years of med school. Then they went off to become dermatologist or internal medicine or stomatologist. I think that was a better system than what America did in 1880, where since the dentists needed a chair and the doctors needed a bed, they separated. And now, 140 years later, they're coming back together.

Yeah, it took us that long. But I'm glad to see, and I see this more in the medical community as well, where they're trying to bridge the gap between dentists and medical doctors, as we need it desperately. Twice a year, I go to medical conferences to see what's new in the medical community. And, you know, we have new diseases today. Like metabolic syndrome, for example, popped up. It's right before, like a pre diabetes stage where all the organs are involved in. And diseases like chronic fatigue and leaky gut syndrome, for example. And leaky gut syndrome, where the intestinal lining is inflamed, is very similar to periodontal disease, where the same thing, the lining of the pockets is leaking, so to speak.

You know, of all the nine specialties recognized by the American Dental Association, I think your specialty of periodontalist changed more than all of them. I mean, 30. I mean, 30 years ago, it was all these gum surgeries, and the patients hated it. And then when implants came out, everybody was so quick to, if in doubt, you know, pull any molar with periodontal disease in place with implant. And now I see pulling all the perioinfected molars and replacing them with titanium, I see that pendulum starting to swing back now. I think a lot of people are thinking, well, number one, the patient decides if they want to pull their tooth and have an implant or try to keep their teeth. But the other thing that I think the reason it's swinging back is periodontal surgery has gotten a lot less invasive than it was 30 years ago. I mean, 30 years ago was always quadrant flaps. I mean, right down to the bone. Do you think periodontal treatment is getting less invasive than it was 30 years ago?

Absolutely, Howard. Everything's getting less invasive, not just for dentistry, but also medical procedures. Everybody wants minimally invasive. And now, and you're right about what you said about our profession as periodontists has changed so much. And it will continue to change because with new advances in microbiology, we're starting to understand the role of the bacteria and how the biofilm gets to form and how the different bacteria plays a role in the biofilm. So now when we're looking at periodontal disease, we're like, let's do less surgery. Because whenever we cut something that's already infected, all that bacteria has a chance to get into the bloodstream. And we know this bacteria travels. Periodontal pathogens have been found in heart valves, such as especially the highly aggressive periodontal pathogens such as aa. We also found them in joints, in knees, in hips. They travel to the lungs, so we know they don't stay in the mouth. So for my practice, I've completely changed the model that I've learned. Twelve years ago, when I went to residency at ucla, essentially we were taught flap surgery. But I've moved away from opening a flap, especially when we have that infection, and finding out what or who is causing that periodontal infection. With a saliva test called oral DNA, where somebody just simply swishes back and forth. They spit it in a test tube, we send it to the lab, and we can find out within 5 days what microorganisms are causing that particular infection. And then from there, we offer non surgical procedures such as lasers and ozone to be able to clean up the infection. Also given nutritional support for inflammation. And together with this full mouth disinfection, we're able to get great results without the painful surgeries that we had in the past. And, you know, we always used to get the 3% recurrence of disease. We never were able to treat everyone. And I'm a true believer that's because of these highly aggressive pathogens that we didn't even know they were there before because we treated everyone the same. Everybody got scaling and root planing, everybody got osteosurgery, but we never really tested on a regular basis what kind of bacteria this patient has. And now we're changing that model to be a little bit more specific and less invasive.

Almost everyone listening to this podcast is commuting to work. They have an hour commute. They ask for two shows a day for their morning and evening commute. But since I can't take notes, I always do a transcript of the whole podcast and put it on Dental Town. But I also retweet their last Tweet. You're at Dr. Sanda S A N D A. And it's Saunda. It's Saunda. So you can find her there. And she's got her website link on there or Twitter. Ask Dr. Sonda. And by the way, you're the only person I've ever podcasted who is verified on Twitter. How cool is that? That is amazing. So I got 22,000 followers and you got 28. When I get to 28, do I get verified or how does that work?

No, I think. I'm sure you can get verified already. And I sent an email to Helene and she'll let you know how to do that.

And I also know why you've been on cbs, NBC and all these famous television shows, because you have a face for television. I have a face for a podcast. I only have a face for sound.

And also you mentioned personality for television, for sure.

We're talking about integrative medicine and being a physician of the mouth. What percent of dentists do you think have ever done any type of salivary testing?

Actually, I lecture nationwide on the topic of nutrition and this concept. And I'm often sponsored by Nobel Biocare to do this, and I'm very thankful for that. And I find that less than 1% of dentists actually do an oral DNA test. Because I always ask, you know, my audience, how many people actually do a salivary testing? And very, very few. And mainly because oral DNA, I guess, doesn't advertise. It was started by a periodontist and it's been, I think, already they've been around for probably more than six years by now, and it's such an easy test for dentists to be able to incorporate. Even dental hygienists can do this because it's simply a saliva swish and spit in a test tube. It can't get easier than that. And then we get such good information from this. And not only that, the fact that we get good information, but it also, when a patient actually sees this kind of infection in their mouth, it connects them to their own disease. Because oftentimes periodontal disease has no symptoms. So it's hard for patients to see, oh, you know, do I really have this problem? But when they're actually seeing how much bacteria is in their mouth, then they have a tendency to get engaged in their treatment.

