Your Mouth Has 700 Bacterial Species—Here's Why That Matters for Your Brain

Did you know that our mouth has over 700 species of bacteria living in it right now? And the balance of these bacteria is directly driving whether we have brain fog, bleeding gums, heart disease, even Alzheimer's. The good news? We can actually reset it, and most of it starts with 3 simple things we can do even tonight after listening to this conversation. Okay, so I've been going deep down this oral health rabbit hole. You all have heard me talking on other episodes about oral health, but today I'm obsessed with what I'm learning specifically about the oral microbiome. You know, our mouth has all these species of bacteria. Some of them are good, some of them help us with our health. They support lowering blood pressure, they support digestion, they even help produce nitric oxide. And some of them are also bad though. They're what cause the bleeding that we see, brain fog, bad breath, or even plaque in our arteries. And here's what nobody has been telling us: in menopause, estrogen drops everything in our mouth. Our saliva drops, your gum gets more sensitive, and you're more prone to bleeding, recession, bone loss, Even the antibacterial mouthwash that you've been using for 20 years. This is making everything worse. Today's guest is gonna fix all of that. Dr. Sonda is a double board certified periodontist and nutritionist, one of the most respected oral health experts in the country. She's the founder of Beverly Hills Dental Health and Wellness, and she's created the OraSana line of oral probiotics. She's the author of Heal Up, and she's spent decades studying the oral microbiome. She's about to tell us the simple things we can start tonight to reset. Dr. Sandoz, welcome to Midlife Conversations.

Thank you so much for having me.

You know, I learned about you from our good mutual friend Laura Frontero. My audience is very familiar with Laura. I call her the Gut Genie. We've done many episodes about gut and our health and what's linked, and I was telling Laura that I can't believe I missed this whole area for years about oral microbiome. And the Gut Genie, Laura, surprised me because she said that's actually more important than our gut. Like, we have to start there, which I thought was mind-blowing to me. Can you tell me why she said that?

Yeah, I love Laura, and I've been working with her for several years. We have mutual patients in common. So why the mouth is the opening of the GI tract, and I know a lot of people don't think of it that way, but that's where digestion starts. And it's the one place in the entire digestive tract when we can introduce different foreign chemicals like foreign fillings, right? Crowns where bacteria and even mold can lie underneath silent for years, creating health problems and people don't even know it.

Oh, okay. I have so many questions today, but I want to back up because I want to explain to listeners that don't know a lot about teeth yet and the mouth and gums, just kind of the difference between professions. Like, you happen to be a periodontist, you're a holistic one, you also are a nutritionist, but can you just give us like a little rundown, like difference between periodontist, oral surgeon, general dentist, cosmetic, like biological, just so we have a baseline of what that is?

Yeah, definitely. So traditionally, a periodontist is someone that specializes in the foundation around teeth. So peri means around, And dentis means tooth, so everything around a tooth, the gums, the bone, sinuses. So an integrative periodontist, which is what I do, means that I'm actually looking at how does the mouth, the oral microbiome, the gingival health impact the rest of the body. And we are looking to how we can affect the body in a positive way by making therapeutic modifications in the mouth.

Okay. So when you look at like, what does an oral surgeon do? Are they specifically just bone? And then tell it like, what is a general dentist? Mostly just the teeth? Do they— what is their role with gums and area around?

Yeah, great question. And you know, a general dentist can be different depending on where they went to school, like what kind of continuing education classes they've been taking. But generally, a general dentist actually deals with anything above the gums. They typically look at teeth, and most traditional dentists actually just look at teeth and teeth only. Very few dentists actually can correlate teeth to the TMJ and to the whole facial structural health. And even less dentists— general dentists, that is— correlate the mouth with the rest of the body.

Okay. When you look at an oral surgeon, they're just bones specifically. So like, what would a general dentist typically refer to an oral surgeon, and what would they refer to a periodontist?

Yeah, so a general dentist typically would refer to an oral surgeon wisdom teeth extractions. Okay, that's the general, or something called a Le Fort procedure, meaning somebody's jaws are out of balance, out of place. They're trying to align the teeth and they're now having to do surgery to move the jawbone back. So they're mostly, uh, doing that jawbone surgery. They're called maxillofacial surgeon. Some oral surgeons might have an MD degree so they can do plastic surgery. Some of them actually will have that kind specialty. A general dentist will refer to a periodontist when they're looking for gum health. And also, a cosmetic plastic gum surgery is actually when we're reconstructing the smile. It's when somebody has a gummy smile, for example. A dentist will send the patient to a periodontist to realign and re-sculpture the gum tissue.

Now, do you feel— I've seen that a lot of general dentists will typically do a lot of things that should be referred to a periodontist or an oral surgeon, but they've been doing it in their own hands. Do you see that, or is that just something I've happened to notice on my own?

Yeah, and it's interesting because in Europe, the general dentists there are more equipped with different tools. I think that differentiation and through specialties is more popular in United States, where, okay, if you have a gum problem, a periodontist is more fit to take care of that gum problem. But generally speaking, In a general dental office, we can treat gum disease. And how do we treat gum disease? You know, we do a deep cleaning. I think a lot of people are familiar with that, but typically surgical type procedures are done with a periodontist.

Okay, now when we go to our regular dentist, and whether it's a biological dentist or a regular general dentist, and then you get your teeth cleaned, they do something called charting where they're going around your teeth and they're, they're looking for plaque, but they're also reading a number which is about gum recession. Can you explain what that means and what When is it problematic?

