Oral Health Crisis: Why Your Mouth Predicts Disease | Dr. Levine

mouth breathing is rising fast, especially amongst children. We look at children, we think that they're so cute when they're breathing with their mouth opens, when it's actually not. It could be a sign of stress internally. What are the biggest consequences of mouth breathing over time?

The children are mouth breathing during development. The mouth develops a very high palate and a very narrow jaw. Form follows function. The mouth, which was not designed for breathing— the nose was designed for breathing, it's a filter system— the mouth is the top of the digestive tract. This upper jaw, when Go like this. It's a funnel. You're developing a V in the palate, narrow jaws. Guess what happens to the tongue? The tongue is now living in a studio apartment, but it has to live in a penthouse. That means the jaw is small. When the jaw is small, you need your wisdom teeth extracted. You need orthodontics.

Dr. Jonathan Levine, welcome to Rooted in Wellness. I'm thrilled to have you.

Pleasure to be here, Mona Sharma Sharma Sharma.

All right. I was just saying how, how much of a treat it was to meet your son Cody at Smile House in New York, to really experience the work that you do, which I want to cover with everyone today because I don't think we hear the words dental longevity very often. But before we dive in, you should know that this podcast is all about becoming rooted in your health and your happiness and who you are. And what I believe is everyone's kind of inherent knowing their body's ability to heal. So I'd love to start off the podcast with asking you, what are 2 or 3 things that help make you feel rooted in your health and who you are every day?

For me?

Yeah.

For me personally, that's always a great question. And I think as we, as we go through our 20s, 30s, 40s, and on up, you know, we are constantly learning if for that mindset. And for me today, it's always been fitness and motion for me becomes a priority. I know you're Canadian, so I just want you to know your national sport was the sport I played in college called lacrosse. And we had a lot of Canadians both on the hockey and lacrosse team. And we were my senior year national champs. And that propelled me to always like, you know, one, understand the life's a team sport because we did something pretty special as a team. But also I always maintained a high level of fitness as an athlete. And as an athlete, you do learn discipline. You know, the difference between where you are and where you want to go. And so I'm, I'm pretty disciplined with, with my fitness. I'm very disciplined with my nutrition and all of the things that I think really helps drive, which I would say I was doing them without consciously understanding the impact. Today, I, we understand these things so much more as it relates to our sleep, as it also relates to our mindfulness and how we set our mindset. I always like to add to those pillars of longevity, oral health, which I'm sure we'll get to.

Yes, absolutely.

But for me, numero uno, and I compare notes with friends and people in the wellness and the health industry, I agree that, and I live it, is really fitness, is really the ability to have motion because it does drive so many of the other pillars.

Our audience really knows, like, we've overcomplicated wellness and what it means, what it takes to be healthy. And every single person person who sits in that chair recommends something that ultimately is free to feel our best. So thank you for that. And on the flip side, you know, I think you tapped into something that's important— the wisdom that comes with aging and getting older and knowing what our body needs and what helps us feel really good. Do you notice when you drift? Are there things, uh, in your life in a really busy city of New York that cause you to feel uprooted?

Yeah, that's an interesting question about— I, I say it a different way, you know, drifting what my understanding of what you're meaning is that we kind of move away from our center, that we, we start doing things that we actually have to pull ourselves back to a, a spot where an area that we feel strong, we feel healthy, we feel good. And it always happens. And we have our great days and then we have our days that aren't so great. And I think that's where discipline and that's where the mindfulness really sets in. Where we can set our actions based on our thinking. Because we, you have to set your mind and you feel you're healthy there and you're healthy in your thinking. Even when you slide a little sideways, like, you know, you're out with your friends and you might have been, you know, imbibing a little bit too much, or, you know, you stayed up late and you just didn't get that normal sleep. You know where you need to get to, you know? And there are so many great tools today to help us get back to the center because of how much more we know about these things of how the body works. And I love what you said in the beginning of how everybody, you know, we have this opportunity to really understand our body and understand the choices that we need to make to drive the health. And that's where it starts to really understand, you know, what really makes us feel good, but also what are these elements that are gonna help drive this, you know, a positive and an optimistic outlook to help us get back to that center.

Yes, absolutely. Yeah. And the way that you describe it too, it's so unique to you, but ultimately it's the personalization that needs to happen. So we're going to dive into how that relates to your work. But to kick things off so I can get the most information out of you, here are some rapid-fire questions. All right, just whatever comes to mind. Let's see what, what you answer with. What's one body signal that you never ignore anymore?

Body signal. Oh boy. I would say, I would say jumping on the scale and seeing that I just gained a couple of pounds because, you know, I missed a couple of workouts or, you know, I went too much socializing. So that's a body signal with a little bit of a measurement tool that I don't ignore. And my second favorite one though is my Oura Ring that I put on right before I go to bed. But it's a tra— sleep tracker and that I do not ignore either.

I love it. What is one thing that people always get wrong about the oral microbiome?

Well, there's a lack of appreciation for it. The mouth seeds the gut, the, the oral microbiome when it's dysbiotic. In other words, the balance is towards the bad side, the pathogenic side, that unfortunately a lot of people don't have the awareness of how that impacts overall health. And we'll get into it. But the truth of the matter is it has a huge effect on all of these systemic inflammatory diseases like cardiovascular disease, diabetes, Alzheimer's, all these inflammatory systemic diseases. And when you understand that connection and you understand the choices we have to really stay healthy in our mouth, you, you get it.

Absolutely. I can't wait to dive in. What's one oral health skill that you wish everyone learned in school?

Oh, well, you know, it's interesting. We have a Glow Good Foundation, so we go to the Aluthra where people have no access to care. And we saw what happens when we bring in our professionals into the school and teach the children the basics of driving oral health and nutrition. So the skill that, you know, people really have to learn is the importance of an oral health regimen, we say, or have oral health game. Just like a good backhand in tennis, you gotta work on it and you wanna start super young. So that's what I want every young person to know, to really have a great oral health game and to be educated and to also have access to those tools and the care.

I don't even think I was taught how to brush my teeth correctly as a child. So we'll dive into that too.

That's it.

That's it. What's one trendy oral habit that you wish people would stop doing?

Oh, well, um, The habit that a lot of people do during the day, and especially when you're under stress, is they clench or grind their teeth, or they have this grinding position. And what ends up happening is you're wearing down the edges of your front teeth, which have an impact not only on the aesthetics because you shorten your teeth, but also on the function. These front teeth have a role and responsibility of separating the back teeth when we're chewing. And when you're missing that edge, you lose that functionality. So that's one thing that people could like really stop themselves from doing because it's just becoming aware of it.

Yeah, most people normalize this. So these are really, really great. And, you know, just to share with the audience, I was recently in New York and I remember I took a red-eye in. I was exhausted, but I miss that city so much. I walked for like an hour when I landed and I walked directly to Smile House where I was met by your incredible son, Cody, and I walked into this, I'll call it a dental clinic, which I thought I was attending, and I felt like I was walking into a wellness spa. Like the environment was so inviting. I was hanging out in the front lounge for a little bit. Cody welcomed me with open arms. I took a tour. I was having tea, and before I know it, I was there for about 2 hours, but I left feeling completely rejuvenated. And for my audience, I'm describing this because when have you ever thought about longevity through your mouth through dental hygiene and care. And that's exactly what this experience was. And for our audience to really understand that this isn't just like a really unique experience, I really hope that what you're building in Smile House is the, the way of the future. Because right now, when we think about inflammation, when we think about fatigue or brain fog or even anxiety, the last place that people look is in their mouth. But 90% of systemic diseases have an oral component. And most people walk around with hidden infections. Issues with their, with their mouth that they're unaware of. I had no idea that I was grinding my teeth, that I was actually experiencing bone loss with my teeth, if it wasn't for attending Smile House. So let's dive into this. We know about inflammation in the mouth, but tell us a little bit more how it's related to our overall health.

