From Mouth to Body: Understanding the Influence of the Oral Microbiome with Dr. Katie Lee

Welcome to The Perfect Stool: Understanding and Healing the Gut Microbiome. This is your host, Lindsey Parsons, and today I'll be speaking with Dr. Katie Lee. Dr. Lee is a dentist, speaker, author, and coach who lives in Aurora, Colorado. She graduated from University of Illinois at Chicago in 2010 and was an owner-partner in over 80 DSO-supported dental practices throughout the US and served as clinical partner overseeing 5 states. Currently, she consults for health technology companies and provides implant education for general dentists. Dr. Lee authored a book entitled Saved by the Mouth to educate patients and clinicians on the importance of oral health and has won many accolades, including Top 40 Under 40 Dentists in America and International Woman of the Year in Dentistry. But before our conversation, if you haven't yet followed or subscribed to the show, be sure to do so. And if you want to get transcripts of the podcast, pop over to my website, HighDesertHealthCoaching.com, and sign sign up for my newsletter. You'll also get my free ebooklet, Finding Your Root Cause Through Stool and Organic Acids Testing, when you sign up. And if you haven't yet done my quiz on which stool test would help you get to your root cause, you can find a link in the show notes and take that. Now on to the show. Welcome to the podcast, Dr. Lee.

Thank you for having me. It's a pleasure.

Yeah, it's my pleasure. So I know that you had an important personal event that led you down your current career path, so can you touch on that briefly? Sure.

So when I was 14 years old, I was on a four-wheeler and crashed into a telephone pole. I broke every bone in my face from my eyebrows down.

Oh man.

I had my jaws wired shut for 8 weeks and my teeth were all broken and, and missing when they wired me shut. So as you can imagine, over the next 8 weeks of only eating ice cream and pudding and Jell-O and mashed potatoes, my teeth just kind of rotted and fell apart. And so I had massive amounts of infection, not to mention malnourishment. And so I learned at a very young age just how much your oral health affects your overall health. Yeah, that's what got me into dentistry and started me down this journey. But yeah, it took 4 years and 9 reconstructive surgeries to fix my face, be able to open my mouth because my, my jaw was fused shut for about 4 years. So It was a long journey, long road.

One nightmare. One nightmare. But I'm glad you're better now.

Thanks.

So I know that bacteria have niches that they like to inhabit. So you might have certain bacteria that are predominant in the mouth but don't survive past the stomach acid, for example. So how are the oral microbiome and the gut microbiome related?

Yeah, so, you know, it's, it's pretty common knowledge that we get introduced to our first microbiomes when we're born, right? We go through the vaginal canal, we get introduced to mom's vaginal microbiome as well as some of her gut microbiome. And then after that, there are several ways that bacteria get into the body, and one of the main ways is through the mouth. And so we're swallowing 80 trillion bacteria a day. Further, if we have leaky gums, which I'm sure we'll get into later, bacteria from your mouth will go in through your gum tissue and can circulate to the rest of the body and start occupying areas that they shouldn't. A major source of your gut microbiome started in your mouth, and so you can't have a healthy gut microbiome without a healthy oral microbiome.

Got it. So what are the oral signs and symptoms that indicate an issue with your gut?

Yeah, it's, it's really interesting because a lot of gut issues start manifesting or showing signs in the mouth. For instance, a really common condition, Crohn's disease, we will actually see cobblestoning appearance on patient's gum tissue, and that'll tip us off to something is wrong in the gut. And so anytime that someone has inflammation in the mouth, we, we know that something is amiss with their microbiome. And so if someone comes in with bleeding gums, swollen, itchy, receding, those are all signs that something is going on in the mouth or the gut and manifesting in the mouth.

I actually had one of my earliest clients who told me that after we'd worked together and we'd addressed some of the inflammatory foods in her diet, and we were working on, on trying to reverse her Hashimoto's thyroiditis, that when she went to the dental appointment, all of a sudden the depth of her teeth was much more normal. It had been, she had much bigger, you know, pockets by her teeth indicating that they were inflamed.

Definitely. We see massive, uh, changes in the, it's called periodontal pocketing, what you're Yeah. Referring to. So we measure the depth of the patient's gum tissue to their bone level, and that gives us an indication of what's going on, whether the gums are swollen or whether their bone is actually dying off and deteriorating. And what we know is that diet, you know, as much as it affects the health of your gut and your symptoms of your gut, it definitely also affects the symptoms of the mouth. So whatever is going on in the mouth is also going on in the gut and vice versa. And there's an enzyme that correlates the two, which I'm sure we'll get into later. But one of the big things in my dental practice was actually having my hygienist spend time educating patients on anti-inflammatory diet because we just saw that much of an impact on patients' overall health. Yeah.

So what are the types of oral bacteria that people need to be aware of that contribute to gut health issues? And don't be afraid to name strains and, you know, get into it. Yeah.

Okay, good. Good. So there's two main ones that people should be aware of, and it's PG and FN. And these are two bacteria that are in the mouth. They are very invasive species. They— FN, I call it the uber bacteria, Fusobacterium nucleatum. Everyone has this bacteria, but it's when it partners up with other bacteria, especially PG, that it can cause a lot of damage. And FN can get into the bloodstream very easily, and it circulates freely throughout the body. And oftentimes what it'll do is it'll partner up and latch onto another bacteria and take it with it and then cause disease in other places. So those are the two bacteria that will cause gum infection and periodontal disease in the mouth and then also affect our gut health as well. So PG stands for Porphyromonas gingivalis.