Yes, and charting is something very traditional in periodontics. In today's day and age, I highly recommend digital photography, even if you're a general dentist, let's say. Why? Because a photo tells us a lot. A photo speaks a thousand words, where a chart only gives us certain numbers. So charting has been around in periodontics for like decades. Digital photography, not so long. So what do we chart? The distance from the gum to the bone, We chart also gum recession. We chart if whether or not the tooth has what is called a furcation or bone loss underneath a tooth, especially in the back, back teeth area. We chart something called tight gum tissue or keratinized tissue, meaning is the gum around your tooth protective? These are all the things that we chart. We also chart tooth mobility, meaning are the teeth actually loose? Important to chart this.

Now, when you hear numbers, and I know you said the best way is really the images, and there's other ways to track, but when you do hear a number, like you hear 2mm, 3mm, 4, what is like the danger zone?

So when you're talking 2 to 3mm, it depends whether or not we're talking about the pockets, though we refer to the pockets, or are we talking about gum recession? And I can—

oh, they're different. What's the difference between that?

Yeah. So the pockets are something, or is a distance between the gum line, underneath the gum, towards the bone, but not quite all the way to the bone. So in health, we wanna see 2 to 3 millimeters. Sometimes 4 is okay if it's not a bleeding pocket. What we're more interested in is that pocket bleeding. Super important to know. So it's not just the number of the pocket, but is that pocket bleeding, which is also chartable.

So if it's bleeding, what does that typically mean?

If it's bleeding, that means we actually have an ulcer, very similar to a stomach ulcer but underneath the gum, and obviously a lot smaller than a stomach ulcer. And it's actually caused typically by bacteria. So if it's something that's bleeding just on touch, that lining inside the pocket, which is made out of epithelium, is now gone, creating an ulcer. And this is due to inflammation or activity underneath the gum.

So I'm going to ask you about floss in a minute and when it bleeds there, but before I ask that, when you said there's different types of recession and sometimes it's bleeding, if it's not bleeding and you— they say you have, you know, call it 3 millimeters and then all of a sudden it's 4 millimeters but it's not bleeding, is that still an issue?

It depends on the microbiome. So typically if somebody comes to our integrative dental office and we see gum recession generalize more than 2 millimeters. We see gum pockets that are, you know, 3 to 4 millimeters, even though they're not bleeding. We will do an oral microbiome test, a saliva test, because numbers don't tell us everything. This is how periodontics has changed in the last, I want to say, 10 years. As these PCR tests of saliva have become more popular, now we're looking at what is your microbial fingerprint and is it causing gum recession. Can we stop that gum recession by reversing the microbiome? So that's a super important piece of information in order for us to determine course of action. Okay.

And would that be the same thing if you're flossing and bleeding? So if you're flossing and you're constantly bleeding in a certain area, what does that mean? And aside from the fact that if you never floss and then all of a sudden you go floss, you're probably going to bleed. But assuming you're flossing and now, but you're regularly bleeding in an area, what's the difference? When, when is it, when do we know that's problematic?

It's the microbiome. So if somebody's flossing but they're constantly, continuously bleeding, most likely they have an aggressive type of pathogen, meaning a disease-causing bacteria, that must be addressed. And typically these kind of aggressive bacteria lives deeper in the gums, and they're very resilient. They just won't go away simply with flossing.

Now, you talk about oral microbiome and testing for that. This does not seem to be standard of care. I've had that test a few times, because I go to a biological dentist, but most people have not. Why is it not standard of care? Is it because people don't know how to treat it, or what's, what's the reasoning behind that, and how does one test for it?

Yeah, and you know what's interesting, the oral DNA test, which is, uh, I don't know if that's what you had done, but it's been around, I want to say, about 15 years. I started using it more than 10 years ago, and the problem is, number one, is education. It's not something that's being taught in school. And secondly, for the longest time, people didn't know what to do with the information. You know, that's the biggest problem. But I love the saliva test, especially the oral DNA, because it reveals 11 different types of bacteria that actually trigger not just gum disease but heart disease, dementia, Parkinson's, metabolic issues, cancers that we can see in the mouth. And we can try to reverse this oral microbiome. We do have a second test which I really like. This is a more recent test that's coming from Europe. It's called the Oral Fitness Test, and, uh, it's very new to the United States. Probably, um, you haven't had this one done. What it does is still a saliva test, but it actually measures the breakdown in real time of the gums. So what is the inflammation today? So let's say you have the oral DNA test, we find a different bacteria. That bacteria will affect two different people two different ways. For somebody, it might be really inflammatory. For somebody, it might not, based on their genetics.

Okay, so this is kind of some wild information. So when you take the test, which I did, my dentist said you need to have your husband take it too, because usually you'll both have it. It is absolutely contagious. It goes back and forth. So, if one of you have it, the other one does. So, me and my husband both took it. We had almost identical, but he was higher in some levels and I was higher in some. So, you— when you do this, you can't just do this for yourself. You have to almost treat your— you have to treat your partner too because otherwise you keep giving it back and forth, I learned.

Yeah. I'm so glad you brought this up. You're absolutely correct. That is transmissible. So, what does that mean, right? Through kissing, you can transmit this bacteria to your partner and then it just lodges into the biofilm. Or the, you know, the layer of plaque, and it can live there.

Yeah. So, we had heard, all of us listening have heard before, like, oh, gum disease or periodontal disease links to heart disease. But I want to— I think it goes over a lot of our heads because people are thinking, well, I don't have bleeding gums, or they're assuming that. I don't either. I didn't have any bleeding gums. My teeth look good. I don't have any cavities. Like, everything looks good. But me and my husband both had these bacterias, which when I really went into the bacterias, all of them linked to not good things. Like, we had a huge marker for heart disease, which was It was wild to me. So, when you see these markers, I think my initial reaction, everybody's initial reaction is, "Well, I want to kill the bacteria." Can you talk to us about the idea of killing it versus like figuring out the root cause and where it's coming from?