Yeah, for sure. So what, what happens in the mouth, and the mouth I have a new book coming out in next quarter, and it's all about putting the mouth back in the body because there's been a disconnect between dentistry and medicine forever. And it has a lot to do with political reasons that I won't bore your listeners to, but it's—

It's always been separate. They've never been together.

It's always been separate. And in fact, in Europe, up until about 20 years ago, you were an MD first, then you specialized in dentistry. Only Harvard has the dental school part of the medical school, and Harvard is leading, leading probably the country by far in the innovation and the connection of oral health and overall health. So I give them a lot of kudos. But what has happened because of this separation is that dentistry, and we know about the specialties in medicine, it's very siloed. And the siloization of that, unfortunately, causes this disconnect. So let's fast forward to today because we're really into an era where the ability of our, of genomics coupled with high-powered computing, coupled with bioengineering, has changed everything for healthcare. It takes 17 years to adopt new techniques and methodology in general in healthcare, and dentistry is slower. But finally it's kind of coming around. And, and when we started Smile House, and I've been at this now 35+ years, and I've kind of lived in this innovative world in oral health, I have about 30 patents on medical device delivery systems and all that fun stuff, but also living in an academic, in an academic world running a program at NYU and teaching. And so what has happened today is because of new science and because of new technology, We're able in dentistry to diagnose and look at things we've never been able to see before. So what does that mean? We have a CAT scan for the jaws that allows us to see from the top of the nose to the airway so we can see nasal obstructions. Why that's important is that people have to breathe through their nose to get into deep sleep. 'Cause if you breathe through your mouth, your tongue doesn't take a great position, your airway gets blocked structurally, and you can't get into this deep regenerative sleep. And in fact, a lot of people end up with early stage either obstructive sleep apnea or snoring, which is a very early stage, or even more aggressive than that. And if you don't get into your deep regenerative sleep, which means if you're not nasal breathing and you're not getting into this deep sleep, you're not repairing your body at night. And that's why these sleep trackers are so important, because you can track your deep sleep. It breaks it down into light sleep, REM sleep, and deep sleep. And that's when we fight the cancers and the environmental toxins that we all live under. Because cancer is living in all of our cells. And unfortunately, as we age, our immune response goes down. So what do we want to do as early as possible? What we want to do as early as possible is control our health. So we have these pillars of longevity, but there's a pillar that's necessary in the longevity of your mouth, right? The Center for Dental Longevity is what we call Smile House because we're taking these technologies and we're integrating it in a very interesting way that we call mouth mapping. So if you take aesthetics, which is how the teeth look, and we just talked about what happens when you lose the edge of your front teeth and it looks like you have darkness while you're speaking, it ages you. So we look at aesthetics with— now we smile design digitally on computers, we 3D print that, we mock that up in the mouth, we can create veneers and crowns, CAD/CAM from copying natural teeth. So all this wonderful world of digital workflow because now it's not a person sitting and waxing like making jewelry, but now we're really designing through CAD/CAM and 3D printing. That's aesthetics, but it has to be supported by structure, function, and biology. Every one of those, those pillars of structure, function, biology are now supported by new technology. So now structurally with the CBCT, we look from the top of the nose to the airway. We diagnose microbiome problems in biology through Salivary Diagnostics. We, we look at structural issues like deviated septums, small jaws, and upper airway restriction. In other words, a small airway. We can see the, the circumference, the diameter of our, of our upper airway. And a lot of times if we gain weight as we age, if it's structural problems with the tongue falling back, sometimes there's something called myofunctional problems where the tongue isn't kind of doing what it has to do to get into this deep sleep. So now we have all these different ways work with even changes to people's habits of where we put our, our tongue a lot of times. And I can get into it about swallowing patterns that obstructs the airway. So if we couple all this data together and you experienced it, mouth mapping, we can take a very visual approach. You saw things on the big screen, you saw your CAT scans, and then we send the Salivate Diagnostics to a great salivate diagnostic company we work with called Bristle. We get a, a breakdown of literally 200 different species of bacteria. And the important ones are these bad bugs, the pathogens. And each pathogen has an impact on something going on with our body. P. gingivalis has a huge impact on cardiovascular disease. That was researched literally 20 years ago.

Yeah.

So if we turn back the clock, we look back the last 20 years, we're tying inflammation in the mouth like we understand what leaky gut is. The interstitial cells open up that space between it and we, these toxins get into our body and there's this whole gut-brain axis. 80% of our immune response happens from our gut. So if it's inflamed, we got problems, right? The body is gonna get impacted by these toxins. Guess what? The same thing happens in the mouth. So in the book, the new book we got coming out is we're calling it Leaky Gums.

So there you go. That's brilliant.

What happens with the gums? So when the, the, the gums get inflamed chronically, the, the epithelium that touches the roots of your teeth. So if you put your fingernail up under your gum, that's the root. Well, guess what happens when a balloon is blown up? What happens to the wall of the balloon? In other words, when the gums get inflamed, what happens to that wall that's sitting on that root surface where you have these bacterial byproducts? Those byproducts and the toxins, gingivites. Those are these breakdown byproducts of the bacterial wall, ends up in the amyloid plaque of Alzheimer's patients, in the interstitial cells of leaky gut, in the cardiovascular, right in the arteries where they get hot and inflamed. What's it doing there?

P. gingivalis.

So we now know that every chronic inflammatory disease, there's about 57 of them, we can find a link to chronic inflammation in the mouth. Through this pathway where the epithelium touching the root becomes permeable, which means that those byproducts are getting into the superhighway of the body, the blood system. We also know that the P. gingivalis and these bacteria we swallow 2,000 times a day, that they also work its way through the digestive tract. The mouth is the top of the digestive tract, so it ends up into the into the gut lining. So there's two ways of this inflammatory problem of these bad bugs working its way into the body because the mouth is part of the body just like everything else. We're all connected through our systems. And thank God for the integrated medicine people because they're the ones, they're the ones that have made the noise. Mark Hyman, who I know should win the health awards of the world. I mean, the man is the one who helps start a lot of this movement. And then between Peter Attia and Huberman, all these fantastic people, we now understand how the systems are connected and we're starting to move the needle in these wonderful health systems like Mayo Clinic, Cleveland Clinic, Johns Hopkins, and now Western medicine that's been such a sickness model where we wait too long for people to get sick. We can get a little bit upstream. We start, and we believe people in, in the industry in, in oral health and dentistry, we believe that we can be the tip of the spear to get ahead of these chronic inflammatory disease 'cause we can diagnose early because people go to their dentist more than they go to their primary care physician.

So now we're looking at biomarkers and a company called Oral Genome that tests 3 biomarkers, one being MMP, which is an inflammatory marker that shows up in our body and we can test it in the saliva. If we see a high risk for MMP, then we know that there's something happening systemically. So we can make the referral to their primary care physician or their cardiologist. We also can test blood glucose— excuse me, we can get the glucose level from our saliva, not A1C, but at least the blood glucose that tells us, let's go test for A1C and let's see what's going on with that patient, potentially pre-diabetic. And then we're also testing for PG for high risk. And PG puts us down the road that we know that P. gingivalis, one of these pathogenic bacteria, are in the mouth. And we know as dentists, that oral health professionals and specialists, we know how to treat that, but we can make that referral to their physician. And this we're calling DMI, dental medical integration. We now are taking that to the next step, and I'm working with a fantastic company called Henry Schein. We're gonna bring this out to the industry where through a finger prick, we're actually able to test almost 25 biomarkers in the blood. So we can test things that the doctors know about— lipids, lipoprotein, HDL, LDL— and, and also we're looking at C-reactive protein, which is another inflammatory biomarker for cardiovascular disease. That's coming. And that's gonna be at Smile House in the next month or two. So as we're moving the needle, I call it the rule of opposites. Unfortunately, whatever's been done in dentistry, I say let's do the opposite. And I mean that from the environment standpoint of the hospitality approach, but also that we're embracing technology. You know, a lot of times the professional gets worried about new technology and if you have to have a mindset to say, let's get after it, let's see if this is interesting because the mouth is connected to the rest of the body. And we believe that we can really help people to be, their overall health could be healthier by having greater oral health and really for people to understand the relevance for that.