Okay. I think we've heard of gingivitis, so that's—

Yes. Yeah.

Yeah. Very familiar. Yeah. So now Fusobacterium, I'm pretty sure those are hydrogen sulfide producing bacteria.

Yeah, they're gram-negative. They love oxygen deprived environments. So that's why they work really, really well in the gut or why they live and can thrive in the gut. And their FN particularly is very difficult to kill off and to lower. So again, it's, it's not necessarily that FN is bad, it's just, is it in association with other bacteria and causing harm?

Mm-hmm. Okay. I know that it's been publicized in the news about the bacteria in your mouth and heart health. So can you dig deeper into that connection and, and with other health conditions as well?

Yeah. So PG is actually really heavily implicated in heart health, also really heavily implicated in Alzheimer's. In fact, there's been some direct links of PG causing Alzheimer's that they found. PG in cerebral spinal fluid of patients with Alzheimer's. So we know that we shouldn't have bacteria in our brains. So when we have it there, our body creates these amyloid plaques and can cause our brain to shrink over time and, and impair our brain function. And so these bacteria are also implicated in the heart, arthritis, and gut. You know as well, anytime you have gut issues and massive inflammation in your gut, those patients also oftentimes have arthritis issues and joint issues because of the systemic inflammation that's going on. And what happens is, and I think what a lot of dentists and clinicians didn't realize in the beginning is we know that bacteria in the mouth don't stay in the mouth, they go into the body, but we never really understood how that happens. And so now we know that there's this enzyme called AMMP8, it's a matrix metalloproteinase, which is a collagenase enzyme. And what happens is, you know, we get bacteria in our mouth that shouldn't be there, viruses or fungus or whatever. The body releases the immune system to go and protect us and kill off whatever invader is there. And in order to get the white blood cells to that area, it releases MMP-8 to go through and cut through the cell junctions to allow the white blood cells to get to the invaders. The problem with that is, is now we are breaking down tissue. And so that's what leads to leaky gums or gingivitis and periodontal disease in the mouth. And that's what allows the bacteria to get into the circulatory system and cause systemic damage. That's also the same enzyme that's responsible for cutting down the tight junctions in the gut too and causing leaky gut. So it's directly related.

Interesting. So are there any other strains of pathogenic bacteria that are particularly bad in the mouth beyond those two?

Yeah, we call it the red complex bacteria. So there's a bunch of bacteria in the mouth that we are really concerned with. TDTF are a couple of the other ones that we're always trying to lower so that way we don't have systemic ailments. But FN and PG are definitely the two main ones. AA, actinomyces aggregans, is another really big one. It's— when it's present, it causes a ton of damage, but fortunately it's not that common for someone to have it. And that, that one runs more in families because it's passed down generation to generation. But what's really cool about all the stuff that I'm talking about is you can now test just like you can do microbiome testing for your gut and do stool samples, stool testing, we can actually do saliva testing now and test patients' oral microbiome. And we can actually test the enzyme level, the MMP8, so we can tell, does the patient have these pathogenic bacteria in their mouth and what is the enzyme level? And that tells us how freely stuff is going from the mouth to the body.

Hmm. And those other two strains you mentioned, can you gimme the full names?

Treponema denticola and Tanner-Rhodes for Cynthia. We always just say the abbreviation.

Okay. Tell me the name of the test that does the, does the microbiome of the mouth.

Yeah, so there's several tests on the market. The two that I really like, one is with Access Genetics and it's called Oral DNA. I really like that test. It tests for 11 different strains of bacteria. It'll tell us the level of the bacteria that the patient has. It breaks it down into high-risk, medium-risk, and low-risk pathogens. And when it talks about that, the risk is associated to how much bone loss or damage will it cause in the mouth, and then how much the risk for the rest of the body for systemic conditions. And then it'll also tell you how to treat those bacteria as well, because what's important to know is just because you have bacteria doesn't mean that it all responds to the same treatment. And so for many years, clinicians made the mistake of you know, a patient would come in with gum infection and we just had one kind of kitchen sink approach to treating their gum infection. But what we would notice is some people would come back every 3 months and their condition never got any better. And that was for a couple reasons. One is we were never, you know, looking at gut health or, or nutrition or, or supplementation or systemic issues. But then also bacteria are not all responsive to the same types of treatments. And so what's nice to know about microbiome testing is you can really tailor the treatment to what the patient has. The other test I really like is HR5 by Direct Diagnostics. It really just hones in on the top 5 pathogens that cause periodontal disease and systemic disease. So those are the 2 I really like. And then for the enzyme test, the MMP8 test, that's a very unique proprietary test done by Dentagnostix. It's a German-based company. They've been doing this test in Germany forever, and then it just came to the US a few years ago. And that's a chairside point of care test, which is awesome. And so we would call it fitness. So we, a patient would come in and we'd say, let's measure your oral fitness. And that would just give us a read on how is the patient doing at this very moment with their oral health and systemic inflammatory levels.

And are those directly administered by dentists only? You can't order them yourselves?

So that's a really good question. The MMP8 test is only available at dental offices right now. I know they're working at trying to do some at-home tests. And then the saliva microbiome testing you can get through a dentist. You can either go through a dental office, you can ask if your dentist will provide that test, or for instance, that's something that some of us online dentists do. So people can go to the website and order the test from the website and then, uh, we will go over the results with them.

Okay, great. So let's go through the extent that you haven't yet, the different pathogenic strains and the connection to various diseases one by one. Of the ones that you haven't yet mentioned?

