The Overlooked Connection Between Dentistry and Migraines with Dr. Amelia

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 Natural way.

Hello everybody. So here's my experience as a neurologist. Somebody comes into my office and they have pain in their upper jaw, their lower jaw, and their dentist has told them there's nothing wrong. So the only thing I can do is just throw medications at that. So I would love it if we could start today, um, if by just clarifying What else might be going on under the surface for these people so they're not basically stuck with a lifetime of just meds to manage mystery pain, which is kind of how I feel it always ends up. Dr. Sanda Moldovan, what do you think about that situation?

Dr. Amelia, I'm so curious to learn from you about migraines because, you know, in dentistry, we're not really taught much about migraines, but we know, just like I know in medical school, you're not taught much about dentistry.

Right, exactly, which is why I have this burning question. Exactly.

There's just so much we can do in dentistry in order to diagnose better. So I really think the biggest problem that dentistry has is diagnosis. You can't see anything on 2D x-rays. Most people going in the office, they go and get 2D x-rays. On 2-dimensional x-rays, we have studies that show they only diagnose about 50% of the problems. So that means the remaining 50% of the problems go undiagnosed.

So that could be part of what's going on for these people who have pain in the jaw. They go and they just get the standard x-ray. What should they be asking for instead?

The best way to diagnose in dentistry is via 3D imaging. It's called a cone beam CT scan, and it's a digital scan, digital imaging. So it has a lot less radiation, but it allows us to see clearly, you know, and the newest machines are so crisp. Like we could really see like cracks in the teeth, which can create radiating pain and migraines. And really, really clear what is going on. And if the migraine pain is due to anything related to the jaw or the TMJ, we can see.

Wow, that is so helpful. Okay, so right there, people already have one concrete usable tool that they can implement right away to try to guide their own care and make sure they don't just get stuck on chronic pain medications. Thank you so much for sharing that. So I think that the situation that happens for people a lot of times is they're having this pain and it might flare up an existing migraine disorder, or they might develop one of the other things you're talking about, like TMJ, and that will then flare up their existing migraines. So for a lot of people, that might explain why they're getting worse when there's no other apparent cause. So I'm curious, it sounds like you already do have a different approach than what other people do. I'm curious, what do you think is the biggest thing that other practitioners in your field get wrong?

I think the biggest thing that people get wrong is the diagnosis. If you can't diagnose properly, we can't treat.

Right, right.

And in cone beam CT scan, a lot of people don't know how to read it. As a matter of fact, I just had a class for our general dentists in the area to learn how to read a CT scan because I think it should be the standard of care in dentistry at this point. But not to worry for those dentists that maybe are listening to this, they can actually send their patients to a radiology center where they could have the dental cone beam CT scan and a radiology report for that patient so that they're not forced to read the CT scan by themselves if they don't know how.

I'm sure that helps a lot.

Absolutely. And there's even, you know, it's interesting, mobile clinics, mobile vans that all they do is drive around the neighborhood and they're in a lot of big cities nowadays. And as a dentist, if you can't afford to put a CT scan in your office, no problem. Just call a mobile service. They'll come pull up right up in front of your door and they could take a CT scan. So, or even if anybody listening, you could tell your dentist that this service exists. So all they have to do is search for someone, have them come to the office, you get in the van, get a scan, and then you'll get a full report on it.

That's so incredibly helpful. I, and it sounds like it's really just like going in for imaging for anything else.

Yes.

Yeah.

Exactly. What about you? I'm curious from your perspective, what is the biggest thing that people miss in migraine therapy?