Yeah, I think it's almost like the germ theory hasn't come to dentistry yet because you still go into dental offices where a hygienist will see the mom every three months for a periodontal cleaning for 10 years, and she's never once seen her husband. And then her husband finally comes in and he's got a bombed out molar and he's got, you know, he's like, you know, they're kissing. I mean, isn't there, you know, they're giving this stuff. I've seen studies that says a single kiss can transmit 80 million microorganisms. I mean, how do you treat the mom and not the dad for periodontal disease?

Absolutely, I agree with you. And that's something that we actually stress in the office, especially in the high level of aggressive pathogens. When you get the report back for a patient, it actually says in there that this bacteria is transmissible. So of course it actually says that. Yes.

Oh, my God, that is amazing. There's still dentists on dental town that deny it. And as far as the microorganisms, Rilla Christian is a PhD oral biologist, and she says that they're discovering a new species of bacteria every quarter in the mouth. So it may be even 100 more years, it could be 200 more years before we even know every name of every virus, bacteria and fungi even living in the mouth.

Absolutely. And that's exactly the point. It's not just bacteria. Well, we know it's also parasites. You know, I work with this lab in Colorado called DNA Connections, and I oftentimes they do this floss, this where you could floss and see what you have in the mouth. We don't know yet what to do with this information, but we're just kind of gathering data right now to see what Exactly. Is living in the mouth. So they're testing things and bacteria, everything that they have markers for. We find parasites, we find viruses, we find fungus, different species. So we know that biofilm is not just bacteria, as you say. And you're right. Right now, it's just, I think, just the beginning of microbiology. So studies in the mouth. But periodontal disease will change the way we look at it and the way we treat it, for sure.

And what is this DNA Connections, how are they different than oral DNA? What's the difference there?

So DNA Connections, they do things a little bit differently. They also biopsy things that are deep inside the jawbone. So, for example, one of the practitioners who works with me as an endodontist, and oftentimes we biopsy things that are at the apex of the root canal teeth, because we're also trying to understand what's living in there. So DNA connections, we use them mostly for a deeper kind of test to see what microorganisms are living inside the jawbone. But also some patients can contact them directly. They don't actually need to go to a physician to have one of their tests. So DNA Connections offers what is called a floss test, where you can actually floss all your teeth. Put the floss in a little baggie and send it in the mail, and they'll tell you what's living in your mouth. But we don't know what to do with that information, really. Right. We're not there yet.

Okay. I just found them on Twitter. They arenaconnections and their last tweet. What is Lyme disease? And what are the symptoms to look for? And let's see if there's anything more. Dental.

Yes. And actually, a lot of the physicians I work with are chronic disease physicians, and they do treat Lyme disease. And we do see a strong association between oral infections and Lyme disease. And we see more and more patients, younger patients with Lyme disease and oral DNA Connections offers one of the best tests for Lyme disease.

And while we're on that, I noticed when you're integrative, natural, nutritious. What's your view on the silver filling? Because it contains mercury, silver, zinc, copper, tin. Is that a no no in your mind, or is that. Or what do you think?

Well, you know, it's interesting you said that, because today, this morning, I was reading the ADA Journal, and they were actually talking about California Proposition 65, which goes in effect next year, and we actually have to post in every dental office in California the harmful mercury in the amalgam. We actually have to make it official that if we take out amalgam, we have to put up a sign saying, hey, this is, you know, causes, it's a neurotoxin. It causes birth defects and other things. So I think we have enough evidence now to, for all of us to realize, yes, the mercury in amalgam does cause a problem. It's a neurotoxin. And you know, I know one of my dentist friends in Portland, she actually had to quit dentistry for a couple of years because her mercury levels were so high from removing amalgam fillings that she had blurry vision, headaches. So she had to quit, chelate all the mercury out of her system, and finally she's getting back to work slowly. So I tested my own mercury level in the blood and I highly encourage all dentists to test their mercury level and see how high it really is, because we are getting infected. Not only us, but also the patients. But especially as health practitioners dentists, we are exposed to high levels of mercury 2000 times more when we actually take an amalgam out in the air than the EPA even allows. So it is definitely a neurotoxin that we should all be careful of.

So do you take any extra precautions when you remove them?

Absolutely. So I don't remove amalgams. I do mostly extraction of teeth who have mercury fillings, but I never cut into a mercury filling. If I have to cut the tooth, I will cut around the mercury filling and not actually cut through the filling itself. Here in our office, we have a multi specialty office. So the dentist I work with, they take precautions. They use the SMART certification from IOMT and we have the vacuum to suck out all the vapors that come from the mercury. And we use a rubber dam to ensure that we kind of trap these mercury vapors and we don't inhale them.

You know, even if we never place an amalgam again, we would be drilling them out for a century. And actually, the worst thing about a silver filling, which was the nail in the coffin, was that when you look at environmental mercury in the air, 50% of it comes from burning coal, but 6% of it comes from cremating humans who have silver fillings in their amalgams. I mean, California, if they wanted to get a great lid on it, it would at least pass a law that somebody has to go in and extract the molars. You can't, you can't cremate a human that has, you know, half dozen mod amalgams in their mouth because it's all hot, it's heated, it's crazy. But I want to go back to. Patients hate surgery. They hate periodontal surgery. And a lot of them emotionally don't want to lose it too. So I want to go back to non invasive. You talked about microbiological testing. I know lanap came out years back. A lot of people are using lasers. Are you using lasers?