For which ones specifically? They're all kind of overlapped. It's all those top 5. Yeah, like the HR5 bacteria that I was talking about, those are the ones that really cause the most systemic conditions. And that's why Direct Diagnostics focuses on just those 5, cuz those are the ones that we see repeatedly over and over again. So FN and PG are the, are the big ones. TD and TF are also implicated in gut health. But FN specifically to gut, we know that there's about 20% of colon cancers that test positive for the presence of FN. And so what happens is FN gets into the colon, it causes these inflammatory responses, polyps are formed, and then FN kind of aggregates into the center of these polyps. And so we know that patients that have FN-associated cancer are more difficult to treat. And they're less responsive to chemotherapy and they're, they're more at risk for recurrence. So yeah, FN and PG are the big ones in, in gut health.

Okay. And so what kinds of treatments are you doing on these? Is it like antibiotics or is it just something inside the mouth?

Yeah, to treat the FN infection or cancer or—

Any of these, any of these infections you're talking about.

So for FN and PG specifically, what we typically do is we'll administer scaling and root planning, which is a periodontal cleaning. What a lot of people don't understand is that, you know, aerobic bacteria live above the gum line, and those are a lot less dangerous than the bacteria that live underneath the gum line, such as PG and FN. And so you can't do a supragingival, so above the gum line, cleaning if you're trying to target those pathogens. So you must go underneath the gum tissue and do what's called scaling and root planing to clean those bacteria out. Now, the bacteria that are resistant to scaling and root planing, you need to go in with some sort of medicaments or antimicrobials or lasers to try and get rid them. So oftentimes we'll use ozone therapy when we're doing these cleanings. We'll use, you know, you could do iodine and rinse them out that way. You can do Peridex. There's all kinds of different chemicals or medicaments to rinse the bacteria out. And then I love to go in and actually decontaminate the gum tissue, the inside of the periodontal pocket, with a laser. Laser therapy is very, very effective at killing bacteria because you got to think about it, you have your tooth, your root, and then you have your gum tissue. And so bacteria not only live on the tooth root surface, but they also live on the inside of the gum tissue. And if you don't treat both the root surface, the free-floating bacteria in the pocket, and the gum tissue, you're not going to have a clean environment for healing. Because what we want to do is we want to clean everything up. We want that gum tissue to shrink and reattach to the tooth and act as a barrier so nothing can get back down in there. And if the gum tissue is not being treated specifically, it's not going to reattach to the tooth and you're never going to close that, that barrier. So laser is really, really effective in treating that tissue.

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Yeah, that's a question that we get a ton for from patients. So when we talk about scaling and root planing, essentially what we're meaning— so scaling just means scaling the teeth, so scraping the teeth. You get that done when you get a regular prophylactic or healthy mouth cleaning anyway. Root planing just means that the root surface is actually rough. So if you look at it under a microscope, the crown of your tooth is real smooth, it's like a, a sheetrock, but then when you go down to the root surface, it's actually very, very porous. Those porous roots are where bacteria love to stick to and grow and thrive. And the bacteria will actually colonize, mix with the minerals in your saliva, and form tartar or calculus. And, and there it's like barnacles attached to the surface. So when you go in and clean, what you're doing is you're scaling all that off. But then we need to take our instruments and go in and actually root plane, so smooth the root of the tooth, make it nice and slick so less bacteria and less debris is likely to attach. So thank you for asking me to clarify that. Sometimes I forget to explain that.

No problem.

Here's some advice is number one, you know, get in and treat it before it gets to a level where, you know, you have super deep 6, 7, 8 millimeter pockets because the worse off the condition is, yes, the more painful that the procedure's going to be. Number two, we definitely will numb patients up or anesthetize them. Because it's, it's more important to have the patient comfortable during the procedure so that clinicians can do a great job. You know, we'll have some people come in and say, "Yeah, but I don't wanna be numb." Okay, well, if you're moving around and jumping in the chair, we can't get in and adequately clean. So I always advocate for either a topical anesthetic or doing full, you know, like dental anesthesia.

Okay. So cancer is of particular concern to me and pancreatic cancer in particular, because I know two people who died of it. One of them a very dear friend. So what bacteria is associated with pancreatic cancer and is it the same procedure for eliminating it?

Yeah. So PG is the main one associated with pancreatic cancer and yes, it's, it's same, same type of procedure that I'm talking about. If you do the scaling and root planing, if you do the irrigation with some kind of medicament, and if you do the laser, you're kind of, that will really take care of everything that I'm talking about and all the different strains and treatment of all the different strains.

And so how about the connection between oral health and infertility? Is that just related to women or men as well? No.

So this is one of my favorite topics because I have a personal journey with infertility. So same process, right? You get bacteria in your mouth, MMP8 is activated, bacteria or the MMP8 breaks down the gum tissue, bacteria from the mouth circulate. One of the places FN loves to go to is the reproductive system. And what we know about infertility is that 50% of all infertility is male and female. So it's half caused by women, half caused by men. So it's not just a female issue. So FNMPG play— for men, what it does is it actually inhibits arginine production. Arginine is the precursor to nitric oxide, which is what is needed for a man to get an erection. It decreases the number of sperm, it decreases the swimming strength of the sperm, if you will, the motility, and it changes the shape of the head of the sperm. Now in women, it causes inflammation in the uterus and the ovaries, so it makes it not a great environment for, for an embryo to implant. It decreases our ability to ovulate and then decreases our ability to carry the baby to term. And so especially FN, which is highly involved in gut health as well, but FN causes or is associated with preterm birth, low birth weights, and even stillbirths. There was a lot of studies that are done on stillbirth babies and what they found is that they were all infected with FN bacteria.