So as a practitioner, I'm over here taking all of these notes out of inspiration. You just connected your oral health to a list of chronic illnesses and disease and preventative healthcare. And I agree with you. I've been able to work with Dr. Mark Hyman. He's brilliant. He has brought integrative healthcare to the table. But I don't think we're practicing integrative healthcare. I don't think enough doctors out there are really kind of integrating the systems within the body. That was kind of inspiration for this podcast, to go back to ancient, uh, Eastern wisdom and Eastern medicine. When you go to see a traditional Chinese medicine doctor or an Ayurvedic practitioner, the first thing that they do is they look inside your mouth. They look at your gums, they look at your tongue first, and they recognize that as a key factor for all of your digestion, which is the root of all health. And for listeners, I want you to know that when I was at Smile House doing mouth mapping, it was the most comfortable, relaxing test ever. It was actually fascinating being able to see your entire oral cavity, your, your skull, your nasal cavity up on screen, because you, you become attuned to it being part of you. Most of us don't give it any attention outside of brush your teeth twice a day. Hopefully you're flossing once or twice a day as well. And to your point, I just, I don't think that doctors are talking about this, nor do I think that most people— and this is probably why you're such a great educator Um, most people don't understand that gum inflammation could be associated with preventing disease and aging well in the future. So for our listeners, talk to us about gum inflammation in the mouth, how it can be an immune trigger, but really, how do you tell if you have gum inflammation?

Yeah.

The first time that I experienced gum inflammation was when I was pregnant. I had bleeding gums, which is a common symptom for women. And now I'm very aware of it and I'm very aware of how I'm flossing and stuff like that. But. Tell our listeners the connection.

Yeah, you know, it's not so easy because periodontal disease is silent. So if you go back 20 years ago, David Satcher, who is the Surgeon General in the United States, 20 years ago on the COVID of Time magazine called periodontal disease the silent killer. Interesting, because a lot of times you don't know you have it. So just know that 1 out of 2 Americans have some form of periodontal disease. Over the age of 65, 70%. Imagine. And you got a country that's 55 to 60% pre-diabetic and diabetic, which hopefully is gonna get better with the new pharmaceuticals. But the truth of the matter is we don't do a very good job to understand it because it is a little complicated. Some early signs could be a little bit of blood while you're brushing. You look in the mirror, look at your gums, is if they're red. In other words, they're not pink, tight, and healthy, but if they're red and they look a little, you know, inflamed, you can see it. But it's important to get to the oral health professional, to get to your dental team, to have a great dental team. And it's very important for the individual person, right? And I'm sure you talk about this all the time, Mona Sharma Sharma Sharma. You have to own your health. You have to be the CEO of your own health. So you have to know what are the things I have to ask my dental professional and my hygienist to make sure that they're on their game. And I always say, hold your team accountable because if they're not up to the latest, if they don't have new technology, if they're not embracing the new science I'm sorry, but find the people who do. And it's the same thing with integrative medicine. You know, we have to build a care team as, as we can own our health and we are lucky and we're fortunate to have access to care versus people who live in these healthcare deserts. We really can own our health. So for periodontal disease, the early stage could be a little bit of bleeding when you're brushing and then you rinse out and you see the saliva's a little bit of red. That means you're getting inflamed. Really is, because periodontal disease, you're not gonna have a lot of pain unless you're trapping food and then the ligament around the teeth gets inflamed, and that could be a little bit painful. And then of course, a toothache, that's super painful. So it goes from almost not feeling it to a tooth problem, a hard tooth problem, because the nerve dies and the body defends it. And now the area at the end of the root, which living in bone, gets inflamed. Bone is inelastic. So all of a sudden the fluid builds up, and that's where the pain comes from, the pressure. And then if you imagine your upper teeth in direct correlation to your brain, it's a very short distance. Pain is excruciating sharp and lancinating. So back to periodontal disease, when the gum is inflamed, you go to your professional, they work with you, they work with you on your ability to understand your— how you brush, like you said earlier. How you floss, how you could use a water flosser, how you can use a tongue scraper, how you can start with an oral health rinse that raises the pH and oxygenates without antibiotics, how you could use these floss picks because you don't want to, you know, doing the floss mechanically could be difficult for some people. On and on and on. So understanding the tools, the order by which that we use these tools, and we should offer up all of your listeners, we have an oral health regimen guide. We can, you know, they can be in the show notes, right? And people could see, hey, this is what we're figuring out. Here's the latest thinking around this. How long do you spend? And know that electric brushes are much better than manual brushes because manual brushes take a lot of technique. You have to angle it just right. You gotta hold it there some just right. And the electric brushes do all the work for you. You just have to do it long enough, anywhere between a minute to a minute and a half, hitting the 4 areas of the mouth. The outer area and the inner area angled properly. Electric brush, great. But then we have these high-powered water flossers. The great ones work. Always look for about 50, uh, 60 PSI on pressure because that will shoot the water between the teeth. It will dislodge any food particles, but it also helps to dislodge the bacteria that get between the teeth. So between the teeth is where periodontal disease lives. We run our tongue on our teeth, we're wiping the bacterial biofilm off. But what happens between the teeth? So flossing, water floss or regular string floss, that's how we get between the teeth. That gets under the gum. And what happens under the gum? Just to bore everybody, that's where the bacteria that cause periodontal disease live. They live without oxygen. So if you have oxygen, we say it's aerobic, right? Remember aerobic training? Then we go into anaerobic when we've gone through our oxygen. Well, anaerobic is no oxygen, and that's where they're called gram-negative anaerobes. These are the bad bugs, the pathogens. There's 7 of them that cause the inflammation. When we don't clean that bacteria off our teeth really well and it resides for 2 days, 3 days, 4 days, and we miss these areas or we never floss, then you're going to have chronic inflammatory disease. We call periodontal disease— I like to call it leaky gums because it's going to leak into our system and it's going to cause and be additive to these chronic inflammatory disease. Here's a statistic that'll rock it. When you were— we were over COVID, you were 4.8 times more likely from 3 parallel studies to end up on a ventilator if you had periodontal disease. Now that's the truth. Because you have one layer of inflammation, then maybe you have a level of cardiovascular disease, or you have COPD, or you have diabetes, and your body is inflamed. Can our immune response handle that much inflammation? Our immune response is built to protect us. Think of like we live in a castle, our body, and we have the skin that protects us from the outside. Great. All of a sudden, the foreign invaders are coming in from every angle. Cardiovascular disease, periodontal disease, Alzheimer's or COPD. And you think of all the diabetes, all these chronic inflammatory disease, our immune response gets overwhelmed. Then what happens? Then we become laden with autoimmune disease. We start attacking our own cells. And inflammation is a double-edged sword that is designed to help us, but as you know, can hurt us. And so interestingly enough, Gum inflammation is just one more layer of inflammation in the body that we can control probably better than any other area of our body because we can have the tools and the habits and these high-performance habits to do every day to control the, the plaque that builds up on our teeth.

When I meet with my clients, I speak to them of a concept of building your healthcare prevention team, the people that you need to help optimize your body to prevent illness in the future. And I'm I'm really upset that I haven't included a dental doctor or hygiene team for your dentist on that up until today. Okay, I will never go back. The concept of preventing leaky gums to prevent leaky gut to prevent disease, and let's just say all-cause mortality from that lens, is, is fascinating. So, uh, electric toothbrush for sure, uh, water flosser, which I invested in for myself and for my family, and I do recommend that to my clients. What about children? Should they be using water flossers also?

Oh, 100%. First of all, it's so much fun because it's a— it's an amazing water gun. So, you know, like next to your spouse or, you know, your significant other, you just kind of shoot it while they're next to you. It's so much fun. You have a water fight and kids are going to love it. But, you know, look, at the end of the day with kids, you just got to make things fun. You just got to make things taste good. You know, toothpaste. You just got to do things like that. And then they're going to embrace it and they're going to build these beautiful habits all the way through their life. So the short answer is yes.