Yes, I've used lasers now for 10 years, and I'm more of a biolase user. And the reason why I like the biolace YSGG or the Ergumia lasers is because they have the ability to affect hard tissue. A lanap is really just a soft tissue laser. It's essentially a diode laser. But I prefer something because when I treat pockets that are 9 millimeters deep, I actually want to recontour the bone on a close flap situation. I want to get the osteoblasts, I want to perforate little microperforations of the bone to be able to get the osteoblasts to come out of the bone level. So in my hands, the YSGG Waterlase works great in re establishing periodontal health in moderate to advanced periodontitis.

You're saying it's the Waterlace YSGG?

Yes, it's YSGG.

And if you did 100 quadrants, what percent of the time would you use the laser?

99% of the time. I rarely will flap a cake because I do see bone regenerating, even an angular bony defect. And I actually did one of the cases for the Doctors TV show on CBS on my website. That particular patient had advanced periodontal disease and 10 millimeter pockets that have fully been eradicated just by using the laser and not having to do major flap surgery.

You know, when I think of periodontal disease, it's amazing how this oral systemic health. What's motivating the medical insurance companies the most is that the association between gum disease and premature birth. And that's their most expensive line item ticket. It's about a million dollars cash to have a preemie. And some of these CEOs are starting to look at that. When you insure someone with medical coverage, if it doesn't include dental coverage for the pregnant mom, you're gonna have to get out your checkbook. What do you think about the association of gingivitis, periodontal disease, and premature babies?

Well, we know from periodontal research, Dr. Offenbach, he published papers showing that moms with periodontal disease have babies and they give birth earlier and their babies are low birth weight. So we know that this bacteria travels to the amniotic fluid and has an effect for sure. It creates inflammation and in turns then we have preterm low birth weight babies. So definitely I think we should work more with obgyns. And you know, I wonder at how many obgyns really look in the mouth when somebody comes to them pregnant saying, hey, how is your periodontal condition? Do you know that this can affect your baby and encourage them to actually have a visit with a periodontist to ensure that mouth is healthy.

It still cracks me up because I've gotten a physical every year for 30 years and every time they go to the mouth he says open up. And he looks there at this life like one second, then he's done. And I'm thinking, okay, I've been a dentist for 30 years. The hell could you have just done? It's like open up, say ah. Ah. And it's like, okay. And then he, then he throws the popsicle stick in the trash can and moves on to other body parts. I'm just like that. I, I, I almost can't quit laughing. So when you're treating a standard patient for gum disease and you're using your laser and all that stuff, what percent of the time, when you're done with your periodontal specialist hat, do you put on your nutrition hat and start talking? Nutrition? Do you give supplements? How does that work?

So in my office I've created a program so when somebody has inflammation in the mouth, we do what is called a full mouth disinfection and that includes automatically nutritional support. And we have such great evidence today that certain supplements are key to decreasing inflammation in the body. And of course not just supplements, because I'm a true believer that the diet and lifestyle influences how things heal. So definitely we have a chart, we talk to patients about what to eat, we help them with substitutions. Not like, I'm not of the opinion that we should cut out everything that we really like, everything that we're addicted to. All of a sudden we just have to find good substitutions for patients. For example, sugar. There's so many great substitutes for sugar today that could be even anti inflammatory or promote the health of the mouth, such as xylitol or trehalose. We have also monk fruit drops that are good sugar substitutes. So things that are a little bit more natural, non artificial to get off the sugar.

Have the Russians invented a vodka yet made out of xylitol, so you drink it and not get Diabetic and all, that'd be good.

But, you know, whoever invented that, they.

Were first in satellites with Sputnik. Why don't you send their dental society and say, since you guys drink most of the vodka in the world, why don't you make a xylitol vodka? Think they could do it?

Those Russians? I tell you, they study microbiology unbelievably well. So I'm sure they have a method.

They have probably one of the most disciplined education systems in the world.

They do. And you know what they're studying? I was actually talking to one of their researchers. They're studying to do bacterial testing based on their quantum vibration. So they're going back to quantum physics. So instead of being a blood test, saliva test, they. They're just basically testing the quantum vibration and being able to tell what kind of bacteria is present in that infection instantly without waiting the five days.

So I want you. We just had 6,000 kids graduating 56 dental schools last week. Since I've got out of school, you know, indemnity insurance paying 1,000 for a root canal. Now it's 95% of dentists take PPOs. If you consider Delta, you know, Delta is a PPO, and at least 82% take two or more PPOs. And a lot of dentists listening to people like you say, well, I'm not going to do it unless there's an insurance code. What would you say to the graduating class when they go get a job with some old fart in Parsons, Kansas, and he won't do anything unless there's a billable code for it, and he just sits down and he drills, fills, and bills insurance codes all day. What would you say to the graduating class?

So insurance codes are revised every year, and we actually do have insurance codes for microbiological sample, for saliva tests. There's actually codes for that, and they're definitely billable. And there's also codes for nutritional counseling in the dental office. So that is actually a billable code.

