Welcome to the Huberman Lab Podcast, where we discuss science and science-based tools for everyday life. I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine. My guest today is Dr. Stacey Whitman. Dr. Stacey Whitman is a functional dentist with expertise treating both adult and pediatric patients.

She focuses on oral health as a key feature of overall gut health and a powerful modulator of brain longevity, heart health, hormones, and fertility in both men and in women. Today, we discuss many of the common myths about tooth and gum care and how to use specific nutrition, breathing, and cleaning methods to repair cavities, whiten teeth, and freshen breath, while at the same time improving the oral microbiome.

This is very important because as Dr. Whitman explains, most of the things that people do in pursuit of better tooth health and appearance and fresh breath actually damage their oral microbiome and indeed can lead to serious cardiovascular issues. So today, we discuss how to brush, how to floss. I know we've all heard that we need to brush and floss, but Dr.

Whitman explains exactly how to do those so that they are of the maximum benefit for our tooth health, gum health, and oral health generally. We also discuss the science and benefits of things like tongue scraping and oil pulling, and we discuss fluoride which of course is a very controversial and timely topic nowadays.

It's a very interesting conversation that I believe everyone, young, old, parents, and kids need to be aware of. We also discuss treating things like tongue ties, deviated septums, canker sores, and more. By the end of today's episode, you'll have the most up-to-date knowledge about how to take care of your oral health, both for aesthetic reasons and, of course, to reduce cavities and gum disease, and in doing so, how to support your brain and heart longevity.

Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford. It is, however, part of my desire and effort to bring zero-cost-to-consumer information about science and science-related tools to the general public. In keeping with that theme, this episode does include sponsors.

And now for my discussion with Dr. Stacey Whitman. Dr. Stacey Whitman, welcome. Thank you, Andrew. I'm super excited to talk about oral health from all perspectives. Your public-facing content, especially on Instagram, has completely transformed the way I think about this thing that I call my mouth, that people think of as their teeth and their mouth and their breath and their tongue and all this stuff, as a key site for evaluating and maintaining health of my brain, my body.

And today you'll make it clear as to why that's the case. I'd like to just start by looking at this oral health thing through the lens of what I think most people think of when they hear the words oral health, which is people want, it seems, whitish or very white teeth, depending on their preference.

They want fresh breath or at least to not have bad-smelling breath. And they want their mouth to sort of feel good, right? The question I have is, what are some of the things that many, many people do in trying to have white teeth, fresh breath, that actually are very destructive for our teeth and our oral microbiome?

If we go through that entry point into this conversation, then we can get into some of the specifics of why that is. So what's something that you see many people doing in terms of trying to have bright white teeth that actually is harming their teeth? Sure. Great question. Great way to start off.

So I first want to commend you and thank you for including the oral microbiome and oral health as one of the pillars of health. That means a great deal and it has a lot to do with this answer. So unfortunately, we have been taught that we need to carpet bomb the mouth.

We need to add astringents and alcohols and foaming agents and really strong essential oils to clean, disinfect and to freshen the breath. But we're really, what we're doing with these products is damaging our delicate microbiome, which can make things far worse. So much of oral health is a less is more approach and it's not so product heavy.

It should be more focused on diet and lifestyle like anything with health. Unfortunately, dentistry has been separated and compartmentalized out of the body like much of medicine. You know, we were so specialized and sub-specialized in dentistry is included in that. And we need to remember it's all interconnected and what we're doing to the mouth, whether it be strong toothpaste, mouthwashes, certain gums.

And even what we're eating and how we're breathing can really do a number on our oral health. And so it's taking a different perspective and it's a bit of a mindset shift to really get us back to optimization. So do you think that most of the common over-the-counter toothpaste, while they smell minty or pepperminty and taste minty and pepperminty, are they effectively cleaning teeth and are they causing any damage to teeth by virtue of what they have in them?

It really depends on the ingredients. So I'd like people to start looking at their oral health care products like they're starting to look at food labels. We should be reading the ingredients and understanding why they're there and what they're doing. Where are they sourced from? But certainly, I think so many of us feel it has to burn in foam to be effective.