Absolutely. Yeah. And it's— look, it's not denying that I don't understand the importance of oral health. From the time I was a little girl, my father, he's South Asian, he grew up with Ayurveda, and he would introduce me to massaging our gums. So every day, massaging our gums in the shower, often using essential oils and oil pulling, which is a trend right now. So let's tie this in, the trend of oil pulling. And you mentioned the bacteria in the oral microbiome and how that's related to the gut microbiome as well. A test that I did at Smile House was really understanding the bacteria that were deficient in my oral microbiome, which I need to start working on. So can you talk to us about, you know, what's right from the sense of oil pulling? How do we optimize the correct bacteria in our oral microbiome?

Yeah, it could get very scientific now. We test the oral microbiome as a basis. So you come to Smile House and you're going to come to many dental offices in the country and in North America that look at our salivary diagnostics and our microbiome testing as a standard of care. What you experience is we have all these things as standard of care that has not been embraced in dentistry yet, but it's on its way. And so you need people ringing the bell. I like to ring the bell. Like, you know, people who know me, they call me a troublemaker. But the truth of the matter is I like to ring the bell. Come on, everybody, we can do better. Yes, and we really can. So you have a basis of of salivary diagnostics, and that's baseline. That's before you have a cleaning or you got into better oral health habits and high— these high-performance oral health habits. And so now we have a basis. Let's say you have 2 or 3 chronic inflammatory areas. You got 4s and 5s, and those are measurements with a probe between where the gum meets the tooth. It's, it's— when it's healthy, it's called the sulcus. When it's inflamed, it's called a pocket. A pocket means it's swollen. Remember that, that epithelium now thins out and then you can get the leaky gums. Okay, so you probe, and when we probe, there's bleeding. So now we have the start of periodontal disease. Great. What do we do? We go take the patient through our professional regimen that's been figured out over the last 50, 60, 70 years. People at a place called Forsyth Dental created all the names, these fantastic periodontists, Max Lissgarten, Max Goodson. Now we have tremendous people there, Hatice Hastürk. And Tom Van Dyke. And these are the people that are microbiologists that have figured out what these bacteria are in the mouth, what are the pathogens, and how do we treat it. And these are the periodontists in dentistry, and they're really the people that are working hard to figure out this kind of microbiota. And what do we do from a service standpoint, from a therapeutic standpoint? We have to hit it with everything we have because many of these chronic inflammatory diseases, in fact all of them, are multifactorial. What do we mean? It's caused by a number of things and there are a number of risk factors. Okay. So if we allow the plaque and the bacteria, that biofilm, to reside on the, on the gums for a long period of time, the bad bacteria start to thrive. So when we, when we play it back, the, the, the home care that we develop, the ability to remove that plaque is so important because it doesn't set up and the gums will never get inflamed. So this is our thinking. And in dentistry and in Smile House, we take this, you know, we take this approach where you're teaching people the basics. And what we've taken for granted, think of these people who have developed techniques for a long time. You talk about the Ayurvedic medicine. I'm a big, I'm a huge fan of it. Oil pulling works, but you know, you're spending a lot of time. A lot of people don't have that much compliance and anything that's going to get the microbiome healthy. So you start with a baseline and let's just say PG is high and Fusobacterium is high and Treponema is high. We test again after our therapeutics. So if you had, if somebody had some chronic inflammatory disease, we run 'em through the therapeutics. We have lasers today, which, you know, there's something called the Lenape laser from Millennium. There's a Fotona laser that is a medical dental laser. It disinfects the roots and it, it kills those endotoxins, that bacterial byproduct. So there's conservative ways to treat these periodontal disease problems that sometimes you do have to do a surgical approach. Other times you can do it closed. The periodontists of today are expert at that, and we have many techniques because we've been at it now for 40, 50, 60 years of periodontal therapy. We, but we test again. So if people don't If people have these techniques in the dental office, so in the dental office with this specialty team, and, you know, in our world of Smile House and our JBL New York City practice, we have all the specialists under one roof. So we work very collaboratively. And that's, you know, I call it Grand Rounds for the Smile, but that's really what I believe is the future of the dental practice. And so we test our therapeutics, but if the patient goes home and they're not doing their their oral hygiene regimen and they don't have oral hygiene game, everything we did in the dental practice, forget it, it goes back to what it was. So you had a, you were a periodontal patient, you will become another periodontal disease patient. So it's, you gotta meet in the middle. People have to really get excited, inspired to really have a great game. And then the therapeutics that we have in dentistry today, you know, is, is pretty amazing to eradicate inflammation in the mouth. Mouth and to create barriers in the mouth that prevent this bacteria from getting into the body. There's all these new grafting techniques. And then if you lose the teeth, now we have, you know, implantology that is now 35 years old in this country since the late '80s. That is very predictable. But everything has to be in place. You still have to have a great oral hygiene regimen. You have to use the right tools. You can't, you can't be short on that. Yeah.

So this is really powerful because what I hear you saying is we're looking at these concepts that could come from ancient wisdom. We're now using the incredible aspects of science and text to really kind of advance whether it's modalities for treatment or assessment, which is key. And I am with you. I will scream from the rooftop with you now. I am such a fan of your work and my experience there, but what is it going to take to really democratize this aspect of dental care then? Because, you know, most people listening without experiencing Smile House, they maybe dread going to their dentist, hopefully a few times a year. Uh, it's an in-and-out visit. The doctor comes in and just tells you if there's something that's an emergency to take care of or not. They're not really recognizing this. And I believe like every single nutrition school should actually talk about oral health as a part of healing. Like, it needs to be one of the primary stages, as important as nutrition, as important as sleep and restoration and stuff like that. So what is it going to take to democratize?

Oh, I love you. I love that you went to the schools. So let's start there. Quick. When I was in medical school for the first 2 years, then I go over to dental school. That's Boston University Goldman School, my alma mater. Okay. Back then, there was not one nutrition course in medical school. Today, 55% of the medical schools only teach nutrition. Today, 2025, where we know nutrition is one of the pillars of longevity.

Okay.

Oral systemic medicine. That's what we're talking about. The connection of the mouth and the body. This has been well known, well known for 25 years. Remember when I talked about the COVID of Time magazine? So Moisey Devereaux and his Columbia team 20 years ago had the INVEST studies that had a definitive link to periodontal disease and cardiovascular disease. PGE2 was found in the carotid artery of cardiovascular disease 20 years ago. Okay, so oral systemic medicine is not taught in any dental school. There's maybe 2 or 3 that have a little bit of a course. Okay, I could keep going. So if the medical schools and the dental schools aren't embracing it, how is the consumer going to embrace Well, guess what? The consumer's going to embrace it. And it's people like you, Mona Sharma Sharma Sharma, who is gonna ring the bell, and I'm right there with you, and I'll do it with you. And people like myself that are motivated to say we can do better because the consumer patient is gonna walk into the dental practice and say, oh, where's my oral cancer screening exam? Oh, where's my periodontal probing? And if they are in a dental office that doesn't pick up a perio probe, So please tell the consumer patient, run for the hills because I'm sorry, that is a departure from the standard of care. You wanna be in the dental office that thinks of the standard of care at an extremely high level. And let me tell you, there's a business model innovation that's happening in dentistry in North America, Canada and United States that is changing everything. It started out, it was changing things maybe not for the good, and now it's moving in the direction, it's changing things. It's called the Dental Service Organizations or DSOs. So there are DSOs now are connecting medicine and dentistry. There's one specific called Pacific Dental. My friend who's the CEO, Stephen Thorne, he's a thought leader in this whole world. There are, there is Aspen Dental looking at it, Heartland Dental. They own 1,000, 2,000 practices. They can move the needle because now you have not only business people but chief dental officers creating a standard of care in the dental practice. Dentistry grew up with one dentist, one hygienist, one assistant for the last forever. Those offices are becoming dinosaurs, and God bless, they should be, because you can't have the level of accountability to hold people accountable to say, you have to embrace the latest science, you have to bring the latest technology here, and if you don't, you cannot be successful. Well, that happens when you have oversight and you have to hold each other accountable. And so the DSOs and multi-specialty practices like myself and multiple doctor practices that are focused on technology research and providing the highest level of care. That's where the future of dentistry is gonna go. And it's starting to really happen today. So I'm an optimist. I know you are, and I believe we're gonna get there. The question is, how long is it gonna take? How long is it gonna take?