Interesting. I really hope you write an article with Dental Town magazine on this periodontal nutrition, because I've had that magazine since 1994, and I've never seen the. It's kind of like, who got peanut butter on my chocolate? You know? And I think this really a really neat mix. And what's really exciting about Dental Town magazine, which is crazy, is since it's online, it's actually more people read it digitally than the 125,000 we mail it to. I mean, this Internet, it is. So it is so romantic when you get emails from little girl Dennis in Somalia and Ethiopia and, you know, Cambodia saying they look forward to it every month. But this is truly new. What about speaking of sweater, when you lecture in South Africa, they like ozone, and it really never took off in the United States. What are your thoughts? Why do the South Africans, who are also brilliant, why are they into ozone and the Americans aren't?

You know, that's interesting, because we should be. Ozone's been around for more than 100 years. Nikola Tesla developed the first ozone machine for medicine in 1898. So it was actually very popular during that time because we. We didn't have antibiotics. But what really happened with us as the antibiotics came on the market, the ozonator fell out of favor because somebody had to have a machine. You have to go to the office. It's much easier to write a prescription to give it to somebody and have them treat the infection. And it was fine then, and it was taking care of a lot of infections. But now we're seeing that a lot of bacterial resistance is popping up with recurrent infections. So we're starting to move towards something that cannot cause resistance. And that's what I see with ozone. And ozone being three atoms of oxygen, and we have that one oxygen that comes off, and it starts basically poking holes in all the membranes of bacteria and parasites. And it doesn't discriminate. So it really has the ability to wipe out on contact, any, let's say, pathogenic biofilm, not just one bacteria, like, for example, as we do with antibiotics, because really, antibiotics don't get rid of parasites, don't get rid of viruses, whereas ozone does. So I started using it in my office, I would say, probably about four years ago now, and especially for periodontal disease, where we're dealing with biofilms while dealing with pathogens, it's made a world of difference.

And it's a machine you're using. Who makes the machine?

There's different companies now who make the machine. And there's actually good news. One of the dentists here in California, he has a machine called therazone. It just got FDA approval for making ozonated water. So I think we're slowly moving towards getting ozonators out there because for us especially to use ozonated water to clean the dental lines, which we know are full of gunk in there. I think it was on 60 Minutes that they were uncovering how dirty the dental lines are. So ozonated water will actually flush those lines with no problem.

And it's Called Therazone.

Therazone?

Yes, Therazone. Man, you are a world of information. So, okay, I just found it. So their website is T H E R O Z O N E Thera Zone. You said a dentist made that?

Yeah, and he's actually, I keep meaning to go visit him. And he's on my list, definitely. He's out in the Santa Monica area. And you know, it's so hard to get FDA approval for anything. So hats off to him for actually going those steps to be able to get this machine FDA approved. Because that was the biggest complaint before. We don't have any ozonators FDA approved, although there's many things in dentistry that don't have FDA approvals when we're using.

Well, speaking of that, the graduating class is, you know, they're young and they're learning communication skills and one of the things they complain about on Dental Town is that when they tell people to floss, they said, the New York Times said there's not a shred of evidence on flossing. And you just said, you know, there's a lot of things we use at FDA approved. What verbal skills would you give a 24 year old kid who's telling some old man to floss? And he says, maybe you should read the New York Times because if you did, you'd find out there's. What do you say to patients who say.

Well, that's a good question, Howard. It's like if we actually listen to everything that FDA actually comes out with, we'd probably be dead right now. Because they put drugs on the market, they say, oh, this drug is totally safe. And then two years later the drug kills a bunch of people and then they take it off the market. So I think we really have to look at the research and use common sense and you know, what works, what doesn't work. And it takes really years for something to get FDA approved. And during Those years, sometimes 10 years, one of my colleagues is trying to get a supplement for chronic fatigue, FDA approved. He's been in the process for 10 years and it's still not there. Does the product work? Yes, and it's all natural. And he's been using it. He's been shelled trial after trial. So as soon as I suggest to those young graduates to go look at the research or ask an expert who has looked at the research, what does the research show? Is this product detrimental to one's health or is it not? Ozone, for example, is all natural. We know that it also has an immune effect that stimulates the immune system. It doesn't just kill organisms, so it stimulates one's immune system to clear up the inflammation and the infection. And there's lots of papers from all over the world. Europeans use it, Australians use it. It's not one of these things that just popped up. If something has been in use for a long time and has good research, then I suggest to them to go learn more about it and use it.

I want you to address another very common complaint. All these kids just graduated. They say, I just graduated dental school and we never placed one. One implant. And it'd be easy for you to go from a thousand implants to a thousand and one. But she's got to go from zero to one. And she's standing out there looking at, you know, what advice would you give her? And the other, the other problem that she says is in America so much of the implant training is tied to the company. They almost get paralyzed first because they think they have to find the perfect implant system first because all the training is tied into the implant. And there's over 175 implants that are sold at the ADA convention. So give her some coaching advice. How does she go from zero to one? Because you're teaching it at ucla. Did the UCLA students when they graduated, had they placed it in planned?