What is toothbrushing? What is it really doing? You're disrupting the biofilm, which is really the plaque or the bacteria that are adhered to your teeth. And so all these extra bells and whistles, it's sort of extra credit. But if you're perfectly imbalanced, we shouldn't need all these stripping agents and strong mints and things.

So, for example, sodium lauryl sulfate is a foaming agent, but it also can be really disruptive to the oral mucosa and can lead to oral ulceration. So that's a common ingredient that causes foaming that I would argue we do not need. Your toothpaste shouldn't foam, nor should it burn.

Essential oils, we think, oh, those are natural, they're healthy, right? Well, many are very antimicrobial, and so they could be damaging the healthy bacteria in your mouth. So that's where that strong burn after many toothpastes, you really don't need that. And if your breath is so bad or you have halitosis that you feel the need for that, then I would argue, well, let's dig deeper.

Why is your breath so imbalanced? There's probably something else going on. So I really encourage people to start learning about their products. I think we just give dentistry and teeth, just we push it to the side. It's kind of an afterthought many times, and just like we're prioritizing skin care, shampoo, things that we're putting on our bodies, we need to be focused on the ingredients in our oral health care products, too.

Especially since we're literally putting it into our body, not just on the surface of our body. What was the foaming agent again? Sodium lauryl sulfate. And the problem is there's derivatives. So some cleaner versions might have coconut-derived SLS derivatives. Many people will do okay with those, but a common complaint I see in my office are oral ulcerations.

And the first thing I think of is what's in your toothpaste. Does it have SLS or a derivative? Because we're all different and some people have more sensitivities and will react more to those. Are oral ulcerations canker sores? Mm-hmm. Yeah. Or are canker sores? Yes. So if one gets a canker sore, what does that reflect, typically?

Let's assume the toothpaste doesn't have anything to do with it. Is that a disruption in the microbiome? Is it from a physical injury, like a bite to the gum? It could be all. Okay. So it could be secondary to trauma, certainly. It can be viral-related. So the herpes virus often will result in oral ulcerations.

Sv1. Yes. But also, and this is not on many people's radars, you know, the mouth is the gateway into the body and the mouth is the gut. I want people to start thinking of it that way. So what happens in the mouth can be a reflection of what's happening in the gut.

And so a lot of times when I have patients that come in with recurrent apthus ulcers or ulcerations, that can be a sign of Crohn's or celiac, IBS, like something going on deeper within that we need to be evaluating, food sensitivities, et cetera. I'd like to take a quick break and acknowledge our sponsor, Eight Sleep.

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Again, that's eightsleep.com/huberman to save up to $350 off your Pod 4 Ultra. Today's episode is also brought to us by BetterHelp. BetterHelp offers professional therapy with a licensed therapist carried out entirely online. I've been doing weekly therapy for over 30 years. Initially, I didn't have a choice. It was a condition of being allowed to stay in school.

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Again, that's betterhelp.com/huberman to get 90% off your first week. This would probably be a good time to talk about the whole concept that teeth can essentially build themselves and destroy themselves independent of sugar intake and other factors. So, if you would, could you just briefly walk us through this whole business of mineralization and demineralization of teeth?

Yeah. Because I find this so interesting and later I'll share a little bit, full disclosure, I have a very complicated oral health history. And had I known what you're about to tell us, I think I would have spared myself a ton of pain. Potentially. I'm sorry to hear that, but we'll unpack that.

You weren't my dentist, unfortunately. No. I have stories to share too. We'll get to as well. I think many people do and that's the problem. So, I wasn't taught this in dental school, interestingly enough. So, this is something I learned later out in practice. And it's the concept that your teeth can naturally remineralize if you have a small cavity.

But let's start further back. So, your teeth are constantly going through demineralization and remineralization. And this is very natural. And anytime we put anything into our mouth besides arguably neutral water, and this has to do with pH. So, anytime we eat, our mouth is the beginning of the digestive system.