Exactly. All right, let's make this go viral. I'm on a new mission now. I'm gonna get the word out.

Yeah, you go.

Let's go.

Let's go.

Let's go.

All right, so here's something I was really excited to talk to you about. Living in Los Angeles, fluoride has been one of the most debated topics ever, and I want to understand your point on this. A lot of dentists here, they're completely avoiding fluoride now, especially with children. In 2019, JAMA Pediatrics, they— there was a study about possible neurodevelopmental risk with high maternal fluoride intake. So it's like, it's controversial. We're told to use fluoride, especially for our kiddos, to prevent diseases. I know a lot of parents out there You know, if we go to the dentist here, we're like, no fluoride. We're looked at as sometimes an irresponsible parent. Also, you have some fluoride in some of your products. So tell us, are we using fluoride? Are we not? Is it safe for our brain or is it not?

Yeah. Okay. What's a good analogy for this? I, you know what, I have a great analogy for this. Whoever's listening, everybody understands what microdosing is, right? Microdosing, microdosing psilocybin, microdosing LSD, microdosing. Okay, these drugs can kill you. These drugs can make you happy. All right, there you go. Microdosing. So I'm just being tongue in cheek here, but the truth of the matter is everything is dependent on the dosage amount. Fluoride was the greatest public health breakthrough ever, with all due respect. With, oh my God, what's happening in the United States with vaccines and fluoride. The truth of the matter is we need fluoride to protect our children, but we can't overfluoridate them. Fluoride in high concentrations is a neurotoxin. And you could say that about every drug. Every drug, if you take too much of it, you're either— your liver's gonna shut down, your cardiovascular system, but it's all dependent on The dosage is— there's something called the dose-response curve in pharmaceuticals. Okay, so what does that mean? The American Dental Association, Canadian Dental Association, there's guidelines that have been around for decades and decades. Let us just not— let us do not discount the science. The science says a very low 6 parts per million in toothpaste. We don't swallow toothpaste. If you have Fluoride in your water. Do you need to have fluoride treatments and do you need to over-fluoride your children? Probably not, but you need to have some level of fluoride. So you just want to manage the fluoride intake. If you have fluoride that gets, gets to the baby, you know, during pregnancy in formation, the mom does have to watch her fluoride intake. Now you can minimize your fluoride. You could also use these new products that are showing promise like nano hydroxyapatite, but this still doesn't have the efficacy of fluoride. But I will tell you, if I had to go 12 months, 18 months, 'cause I'm, I'm talking to a number of these companies, there's gonna be a huge breakthrough with the microbiome and what these bacteria, the, the strep mutans bacteria that causes decay, it's around the corner and it has everything to do with our knowledge of microbiology and biochemistry. And this is how how fast things are moving. In 1950, it took 50 years to double the medical knowledge. Well, guess what? In 2025, '26, it takes how long? 72 days to double our medical knowledge. That's how fast things are moving. You talk to the singularity medical folks like Daniel Kraft and, and Ray Kurzweil, these people who are looking at the future. So it's amazing what is happening with our science and answer. So my short answer is you don't hold off on fluoride for your kids. Be conscious of the amount because you have fluoride in the water and then you have fluoride in the toothpaste and then you have fluoride, you know, at the dental office. That could be a little bit too much. So you just gotta be mindful. You gotta be mindful. If you don't have fluoride in your water or if you're filtering the fluoride out, then fluoride in the toothpaste makes a lot of sense. And you can look at other products with, with nano hydroxyapatite. And there will be a breakthrough very soon with preventing decay in the mouth. This is the number one non-communicable disease in the world. 3.5 billion people, you know, have problems with decay. It takes people out of their work. It causes emergency room visits where we don't have any dentists and we spend $4 billion a year on emergency room visits and they don't do anything but give people pain pills. You know, we have a system that obviously needs fixing, and us are individuals. What we've been talking about is for us to become knowledgeable about the pros and cons of these things. So fluoride, yes, you need, but it's the amount.

All right. And like, leave it to media to really demonize something the second they catch on to a specific study when there's no longevity to the study. And I'll be totally honest with you, like, I'm a holistic nutritionist. Fluoride was completely demonized, so I haven't given it to my kids. But let Let me preface that with my kids have amazing oral hygiene. They use electric toothbrushes. We're now using a water flosser. We spend time massaging gums and they've never had a cavity and they are 8 and 11.

And nutritionally.

And nutritionally. Exactly.

How much sugar, candy, and all that's the substrate that causes decay. So you've managed them through their behavior and their knowledge, which is beautiful. Which is beautiful. Which is a great thing for parents.

Absolutely. Yeah, but what I'm understanding— this is why I wanted to go to you, the source, to really understand— it's the dose that makes the poison, and that there are so many therapeutic aspects to it. And I think geographically too, looking at where we're living, the source of our water, how much fluoride we even know that we're getting. So be mindful of it, but what I'm understanding is there's an option to use it therapeutically, as you should for prevention.

All right, that's right.

All right, let's go back. You had mentioned, so, understanding how we breathe teeth, how we restore overnight. Mouth breathing is rising fast, especially amongst children. We look at children, we think that they're so cute when they're breathing with their mouth open, when it's actually not. It could be a sign of stress internally. What are the biggest consequences of mouth breathing over time? I'm guessing you're a fan of mouth taping as well.

Yeah. So let's start with the tilt because this is a really big point. There's a movement in orthodontics, one movement from the West Coast, from Sandra Kahn, the orthodontist from Stanford, wrote a book called Jaws with Pearl, Paul Ehrlich, and it explains things very well. Concept was developed in England by a man named John Muse, who was an orthodontist. He was so revolutionary that the orthodontic community took away his license. Just to understand what happens when you have somebody that's ringing a bell and people don't agree with. So Sandra's come up with forwardontics, and there's a number of groups that are really understanding in orthodontics. And what happens is if the children are mouth breathing during development. The mouth develops a very high palate and a very narrow jaw. Form follows function. So if the mouth, which was not designed for breathing— the nose was designed for breathing. It's a filter system. The mouth is the top of the digestive tract. This upper jaw, when you go like this, it's a funnel. Developing a V in the palate, narrow jaws. Guess what happens to the tongue? The tongue is now living in a studio apartment, but it has to live in a penthouse. That means the jaw is small. When the jaw is small, you need your wisdom teeth extracted, you need orthodontics, and you have orthodontists still practicing extraction of teeth instead of expansion, palatal expansions, all these things that we have, all these techniques to bring the jaws back to normal. So what has to happen, parents have to be very conscious that if the child is mouth breathing, which creates all these facial structural problems, which is also aesthetic problems because it creates a narrowness. There are so many things that they can do, but they have to go to the specialist that really understand these things. You have to change their diet. You have to look at therapeutics that's gonna widen things, and you have to make sure the nose works.

Works.

So if the child has rhinitis and stuffy noses all the time, or sinus issue where people have deviated septums, the nose has to work. The nose doesn't work. The only way you're gonna get air in is through the mouth. And now you're gonna have all these developmental problems. In the adult, it's similar, but you're having the restorative sleep deficiency. Because if you are breathing through your mouth and not through your nose, you can't get into deep reparative sleep. James Nester wrote a beautiful book called Breath.

Yeah.