Yes. And not the students themselves though you actually have to be in an AGD program or you have to be and a residency program. And it's unfortunate when I hear these things that still dental schools have not really implemented implants in their teaching facilities because they really are the standard of care instead of bridges. And unfortunately only about 20 to 30% of dentists are using implants right now. So some guidelines to recommend where to look for classes is one. Pick a company that has at least five years of research to know that you're offering a patient good solution. So the success rate for implants today in a 10 year period really should be over 95%. But if a company doesn't have that yet and it's only been there for like two to five years, they don't put money into the research. I wouldn't recommend going with that particular type of implant just to save some money. Because I think our reputation is the most important thing. After all, especially as a young dentist, you want to establish a good reputation from the beginning. And then there's so many courses out there. And I know working with implant education for 10 years, you can find it Asparta universities and continuing education or even the implant companies, the Most reputable implant companies, they have great courses that they offer hands on as well. I just gave a course actually in Portland, Oregon on pig jaws. And that's a great way to learn before going on patient, to use something to simulate before you actually go into a patient's mouth and find a mentor. That's the other thing. You know, I'm more than happy to mentor young graduates who want to learn the right way to do dental implants. I think general dentists, some of the general dentists have great surgical skills and they should really look into adding implant surgery into their practice. And. And I'm happy to mentor.

Well, I'm sure she's listening to this as she's driving to work and she's thinking, I want to know what Sonda uses. What does Sonda use? What are you teaching at ucla?

So we work with Nova Biocare exclusively and Nova Biocare has the most research that they've done over the years. And I use mostly now Noble Active. Noble Active is like a corkscrew type implant. And I use it a lot in immediate cases, teeth in a day when we use full arch restorations. And one of these surgeries we actually did for the doctor is where we replaced upper broken teeth with four implants, the all on four treatment concept, and a full arch bridge. Because let's face it, a lot of people are afraid of going into dentures, especially a lot of my women patients. They do not even want to see themselves without teeth. And they say, you know, I just don't want to wake up in the middle of this. I just don't want to see that I have a denture. So this kind of replacement, especially with an implant that's had great research and the all on four treatment concept has had now 20 year research we know, has high predictability if done correctly.

And that was with Palo. Is it Paloma? How do you pronounce that? Palomalo.

Polymalo? Yes.

Palomalo.

Yes. And I was fortunate enough to. I'm very thankful for his teachings. I went to his facility in Portugal and I spent a week over there just to, you know, to learn from the best, really. And he developed this technique 20 years ago and nobody believed him that this will actually work, that four implants could support a whole bridge long term. And finally, after 20 years, when we actually have the research to know it's predictable. A lot of people are getting on board with this because it's a great treatment for patients. And it's a treatment that saves people money because we don't have to do sinus lifts. We don't have to do bone grafts that typically drive up the cost.

So you, you like doing all on fours?

I do. I think it's so gratifying for me to, you know, to see people's smiles after the fact. Not to go from really sitting at home. We have a lot of women that actually sit at home.

I don't think we've ever published an all on four case on dental town. Maybe that there's another idea of an article to publish in dental town. Can you hear me?

Oh, sure. Absolutely. Pleasure. Yeah, I can hear you. Okay. Yeah, sounds good.

Yeah. Lisbon, Portugal. That was the first European, that was the first city outside of America that I ever saw. When I was 16 years old, I went to a Catholic school and they had this, this, I don't know, what do you call a recruitment trip. So they loaded up at 7:47. But every year they'd put 450 Catholic high school boys from Kansas, fly them to Lisbon, Portugal and Fatima and all that stuff. And every year they'd get about 10 conversions that would cancel their flight home and join the priesthood. So my, my mom tried so hard and she sent me on that trip. She was so hoping that I would switch from dentistry to priesthood. But it didn't work out. So you like the noble biocare, you like the noble active. You're doing all on four. But how long would it take a 24 year old graduate from dental school to go all the way from I've never placed one to someday I'm placing all on four? I mean, that's a long journey. Where do you think she should start at?

So I think they get probably some basics in dental school about dental implants, but if somebody is never placing one implant, I would say start small, start with a single implant. And my rule for this is always if you don't know how to treat the complications, don't do the procedure. Because I think the most important thing is learning how to deal with complications. And of course they arise rarely. However, if you don't know how to deal with them and you don't have somebody to help you deal with them, and then that's a problem. We're not really serving the patients. And of course things happen to everyone. Like my mentor, Sasha Jovanovic. He says if you haven't gotten a complication, it means you haven't placed enough implants because they will arise. Everybody heals at different rates. Things happen. The bone quality can be poor to start out with, so things will fail. It's just learning how to deal with that's probably the most important thing in implant therapy. So I would say start small and, you know, do single implants not in the aesthetic zone. Start with a premolar or molar site where you have a lot of bone. Once you get comfortable with that, you know, take a bone graft course and then do an implant and a bone graft, and then just keep getting a little larger, do an implant bridge, and then probably after you get comfortable with that, then go into the all on four treatment concept. But in terms of restoration, a skilled surgeon and a lab technician who's done many all on fours can definitely guide a young dental into restoring these cases properly.

I'm going to ask you the most controversial implant question on the dental town boards, and I want you to know that no matter what you say, half of the dentists will disagree and the other half will agree. That is, a lot of people say, like you said, you need to learn how to be able to deal with the complications. A lot of the everyone who's placed a thousand to ten thousand implants say you need to lay a flap and see the bone and you need to be a surgeon. But the millennials are saying, I don't want to lay a flap, I want to make a surgical guide, and I just want to punch through the tissue. Then the old guys are saying, that's like putting training wheels on your bicycle. You got your doctor, you're a surgeon, you got to put the, the scalpel to the bone. So my question to you exactly is, when she starts her journey and is looking for something not in the aesthetic zone of premolar or molar, would you recommend a surgical guide or would you recommend getting a scalpel and going to bone?