So, we release amylase, which is an enzyme that helps break down our food. And in doing that, the pH drops. This is how we start digestion. When that happens, we lose minerals in our teeth. The acid will leach out calcium, phosphorus, and minerals from our teeth. But the concern is, we don't want it to stay in that acidic state for too long.

In that demineralized state for too long. Because if we allow our body to do its thing, our saliva will naturally remineralize our teeth. This is all part of a healthy balance system. So, our saliva is this golden elixir of our body. And it contains immune cells and enzymes, but also the minerals that we should need, if balanced, to create that remineralization.

So, there's something called the Stefan curve. And essentially, it's showing us how our mouth will become acidic and neutral and acidic and neutral throughout the day as we eat. The problem is, in modern society, we tend to be snacking and grazing and sipping all of the time. So, we're not giving our mouths enough of a break, enough of an opportunity to remineralize.

So, many of us are staying in the state of constant acidity and demineralization. But what's interesting is, so if you have a small cavity or lesion that hasn't yet truly cavitated, then a cavity means a hole. So, if you look on an x-ray and I see a shadow on your tooth, it's called an incipient lesion.

Those, if they're still in the enamel, those can, quote unquote, heal or remineralize. And this is where you would need to work with, let's say, a functional or biological dentist to understand how deep your cavity is. Once it becomes a hole, generally, you do need some sort of treatment.

But our body is meant for stability. You know, it knows what to do, but how you eat, how frequently you're eating. And then we can get into this, but how you're breathing and certainly the products you're using and your hygiene practices all factor in as well. So, my understanding is that the minerals that make up teeth are not the same materials that are put into a lot of common tooth care products.

So, without getting into a discussion right now about fluoride in water, we will get to that conversation a little bit later. But in order to frame that properly when we arrive there, could you explain why it is that fluoride is in most toothpastes? Mm-hmm. When, basically, we don't have fluoride in our teeth at birth.

That's right. But there are other minerals in our teeth that certain toothpastes have. Mm-hmm. And, you know, so why would we give an artificial substance to our teeth? Maybe you could explain demineralization, remineralization in the context of fluoride and these other minerals. So, we have hydroxyapatite, which is essentially calcium and phosphorus.

In our teeth, our enamel is about 90% hydroxyapatite. The dentin, which is the layer below the enamel, through the enamel, is about 60%. And our bone has hydroxyapatite, too, about 60%. Our limb bones? Mm-hmm. All bones. 60% hydroxyapatite. 60% hydroxyapatite. Yes, which is calcium and phosphorus. Our saliva will also have calcium and phosphorus floating around, too.

So, what fluoride does is it throws off the hydroxyl group in hydroxyapatite, and so it changes it from hydroxyapatite to fluorapatite. So, it restructures it a bit. When it does this, the bonds generally are considered stronger, and the dental crystalline structure is more densely packed, so it's known to be more acid resistant.

And so, we can get into the history of how they discovered this, but essentially, fluoride was put into toothpaste in about the 1960s. It became very popularized. So, that is why many dentists love fluoride, is that you're using it, and it makes your teeth more acid resistant. And also, it has some antimicrobial effects, too.

The issue I have, and we can unpack this more later, is that it's not super selective. So, it's not only selecting anaerobes or pathogenic bacteria, but it potentially could be damaging beneficial bacteria, too. So, that's why toothpaste has fluoride in it. It also will lower the critical pH. So, the critical pH is the pH of which your enamel will start to demineralize or degrade.

And for enamel, it's 5.5, and then for dentin, it's closer to 6.5. So, what fluoride does is it raises the pH resistance. I see. So, for people that aren't familiar with pH, it's a measure of how alkaline or acidic a given environment or something is. And so, what you're telling me is that fluoride makes teeth ultra-strong.

Mm-hmm. It's not a mineral that teeth normally see. Like, if a child never used fluoridated toothpaste or drank fluoridated water, they basically, unless they happen to drink from a stream with fluoride in it, their teeth would rely on hydroxyapatite to remineralize. But we put fluoride into toothpaste and into water, and that allows teeth to become even stronger and even more acid-resistant.