And it's a fantastic book for the layperson and the professionals to read because for the professionals, they'll then unpack it and go deeper to understand what are the diagnostic tools that we have at our fingertips. And we'll have an appreciation for the new science. Much of this is the new science and research that has emerged in the last 10 to 15 years. And so the development, you know, and this, you know, I have to tell you, because we were talking about like Ayurvedic and bringing back these old concepts. In the 1930s, there were archaeologists in Dennis that were figuring this stuff out because they looked back at the skulls of 400 years ago. And sure enough, they saw that the people had these big, beautiful arches. They didn't need orthodontics. They had their wisdom teeth. And look today, narrow arches. So we call it the buccal I'm so busy doing aesthetic dentistry work with my specialists because we're expanding arches, creating dynamic smiles, because people grew up with a lack of development of their jaws, which leads to all these systemic inflammatory issues. So what's the message to the parents? Get to the problem as early as possible. Find these specialists that are embracing facial aesthetics and this kind of concept of expanding the arch when it's narrow. Grow. And you know what came out of the study from the skulls of 400 years ago is that soft diets and bottle feeding causes the jaws not to develop wide. And that, you know, was a great concept that James Nestor has brought to the public. And this was all based on his, you know, his authorship and his research from the scientists that put all this time in to understand it. So what the message is to my specialist colleagues is you gotta embrace the new science, you gotta embrace the research. And there's a, there's a company called Myosa that came out of Australia that is not only looks at the expansion necessary in the jaws, but it looks at sleep, airway, and myofunctional habits as a continuum using these, these devices. And they have it for children and adults. And it's a wonderful technology. Very few specialists in my industry know about it yet, but it's gonna be a very big movement because sleep and sleep disorders Alzheimer's are becoming, you know, such a huge problem for adults because of our lifestyle, because of the things that we eat, because of alcohol, because of sugar. And so we can get ahead of all of this. And it's just, you know, just kind of embracing the new science and technology.

My jaw dropped, pun intended, when my son's orthodontist was talking about the structural changes that he's changing, the evolutionary concept of that. Us. And, uh, through our modern-day lifestyle. And my biggest pet peeve, when we walk down the kids' food aisle, everything is soft, it's processed, it's packaged, and that's making up the bulk of our kids' food. And for my son, he's wearing an expander, and I was like, is this really necessary? He's so young, it feels like trauma. But the orthodontist said, well, chances are he's probably going to live until he's 120. Do you want him to have his teeth I was like, yes, I do.

Your orthodontist, give him a hug, or him or her, or a her. You know, that's it. And, you know, the orthodontists, they're not 100% in on this. You still have schools that are teaching extractions and you're making jaws smaller. No, there's no reason to do it. You have to expand the jaws. And the earlier you start, the easier it is because we have a suture line in the palate. Palate that gets expanded, and they're all stem cells in there. So you expand and you get bone formation, bone formation. You get these beautiful jaws. So you have greater function, and you know what you have? Gorgeous aesthetics. You have this big, beautiful white jaw. I have that. My own son Cody, who you met, I had him at an orthodontist that I thought was a great orthodontist. He wanted— my wife calls me up, she's over there, and he wanted to extract 14. I said, what? And this was how many years ago? 32 years ago. So 20 years ago. I said, no, let me send him over here. And sure enough, they understand the whole concept of expansion. And he's got this big, beautiful smile and he still has his premolars.

God bless.

Nobody took out any teeth. But, you know, you got— parents have to do their homework on this because there are schools of thought. And I'm sorry, but I would have an argument with every one of the ones that want to take out teeth. I don't understand the rationale. When you, when you see a small jaw, you really have to expand. And what happened, just so you know, orthodontics was very focused on tooth-to-tooth relationships. They were not focused on structural things that impact our health, airway, nasal breathing, what the mouth is really, you know, determined to do evolutionary. What, what does the mouth do? What does the nose do? Now that we have that data, That's it. The jury's out on this. This is it. You have to have the specialists that are gonna create gorgeous aesthetics and great function to set you up for the rest of your life. What your orthodontist said was, we can take it one step further. He's gonna live to 120. We want him to live to 120. And we want him to be void of these chronic inflammatory disease.

Thank you for affirming that. And yeah, to your point, there's such a bigger picture to it when we think about children, just the level of stress and anxiety that they are introduced to. In this world, if they're not breathing properly, then we're not even giving them a chance. So it's just another way to, to look at the benefits of this. All right, let's tie this into— for our listeners now, I get questions all the time. Charcoal toothpaste, whitening powders, hydroxyapatite toothpaste— which ones can concern you the most? Which are the most abrasive? We're hearing charcoal now is not the best idea. Where are you going?

Yeah, yeah. So there's something called RDH, which is aggressivity index, and there's independent, uh, laboratories that test all the toothpaste. It's gotta be below 70. You have toothpaste that are 200, 220. Charcoal in itself, it's, if they didn't micronize the charcoal and make these very fine powders like they do with silicas that are in toothpaste, you're gonna have a high R-D-H. You could look up your toothpaste. Thank God for ChatGPT. They can give you a nice list. God bless. We love ChatGPT and everything else around AI. And you look at their numbers. If you're using a toothpaste that has an R— a high R-D-H, change your toothpaste. You want a low abrasivity index because you don't wanna scratch your enamel. When you scratch your enamel, you're gonna make it more prone for the plaque bacteria and stain to stick into. There are these tiny little microcracks. So low abrasivity index for your toothpaste. Yes. What else did you ask about? About that.

So hydroxyapatite is great, you know, you got calcium and phosphates.

What happens with the tooth is that you get uptake in our saliva is calcium and phosphates. The saliva has been designed by the man upstairs in evolution, and Darwin was 100% right. We, we evolve. And, uh, in our tooth, in our saliva, it's designed to protect us. So what does it do? It buffers our mouth. So when you went to Smile House, remember you had a pH Why is that important? If your pH is acidic, your environment for your bacteria goes to the pathogenic side, to the bad side. If your pH is low, you're gonna demineralize the teeth. What does that mean? That means you're going to take down the mineral decay, loss of enamel, which is like losing the insulation of a wire. So people have these abfractive lesions, these V-shaped notches. From the acid and from clenching teeth or toothbrushing too hard. You see in that, we see enamel loss from sometimes from gastrointestinal issues, GERD, acid reflux, that gets acid in the mouth. So pH testing has to be a standard of care in dentistry. It is not yet. So you wanna have buffering in that saliva. In the saliva is calcium phosphates. HA has calcium phosphates. Calcium and calcium phosphate. So you're helping it go back into the saliva and help remineralize teeth. You just want active ones. And the beauty with nano-HA, nano-hydroxyapatite, is they're very small particles. They're down to 10����, 10���� nanosize. So you get better uptake onto the surface of the enamel. The good news is, and the dentists that are on top of this, there are new peptides that are being developed by a number of companies. That are remineralizing the teeth. CuraDent is one of them. There's a number of them that are coming out. And what's happening with the peptides is it's getting onto the surface of the tooth. There's some new breakthroughs. I have another company I'm working with in London, super exciting, using a very interesting, interesting material and molecule to remineralize teeth. So that's what's exciting because literally in the next 10 years we're going to see so many improvements. That people will not have an excuse for having decay or periodontal disease. Now we just gotta be very proactive and go after it.

Right.

You know, now, you know, what you did with your kids and your knowledge that drove their behavior and, and, you know, really giving some, a nice level of discipline in all those important verticals is, is what really parents have to do. And, you know, and we have to live it ourselves, right? You can't say you gotta do this, but oh, there you are having a Snickers bar, with all due respect to Snickers.

Exactly.

I mean, you know, you got, we, we gotta walk the talk. As they say.

You got it. Yeah, we're imprinting all of our rituals on them. Um, you brought up a good point too. So when we think about this, you know, the quality of my enamel has always been important to me. And I think that just like with our health and our nutrition and our body image, when it comes to the way that our teeth look, we want the quick fix, we want the fast, we want the now. And looking back, I don't think that a lot of the harsh whitening treatments that are out there have been the safest for our enamel or for our oral microbiome. So what do you say, like, is over-whitening or DIY whitening products, are they damaging our teeth? And please tie that into the JBL tooth whitening system. That's what I use and it's been a game changer and it feels very gentle, feels non-abrasive.