Well, you know, it's that the biggest thing that people miss with migraines is that they don't look hard enough. For fixable causes of migraine. So, for example, super common migraine is very common in menstruating women. What are they at risk for? They are at risk for anemia because of their monthly cycle, which is often when the migraines flare. Many of these people end up having low iron, especially when you look at more detailed types of tests. And what I'm talking about here is ferritin. It's a more sensitive test for iron deficiency than some of the ones. We typically look at. And when we look at those tests, we find that a large percentage of women, over half of menstruating women, are actually low on their iron stores. And when you bump up their iron, even through something simple like eating more foods that are rich in iron, using an iron skillet, I mean, taking a supplement also helps. When you do these simple measures, you actually reduce their migraine frequency. Their menstrual migraines actually get better. So I think that that is the biggest thing that people miss. They just don't look hard enough for those fixable biological problems that are contributing to migraines. We tend to just focus on giving people a pill and, you know, scheduling the follow-up visit. We're so focused on treatment, we don't take a step back.

That's such a great tip. I love that.

Yeah. And there's so many other labs that are like that too. I could go on about that all day, but I think that's, that's a huge problem in neurology these days.

Amazing. I'm actually gonna try it for myself cuz that's something I get. Ah, like the first and second day of my menstrual period, I get headaches.

Ah, okay. There could be a migraine component to that for sure. Yeah.

Yes. Yeah. What's the difference between a headache and a migraine? Actually, a lot of, as a dentist, I don't even know this.

So migraines tend to be more one-sided, although they don't have to be. They tend to have more of a throbbing quality, like pulsating, like your heartbeat. They tend to have more of that quality, although they don't have to be. They tend to be associated with more nausea or vomiting. And sometimes that nausea is really just like, I'm not eating lunch today. I'm not hungry. I'm going to skip it. I'm a little headachy. I don't feel good. I just don't want to eat. That can be a manifestation of migraine as well. It can be that subtle.

Okay.

So that is another common feature. And they last longer than your average tension headache. They tend to last up to 3 days. And so that doesn't mean you're in constant pain in bed for those 3 days. You might be able to function, but it just sort of keeps coming back. Sometimes it can be that subtle. And so I'm bringing up these more subtle variations because the American Migraine Foundation estimates that only about 5% of people who actually have a diagnosis of migraine have seen a doctor, been diagnosed, and been given migraine Specific medications. So that's a really small percent of the population who is actually suffering, and they don't even know that that's what their diagnosis is, that there's so much more effective treatment options out there for them.

I love it. You just helped me diagnose me because my headache tends to be on the left side and it does pulsate.

There you go. You got migraines, girlfriend.

I'm gonna try the iron thing. I'm gonna eat some liver, like There you go.

There you go. Cook it in an iron skillet and make sure you take it with some kind of high vitamin C fruit.

Okay.

Vitamin C helps absorption of iron. So, yeah.

Perfect.

Yeah. Yeah. All right. So I've got another question for you. Do you have any patient cases that have changed the way you take care of people? Like, take me back to the beginning when you were first deciding, okay, what kind of Dentist do I want to be? What got you into holistic dentistry as opposed to just a more general type of dentistry?

Yes, it came through my own struggles with oral health. I actually had 16 large mercury fillings in my mouth, and I decided as I was going to school at UCLA and I was in Hollywood going out that I hated the metal filling look. Whenever I opened up my mouth, and I do have a Bright, bright, broad smile. So, uh, I said, I told my friend, take them all out. I just want white fillings. I don't want any more metal in my mouth. So he did. And I didn't know anything at the time about removing mercury safely. And shortly thereafter, within a month, I had them all removed within a month. Uh, I started developing headaches and I was fatigued. And I'm like, what is going on? You know, I just couldn't do my normal walks and run in canyon, go to the beach like I used to. I just wanted to sleep. So I ran into a naturopath who said, well, let's do your, your heavy metal testing and see how, you know, how your heavy metals are. I'm like, okay, we'll do that. And sure enough, my mercury was off the charts. And I asked her, I was like, Where did I get this mercury from? And she's like, well, you had all these mercury fillings removed. They're 50% mercury. And I didn't know that at the time that I could actually get toxic. And then I remember at the point I got really upset. How come nobody in dental school warned us about this? No one mentioned that when you cut into a mercury filling or a silver filling, right? Because that's what they're called, silver amalgam fillings. Nobody said that, hey, when you cut into this filling, there's vapors of mercury being released and you can make your patient toxic. Oh, and what's worse, the dental team, your dentist, your assistant will also be toxic.