Wow. So important to get this checked before you get pregnant, I guess.

Yeah, people definitely wanna get checked before they're pregnant or if they're trying to get pregnant and they're having difficulty. I always tell any, you know, anyone thinking about child rearing needs to have an oral microbiome test. And even if you are pregnant, it's still important to get this checked and treated because if you treat it, you can get rid of these bacteria or at least get them in check. So that you can go on and carry the baby to term and have a healthy delivery.

Yeah.

So it's still safe to get treatment during pregnancy.

Great. So is bad breath a sign of having these sort of strains in your mouth?

Yes, definitely. It can be, you know, bad breath is associated with bacteria, periodontal disease for sure. All it is is it's the sulfur byproduct of the bacteria. And so oftentimes when patients come in, you know, there's a very distinct smell between an abscess usually and perio breath. You know, only if you're a dentist or hygienist, you know, you would probably know what I'm talking about.

Yeah.

But bad breath can definitely be associated with gum disease. It can be associated with tooth infection. Also, acid reflux is another one that causes bad breath. Sinus issues, if someone has a sinus infection and mouth breathing. Mouth breathing is actually horrible for your oral microbiome, which is then horrible for your gut microbiome. I don't know if you ever do anything with, with airway, but Airway is super important for all of this.

Yeah, no, I actually was gonna ask you about like whether snoring and sleep apnea increased pathogenic bacteria in the mouth.

Yes. So in our nose we have billions and billions of cilia, right? Little hairs, same, same in our guts. We have all these little hairs that help filter things out. And that is what our nose is designed for, is to take the air that we breathe, filter it, and then put it into our bodies that we can use the purest form of air and oxygen possible. The problem is, is when we don't breathe through our nose for whatever reason, our nasal passages start to get inflamed because the mouth or the air that we're taking in through our mouth is no longer filtered. So we are breathing polluted allergen-infested air that then goes into our body. Our body knows it's not supposed to be there, so we initiate an inflammatory response. Now we have chronic inflammation going on everywhere in our body.. And so mouth breathers will say, well, I'm a mouth breather because I have allergies. Well, true, but I wonder way back when, when you were young, maybe did we have some oral habits or our jaws and sinuses didn't develop the way that they should have. And so that caused us to mouth breathe, which then led to those allergies. And so when we are breathing through our mouth, we're getting dirty air, our mouths become very dry, bacteria love to stick to dry porous surfaces, which is our entire mouth. So then we get a shift in our microbiome. So instead of being a healthy homeostatic microbiome, we now have dysbiosis. And again, we're swallowing that all day long and that affects our gut health. So long answer, but yes, it definitely affects oral and gut microbiome.

Okay. So I have some personal, uh, experience with this because my partner snores and—

Yes.

I asked him, and clearly has sleep apnea, is undiagnosed or treated. So I told him to get one of these devices that keeps— I guess it pushes your lower jaw forward, maybe to open up the airway. But on the pamphlet that comes with it, it says, don't use this if you have sleep apnea. And I'm thinking, but if you use this, then you won't have it, won't you? Or you won't.

Did he get it like on the internet or over the counter? Yeah, I think they probably say that because of liability, because if you have sleep apnea, you need to be treated by a clinician that can treat sleep apnea because you have to be titrated. So wherever that lower jaw is positioned, is dependent on the volume of your airway, the obstruction, how severe your sleep apnea is, and then how well you can tolerate it in your TMJ joint. Because if, you know, sometimes people will buy devices and their lower jaw isn't moved forward far enough, and so it's actually not treating the sleep apnea. So if someone dies in their sleep from having a heart attack from sleep apnea, they don't want the family to come back and say, you know, oh, they got this device to treat sleep apnea You know, they're, they're saying, oh, well, it's not treating sleep apnea. So it's a, it's a liability thing. But the devices are, they're very easy to get from dentists who treat sleep apnea. And again, the positioning is critical because you want to make sure that they're pulling the lower jaw forward enough to open the airway. It's like a kinked hose, right? You want to pull it open enough to where they can breathe, but you don't want to pull it too far forward to where it changes the bite and causes joint pain.

Okay, so I should tell him to take it to his dentist and check it out.

Yeah, yeah, tell him to take it to the dentist. Another important one is we see people oftentimes grinding their teeth or that they have acid reflux, and that is a tip-off to— oh, or mouth breathing— that they probably have an airway issue. And so a lot of patients will say, well, I have a night guard because I grind my teeth. Well, I don't give night guards to patients unless they've done a sleep study, because most of the time those patients don't have a grinding issue. They have a sleep apnea issue and the symptom is grinding. So if you correct the sleep apnea, the grinding will resolve itself. And the night guards, you don't want to give someone a night guard if they have sleep apnea because you actually make the tongue space smaller and you can make the apnea worse. So it's really important you get it checked.

And why would the grinding be caused by the sleep apnea?

Great question. So when you fall asleep, what happens, you know, OSA, obstructive sleep apnea, what happens is you essentially choke. Most of the time you're choking on your tongue and your airway gets pinched, or your soft tissues kind of collapse the airway. And it always gets worse as we age. And so what happens is when you stop breathing, your brain says, oh my gosh, we, we're not getting any oxygen. If we don't get some oxygen up into our brain, we're gonna die. And so there's a rush of adrenaline that's sent to our brainstem, and that causes us to start grinding our teeth forward to open our airway. So what we're trying to push our own jaws forward. So we start grinding back and forth to open the airway and unkink it. So that's where the grinding comes from.