Yeah, definitely. And, you know, we cannot kill the bacteria. We are outnumbered 10 to 1. There's 10 times more bacteria in and on our bodies than there's human cells. So, we're never going to win that war. That's why I'm very much against people using harsh mouthwashes even if they're natural. Tea tree is very popular. It's not a good thing because what ends up thriving is pathogens in that environment. So it's super important to reset the oral microbiome, not think about killing everything, because actually in a sterile environment we can actually have more problems.

So when I heard that about—

not—

so I don't— we don't use things like Listerine or any of the traditional ones. However, we then started using something called dental seitan. Is that still doing the damage, or is that a temporary— that's supposedly a more natural way to kill the bad bacteria. Tell us about that.

Yeah, and I like dental seitan if somebody has periodontal disease. So in today's day and age, we have to personalize our care. So what exactly is, you know, the problem that I need at this point in my life? For example, you know, I'm 50, I'm a woman, so I want to protect my enamel as much as possible. I don't have gum disease, I don't have bleeding gums, so dental seitan would not be my go-to. I would want something that would strengthen my enamel.

Is that the hydroxyapatite, something like that?

Exactly, calcium hydroxyapatite. I think that's great. There's good studies of strengthening enamel and reducing sensitivity. Uh, some women, especially with the menopause, can actually start experiencing drier mouth, change in the oral microbiome because of the dry mouth. So it becomes even more important to make sure we mineralize that enamel because with dry mouth, the enamel can get thinner.

Can you still use things like calcium hydroxyapatite to strengthen enamel if you have veneers or you have crowns on your teeth, if you have cosmetic dentistry in there?

Definitely, because at the line where the veneer meets the tooth, and especially veneers on the back side, right, there's a connection there. The calcium hydroxyapatite will still help strengthen that part of the tooth. Makes sense. Yeah, I mean, I love 3 steps, and I always talk about the 3 steps to optimum oral health. Okay, brushing, water flossing, especially if somebody has veneers or crowns or implants, and then a chewable probiotic to rebalance the oral microbiome.

A chewable probiotic? Okay, tell us about that, because everyone is taking probiotics. What would you tell us about chewable?

Yeah, you know, I remember it was around 2004, 2005 when the first studies on the oral microbiome were coming out, and, uh, at the time I'm like, well, let me try using a probiotic right after, you know, people were getting deep cleanings or, you know, periodontal work and cleanings. And people hated the flavor. It was just one of these flavors that was very chalky. So no, people— my patients wouldn't want to take it. So I was like, do you have something better? So full disclosure, you know, I have a line of vegan-certified chewable probiotics. They're good tasting. So that's when I started really to— so this is 20 years ago that I really, um, started this process of looking into probiotics. And nowadays the market is full of oral probiotics, which is good because we do see good studies being used as an adjunct. So not as the only thing, but as an adjunct to treating periodontal disease and especially also peri-implant disease. We know that, uh, Trobo probiotic can also help with sinus health, with respiratory health, and of course with lowering Candida numbers in the mouth.

It makes sense because when we think about probiotics, we also do vaginal probiotics. Where we do it like a suppository, right? So, that makes sense. Like, we haven't really thought, like, why aren't we doing that? So, I'm assuming with a chewable, are you, like, chewing it in your mouth for a longer period of time, or does that matter?

Yes, it definitely matters. You just— especially when the mouth is driest. When it's not, it's at night. So, after you brush, you floss, you pop in a chewable probiotic. You can chew it or let it dissolve, and then take your tongue and rub it against the outer surfaces of the teeth and the cheeks.

Okay.

And people would notice that if they have like a whitish covered tongue, right? If you stick your tongue out, you look in the mirror and it's covered with white, especially when you wake up in the morning. When you start using a chewable probiotic at night, that coat will actually disappear with time.

Oh, wow.

Because we are changing that microbiome.

What about tongue scraping? Where does that come in and is that important? And then also the floss versus Waterpik, or do you do, say, both?

Yeah, tongue scraping is definitely important. Why? Because 60% of bacteria lies on the dorsal surface of the tongue.

Okay.

And, uh, it's sloughing dead cells all the time. Uh, I had this conversation, funny, with my acupuncturist, and she actually says we shouldn't need to brush our tongue because if we have a good digestion and if we have a good amount of fiber in our diet, then the tongue will automatically clean up. And I check in with my tongue. It's not something that I do every day. I look at my tongue, depending on my fiber intake, it seems to— it has a nice pink coat.

Yeah.

And then let's say if I'm fasting, right, for 24 hours, all of a sudden I'm seeing a whitish coating developing. So it really depends. I would say check in with your tongue. I highly recommend doing like almost a daily oral check. Just stick your tongue out, see what your tongue is telling you about your health that day. And if it's coated, you can go ahead and scrape it and keep it clean.

Different doctor that I just recently interviewed said when you scrape, you want to use copper and you want to do it 10 times. Is that how you feel?

It's not one size fits all, you know? So as long as we scrape it, you can use like a teaspoon that you have in the drawer, stainless steel. It's like the same action, like a callus on your foot. So as long as you quickly remove it, It doesn't matter what you remove it with.

Got it. Okay, so different thought process there. Okay, so floss versus Waterpik or both?

I did a recent episode on my podcast, The Holistic Dentistry Show, on the science on water flossing, and it was very interesting doing this research. And part of being a periodontist at UCLA, we actually had to study the research of string floss. And floss has been around since the 1850s, and the problem with floss is like, it's, it's old school, right? We didn't have electronics. But if we look at the science of how much better a water flosser cleans than string floss is really astounding, not just when it comes to teeth but also dental implants, because the water pulsation— and these are studies done at USC at the Center for Biofilms— 3-second pulsation with the Waterpik— these were Waterpik studies— gets rid of 99.9% of plaque and even calcified plaque. You can't say that about floss. And the problem was it's a lot more technique sensitive. People don't use it correctly if they use it at all. I have a lot of patients that say, especially men with big hands, I can't get my hands back there, I can't floss. So the next best tool is definitely using a water flosser.