Oh my gosh.

Wow. We, I had no idea. Nobody talks about this in dental school. So, and then I'm like, okay, what else did they not tell me? And so I started going to the Institute of Functional Medicine where I learned about cavitations, root canal treated teeth, that they danger of that. So that's how I got into this field through my own, you know, challenge with, with getting rid of mercury. And it was a long process. It took me a couple years to actually get rid and chelate the mercury out of my body.

It does take a long time. It's so interesting that you brought this up because that was part of my introduction to functional medicine as well, mercury toxicity. And for me, it was more because my body does not clear it out genetically. I'm very challenged that way. And so I am just one of those people who, even though I had more, more normal levels of mercury exposure in the environment, it was really accumulating in my body. And that was combined with a couple other things going on and similar symptoms, extreme fatigue. My headaches were a lot worse. I do get migraines. Those were worse. So, and it's, it's a project to come back from that, isn't it?

It really is. So if we can, you know, I made it my mission to, if we can save people from going through this pain by removing their mercury safely and better yet, not having mercury placed at all. It's not necessary because believe it or not, in this country, we're still allowing dentists to place mercury amalgam fillings in people's and children's teeth. Wow.

Yeah.

Yeah.

Well, that would be nice to see that change. That would alleviate a whole lot of problems down the road in the future.

Yeah. And then you also asked me about a patient that kind of changed the course. So my own experience definitely changed the course of the way I practice, but This one particular patient, this was already probably 10 years ago. She came to me with trigeminal neuralgia and pain on the left side of the face.

Mm-hmm.

She has been to several practitioners, TMJ specialists, and usually the TMJ specialists, they're dentists basically that have taken courses for the TMJ. And she said, you know, I've been to these specialists. They've given me medication. I think she was taking gabapentin. And also they made her some kind of guard because they figured out, you know, the pain she kept, she said it was triggering from her teeth and then kind of shooting upwards. And then the whole day she would have this migraine.

Mm-hmm.

And she was wearing this guard that the dentist made her in order for her not to touch, have those teeth come in contact. And I asked her, is it helping you? And she said, no. It's not actually helping. And I took a CT scan. She had one root canal tooth on that side.

Okay.

And I couldn't particularly see a fracture, but what I could see, it's a very small lesion, maybe 1 to 2 millimeters, like a little cyst attached to the tooth. And I said to her, let's take out this tooth. Mm-hmm. I said, I can't promise you that it's the cause of your headaches, but I said, it's not helping you because you have inflammation in the bone. And she said, well, how come nobody's told me this before? I said, I don't know, but I said, this tooth is just causing inflammation. Let's take it out.

Mm-hmm.

So she said, okay. She trusted me. I took out the tooth and within a week all her pain was gone.

Really?

All her pain was gone.

Wow. I love that kind of home run. That's amazing because I, I, that's what everybody wants is to actually get to the bottom of things, find and fix those root causes and just make pain go away. You know, nobody wants to be stuck on chronic medications of any kind if they don't need to be. If there's something going on in their body, they can just fix and make it better. That's awesome.

Yeah. So, so I think, Dr. Amelia, just, you know, root canals, they're underestimated for the kind of problems they could cause, including migraine headaches.

Mm-hmm.

We're not really looking at that. So really, I encourage dentists to look to see if somebody, let's say you're referring somebody for migraines, you know, take a cone beam CT scan. If they have root canals on that side of the face, my recommendation is to remove them.

So you take out the tooth and then do you have, do you put in like an implant or something? Is that the progression?

Yeah. So for this particular patient, I told her, let's take out your tooth. I don't wanna introduce anything new until I make sure that you're feeling better. If they have headaches or some kind of tri— you know, atypical facial pain, right? I take out the teeth, I clean out any kind of source of inflammation, like cavitations, and then I say, let's wait. When they're stable, then we can now introduce ceramic dental implants. And for her, that's what we did. We actually, like, you know, 2 months later, I placed a ceramic implant for her. She had no issues at all with that. The pain didn't come back.