You know, when I did my residency, actually, we didn't start dental implants until we learned to deal with flaps. And my, my resident, my director of the program at ucla, he said, you know, you guys have to learn to manage flaps before you do implants, because if you, you don't close the flap properly, your implant can fail or you can have problems or recession and things like that. So I think it's definitely key to learn how to do flaps and learning on an animal model, for example, if somebody who's already graduated is great, like pig draw or sheephead, there's lots of animal models out there that somebody can start learning flaps. And then I believe that flapless procedures are a little more advanced of a procedure because you already have to kind of imagine what the bone looks like underneath And I know guided surgery is a thing that of the future. And I love guided surgery. I used a Nobel clinician to be able to kind of simulate the surgery before we go in there so we can treatment plan better and understand what could happen and things like that. But it's still not a foolproof. We still have to know in case that implant doesn't engage properly to be able to raise a flap and correct the situation for sure.

Another problem dentists are having in the, out in the field is that, you know, patients come in with peri implantitis and, you know, they have no pain, they're chewing, they're eating, and you have peri implantitis. What is the, what do you think is the incidence of peri implantitis on implants placed in America 10 years ago? And how are you treating that?

This is actually a topic. Perineplantitis is a topic I talk about nationwide because it's such a problem. We know the statistics today. This was published in J. Perio just last year. One in five patients will develop peri implantitis within five years. One in five patients. And that's really scary because we're offering a treatment that could potentially last a lifetime. But I think as a student, even I remember going to the conferences and into the years after that, and I hear a lot about how to do dental implants, but nobody really took the time to spend time on how do we maintain these implants long term. And that's something that I'm very passionate about, kind of spreading the message. We do have some recent guidelines. We had a consensus in Europe and like 10 of the best clinicians got together and said, okay, how can we help prevent hair implant diseases? And they put some guidelines together which have been published to help the practitioner maintain the implant long term. Because right now we're just telling patients, okay, well, here's your implant. This is what I hear a lot. And just brush and floss normally, but that's not really correct. For example, just using an oral irrigator around an implant and we can increase the longevity of that implant because floss doesn't clean properly. We really. Oral irrigator versus string floss. We know oral irrigators clean much better. So even as simple as that, something as simple as that should be incorporated in the implant treatment plan.

You know why I think patients don't like using the water pick? Because it's so dang messy. And I was so excited to see that water pick now has a rechargeable water pick that you can take into the shower. And what I always have is on mine is the shower floss. Because when you're water picking or water flossing in the shower, no one cares where the water goes. But when you're at your kitchen sink and there's splashes all over the room, I think they think it's messy. Then moms will get one and then their kids come in and start using it and the next thing they do is they want to put it under the cabinet. So I think the shower floss and that new water pick one that you can carry, that you can fill up and carry into the shower would be better for that. So you're talking about that you could prevent it better with. Instead of brush and floss regularly, getting a water pick or do you have a brand? You're a periodontist. What brand do you like?

I use different brands. I think I like personally a portable one. And of course Water pick is the most well known brand out there. And they do have the portable. They have the shower pick one and they have the one by the kitchen sink. But I myself love a portable one. And my portable water pick is even black so it matches everything else and it stays clean. So nowadays you can find really cool designs for portable oral irrigators.

What is the point of that?

I actually use something called Poseidon. It's just a smaller water pick that I use. Poseidon? Yeah.

Did you ever see the movie the Poseidon Adventure?

I haven't seen it, but you know, the God of the seas, so it must be a good movie.

That was a great movie. That was just a classic movie. There were so many stars in that movie of the Poseidon Adventure. They were on a Greek cruise and there was an earthquake and the boat got flipped over. But so that's how I remember that. So. So Poseidon makes an oral irrigator. That's the name of the company.

That's the name of the company, yeah.

Did you find it?

So we like it because it's inexpensive and people have a tendency to try it. You know, it's not. It's a lower cost, but I love it because it's smaller, it's more compact, so you can take it in the shower. As you said, you don't have to make a mess.

So you talked about prevention. You said you can't just brush and floss. Use an oral irrigator. You recommend a Poseidon. What other things to prevent and then go to treat the 20% that have it. So what other things were they saying to Prevent it. And then let's say they already have it. They're that 20%. How do you treat it? As a periodontist.

The other big problem that I see out there is we don't recognize mucositis, let's say peri implant mucositis, which is the initial inflammation of the gums surrounding implant without penetrating into the bone. If we start recognizing that when it first starts, we see the bleeding upon probing right away, then we can do something about it right away. But I think what happens is, especially as a specialist, I see these implants when they actually have advanced peri implantitis already. So I think we should learn to recognize the signs. If somebody comes in for hygiene maintenance and their implant is bleeding, that's the time to do something about it. If we keep telling the patient, oh, just go home and brush and floss them more, it's not going to work. So at that time, I think we should be more proactive into recommending them something different for our hygiene, but also doing some ozone treatments or laser treatments to help tighten that tissue again. And also recognizing when we have very thin tissue around an implant, that also creates a problem with bone loss. So being proactive into grafting these sites and maintaining healthier and thicker periodontium or peri implant tissues would be ideal.