Any harm in using both?

There's no harm in using both. And what's interesting, people who are skeptics will use a string floss and then they use a water flosser. That's what I do. And then they will come and tell me more stuff comes out after I'm done flossing.

That's what I said. That's what I was going to say. That's exactly what I experienced. And I use a good floss. I don't use like a waxy floss. And so I'll thoroughly floss. And then I notice the Waterpik after even more comes out. So that's, that's what sold me on flossing. I mean, I'm sorry, on Waterpiks. When you use a Waterpik, is there a proper way or amount of time? And like, because when you— like, I have a Waterpik and it has, it has different heads that come with it. Like, one is just a stream of water. One has like the little, little points. Like, is there a proper way and how long on each tooth?

Yeah, a lot of the studies were done on a medium power. So you'll notice it has several powers there, but all the studies were done on medium. I have some patients that love to blast it, you know, on the highest power. Is it necessary? No. And people with a thicker gum tissue will actually withstand it with no problem. So the message is, if you have thinner tissues, recession, I wouldn't use it more than medium. It's really not necessary. It's very effective. Medium power. And, uh, you can use for certain particular areas, there's different specialty tips, like a little rubber tip for narrow areas that you can get into. The brush tip is more for people going through orthodontics. I like the brush tip with like 4 tufts because it helps people guide it along the gum line. What I think sometimes people take a water flosser like, I don't know where I'm pointing at, where you go. So when you actually have tufts at the end of the tip, it'll help you guide them right at the gum line.

How long should you be doing like— like, should you fill up the whole thing of water and use all that? Like, are you a certain amount of seconds? Per tooth?

Yeah, I want to stop. So because of the studies show 3 seconds, 99.9% of biofilm, I would do exactly that. 3 seconds of tooth, an area in between.

Okay.

Okay, because that's what we call it, a water floss. So the outer part, as you go along, it'll just basically flush it out. But in between the teeth, definitely wait those 3 seconds in between the teeth to make sure we flush those areas appropriately.

Got it. Okay, so that's how we handle like the actual mouth. So all the things that you said, the brushing, the flossing and Waterpik, or just Waterpik, the chewable probiotic, the possible tongue scraping if you're checking in. We use— ideally the toothpaste would be calcium hydroxyapatite unless you have a very specific type of periodontal disease and you want to use something like a biocidin for a temporary amount of time, but it's not your everyday toothpaste. Let's talk about— that's how you kind of manage, right? But how do we now figure out the root and correct? And like, what's our priority? Like, a lot of my listeners, they had old amalgams, they've removed them. Some of them haven't, but they— a lot of people have crowns or old root canals or even cavitations. Help us with like what's what there and what's important versus we can wait.

Yeah, absolutely. And you know, this reminds me of somebody that came to me recently. She had this, uh, whole mouth down like mercury amalgam fillings replaced, had a tooth removed, implants, and her gums were still red. So I did a saliva check on her. She had aggressive pathogens in her mouth, something called AA, which affects heart health, and P. gingivalis, which affects brain health long-term and joint health. And she actually had some joint pain. That's why I believe so strongly in doing an oral microbiome reset prior to doing all this work. Okay, not, not after, because it's important to have good terrain. Just like if somebody has ever gardened which I am, right, gardener. The first thing I want to make sure is my soil is good when I'm trying to plant something. So it's the same thing with the mouth. Let's reset the microbiome, make sure you have good terrain that's conducive to good healing before we start taking everything out and doing a whole reconstruction.

Okay, but if we didn't do that— so there's a lot of my listeners, they didn't do it. Like, they, they listened, they removed their amalgams, they're— maybe they had like So we're dealing with what we're dealing with. So like, but my audience is super savvy and they want to start going, okay, what's my priority here? Can we sort of talk order of priority? Like, I want to start with like old root canals, like your feelings on that. Do you leave them alone? Should you remove them all? Like, how do you know when you should remove it?

I believe in 4 pillars to integrative health, right? Especially oral health. Number 1 is the oral microbiome, as I mentioned. Number 2 is healthy jaws. What does that mean, healthy jaws? No cavitations and no infected root canals. Okay. Because that's also part of the foundation, the jawbone. And number 3 would be healthy teeth. No metal restorations, no mercury, replacing them with biocompatible ceramics. And number 4 pillar is sleep. Actually getting a good night's sleep. And in dentistry today, that's something we address.

Unfortunately, though, if we do have underlying infections, or we do have— it's probably affecting our sleep. So, sometimes, even though sleep sounds amazing, until we address that stuff, it might affect our sleep.

That's right. That's why I listed the 4 pillars in that order. Oral microbiome, healthy jawbones, healthy teeth, and sleep.

Now, let's start with cavitations. What is that? And, when I was telling Laura, for example, I said, well, I had a cone beam scan. Yep. And my biological dentist said she was surprised, but I didn't have any cavitations. And Laura said you should send the cone beam to Dr. Sonda because she'll find cavitations. So tell me why she said that, and do you believe most people have them?

Everybody is trained differently. So if your dentist that generally treats cavitations— is he an expert in cavitation? Yeah, yeah.

My doctor is a biological dentist, and she also has a radio— like a radiologist double check with her, but she treats cavitations cavitations a lot.

Oh, okay. Yeah, if she treats cavitation, then she probably diagnosed it correctly.

Okay.