Yes. Some out there argue the enamel structure actually is weaker. This is very nuanced. But generally, the dental community believes it's a stronger version of enamel. Some will argue when you look under scanning electron microscopy, the crystalline structure can be more wave-like, and potentially the bonds could break more easily.

But generally, you know, topical fluoride does work. However, it is no match for a poor diet, you know? So, all of this really comes back to what you're eating. So, it will make you less at risk for cavities, but it's not a shoe-in. Like, it's not for sure going to prevent decay.

What are the times in each 24-hour cycle when our teeth are repairing themselves? So, like, in the middle of the night, provided somebody's asleep, they're not eating. They're not drinking unless they get up for a moment and have a sip of water or something. In between meals, they're not eating.

I just sort of naturally intermittent fast. I generally eat my first bite of food somewhere around 11 a.m., sometimes a little earlier. But that's just habit. It sort of falls under this intermittent fasting kind of thing. So, I and many people have stretches of time of anywhere from 3 to 14 hours when we're not ingesting any food or caloric beverages.

Is that when remineralization occurs? It's a tough one. It's a tricky word. It's a tough one. Remineralization. We'll have to do it. Remineralization. Right. Oh, that's right. You have to put the accent. Remineralization. Thank you. That helps. You said that before. Yes. Thank you. Is that when our teeth repair themselves?

Yeah. This is great. This is important. So, generally, after you eat, you know, as I mentioned, your mouth will become more acidic. After about 20 to 30 minutes, your saliva will naturally start to buffer. So, it will start to rise and raise the pH up. I like to see us eating more in a schedule.

So, generally, every two hours or so is when we'll get full optimal remineralization. The issue is we are a society on the go and we're grabbing crackers and chips and granola bars and we're eating and nibbling and sipping on frappuccinos. So, we never allow that remineralization to take its full effect.

So, yes, when you're not putting food or drink, in theory, in your mouth, your saliva, if it's optimized, and we should talk about that as well, we'll be remineralizing. But, unfortunately, I do feel so many of us are just not in balance. You know, we're dehydrated. We're mineral deficient.

We're calcium deficient. We're phosphorus deficient. And we're mouth breathing. So, the pH is changing just for mouth breathing can make the mouth more acidic. And so, there's a lot of factors at play. But, in theory, if I can make one suggestion to someone out there who might be struggling with cavities, I want to know not only what are you eating, but how frequently are you eating it?

So, this is a great reason why, from a dental standpoint, fasting, intermittent fasting, or, you know, time-restricted eating is a great way to combat dental decay. It's also better on gut health as well. You know, the migrating complex, the cleansability, just giving things a break and a rest is really important.

I grew up hearing that sugar causes cavities. Does sugar cause cavities? And when we say sugar, of course, all the biologists and people with a nutrition background roll their eyes because sugar is a very broad statement, right? There are simple sugars, there's fructose, there's sucrose, there's glucose, there's all sorts of variation within the simple and complex carbohydrates.

But, when I'm saying sugar, I'm thinking about foods that taste sweet or that contain sugar that's masked by other flavors, just for sake of simplicity. Like added sugar. Like added sugar. Like added sugar. I mean, now if you buy a cracker, typically if you look at the package, there's some sugar in there, which is ridiculous, but that's a whole other discussion.

Yes. But, or we could just even say starchy carbohydrates. Fermentable carbohydrates is what I like to say. Fermentable carbohydrates. But that gets kind of nerdy. So, not directly. It's really acid that causes cavities. So, what sugar does, and I like everyone to think of flour like sugar. This is also very important.

Because the bacteria in our mouth, they thrive, the pathogenic bacteria, they thrive on sugar. But flour will act like sugar in the mouth. So, they'll also thrive on flours. So, the crackers. Bread. The bread. Yeah. Even a good sourdough bread. Well, the issue. You have to give up sourdough bread.