And then as far as treating it, when you see it, do you flap that? I mean, do you try to regenerate bone around implants when they've lost bone, or is that very successful? Or is that more of a pipe dream? The implant needs to come out and be replaced?

Yeah, unfortunately, once the implant has lost bone, we don't really have a good, predictable way to really rebuild this bone back. My favorite way to grow bone back around an implant is using lasers. And there's a peri implant protocol, again with the water lace with the ysgg, to help regenerate the bone and repair the bone around an implant. With bone grafting technique, when we have to raise a flap, I really reserve that for larger bone graft, more than 50%, for example. But often the limitation is the fact that, again, the biofilm gets into the implant surface and we just can't clean it out before we do the bone graft. So it's best oftentimes to just take the implant out if the bone loss is over 50% and just place a new one with new bone regeneration.

So are you buying that Poseidon toothbrush from Toiletry Products? Is that where you get it?

Yes.

Yeah, Ryan found it for me, and so I just retweeted them. I never even heard of it, but they're following me. They're oylettreeprod for Toilet Tree, a play on toiletries. I think it's pretty cute. So a toiletry. I'm sure toiletry was already taken. So they're toiletry products. And I, I retweeted that deal and I, and I saw the, the picture of it on the website. I could see. I. When is Father's Day next? Not this Sunday. What, next Sunday?

I think so. I don't even know.

Yeah, so. So here it is. I'm gonna tell Ryan. Ryan, that's what you need to get your dad for Father's Day. Come on, Ryan.

You know the portable one is even better than that one. I think that's their sync model. Oh, that's a sink model.

And they also got a sonic toothbrush. Oh, you mean. Okay, so right, right there. That one.

That's it? Yeah, that's the one.

Nice. I never even heard of them before. Very interesting. So UCLA has a, an implant residency though, don't they? I mean, that General Dennis can take?

Yes, they have a one year implant of residency also. There's Global Institute for Dental Education Guide. They also have a one year master's program. And I'm also involved with them in terms of teaching properly. And you know, the nice thing about taking a one year residency is that as somebody starting with implants, they have a place where they can bring their cases and say, okay, this is my case. This is what I'm having difficulty with. What do you think I should do here? So it's a nice way to, to have a support group.

So you're on the faculty with Guide G, I, D, e?

Yes, yes. Dr. Sasha Jovanovic founded that. He was my implant mentor and I am very grateful. I learned a lot of my surgical skills from him and he has asked me to come on board and help with the classes there.

So what does guide stand for?

Guide is Global Institute for Dental Education.

Global Institute for Dental Education. And is that. And where is that? In Southern Cal?

That's very close to Beverly Hills. Probably maybe four miles away. It's on the West LA area.

And where's the ucla?

And UCLA is in Westwood, also about four miles away from Beverly Hills.

So you'd recommend both of those or would you recommend one more than the other?

I do, I do recommend both of them. And of course there's other great programs in the country that have a one year residency also. Loma Linda, for example, their program is actually two Years, it's a little bit more involved, so it really depends. But the nice thing about a weekend program over one year is that somebody can still practice. They don't have to give up their practice in order to learn a new skill.

What do you think of this new trend where you go outside the United States to like Mexico or the Caribbean and place a bunch of implants there, where you're free from lawyers and all that stuff? Some people say it's a great experience because you get to place 10, 20, 30 implants. But then other people say, well, the most important thing is to see those patients 30, 60, 90 days later and follow them a year later. And if you're not going to see that patient again, you're not learning. What's your thoughts on that?

Yeah, I tend to agree with a latter thing that you said that it's nice to be able to follow up the treatment of the patients to see how is it healing, is the patient having pain? How are you managing those conditions? Conditions? I think literally placing an implant is easy. Anybody can put an implant into any bone. But, you know, did we give the enough prosthetic support for this implant to be restored properly? Did we take care of the tissue properly? You know, is patient in pain a lot? Are most of the patients in pain? Maybe something with my surgical technique, I'm burning the bone. So I think follow through is most important with any surgery.

So how much are these? How much is the one year residency at Guide or ucla? How much investment is this gonna be?

So they run anywhere? I think from about 8,000 to, you know, $16,000, depending on the type of program and, you know, where you have it. And of course, I think the Loma Linda is even more than that because it's a yearly program, but it's more of a somebody has to give up their practice to go there. And that's even more expensive. I think 20 or 30,000.

Yeah, so. And then last thing, you've been so adorable giving me an hour of your busy life. I'm almost out of time. But I want to, I also want to ask you, do you think this is true, this statement is true or false? You know, a lot of dentists, I believe that the critical mass for a doctor is you got to do it once a week. I don't see any evidence that someone who does an Invisalign case three times a year is fast, high quality, efficient and profitable. These people will start learning sleep apnea and they'll do two cases a year. Dentists that make one Denture a year. Oh, my God, they're horrible. Do you think if you get into this implant, so it's an investment of 8, 10, 17,000, well, you can recoup that. Implants are 1,000 a piece. I mean, 17 implants. But do you believe that you have to place one implant a week or do one dental procedure a week to really reach critical mass? And the flip side of that question is, say you needed a surgery. Would you want to go to a doctor who does that surgery every three months, or would you like to go find a doctor who does that surgery at least every week?