But there's general dentists that are biological, and not every biological dentist can read cavitations. It's just not something that they're trained on, how to read a CT scan. Like, I read my own CT scans a lot of times. Even a radiologist— like, I work with radiologists at UCLA for pathological problems, but unfortunately they don't know how to read cavitations properly.

What is a cavitation? Help my audience understand.

A cavitation is a hole in the jaw where somebody used to have a tooth or a root canal. And it's very similar to a cavity in a tooth, except the cavitation is in the jawbone.

Okay.

And it's full of microbes usually. And how do they get there? Usually when a tooth is removed or a root canal is done, microbes can settle inside the jawbone because they don't need oxygen to survive. And the reason why I say microbes, not bacteria, is because it's not just bacteria. 70% of the time, parasitic activity inside the cavitation site. I've been biopsying every single cavitation site now for years, and these are kind of the patterns that I'm seeing. I, I, we find anywhere from 2 to like 20+ microorganisms.

Oh wow.

Including Lyme disease.

So how does one properly get assessed for a cavitation?

The way to diagnose it is definitely a CT CT scan, a dental CT scan.

That's a cone beam, correct?

It's a cone beam, yes, meaning it's a digital CT scan.

Okay, so not your regular x-ray.

Yep. Yeah, a regular x-ray does not diagnose properly cavitations.

Okay, and then what if you have one, how do you— what does one remove it?

The best way to remove cavitations is making a small incision cleaning out whatever it is that doesn't look like bone, using ozone— super, super important to use ozone because really what we're dealing with inside here is, is biofilm, is microbial biofilm, some— a different type of microbiome. So we need to remove this, sterilize the site, and then use PRF or platelet-rich fibrin, which comes from someone's own blood, to help heal the site.

Okay, what about— let's talk about root canals for a minute. You have a patient come in, uh, this is very much my audience, they had a root canal 20, 30 years ago, okay? They don't have pain. Pain's a whole different story. If they don't have pain, uh, but their oral microbiome or their health— something's going on with their health, you check their oral microbiome, you see bacteria— what's your stance now on the root canal? You do a cone beam scan, obviously if you see an infection you're like, we have to get it out. But you don't see an infection, what do you tell them?

And actually, this is exactly what happened to me. I had a root canal tooth at the age of 14. It happened to be my lower left molar, and that was linked to my digestive meridian if we look at the meridian chart.

Yep.

And, you know, I just was noticing that every time I flossed, it would smell. It would have a bad smell on the floss. And I took a CT scan. You know, my colleague's like, oh, this tooth looks great. There's nothing wrong with it. I'm like, how can there be nothing wrong with it when I smell like ugliness on the floss. So, and I started looking at it, started to turn black. And at the time, I was dealing with some digestive issues. I had some heart palpitations that just popped out of the blue. And just my intuition told me, just take this tooth out. This was, you know, over— yeah, years ago now. So I had the tooth removed. I felt better. Okay. This was like towards my beginning of being, you know, going into the integrative space. My digestive problems improved. My gums stopped bleeding in the site. It was just bleeding for no apparent reason. The smell went away. My heart palpitations went away. So just because it doesn't have bone loss, why wait till we get there? If the tooth is turning black and somebody has symptoms like I did, you know, let's say it might be asymptomatic in terms of the tooth pain, but are you having problems in that meridian? Let's say, you know, if you're having— yeah, and the tooth is turning black, what does that mean? When a root canal tooth turns black, it means that bacteria and mold are starting to filter in inside the tooth and create a nice home for themselves.

It brings up two things, um, that I want to dive into. So you bring up the floss and the smell. So I didn't actually have that on my old root canal that I removed, but I did have that on a cracked crown tooth.

Tooth.

So, I noticed that. And so, I thought, is it trapping food? What's going on? And I then, my dentist caught it, hey, it's a cracked crown. So, just, it doesn't have to be a root canal. Any cracked anything could be trapping bacteria is my understanding.

Yeah, you're absolutely right.

Okay. Back to the root canal. So, black bleeding shows up on it. Let's just say no one has any of that. Like, there's, the tooth looks great. It's healthy. You're, you're, the gum around it looks looks good, the cone beam shows there's no infection, there's no black, there's no smell, but we still have general health issues. Do you still want patients to consider removing those?

Yes, absolutely, because I think it's, it's important to be healthy, you know. That's what we do. It's important to be healthy. And we don't know energetically how a dead tooth is affecting someone. And I have patients that are super sensitive. Yeah, they're sensitive to, to the smallest thing, like especially people with mast cell disease.

Totally.

So it depends. We have to look at the whole person.

So I've been sharing with my audience very publicly that I have two old root canals, 30 years old. One of them had the recession, oral microbiome showed on the cone beam that it was starting an infection. I had it pulled. I'm like, I'm not messing around. It's out. I'm in the process of I'm going to restore it with ceramic. I have another root canal on my lower, 30 years old, showed nothing on the cone beam. No No sense, no, there's nothing, nothing that's showing. I am still going to remove it after I restore the top one for this exact reason that you just said. Um, when I've shared that, people have challenged with why would you not just leave it alone? You're going to mess up your bone. An implant could be worse. Can you help with the reasoning around that? And do you ever tell a patient to leave it alone?

Definitely. I don't do that. I, I leave it up to them. I think the important thing as a practitioner is give people pros and cons to every option and let them decide what feels good to them intuitively. I think this is one of the biggest things we could do for patients. This is the pros and cons, because we cannot guarantee, oh, we're going to take this tooth out, am I going to feel miraculously better the next day? We don't know. We don't know. We're, we're dealing with, you know, an organism of living cells. We don't know how someone will react to treatment.