I like sourdough too. The issue is more contact time. So, things that are really sticky and dried, I would argue. So, crackers or toast. Chips. Chips. I mean, think about if you take a handful of goldfish crackers. I haven't done that in a long time. But imagine that. It's all throughout your teeth.

In between the teeth. Down in the grooves. It's sticky. It's just a smorgasbord for the bacteria. And so, what do the bacteria do when they metabolize the sugar or the flour? They release acid. And so, if that food substrate is stuck against the tooth for a long period of time.

And these foods are also hyperpalatable. So, we're meant to be just snacking and grazing. Hitting the bliss point. You know. Grab a handful. Go do something. Come back. Grab another handful. It's constantly feeding that bacteria. So, your mouth is staying constantly acidic. So, it's truly the acid that causes cavities.

But I would argue that sugar or flour is kind of the catalyst that feeds the bacteria to create that imbalance. Is it fair to say, I know you prefer the term fermented carbohydrates or trying to, for most people who don't think in terms of starches versus fiber or simple.

Although, nowadays, people are more versed in that sort of thing. I think of carbohydrates or foods, for that matter, that if you put them in your mouth and you just kind of kept them there for a little bit, that they would dissolve. Yeah. Like a cracker. Yes. Like a chip.

Like rice. Pasta. Pasta. As opposed to like a piece of broccoli, which would get soggy, but it's got a lot of fibrous material. So, it doesn't dissolve in the mouth. And interestingly, broccoli or prebiotic fiber is what feeds the good bacteria. So, I work mostly with children now. And we can talk about why that transition happened.

I used to work with adults. But I teach them, eat the rainbow. Feed the good guys. Okay. So, we want to feed our healthy bacteria more than we want to feed the bad bacteria. And that's not to say you can't ever have fun and enjoy some fun foods, but it's all about balance.

And so, I think people don't realize the true root cause issue with dental disease is primarily diet. You know, we're so hyper-focused on fluoride and what's in your toothpaste and the mouthwash and all these products. But all of those things are really just masking the underlying issue, which is how are these bacteria behaving?

What types of bacteria and in what ratios do we have them in the mouth? And how often are we feeding them? So, I'm hearing this as a repeating theme that diet and lifestyle are going to be more important than drugs or products for keeping the mouth looking good and healthy.

Yes. I mean, for example, I personally haven't used fluoride for many, many years. And neither have my children, just because I know there are other ways to prevent disease. And I have many of my patients that choose not to use fluoride or these products also. I think so many people have been taught you have to have this product, fluoride, et cetera, to stay cavity and disease free.

But if you eat a clean diet, focus on just some of the pillars of health, that will translate into the mouth as well. Perhaps it's worth mentioning just what some of the facets of a clean diet are through, you know, through your lens of, you know, what you consider a clean diet.

Sure. So, I'm not advocating for any one diet and I do believe we're all different. So, what works for some people may not work for others. But generally, what I suggest is really high quality protein sources, a wide array of vegetables, fruit. I would argue you should limit fruit potentially, especially if you're a high decay risk, just because there is sugar, fructose.

But I don't want to villainize fruit. There's so many healthy benefits of polyphenols and everything in it. So, nuts, seeds, olives, pickles. I love fermented foods for gut health and then oral microbiome support too. So, essentially, a whole food diet, you know, things that come from the earth and more from farms and less from factories, less things out of bags.

Arguably, ultra-processed foods should be avoided as much as possible or minimized and then trying to stick to minimally processed or unprocessed foods. Is it fair to say that if one does that, either a child or an adult, that their oral microbiome will not only get healthier, but that their teeth will get whiter?

And the reason I keep bringing this up is I think a lot of people want white teeth or at least not yellow teeth. Sure. Having been involved in the public-facing health education business for a little while now, I realize that nothing that is encouraged to be good for us that takes away from the way that people want to look and feel about how they look gets much traction.