That's amazing. Great. Yeah. Love that.

Yeah. And ceramic implants is a great way to replace missing teeth because we want people to chew on both sides. And I think when people go without teeth on one side, then they start to favor the other side. And now a whole slew of other problems start, like, you know, asymmetry, overuse of the teeth and of the TMJ on the other side. So I always recommend replacement.

Yeah. Yeah. That makes sense. That's gotten so much more common and, and apparently easier to do. Yeah. Awesome.

I'm curious to see, like, you know, if you get a patient like this with like a one-sided migraine, like what is your usually course of evaluation?

So this is difficult.

Okay.

Because I'll tell you about a patient who I took care of recently, who's also a friend of mine. She's had migraines for years. Bad, bad migraines, almost always on the right side though. Okay. A couple of years ago, she started having left-sided pain. Okay. Now, everybody in neurology, you know, if you've been to the dentist, we always say go to the dentist first, right? Dentist says nothing wrong. And then she comes back and I'm like, well, it must just be that the migraines changed sides because they can do that. You can occasionally have headaches on one side of the head, then they can go to the other side of the head. Like, That's part of what migraines can do. They can change a little bit over time. That doesn't necessarily mean there's anything new or wrong or different. But in her case, it's actually not until she had one of those newer types of CT scans that you're talking about that it was found that she had an infection deep on one side, and that was the cause of—

Wow.

The one-sided pain. So I think it's really important to do that deeper level of looking at what the real cause is before we just jump to it. Well, yeah, sometimes migraine does that, which is otherwise our conclusion. And so it ended up being a fixable thing. And the only thing she feels, she's just angry. She's just angry at all doctors everywhere that this was missed. And, you know, she had the pain for— I mean, it's been a couple of years before this really got diagnosed. And, you know, this is a person who's used to pain. She's not a wimp, but it made everything so much worse for her. So I really think that I'm just so excited that there are advances in our ability to diagnose other things that might be going on there. And for anybody listening, absolutely. You know, go get checked out again, check with this newer CT technology to make sure that, you know, every stone has been turned over and we've looked for everything.

Now, one of the questions I had, 'cause I, you know, I see people in the office with sleep apnea, do you see sleep apnea contributing to migraine or is it more contributing to headaches?

Absolutely. It can make either one worse. Most people with bad migraines eventually get regular headache days too, especially as they progress. So there's a lot of overlap. Not all migraine days. And absolutely untreated sleep apnea makes that worse. And so one of the things I usually recommend for people is to start with something simple like a sleep tracker, an Oura Ring or a Fitbit or Apple Watch or whatever you use. Start trying to get some idea of whether or not your oxygen levels are dropping down at night. And if they are, go in, get checked. It's so fixable. There are even things like oral appliances, you know, that I see people being treated with. People are— the number one reason people tell me they don't want to get diagnosed with sleep apnea is they're like, I'm not using a machine. Like, but there are other options. So, you know, maybe—

100%. I actually made one of these. I made one of these appliances for my mom.

Oh, cool. Uh-huh.

Yeah. And, and basically they advance your lower jaw forward. So that the tongue doesn't fall in the back of the throat. And we make them for people with moderate, mild to moderate sleep apnea. But I wanted to share with you another cool advancement in technology we have in dentistry called NightLase therapy. Ooh, what's that? For sleep apnea. It was invented by a dentist about 10 years ago. And what NightLase is, is a non-invasive way. It's non-cutting. It's a laser. That we treat the back of the throat with and the base of the tongue. And it literally opens up the airway. So the collagen fibers in response to the energy of the laser, they just kind of lift up the same way it does for the face. It's a Fotona laser that we use. And basically people can breathe better at night. Wow.

That's amazing.

Yes. And the best part is no downtime. The most they feel is during the session, there is some warmth in the back of the throat that they would feel from the energy accumulating in the tissues. And the change happens over a period of 21 days where the collagen just really shrinks and can open up the airway. Wow.