So it's so funny how root canals are such a touchy subject for people. There, I did this post on my Instagram when I pulled my tooth, and the post went viral. And I made it about— it was about me. It wasn't about everyone should do this. I said, I pulled a tooth, this is why. And I shared. I also shared that I was in dentistry for two decades, a long time ago, working for an implant company. So I am knowledgeable when it comes to dentistry. To me, I said, a root canal to me reminds me of mummifying something. It also— it's like taxidermy in your mouth. Under— in no way do I think that is healthy for us long term. Temporary, maybe to get you out of pain, but long-term, it could be problematic. So, I said, I want it out. I infuriated tons of dentists, like dentists chiming in that I didn't know what I was talking about, that this is good dentistry, and that an endodontist could clean it out. And, I didn't back down because I didn't say everyone should do it. I said, this is what I'm doing. This is what I'm doing. So, do you get that a lot? Do you hear this from—

Oh, yeah. I infuriate a lot of dentists too. Okay. The same list because I am public about, hey, bacteria inside root canals causes cancer. I made a post on Instagram and it's true. We have studies to show that bacteria is the problem, really. That's not the actual procedure. The procedure could be perfect. Yeah.

And it could last for years initially.

Yeah, exactly. It could last for years. But eventually, you know, we have a bucket of toxins that we can tolerate. Yeah, canals are part of that bucket of toxins, and maybe when we're young we tolerate them just fine, but eventually that bucket gets full. And patients that come to me, already their bucket is full and spilling over. So no, yeah, we're doing as integrative periodontist or dentist, we're just removing the toxin— toxic burden off the immune system so somebody can feel better. That's really what we're doing in removing root canals.

My audience watched me explant breast implants, they watched me move out of a house with mold, they watched me navigate hives, watched me do parasite cleanses. They've seen— watched me remove amalgam fillings. And somebody could interpret that as, "Oh, you always have a new problem." I don't take it that way. It's not about always having a new problem. It's about I'm 54 years old and there's this big toxic load that has built up over time. Any one of those things on their own could have been totally fine. But you start piling those things on, all of a sudden, you go get gel nail polish and it tips you over. So, it's not about being perfectly toxic-free. That's like near impossible. I don't think you could do that, honestly, at this point. But, it is reducing toxic load. And, I think of some of these things as majors. I think breast implants and old root canals are two of the majors. I just do.

I agree with you 100%. And, I challenge dentists because in the literature, and unfortunately, a lot of the dentists that do the root canals are not familiar with their own studies published in the Journal of Endodontics. We know root canal-treated teeth in patients are— so those patients are 3 times more likely to get heart attacks. We know that.

Yeah.

So also, a root canal-treated tooth has up to 50 times more bacteria in it than a healthy tooth. So why would you want that in your mouth?

No, I can't wait to get my lower one out now. I'm like, I'm like, I'm— it's gonna be a while because I'm not gonna have 2 big holes, so I'm waiting. Um, but I'm like, it's coming out for sure. Talk about— so I went I had a ceramic crown, so it's not metal, ceramic crown. It was chipped. I told you I had bacteria, but it wasn't hurting. And my initial thought process was, "Well, if it's not hurting anything, can I just leave it?" And my biological dentist said, "No, and this is why. You're going to trap more bacteria. You're going to create more health problems. And then, you're going to end up fracturing the whole tooth. And then, you're back to, 'Do I get an extraction or root canal?'" So, you're back to the same problem. Can you speak into that? Because I see this a lot with people going, "Oh, it doesn't hurt. It doesn't bother me.

I'm going to leave it alone." Yeah, that's, that's not a good way to treat your body. Your body— usually our bodies show us signs. So if there's a smell somewhere or a discoloration, um, or pain right away, right? The smaller the problem, the easier it is to fix.

Yeah.

Now if we let that smell go there, now all of a sudden we start to have sensitivity. That means that bacteria is getting closer and closer to the nerve. And if it does go into the nerve, now there's a high risk that that tooth may die. So I'm glad you took care of your crown, you know, ASAP instead of waiting.

What about ceramic restorations? So we know ceramic zirconia is like, is the most biocompatible with our bodies, so it's pretty neutral. But what about those? You're still filing down part of your real enamel and adding that. There's still a connection there. Are those creating a higher risk for bacteria?

That's a great question because it depends who the practitioner is, who is actually installing that crown, what material they're using. So I highly encourage anybody listening to actually start interviewing your dentist. Hey, are you using something that's biocompatible with my body? And nowadays we can figure that out through testing. What, you know, what kind of process are you using? Ozone before you are cementing a crown? Because we can't see bacteria and microbes with the naked eye. They're, they're 10 to 50 microns. So super important to use ozone before cementation or before even doing a filling. And I like ceramics and a lot of the green materials, even for fillings. We have now ceramic liquid fillings that are about 80% filled with ceramics, which is incredible. Much better way than the old white plastic fillings that were put in the mouth, which were not durable at all. They're releasing BPA, so people are getting a different type of toxin. No.

So how do we know if we have those? Like, if you had a filling that was white 10 years ago, 15 years ago, is it likely not a good ceramic?

Likely, if it's a filling 10 years ago, it's made out of plastic.

And so how do we find that out or test or know?

Yes, the only way to find out is to ask the dentist, what type of material did you use? And typically they hold the records of what type of composite material they put in the tooth.

But what if you've changed dentist and you don't have that access anymore? Can your current dentist figure that out?

No, there's no way. Sometimes we can tell by the X-ray, by the color of the filling.

Okay.

X-ray, if it presents a little bit whitish on the X-ray, most likely it has some ceramic component in it. Okay. Whether or not it's BPA-free, we really don't know.