Interesting.

It's a self-preservation system. But, you know, a lot of people have heart attacks and strokes in their sleep, and most people die between 2 and 6 in the morning because that's when people are in REM sleep. When you're in REM sleep, you're more likely to have apneic events because you're paralyzed, because we're dreaming and we don't want to be acting out our dreams. So body gets paralyzed, you stop breathing, you choke on your tongue or whatever, and you don't wake up. And then that's when you can have a heart attack and stroke. So sleep apnea is very important to get treated. Untreated sleep apnea is fatal. It's just a matter of when if it's not treated.

Wow.

Okay, so go get them to a dentist.

Sounds like serious business.

I'm not trying to scare anyone. It's such an easy thing to treat. It's not painful. And, you know, 70% of people who have sleep apnea are undiagnosed. So it's a— people need to take it seriously.

Yeah. And snoring is a sign of it.

Yes, definitely. It can be a precursor to sleep apnea or a direct sign that someone has sleep apnea.

Okay. Got it.

But not all snorers have sleep apnea. I want to make sure I say that.

Right. But the people who go, uh, in the middle of the night probably do because I hear that.

If they're gasping, they for sure have it.

Yeah. Okay. So are the strains that cause diseases also the ones that cause cavities?

Great question. No one's asked me this actually, and no, they're different. So the red complex bacteria, the 5 main ones that, that I was talking about, those are the ones that are implicated in periodontal disease and systemic disease. The ones that mainly cause cavities, there's a few of 'em, but the one that everyone talks about is Streptococcus mutans. So that's a very specific bacteria. And the reason why it is concerning is because it will ingest the carbohydrates that we have in our mouth. So that could be sugar, it could be processed foods, pastas, crackers, anything like that. That's what it feeds off of. And then it basically excretes acid onto the teeth and that's what causes cavities. That same bacteria is also implicated in causing problems in our heart. So when you hear about patients having heart valve issues or something like that, the cavity-causing bacteria in the mouth can, can go to the heart and cause heart valve issues. Interesting. So a lot of times patients have to have premed, you know, you've heard of people needing premedication before they come in to the dentist, and that's from the strep mutans or the strep family.

Okay. So are there beneficial strains that we want to have in our mouths?

Oh yes. There's just like the gut. So we wanna have plenty of lactobacillus bacteria, the bifidobacterium. Those are really good. I've been doing a lot of studying with the Akkermansia strain. Have you?

Yep.

I'm, I'm taking that or heard anything?

I'm taking Pendulum, uh, Pendulum Metabolic Daily Pro. I started that like 2 days ago.

Yeah. So I've been taking that too. Uh, we're finding that Akkermansia is, is very beneficial in the mouth as well. So whatever is going to be good for your gut, it's going to be good for your mouth because again, the mouth is benefiting the gut. So yes.

Hey, this is Lindsey here, just letting you know that if you're tired of dealing with digestive issues like bloating, indigestion, soft stool, diarrhea, constipation, reflux, IBS, IBD, or the numerous health conditions that come about when your gut is off, like brain fog, weight gain, UTIs, fatigue, mental health issues, or complex conditions like fibromyalgia and ME/CFS, that's my specialty. With my 3 or 5 session gut health coaching packages, we'll discuss different stool and functional medicine tests to find out the root cause of your symptoms. I'll interpret the results and provide clear explanations, empowering you to make informed choices for your gut and overall health. And together we'll develop a customized action plan based on your test results so you can find relief and regain your health and vitality. I come from a functional medicine perspective, trying to incorporate the latest peer-reviewed research and educating you on protocols used by functional medicine practitioners, but devoting lots of time and support to my clients the way a doctor simply can't. If you're interested in a 3 or 5 session coaching package, you can sign up for complimentary 30-minute breakthrough session. Or if you can only afford one appointment at a time, you can book an initial 60-minute consultation. Links for those are in the show notes. Now back to the show. Okay. And are there any dental probiotics that you recommend?

So yes, I'm not paid by any company, so I don't want to— this isn't an ad or anything like that, but there's lots of products on the market that are really, really good. There's this product called— I'm Googling it right now just to make sure I get the name right— Revitin is really, really good. It's a toothpaste. It's all natural. It's food grade, so you can actually eat it. What I love about it is it has prebiotics, which is, as you know, what we need to feed the good bacteria in our mouth and in our gut. And it also contains some vitamins that are essential for oral health. I'm a big fan of, and what I talk to people all the time about, is we need to stop over-cleaning and over-sterilizing our mouth because the mouth is a, is an ecosystem. And for years, and I grew up this way and I was trained this way in dental school, is kills 99.9% of germs, and the burn from the mouthwash is good, it means it's cleaning. And, and, you know, we should use triclosan in our products because it's antibacterial. So I don't like that because the good bacteria, the anaerobes, are so much easier to kill than these pathogenic bacteria that have learned to survive throughout the rest of the body. And so when you take those harsh products, you're for certain killing the good and maybe doing a little bit for the bad, but what you're doing is you're setting up a vi— an environment for the bad ones to thrive. So I always tell people, use gentle products. The Tooth and Gum Company is another really good one. Boca, um, is a great company. I love them. Envivo has a lot of prebiotic and probiotic mouthwashes. Again, not paid by any of these people, just really like their products. Tom's, a really good one that people can get. Tom's, Toms is great. I actually love, love the Toms product line. People can access anywhere.