Okay. What's that called again? One more time.

Yeah, it's called Night Lace by Fotona.

Night Lace by Fotona. Okay. Everybody who has sleep apnea needs to go write that down.

Definitely. You know, and I got trained, I wanna say maybe about 3 years ago, and I know the dentist that invented this technique. He's busy training other dentists and not just dentists. He can train, you know, a sleep doctor to do this. Just look for a dentist in your area that actually performs this procedure because I treated my mom and my husband since then with this procedure.

That is going to help so many people. I mean, you and I both know how essential sleep is for everything, especially brain health and migraines. And it is so hard for people who are living in chronic pain to get that sleep that they need at night. And sleep apnea is just one other obstacle. So I love hearing about that. That's amazing. Cool. So I've got another question for you. If you could wave a magic wand and make everybody do one thing to improve their oral health, what would it be?

That's a great question. So, To me, I think it starts at home. So I'm going to start with home advice. The majority of people, I think, are brushing very quickly. They're brushing using a toothpaste full of chemicals and they don't floss. Most people don't floss, as a matter of fact. That's why the risk of periodontal disease is high, and that creates inflammation in the body. So my recommendation is 3 steps to optimum oral health. Brush using a calcium hydroxyapatite. And full disclosure, I have a company of natural oral health products called OraSana. And I am focused on nurturing the oral microbiome through this product line, not just killing everything. It is so important to have good oral microbiome. So with the 3 steps, they're nontoxic products. We brush by— with strengthening the teeth with calcium hydroxyapatite. Secondly, we use a water flosser. A lot of people don't like string, or if they do like it, they don't use it correctly. And from all the research we have, water flossers can get in between, around the teeth, veneers, dental implants, a lot better. Controlling bleeding around the teeth and gums. And thirdly, pop in a chewable probiotic. And the chewable probiotics through our center are vegan certified, and they've shown to help decrease cavities, decrease oral inflammation. And for those people that have building a lot of plaque, it helps to decrease plaque. Wow.

A chewable probiotic. So does that cultivate good bugs in the mouth, or is it designed to go into the GI system the way other probiotics Interesting you say that.

You know, nothing that happens in the mouth stays in the mouth. It always travels. So we've had reports that people using our Truvil probiotic, their stomach is better. If they were having stomach issues, they're better because people who have oral problems, they tend to have gut problems. We say leaky gums, leaky gut. And another thing we know from the research that was done on these particular strains of bacteria that we're using is that sinus health Has improved.

Interesting. Wow.

Yeah. So people have congestion or allergies. When you take a chewable probiotic, it helps with your sinus health.

Wow. That's incredible. Okay. So just one point of clarification here. I always feel like you're supposed to brush your teeth at the end of everything, but you said the order that you said it in was the probiotic at the end. Do you really do that after you brush? Is that when you take it?

Absolutely. You know, and people are saying it's like, wow, it's like taking a candy at night, right? Because it is, it is sweetened, but it's sweetened with xylitol. And xylitol has been shown to normalize the oral flora, decrease Candida, actually. So people that have a coated tongue, they'll notice if they take the Troboprotic in the morning, they won't have that whitish coated tongue. And it's the best way to take it when the saliva flow is the least. Potent, which is at night typically.

Fascinating. Wow. Well, those are such amazing tools to help keep your mouth, your gut, your sinuses healthy. All of those things are linked with migraine through inflammation in the body, which is one of the 4 main biological drivers of migraine. You know, for so long we've considered migraine to be a disease in and of its own right, but there was a study published in 2023 summarizing really 2 decades of genetic research on migraine showing us nearly 200 different genes that have been found to be linked to migraine.

Wow.

Yeah. And one of the main pathways those genes are controlling is inflammation in the body. So that tells us that people with migraine have more challenges with inflammation. And if that's you, if that's your genes, then focusing on those inflammation pathways is going to give you better results than somebody who doesn't have that genetic wiring. Could be a waste of time for them. Maybe they've got great inflammation genes and it's not going to do much. They need to be focusing somewhere else. But I think it's fascinating that you have all these strategies for working on this when there's such a link between headaches, migraine, and oral health.