So as I'm listening to you, I'm thinking about there's probably 5, 5 people listening that are like, I don't have anything in my mouth. It's all perfect. They have all their natural everything, right? But I would say most of my listeners, most of my midlife women, they're full of rest— like, we've had stuff for years. I mean, my gosh, my stuff started as a kid. I don't— I've got— I'm a fortune for any dentist walking in.

Oh, yeah. My stuff started as a kid. Yeah.

So as I'm listening to you, I start to think, well, gosh, is this hopeless? Like, I probably have plastic in some of those things. Like, when does it end? Is it enough to, like, go, okay, I'm going to— man, I'm going to take out the root canals. I'm going to make sure there's no metal. I'm going to stay on top of— I'm going to do all the things you said, brush, I'm going to floss, I'm going to do the Waterpik, I'm going to use calcium hydroxyapatite. Can you ever win this battle, or are we trapped in this bacteria loop forever?

We definitely can win this battle because oral health has a lot to do with lifestyle and diet.

Okay.

You know, we talk about, yes, oral hygiene, of course it's important, and stabilizing the enamel, also, you know, taking care of the eating gums and dry mouth, especially because we have a lot of women listening. But diet has a lot to do with it.

Now, talk to me about that, because my listeners are savvy. They're eating healthy, like I teach, unprocessed, natural, real food, and variety, and all of that. But I had all this bacteria, and I eat like that. So, what does that mean to you when you say diet?

Diet means, uh, low cariogenic foods, meaning even natural food. Sometimes, let's say, take a banana, or like dried fruit, those actually cause cavities because they're sticky.

Okay, so sticky and sugar is what you're talking about.

Sticky and sugar. I also have actually raw vegans that came to me and they wore out more than half of their tooth structure by eating fruits all day. So really, it was a healthy thing? Absolutely. We cannot eat fruits all day.

Fruits are still sugar unless you're brushing pretty quick after, I would imagine, or during.

And even that, Natalie, is not really good, because after you eat something acidic, we shouldn't be brushing right away because we're— now the enamel is in this semi-soft stage. And let's say you drink a glass of wine, or you have, let's say, something— an acidic fruit like pineapple. If you're going to pick up a brush right away, you can actually brush away microns of enamel every time. But over the period of years, it adds up. So I suggest after eating something acidic, just wait about 30 minutes. You can rinse your mouth with water, and then wait 30 minutes before you brush.

Dr. Dom said the exact same thing, and that was news to me about waiting 30 minutes, but that's good to know. So, I just want to be mindful of, like, we can't chase perfection, right? Like, we could— like, this— I don't want this to be another thing that makes everyone crazy. Like, believe me, we've gone down enough rabbit holes trying to get our gut perfect, or our skin. Like, there's all these things, right? So, I would imagine that the idea is not perfection, it's about improvement. Like, help us with that.

Yeah, I agree with you. You know, nothing's perfect. I was born in Romania. I had 16 large mercury fillings in my mouth. I no longer have them, of course, but I'm always maintaining, right? Maintenance is key. It doesn't have to look perfect. And yes, if you're going to have like, you know, something sweet, it's okay. We can't just have the perfect diet. It's, you know, what we do about it and how we pay attention. And sometimes things happen. But even like, you know, what women with receding gums, just know what you can do to nourish those gums. Collagen peptides, for example, are huge, especially for maintaining receding gums and not over-brushing and having a good microbiome. So just, uh, kind of personalize your oral care and your lifestyle based on what your mouth needs.

I didn't ask you about mouth breathing and nitric oxide connection. Can you help us with that one?

Yeah, there's been some studies on mouth breathing and cavities because what happens, you know, when our mouth is open, the microbiome changes. They keeps going back to the microbiome. So that's why, you know, there's like mouth taping practices in order to help somebody breathe through their mouth. I think it also has to do a lot with like the physiology of breathing, and for that we have myofunctional therapists that can help with that and help someone breathe better, as well as different appliances that we can help patients breathe through their nose versus their mouth. Mouth.

So, like, my husband, for example, he is a big mouth breather, but taping his mouth would not work because his nose is so clogged. So, he's actually having a surgery to correct his breathing so he can fix this. What is nitric oxide? Like, why has this come up as an important part, and what does mouth breathing connect to that? How does that connect together? And should we take nitric oxide?

So, the oral microbiome, a healthy oral microbiome, produces nitric oxide. That's why I'm not a fan of mouthwashes and strong mouthwashes that wipe away all your microbiome. Because then we have a lower amount of nitric oxide in the body. And nitric oxide is a vasodilator, is super important in blood pressure control. So typically there have been some studies done, actually, people that use Listerine as a mouthwash have higher blood pressure because of the decrease in nitric oxide production due to the, you know, destruction of the oral microbiome.

Should everyone be taking nitric oxide in form of food?

Yes. So I'm a big fan of beets. I think everybody should eat beets, right?

But, but not in supplement form. You don't like it for supplement form. Yeah.

I mean, if somebody needs it and you wanna take a beet powder as a drink, I think that's probably the least processed of all of it. But like you, I'm a big fan of, you know, whole foods. I, you know, I, of course I take supplements as well, but I think if we can do something in a whole food format and measure it, I actually have my patients measure their nitric oxide with strips because especially if they're undergoing any kind of surgery, it's super important to have optimum levels of nitric oxide. And some people that are measuring, they're at zero, basically. Yeah.

So, I did measure with strips. I was not at zero. I definitely had it. But because I try so many different supplements, I was like, "Oh, I should try a nitric oxide supplement just out of curiosity." And it was not a good move for me. And the reason is it really lowered my blood pressure. So, I had to learn that the hard way. So, that's why I was asking. I wanted to see what you said there. It's another example of one supplement does not fit everyone. So, it is, I do like the idea of testing and going, okay, does this make sense for me?