Yeah.

You know, our system and, you know, I started a company 10 years ago called Glow Science. We have 24 patents on medical devices and the mouthpiece, which has light and heat, and there's a lot of companies that came out with their version of it. What happens with whitening, and I really studied this a lot, what happens with whitening is when you oversaturate the tooth, what you're talking about, when you use it too much, these DIYs or the over-the-counter products, you're gonna demineralize the teeth because most whitening products are, have a low pH. So neutral is 7, anything below that, 6, 6.5, 5.5, 5, 5, 4.5. And our stomach acids is, you know, just a little bit north of 2.5. So you have this whole range of low pH acidic environment. I mean, let me give you an example. Oh geez, they're gonna kill me if I say this, but I'm gonna say it anyway.

I love it.

Yeah. Yeah. I know there, there, there are these beverages, I'm not gonna name names, but they're very low pH, they're acidic. And if you drop anything like a tooth, which by the way is the hardest substance of the human body is the tooth. If you put it in those sodas, those sugary drinks, I'm not gonna name any names.

Yeah.

That tooth is gonna disintegrate in a matter of days. That's just what happens when we drink those sodas. And you mentioned ultra high processed food and what that does to our human body. Okay, fine. So these, look, this low pH is something that we really have to understand and we gotta realize you're in the nutritionist. So you're really ringing the bell. We have to say to ourselves, what are we putting in our body?

Body.

And we have to be very conscious of this. So understand this acid-base balance, what the buffering effect of saliva does, and what these products can help, uh, add to what's already in our saliva, like the calcium phosphates, the NanoHA. But technology— I'm so excited about some of the new things coming down the road that will make it easier for us to have a healthy mouth.

So brilliant. Um, yeah, and I think that anything that feels harsh or abrasive Just walk away from it. It's not worth it.

Walk away.

And what it's doing for you, your body's speaking to you.

Exactly. Exactly right. And we see it all the time because when you have force, clench and grind your teeth, we only put our mouth together when breakfast, lunch, and dinner, about 14 to 15 minutes a day, right? We swallow 200 times. We put a certain amount of pressure on our teeth, but the teeth barely really touches as we're chewing.

Chewing.

But where is the damage? The damage is parafunctional habits when we clench and grind our teeth either at night and during the day. And guess what the breakthrough science is, Mona, is that it's myofunctional problems and sleep problems and airway problems. 90% of people with sleep disorders and myofunctional problems, 100% grind their teeth. So for the last 100 years, we thought it was how the teeth cope together. That's one of the contributing factors, these prematurities in the bite that act as a trigger to our CNS, our nervous system, to, to kind of feel our teeth. But a lot of it is because the jaw wants to move forward. When we have a lack of airway space and we can't get the air down our throat, we autonomically will move the jaw forward and start grinding teeth. So the tongue moves forward. The new myofunctional traditional moves to get us to get into deep sleep is to put the tongue right behind the front teeth. And when you're sleeping, lips together. So the lip seal is in. That's what lip mouth taping you talked about earlier puts the lips together. So we nasal breathe. It's a great diagnostic tool because if you can't put this mouth tape on for longer than 10, 15, 2 hours, 3 hours, that means you got to breathe through the nose. Well, here's the good news. We can learn if the nose is working. And a lot of people have a little bit nasal obstruction, but they breathe through the mouth a lot also. We could learn to stop breathing through the mouth and we could use the nose. And then if you have nasal obstruction and deviated septum or some type of issues with inflammation in the sinuses, that is of course fixable. And that's your ENT. We make so many referrals to our ENT specialists because now we can diagnose this in a standard of care way. As you noticed in Smile Ons, we can diagnose these things.

So listeners, please send this to your family and loved ones, especially if there's someone that you're noticing is breathing with their mouth open. It's a sign of love. If they are grinding, if it means that they're not breathing properly— if they're not breathing properly, they're not tapping into their parasympathetic nervous system when they're supposed to be restoring. You could be giving them years to their life back. And I want to go back to that pH question just for a second. I think it's important. Um, I'm the nutritionist that doesn't like taking coffee away from people. And I'm also a nutritionist, very aware of the trend of apple cider vinegar, which I think people are overusing, and I think it could be impacting their enamel. Where do you stand on that?

Apple cider vinegar, lemon water, all these things, if they're acidic, take a pH strip. You can buy it in the drugstore for about a few bucks and just dip it and see what your pH is. If the pH is lower than 7, you're in an acidic environment. If you're drinking it a lot, you're now bathing your teeth in acid. So that's the, that's the answer. That's the answer. If, if the, look, the, the, the beauty of fibrous foods, you know, we have as a nutritionist, I'm sure you talk about this, alkalizing versus acidifying diet. Our alkalizing diet is all of these fibrous foods that absorb a lot of this acid. So even though you can say, hey, you know, an orange might have a low pH, but you're in this fiber that absorbs it. So it's, it's okay. You're not gonna demineralize the tooth. But if you're really getting into sugary drinks and low pH type drinks, that's gonna be an issue because that's not only are you demineralizing the teeth with low pH, but you're adding sugar as a substrate for your bacteria, right? Your strep mutans to have a field day because that's what breaks down into the acid that then causes decay cavities. And as I've said, all of of that oral health problems really happens between the two teeth because that's the hard to reach areas. So people gotta be a little bit of a maniac with their oral health game. Oh yeah. Whether you're oil pulling, flossing, water flossing, electric brush that gets the outside inside, but really getting into the between areas. When people know that and you're dedicated to your health, then it becomes just like going to the gym, just like going to do some yoga. You're doing things for yourself and for your body and it becomes part of, you know, your daily regimen.

Absolutely. Uh, yeah, I think, um, they're all rituals. You just have to practice them long enough and then they become you. Two more questions before we wrap things up. Uh, I want to just give a shout out to women, especially now with the rise of awareness with hormonal changes and stuff like that. How does pregnancy, perimenopause, and stress showing up in the mouth— noticing how estrogen fluctuations really impact our gums bleeding and over time through perimenopause having a drier mouth and oral decay and stuff like that. So can you maybe just give a call out to like specific practices? So we've talked about the, the essentials from electric toothbrush to water picking to the right toothpaste, the pH as well. Um, I'm a big fan of tongue scraping every single day. I actually could not live without my tongue scraper. Are there any other things that we can do throughout these hormonal shifts that we go through to prevent these imbalances?