So even the fluoride-free.

So here's the thing about fluoride. Fluoride is a neurotoxin. We know that. We know fluoride is toxic when ingested. But if people are going to choose to go fluoride-free, they need to make sure that they have practices in place to prevent cavity, because a cavity and a dental abscess is way more toxic to the body than fluoride. So fluoride-free is great. Totally. I'm an advocate for that. But make sure that you're using products with nano hydroxyapatite in them, not hydroxyapatite. It needs to be nano hydroxyapatite. That way it's absorbed into the tooth structure. Make sure you have products that have some sort of cavity-fighting product in them. So nano hydroxyapatite. Another really good one for preventing cavities that a ton of research is done about and is also great at preventing sensitivity or treating sensitivity is arginine. And this is where I really like Tom's toothpaste because they are really high in arginine in their formulation. So nano hydroxyapatite is good. Arginine is really good. MI Paste is really good. So yes, you can go fluoride-free, but make sure you do something else and lay off the Coca-Cola and Starburst if you want to be fluoride-free.

And does— do the Tom's of Maine have that nano hydroxyapatite in them?

So I know they don't have nano hydroxyapatite, but they're high in arginine.

Okay. And that can take the place of it.

Absolutely.

Yeah.

Okay. Arginine has a ton of research, so totally, totally into that.

Okay, great. I was gonna ask you about that cuz I didn't know if it was as a dentist you would be like fluoride-free toothpaste. Oh yeah.

No, I'm, I'm totally fine. You know, I would just have patients that would come in, they'd be like, I stopped doing fluoride 6 months ago. And I'd be like, okay, well now you have 12 cavities. So now, you know, I have to put materials into your mouth that like of course I'm going to use as biocompatible materials as possible, but let's change lifestyle. Let's change what we're going to do if we're not doing fluoride. So yes, fluoride-free is fine. Just make sure you're set up for success.

Okay. So if you're kissing somebody who's got pathogenic strains in their mouth, will you necessarily take on those strains, or might your better strains wipe them out?

Absolutely. No, we know unless you have some superhuman oral bacteria or oral microbiome, you know, the oral microbiome is very fragile and just as something as little as eating processed foods, you know, for a week or rinsing with alcohol mouthwash, I mean, it's, you're gonna kill it off. So, and again, bad bacteria are much more powerful than good. So if you're kissing someone, eating after someone, around someone with a lot of pathogenic bacteria in their mouth, it's going to transfer to you. So especially in patients who are doing fertility treatments, we test not only the, the wife or the husband, but we always test the spouse as well. And your kids are gonna get your microbiome too. So when babies are born, get your first introduction through the birthing canal, but then the microbiome is not really that diverse in the beginning. And that's why babies are so prone to infections when they're young because their microbiome is still developing in diversity and they're gonna get it from their environment. So if mom and dad's microbiome or their nanny's microbiome is not good, your baby's gonna get that.

Mm-hmm. So it sounds like no to mouthwash, or at least not the, the really strong mouthwashes, at least. How about fluoride rinses?

So again, you know, the fluoride rinses are just there to put extra fluoride into the teeth. And there's other things that you can do. And I would, you know, I'd always ask people, what's your purpose for doing the fluoride rinses? So if someone has really high cavities and every time they come in they have high cavities and you know, they're a teenager and they're eating sugar and drinking Coke and, and I can't get them to make behavioral modifications, you know, like teenage boys. They're really tough, maybe an fluoride rinse might be good for them as long as definitely they're not swallowing it. If someone does not have a high caries risk or cavity risk and a good lifestyle, no, they don't need the fluoride rinse. They can use, you know, tooth and gum tonic or something like that.

And so, yeah. And so in terms of changing your breath, what's a good, a good option that's not too expensive?

Yeah, the best thing someone can do is number one, tongue scrape. I am a big proponent of tongue scraping. People's tongues are filthy. They don't clean them off. Just buy a U-shaped scraper on Amazon. It's a couple bucks. And after you're done brushing, scrape it off and that will improve breath tremendously. The other thing is for sure, go see your dentist, make sure you don't have a gum infection or a tooth infection. And if they have microbiome testing available, get it because you might have the periodontal pathogen bacteria and they're producing, you know, sulfur compounds causing that bad breath. Another one I would check is mouth breathing. That will cause a lot of bad breath, and so will acid reflux. I don't know if you've ever tried mouth taping, or have you ever tried it or heard of it?

Yeah, I recommend it to any client who says they snore.

Yes, it's amazing. So, you know, mouth tape, I always— for somebody who says, oh, I can only breathe through my mouth, I'll say, okay, well, mouth tape during the day. Start training yourself during the day to breathe and then use it at night so that way people don't freak out if they're going to choke to death and stop breathing at night. And usually just by closing their mouth during the day, that's enough to start, you know, triggering the inflammatory response to calm down. But breathing through your nose will actually make your breath a lot better.

Mm-hmm. Okay.

Cause your mouth isn't dry.

If somebody's just eating a lot of garlic or whatever the situation is, is, are there any mouth rinses that are okay that aren't hurting bacteria? Yeah.