Yeah, I agree with you. And even in dentistry today, we can test a lot, just like in medicine. I think we really caught up, you know, with, with medicine. We're finally starting to test more and more in dentistry before we actually do something.

How does menopause change our oral microbiome?

So what happens in menopause, you know, as our hormones decrease, we start experiencing dry mouth. You know, the saliva glands that we have in the mouth start atrophy. And with the onset of dry mouth— and women will know this, and, you know, as dentists, we actually notice when we do an exam because everything is stickier. Yeah, the cheek actually sticks to the teeth. It's pretty uncomfortable to have dry mouth. And some women will actually say, you know, when I drink coffee, actually, I have drier mouth, so I stopped drinking coffee. Um, but, uh, with menopause, these oral microbiome changes can actually set in And we see more gum recession because the collagen fibril inside the gum also is getting thinner, just like our skin, just like our hair. So does the fibril inside the gum tissue. So somebody that's already had thin gums to begin with, now they're noticing that the gums are receding more. And also plaque sticks to the teeth more when we have dry mouth. We see more plaque deposition. So some women will actually say, you know what, I feel like I got more plaque than ever now. Yeah. Yeah.

Wow. Wow. Good to know. Okay. Gosh, I know I— what do you wish I had asked you that I did not ask you that you want to make sure my audience knows?

Yeah. I— wow. I think you asked me so many great questions. Really good discussion. I can't believe an hour flew by. I think it's important. One thing that I want to leave your audience with is to interview your dentist just like your dentist interviews you. Just have a list of questions like things like, okay, how do you choose my treatment? Do you use ozone in your practice? What do you think about fluoride? Just see what their philosophy is and see if their philosophy of the practice aligns with yours. I think that's super important.

Yeah, I would, I would add a question that I would not have asked a while ago, but I feel like this is really important, is I think my biggest thing choosing a dentist at this point would to ask how they feel about oral biome connected to whole health. Because if they think of it as totally separate, like that, that's all hogwash and no, it has nothing to do— that's not my person. I remember my dentist in San Diego before I moved out to Arizona was a regular general dentist. He's a great cosmetic dentist, but I did ask him about removing root canals and he told me that that was hogwash, that's ridiculous and you're going to mess up your mouth. So, knowing that now, I would not have continued to go to him. That's not the answer I'd be looking for. So, personally, I'm looking for someone that's Just the way I would look for a naturopathic doctor. Like, I want somebody that's looking at whole health, not just, you know, textbook, here's the symptom, here's the pharmaceutical. I do think dentists can be very well-meaning, but I think many times it's like, well, here's the problem, let's drill and fix it, versus like, where is this connected to your whole body?

Yeah, that's my thought. I like that question. I definitely like that question, you know, questioning the dentist about the oral microbiome.

So if somebody does want a root canal out, they have an old root canal, they're like convinced they want it out, whether they have pain or infection or whatever it is. But to them it's scary, that whole process. Like, well, gosh, I'm going to extract it. What am I going to put there? Or an implant's so expensive and how long do I have to wait? Can you tell us kind of your thoughts around that? Is it best to get it out like and do nothing? Like, do you, do you recommend a temporary? Like, what's your process there?

I would say take it one step at a time and find a practitioner that you can really can connect to and listens to you. Everybody practices differently and everybody goes at a different pace. I have patients that are coming into town, we remove teeth, we place dental implants all in one day. But then I have other patients that say, I just want to take out one tooth at a time and not do anything. Yeah. And that's okay. I think especially if you're dealing with health challenges, take out the root canals that are bad, they look black, that smell, and see how you feel before you add dental implants. There's also alternatives. Yeah. To put something temporary in the place, for example, or just leave it open.

Some dentists are very adamant about doing same-day ceramic implants. Some are really against it. How do you decide? You, as a, as a practitioner, how do you decide?

Yeah, now I've been teaching ceramic implants for, for many years, um, and I decide based on the quality of bone that's there, number one. Okay. And secondly, what are the patient's health goals and wishes? Because I saw patients that don't want implants and that's okay. They can have other options, you know, like a removable prosthesis during the period of healing, so they still can have the facial structure there. So we can do that. So, you know, in our practice, we have a multi-specialty practice. I don't do everything, so I'm blessed to work with a team of prosthodontists and general dentists that, you know, we can treat the patients with different options based on their desires.

If you choose to not replace right away and you're gonna— so you, you have that, like, I— for me, I had a I had a back molar, so it was a second to last molar. I'm like, I'll just leave it, the space, right now. Um, how long until it starts affecting your facial structure or bone bite? Because I like— for me, I was gonna wait 3 months before doing the implant. Like, that's what I'm doing. Like, do people— is there a time that you're like, you don't want to go X amount of time?

So the second molars, actually, the way the bite usually is, is like they're all the way in the back, so you can actually go without replacing it and still be able to chew well.

Okay.

If you're finding yourself that you can balance the food on both sides and it's comfortable, you don't actually ever need to replace it.

Okay. What about like a third molar though? Would that— how long would it take to— or not? I don't know. I'm counting wrong. Like, so maybe it's the—

yeah, yeah, yeah. First molar. Yeah. I would say let it heal 4 to 6 months. Sometimes you can go up to a year.

Okay.

And then replace it.

But you're not risking having bone loss in that short period of time, or are you?

Within a year? No.

Got it. Okay. Gosh, this was so helpful today. How, how can people learn more about you? Where can they learn to get your products? Where can they, can people come from all over to be treated by you? Tell us more.

Yeah. My passion is education. So if you want to learn more about integrative dentistry, go to the Holistic Dentistry Show. It's on all platforms. Also on Instagram at Dr. Sandha, as well as my practice website, beverlyhillsdentalhealth.com.

Thank you so much.