Yeah, it's such a great question. Does people need to know if saliva is decreasing, one, as we age, but also because of some of the therapies we have to have if we're fighting a disease and, and some of the pharmaceuticals we take that lowers, lowers saliva flow. You gotta be maniacal about your home care because remember saliva buffers our mouth. Without saliva, you're gonna get root decay as we age 'cause our gums are seed. The roots are exposed. There's no enamel on the roots. So you have to know that from the beginning that your home care game's gotta be a 10 plus. But on top of that, you can also have a diet that's more alkalinizing, which is more— is happens to be a healthier environment, right? It's the environment we put our body in. And so what applies to the mouth applies to the, the, the— what applies to the mouth applies to the body and bidirectionally. It's the same thing. So diet is so critically important. So alkalizing foods, that's gonna raise your pH. Acidifying foods is proteins. So meat, fish. And usually we say it's a 60-40 balance, 60% alkalizing, 40% acidifying. 'Cause of course we need protein for structural elements and so important. But then on top of that, on top of a great kind of home care regimen, there are There are over-the-counter type products that have enzymes in it that does have a nice effect to help buffer the mouth. So one of the early ones is a company called Biotene. People know about it and there's some help. The dentist also can do topical fluoride, which is very helpful where you put a little bit of this extra fluoride on top of your toothpaste. And it's very important, you know, for people that do have low saliva flow and it's the ability to get into your, your dental team, you know, and we call it oral wellness, by the way, and this oral wellness team is gonna get ahead of these problems. So when you get to a root decay problem, it's very important to get to the dentist every 3 to 4 months because you wanna get as early as possible. 'Cause when it's a little bit of decay, no problem. But the thing with root decay, it's only about 2 millimeters to the nerve. All of a sudden, in a matter of months, you could have decay in the nerve. Now you need a root canal, or if it's way gone and way under the bone, now you need an extraction and implant. All of a sudden you have this very expensive traumatic type of dentistry. So just by showing up a little bit more and increasing your visits to the dental office is gonna have a, a huge, a huge impact to get ahead of, of these type of oral health issues, you know, and, and, and, and that's really important. And pH testing, you know, I, I want you to listen to this to, to nudge their professional. Can you pH test my mouth? Can we look at the salivary diagnostics and what is my microbiome of the mouth? And there's a company called Oral DNA that's been around for about 15, 20 years. Excellent company. Dentists use— there's Bristle out of San Diego, a tremendous, great company. That's who I like. There's a number of companies that are new that are going to come into this field and it's going to allow the professional to really have a baseline to understand, well, are you high in strep mutans? That's decay. Do you need to go on a probiotic? That's Streptococcus salivarius that competes with strep mutans and it knocks the mutans out so you don't get the decay. Do you have these pathogens in your mouth? So how do we increase the commensal bacteria, the good bacteria? And that's the balancing act. Well, take this probiotic. And so we use probiotics a lot in our practices because we have a baseline. Of what the microbiome of that patient's like. And when we think about it, you know, when that balancing act of the mouth and the rest of the body, having these diagnostics tests are critical to getting upstream to the wellness approach. This is what we're talking about. And so you have to have back to the care team that is embracing technology, embracing science, and putting it really to work in the patient delivery system.

System. And do you think in terms of like teeth grinding and stuff like that, are there mouth guards? We have all the craze around microplastics, right? And wearing this plastic device in your mouth overnight. Is there a brand or in your practice, are you aware of this? Do you see something in the future?

I think it's an emerging science. There's a material that just came out of Germany last year that we're looking at. Some of the plastics, you know, a number of these companies were 3D printing night guards now, we're CAD/CAMming them. Them on our, on our machines. A number of the plastics are much more biocompatible than others. The BPA plastics, obviously we don't use any of that. But I think it's an emerging science and it's something that's going to be out there in the next couple of years where you have night guards that are made out of materials that are completely biocompatible. Not there yet, but hopefully coming.

Yeah, beautiful. I'm happy I asked. All right, let's end this conversation by giving your listeners a protocol, right? So if they were to do an oral microbiome routine in the morning, what should it look like? And what should each step be specifically to really lay it out?

Okay, so I'm gonna just talk about our oral health regimen guide that I, I would love you to make available. Yes, because it just gives people that information, but we like to get the pH up right away. So we use Immunity Rinse from TWICE, which happens to be, and I'm completely biased, I want all your readers to know, listeners, that I'm biased. That's my son's company.

Yeah.

That of course is a family affair, but it really is a phenomenal product. And any product that doesn't have antibiotics, that's natural sodium bicarbonate, low-level hydrogen peroxide, and all these vitamins and antioxidants as a rinse. It's two chambers because you can't put those together. So it's two chambers. So when it comes to the top, that's when they're mixed. And so what you're raising, you're raising the pH, which is what we wanna do. And you're oxygenating the mouth, which what does that do? That kills the bugs that cause the inflammation. So we start with that immunity rinse from twice and then electric brush, 5 times more effective than manual brush. Doesn't need a lot of technique. Then I like the water flossers because it gets in between and flushes. And then I like the floss picks because I don't have to do the brain. And then we love the tongue scraper. Of course, it's just like between the teeth. You have those little nitis, these little papillae where the bad bacteria, gram-negative anaerobes, go into those areas. And guess what it emits when you don't clean it? Volatile sulfur compounds, VSCs. That's what gives bad breath. So you, of course, you can do that. And what I follow up with, with another shot of the immunity rinse, which you give a pump, you rinse it again, And now you're ready to go. I have timed myself. I'm at it for about 3 and a half minutes.

Yeah.

That's all it takes. That's the beauty of going bang, bang, bang, bang, bang. You do that in the morning and you do that at the night and you're ready. You're ready before you go to sleep to calm down. And of course you're ready to get energized in the morning. And you have to have this routine, oral health game. You gotta develop your game and it's gonna really help you for all of us to live to 120, Mona. That's where we're shooting for.

I love it. With beautiful smiles. We will make that guide available to everyone. Is there anything different about your nighttime oral microbiome routine than from your morning?

You know, look, if you wanted to, a lot of times people do not do the water flushes. They just do it at night. I do it, I do both. So you can see the guide. I like to do what I do in the morning, I do it the night. You know, but sometimes you're rushed and sometimes you got a meeting, you know, so you're a little bit rushed and so, you know, you kind of missed it. That's our, you know, our sliding sideways on our high performance habits. But we know we're gonna bring us back to the middle and get real good again. But, you know, we know the standard. We know the standard. Yeah.

Dr. Jonathan Levine, I am now your greatest fan. What an honor to meet you.

Sweet. Oh, so nice to be on with you, and I love your questions. And yeah, thank you so much.

I can't wait to be with you. I'll come check out and meet with you and your family in New York. Uh, in closing, tell us, tell me something that you're excited about in the future.

Um, I think one of the things, there's many things I'm excited about in the innovation world. Um, what's happening with our, the molecules that we're creating, whether it's a peptide, whether it's a remineralizing agent, whether whether it's a way to figure out how do we disrupt certain bad bacteria in a way that doesn't take on a negative pharmaceutical approach, meaning that you can have any side effects. So I'm, I'm very excited about that in the future. But the thing that I decided to do, I have a podcast for my industry called Think Oral Health. We have a book coming out. So obviously my, my passion lies in the ability ability to really make change in the industry, to be a troublemaker and a change agent. And that's why we did Smile House. So I did Smile House. You know, here I am, 35 years plus in dentistry, and instead of many of my colleagues starting to back off, I've leaned in. And I've leaned in because I wanna really shine a light and illuminate the future for my profession of how medicine and dentistry can, can connect. And I learned through my foundation, when medicine and dentistry connects in where we have our foundation in, in Elluthera with Lenny Kravitz, our Glow Good Foundation, we saw what happens when we work together. And that's what was kind of a catalyzing moment. We've been there now for 12 years of when we do work together. And that's when I said, let's go build a clinic that medicine and dentistry can connect. And that's what we're doing at Smile House. But we're doing it in a way that I I believe can illuminate the path for dentistry to say, this is what I want. For the young dentist to say, I think that's great. I wanna go after that. And so that's, you know, that's what I'm very excited about when I've put my efforts behind. And it's an absolute joy to do it with my family. My wife is the culture queen. She's the head of culture because she gives the love. She's also amazing at design and why it looks like that. We give credit to Stacy. And my two sons, are deep in the, the, the business and my team from uptown. We have 27 people from JBL New York City, all specialists. Now we've added people to the team, so we have about 38, 40 people between the two offices. And we're really looking to, you know, really shine that light on the profession where medicine, dentistry can work together, where the specialists are all together under one roof, and where the patient experience exceeds their expectations. You walk into the place, place, and it's nothing like a healthcare facility. It's really something that's engaging, and that's what we're working really hard on doing.

I walked out feeling restored, as I said, and I absolutely love the pictures with Lenny Kravitz and all the beautiful children. You could see the before and afters of the work that you did with them to give them a beautiful smile. So I am your greatest cheerleader, and I hope our listeners now all go and book their dentist appointment and figure out if they have their care team, and if it's not the right you walk out and you find the right person. Thank you so much for all your knowledge and insight, and I'll see you soon.

I'll see you soon. Great to be here.

Wonderful.