Yeah. I like Tooth and Gum Tonic. That's a really good one. Tom's Mouthwash is really good. I really love Closys, C-L-O-S-Y-S. That's a really good gentle mouth rinse that people can use. It used to be by prescription only, but now it's over the counter, which is great. Anything that's alcohol-free— alcohol will kill the good bacteria and it will dry out your mouth, which makes your breath worse.

Okay, great. So if you're somebody like I am that produces a lot of plaque, especially as soon as I eat anything with sugar in it, is that a cause for concern?

So, and it can be, you just have to be way more diligent with oral hygiene. When you have plaque on the teeth, it can be from, from several different reasons. A lot of it can just be your own mineral content that you have coming through your saliva. When you say you cause a lot of plaque, do you mean like you get a lot of hardened buildup on your teeth?

No, I mean, you know, the sort of like hairy teeth.

Yeah, yeah, hairy teeth. I call it hairy teeth. Yeah. So you just want to be really diligent about your oral hygiene because when Plaque is soft and it starts forming 20 minutes after you finish eating. Plaque is soft, it can be removed. The problem is, is once that plaque is allowed to stay on the teeth and mature and then it mixes with the minerals in your saliva, it hardens and then becomes a safe haven for bacteria and you can't remove that hardened plaque on your teeth. That's called calculus. So not a concern as long as you're being diligent and taking it off. I always tell people, after you eat and drink, make sure you wait at least 30 minutes to brush your teeth. Because if, if you eat something acidic or sugary or something like that and you brush immediately after eating, you're actually brushing that into the teeth and can cause damage. So wait about 30 minutes, let the pH level of your mouth rise. Because that's the other thing, once you finish eating, the pH in your mouth drops because we need to start to break down and digest our food so that we basically start digestive process in the mouth. And so you wanna wait 30 minutes, let the pH come back up, let the food pH kind of normalize, and then brush your teeth.

Okay, great. I'm not sure, did you actually answer about whether there's any dental probiotics that you like or use?

Oh, probiotics. Yeah. So I really love the Invivo line. I-N-V-I-V-O.

As a probiotic.

Yep. They have a really good mouth rinse too. It's a powder that you just mix with water. And then you can rinse with that. That can be your mouth rinse. Another really good one, if you go to Primal Health, they have really great products as well that I like that are nontoxic.

Okay.

Another really good one for plaque and to prevent cavities is actually chewing xylitol gum. Mm-hmm. So have you heard of xylitol?

Yeah, I have gum with it all the time.

Perfect. Okay, good. So another cause of the hairy teeth. Yeah. Another cause of the hairy teeth feeling is one, the teeth could just need to be polished. So when you go to your dentist, ask them to polish them and smooth the teeth out so that they're not so sticky. And number two is dry mouth. And so if you can keep your mouth more moist, and so you can do that by drinking tons of water. If that's not working, then I always advocate for chewing xylitol gum because number one, the xylitol will kill any strep mutans bacteria. So cavity-causing bacteria, the bacteria will ingest the xylitol thinking it's a sugar. But then actually starve to death 'cause they can't metabolize it.

Wow.

And then also it, it causes stimulation of, or secretion of saliva. Saliva bays our teeth and actually prevents the bacteria and plaque from adhering to the teeth. So that's another really good option.

Great. I'll, I'll link to the xylitol gum I use and all these other things. It's, I'll find them and link to them in the show notes.

Great.

So have you ever heard of BioCiden products? And they're, they have a dental rinse called Dental Ciden and they have a toothpaste.

Yes, I actually really like them. Thank you for bringing it up. I believe they're doing akromancia stuff now too.

Really? I haven't seen this.

I saw, maybe it's not out yet, but I saw a webinar and BioSiden was sponsoring the webinar and they were looking at the akromancia line. So that was kind of my first tip into akromancia and then I found Pendulum, which was great. But yes, I really love BioSiden as well.

Yeah, I use that DentalSiden rinse. I've seen studies showing, you know, it helps with the pathogenic bacteria as well.

Yeah.

Okay.

Yeah, they're, they're a great company. They're all natural science-based, which I love. You know, you gotta be careful cuz a lot of things that are out there don't have the science to back it up. And so you just gotta be a little leery of it.

Yeah. So how about the connection between dementia and oral health? Oh, you did mention Alzheimer's.

Mm-hmm. So same process, bacteria in the mouth, inflamed gums, MMP8, leaky gums. The bacteria FN and PG go into the brain and they can cross the blood-brain barrier. And that's really scary because our, our, that barrier is there to protect our brain. And essentially what happens is once PG is in the brain, the brain knows it shouldn't be there. And so it starts creating these beta amyloid plaques around the neurons to protect itself from this bacteria and in essence starves the neurons. And so they begin to die and then that's how we develop Alzheimer's and dementia. So the brain is actually trying to protect itself, but then it ends up harming itself. FN, what we know is FN brings PG up to the brain, but then FN also accelerates PG's pathogenicity in the brain. So again, those two bacteria are highly correlated to Alzheimer's and dementia. Same with herpes virus. There's a lot of research coming out about HSV going into the brain and causing neuroinflammation.

Right.

And so that's one thing I always tell patients when they would come in is Do you have a history of cold sores? And they would sometimes would say yes or no. Why do you care? And I said, well, we need to put you on an antiviral or do something to try and get these under control. 'Cause every time you have an outbreak, we're causing neural inflammation and damage. Mm-hmm.

Yeah. And that's super prevalent. I think something like 80, 85% of people have it.

Totally. Yeah. Yeah. Very, very common.

Yeah.

Yeah.