Yeah, yeah, you have a good point there. And I do think if somebody starts doing dental implants, maybe a way to motivate patients to come in, is definitely able to offer them a lower cost. But I think recognizing what cases are good to do, like the simple cases, especially in the beginning, where, you know, it's not too stressful and everything goes smoothly, and then they can tell other people, oh, you know, this was great, great. And also, you know, I started with my family members when I was a resident, so luckily I had enough family members there, so I practiced them. I would get 20 implants before my patients. But I think there's ways to build a practice with dental implants. And I was recently in Arizona, actually in Phoenix, and there was one general dentist there who actually changed his business models model, and now he's just really taking referrals, and all he does is dental implants and he takes referrals from other general dentists, although he in himself is a general dentist.

So I think you're amazing. I mean, how did you get to be the contributor to the Huffington Post? I mean, those guys are crushing it on the Internet. I mean, when the New York Times and the LA Times are still trying to build up their newspaper delivery thrown on your driveway, the Huffington Post just aimed at the Internet and crushed it. And they got and you got to be their contributor. Congratulations on all that.

Thank you very much. And really, I think anyone can apply to be a provider for the helping composite contributor. They're just looking for new ideas, fresh ideas, something new, a new way of looking at things. And that's really it. And I started my journey after dental school with my interest in nutrition. And I just started going to medical conferences and just starting to connect things, and it was just the passion. And I submitted an article and then they accepted it. And I'm happy to bring you ideas for the world.

Well, you know what I always tell the young kids? They're Worried about their student loans. I said, well, you need to learn how to hustle. You need a strong work ethic, need to be humble, listen to older dentists, colleagues, other people. But when I started my practice 30 years ago, I went over and invited every single pharmacist over my house for dinner. And then I started doing it with the physicians. And there's Dennis listening on podcasts where there's a medical dental building across three with eight MDs in there, and they've never even gone over there and knocked on their door. And I think network. I mean, healthcare is 17% of the economy. That means 17 cents of every dollar is healthcare. This year will be the first year it passes is $3 trillion. And there's 1 million MDs in the United States, especially in smaller towns. Why would you not? I mean, you got to get out and press the flesh. Run for mayor, invite him over your house, take them to dinner. I can't believe. And of all the referrals, the ones that send me the most are still the pharmacist. So many people go to a pharmacist and ask, what's the best anbesol to put on a toothache or, you know, which one is aleve better? Motrin. And Brad will say, you know what, you need to. You need to call my buddy Howard. And I mean, just so. Yeah. So you're out there pressing the flesh with the MDs, networking with the whole healthcare community, and no wonder you're crushing it in Beverly Hills. I mean, that's amazing.

Thank you. You're right. As you said, you know, it's work is networking. Absolutely. And it's, you know, ultimately, we can treat the patients so much better when we have a good network of health practitioners. And as a young practitioner, there's so many new grads coming out today. Definitely have to think out of the box and be out there and spread the word of your skills and your beliefs.

And I want to end on a dark note. I don't want you to think I'm playing you, but here's the deal. Dental Town magazine, its number one complaint for over five or ten years. Years is how come every time an article is written by a dentist, it's always a man. And if a girl writes an article, it's always a hygienist or a consultant. Our team, it is so hard to get content from women dentists, role model leaders. And we tell, you know, the dental school class is half women. I mean, it's gone from a mostly male to 50, 50 male female. And so I, so you young girls out there listening, I mean, trust me, there's not one, we got 50 employees. There's not one single employee that hasn't been told a hundred times. We need more content from women. As young women in dental school, they totally gravitate towards women role models. It's just a natural thing. It's kind of like when your grandkids are over, your grandkids will spend time with grandpa until another little kid walks in. But as soon as another three or four year old kid walks in, your grandkids gone, you know, and they, everyone gravitates to. If you're a young 24 year old woman dentist, you will listen to some old fat bald guy. You want to see what women dentists are crushing it. And so thanks for being a role model to so many women dentists out there. And if you have other women dentist role models out there that could write content for Dental Town magazine or podcast. I mean I look back at the 800 podcasts. I didn't just male, male, male, male, male. If it's a dentist and then if it's a woman, it's hygienist, consultant, marketing, SEO, you know. So thanks for being a woman role model and thank you so much for coming on my show.

My pleasure. I actually have definitely another female colleague of mine. She's an endodontist and she's, she's really amazing. She, I'm sure she would love to be on your show. She uses lasers and ozone to treat root canal teeth and she getting great results, uses stem cells and homeopathy. I think you really like talking with her.

I would love to and I hope both of you guys write articles because we need more women role models. And tell her that. The first question I'm going to ask her is so many of the graduates walk out of school. Half the class already has a self limiting belief. They say I hate endo. I hate endo. It's like, dude, you got $350,000 of student loans. You're in rural America. Patients not going to, you're in pain. I mean imagine if you broke your arm and you went to the hospital. They said we don't do arms, we only do legs. We need to refer you. I mean you're a doctor in your community. The person has a toothache, you don't have to sell them anything. So you got to get over I hate endo. When you just walked out of dental school an hour ago. So tell her how can she get these half the class to revisit Endo and maybe get over the hate thing and start learning how to enjoy it again.

Sounds good. I'll definitely pass on that message to her. Thank you very much, Hari. It's been awesome talking with you, and I'm looking forward to contributing to Dental Town and bringing you nutritional information.

All right, on that note, I'm going to go eat some Doritos. Have a rocking hot day.

Thank you, too.