Yes. And I'm curious, what advice would you have for people from your perspective in terms of, you know, people that are suffering from migraines?

I think that the number one thing you need to do is go in and get some testing to find out what might be going on under the surface. I do have a resource to help people get started with this. It's called theheadachequiz.com. Super quick, quiz that will go through some of the more common symptoms that are associated with each of these 4 main biological drivers of migraine so that you can start to really focus on the areas that are going to give you the most impact. I can't tell you how many frustrated, hopeless women I've taken care of over the years who just feel like they've tried everything, but the problem is they're trying things that aren't really for their headache type, so they're not getting the results they want even though they're knocking themselves out. with all of the lifestyle changes, the supplements, the diets, and you know, that, that's, that is exhausting when you're, when you're dealing with chronic pain. So I think getting a better idea of exactly what's going on for you, looking past this idea that migraine is a single disease because it clearly isn't, we learned that from all of this genetics research and really focusing in on what are the biggest levers that you need to press in your life, whether it's medications, supplements, what you're eating. So that you get to a place of migraine freedom as soon as you can.

I love that. I'm going to go myself and take your quiz here.

Oh, you're so sweet.

For sure. And I love your holistic approach and going in depth with genetics. I think even for us in dentistry, we're always kind of the last to pick up on genetics, but I'm really impressed that you're using genetics in order to formulate a personalized plan for your patients to go along with other tests that you're doing.

Yeah, it has just been absolutely life-changing for some people. I've got somebody in the course right now who was having daily migraines for 10 years. She's seeing one of the top headache specialists in the country. They have tried everything. And now her case was a little complicated. It took us longer, but within 6 to 8 She was down to having 3 to 4 headache days a week instead of every day, just by understanding exactly how she's wired and what she needed to do to get better. And I think one of the things that surprises people the most is that you can actually find out which medications are the best fit for your biology. Some things are never going to work for you. They just aren't because of how you're wired. And you can waste, you know, 3 months at a time going through this trial, that trial, the other trial. Or you can just go in, get tested, know what's going to work, get on it, let the medications do their thing, and then you can move on to the other pieces of recovery because it's not just about popping a pill. There are so many other things that we can do to enhance our recovery. So the sooner you figure out what those are, the better off you're going to be. And then you're not stuck out there on YouTube going, wait. Wait, why does one person say go dairy-free and they're a migraine expert and another person says drink milk when you get a migraine? I'm so confused. You can just stop the confusion, understand how your body's wired, and you know what to do.

Oh, I love it. Now, do you— I would love to work with you on some of my patients. Do you— can you practice in California or how does the online— how do you work with patients?

So everything is online done in a non-practicing medicine format. I do have a certain number of slots available for people in certain states, and unfortunately at the moment, California is not one of them. Even though I did my training in California and I was licensed there in the past, they're quite strict. So that process is on hold. But for people in a handful of states, I can be their doctor, their full-on neurologist, take care of everything and then fix it all, hand them back to their doctor. Amazing.

But it sounds like you're doing some group courses.

Yes, I do. That's the majority of the way I do this work. So we do some foundational work for everybody in the beginning, things that everybody needs to do, optimizing what you're eating, how you're sleeping, what kind of nervous system regulation you're doing, teach everybody those skills. And then we go on with the deeper work based on your DNA, how you're wired. And all of that's available in group format to anybody anywhere in the world.

Great. Yeah. Mm-hmm. That's been so fun chatting with you. I actually learned a lot.

Good. Yeah, me too. I'm excited to have these new tools to be able to talk to people about who are struggling with kind of a facial component of their headache and migraine pain.

Definitely.

Yeah.

I'm definitely going to let people know about what you do because typically there's such a disconnect between neurologists and dentists. We don't, you know, so I'm glad we got a chance to have this chat. Yeah, it'll benefit anyone listening.

Absolutely.

All right, everyone, until next time, keep smiling. 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 @DrSanda. 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.