So I hear a lot of biological dentists recommending removing root canals and crowns and such, but What do you put in their place if you do that? And is that something you recommend?

Oh gosh, you're opening up Pandora's box here. Here's the thing, root canals, in my opinion, don't portray myself as an all-natural biological dentist. Root canals can be very deadly and harmful because once the tooth is dead, it cannot heal itself. And so if the root canal is not done properly, or if the patient has gum disease, or if they have cavities that, you know, teeth are like organs. And so when they are getting insults, they can fight off those insults and heal themselves. When you have a dead tooth, you have no immune system on that tooth. And so that tooth can then develop latent chronic infections. And because there's no nerve in that tooth, the patient can have this massive abscess and never know about it. And if they're not being checked by, by dentists who use this 3D imaging cone beam technology, they can go years with these latent infections that are causing systemic inflammation and draining all this bacteria into their bloodstream and never know because there's no symptoms. That's the danger of it. You know, if root canals are done, number one, prevent root canals, right? Get treatment before it gets to a place of root canal. Number 2, if you need to have a root canal done, make sure it's done by a specialist or a general dentist who mainly focuses on root canals and uses microscopes or, or high technology CBCT to make sure they're getting into every nook and cranny of the tooth. And then number 3, make sure you're getting them checked because this, the moment they start to show that they're getting reinfected, okay, now it's time to take the tooth out and move on to something else like dental implants or what have you.

Okay.

So there's, there's, it's not as easy as saying all root canals are bad, extract all the teeth.

Yeah. Okay.

Because that's not good either.

That helps. That helps a little bit. So that just basically get checked with that 3D, is it an a 3D x-ray or 3D imaging?

It's a 3D. Yeah. 3D x-ray.

Mm-hmm.

You know, I tell people too, if you go and rip out all your root canals, your teeth with root canals, now you have to replace the teeth because there's lots of studies showing that the less pairs of teeth you have, the more it impairs your cognitive function and the more it decreases your lifespan. So the magic number is having 10 sets of teeth or 10 pairs of teeth. And so if you take a tooth out, you need to replace it because otherwise teeth are gonna shift, you're gonna get gum issues, you could get jaw and bite issues. And so now what do you replace it with? And so most often people will do implants. Well, now you're introducing a foreign body into your jaw. Into the bone, into the bone marrow, into your bloodstream. You don't know how your body's gonna react to that. Is it going to accept it or cause another inflammatory response? So the short answer is not just rip out all your root canals and, and replace them.

Right, right. So I actually have all of my wisdom teeth. Is that like super unique?

It is unique because over time, back millennia ago, we needed all of those molars to digest our food, right? And break down the sticks and twigs and the meat and the bones that we were eating. Unfortunately, with the high-processed diet and the agricultural shift in our food and farming, our foods are a lot softer, unfortunately. And so our jaws have gotten a lot shorter, and so there's not enough room for those teeth anymore. And the shrinking of jaws is also why we have a lot of airway issues. And so it is very unique. So congratulations, I think that's awesome that you still have your wisdom teeth. I wish more people had room.

I think it must have been cuz my parents made me eat very tough meat as a child. I had to tear apart. That's great.

There's, there's a lot of advocates actually out there for developing jaws through these myofunctional habits like that of, of eating, eating harder stuff when you're young so that you actually get proper development of your jaw. So good for your parents.

That's awesome.

Yeah.

Not just, not just all processed foods, like eating real foods. Yeah.

Yeah. That's great.

Yeah. So How can people find a dentist who's doing this kind of advanced testing and treatment? Is there any sort of a website or—

There's a lot of advocates out there that are really promoting this, this type of treatment, and I'm sure I'm gonna miss a lot of them, but there's a, an organization out there called the American Academy of Oral Systemic Health. People can go on there and type in a provider and it, some people are linked there. You can go to AccessGenetics website or OralDNA.com, that's the saliva test, and type in find a provider. There's, you know, all of the Instagram influencers. So AskTheDentist.com, that's a really good website. He has tons of followers, but he has a directory of people that you can search out. I think Living Well with Dr. Michelle is another, is another one. But I think it's pretty easy to find these days a doc that will do this.

Okay, cool. Yeah, I'm sure.

And people can just ask for microbiome testing. That's kind of the, the key word to ask for.

Right, right. Okay, awesome. Well, thank you so much. This was super informative. Any final thoughts?

No, I just, the whole point of, of me doing what I'm doing and writing the book and everything is, is just to, I feel like if the more we can educate the public on how the mouth is actually connected to the rest of the body and how it will affect your overall health, You know, by arming patients with the right information, I feel like they can then find providers that will give them top quality care that they need to be well. So I just hope people take the information and they can do with it what they want. But I think it's really beneficial for people to know this.

Awesome. Well, thank you so much.

Thank you for having me.

Well, that was an amazing and informative conversation, and now I'm determined to go out and get my own oral microbiome tested. And do check out the show notes for links to all the stuff she mentioned. If you'd like to support the podcast in other ways, you can buy supplements at a discount from my Fullscript dispensary, order tests at a discount from my Rupa Health Lab store, or use my affiliate links to iHerb, Bulk Supplements, or Amazon. If you'd like to connect with me online, you can follow my High Desert Health Facebook page, join my Gut Healing Facebook group, or join my newsletter list at highdeserthealthcoaching.com, as well as follow me on X, Instagram, TikTok, and Pinterest. Links for those are in the show notes. Thanks for joining me today. Here's wishing you all the perfect stool.