So, what I like about what you're telling us is that all the things of eating mostly unprocessed or minimally processed foods, those are going to be good for our entire body. Great that it's great for our oral microbiome. Probably is good for our whole body because of its effects on the microbiome, at least in part.

But what makes teeth white and will supporting the oral microbiome make our teeth whiter? Yeah. And by the way, there are some folks out there whose teeth need to be less white, in my opinion. Agree. Totally agree. And we're being somewhat facetious, but not really. But I think most people would like to have teeth that would be characterized as mostly white.

Yeah. We want to look good. I mean, I appreciate and respect that. I do think we've moved a little away from reality with some of that. So, I agree with you. I think there are teeth out there that could not be quite so bright, but you do you. I think everyone should do what makes them happy.

So, what makes teeth white? So, interestingly, if you look at a baby tooth next to an adult tooth, and I get this call all of the time from parents. So, the child loses their first baby tooth, the adult tooth starts to come in. And adult teeth are quite a bit darker than baby teeth, which are very white and bright.

And they're worried. What's wrong with my child's teeth? They're so yellow. That's actually a very natural shade of enamel. And why is that? It all has to do with that crystalline structure and the mineralization. So, baby teeth are less mineralized. And the crystalline structure is a little more haphazardly arranged.

It's not quite as organized. So, instead of like Lincoln logs lined up, it's more like pickup sticks to some degree. Why is that? Baby teeth are meant to resorb, dissolve, and fall out. Okay. So, this is why baby teeth are also much more susceptible to decay. So, the whiteness is coming, how the light reflects and refracts off the teeth.

Which is a lot of times why you hear if you use hydroxyapatite or even coconut oil is changing the surface, surface modification. So, it's changing the way light reflects and refracts off that tooth to make it seem whiter and brighter. Now, certainly, with adult teeth, if you're using bleaching agents, you know, hydrogen peroxide or carbon mine peroxide, some of the stronger bleaching, that's actually penetrating into the tooth and changing the structure, pulling out stain.

Do people do that? Do they gargle with hydrogen peroxide? Well, they do bleaching trays, essentially. Well, people will rinse with hydrogen peroxide, yes. And it will make your teeth brighter and whiter. But I'm telling you, it's going to do a number on your oral microbiome. So, I suggest it in a very limited fashion.

The only time I ever had a bad canker sore was because I gargled with 50% water, 50% hydrogen peroxide because an acupuncturist recommended it. He looked at my tongue and then he said, you should do that, you know, and then I did that. And then, you know, four or five days later, I had this like, you know, nickel sized canker sore on the roof of my mouth.

And I was like, ugh. And I will say, and I have no product affiliation whatsoever to any specific products, but by switching to hydroxyapatite containing toothpaste, my teeth, they definitely have gotten whiter. I drink a lot of yerba mate and coffee and I brush, but that was, it was sort of a progressive issue of my teeth dimming.

So, that's been great. I also used to get cavities fairly often when I was a kid. We, I'll talk about that a little bit later. Um, but since switching to hydroxyapatite toothpaste, I've had like stellar, um, dental reviews, assuming my dentist is looking carefully. I believe he is, but we'll see.

And to me, it just makes so much more sense. Like give teeth the mineral that they normally use to re mineralize. Um, it just makes sense. It's biomimetic. It depends on how you look at life. I think I prefer biomimetic materials personally. It's again, it's a personal choice, but I agree with you.

My patients who have switched to hydroxyapatite, and I'd like to point out not all hydroxyapatite toothpaste are the same. It depends on sourcing and the other ingredients that are in there. But generally speaking, their teeth look healthier, stronger, whiter, and brighter. They're, they just look more nourished, more hydrated.

Their microbiomes look more balanced, too. You're talking about kids and the fact that sometimes if their teeth are a little bit yellow, that's normal. One thing, um, that I've been really struck by as the discussion around longevity seems more and more prominent these days is, um, occasionally I'll run into somebody who's in their 70s or 80s, um, even 90s.

And it's very rare to encounter somebody in their 80s or 90s whose teeth are not like the color of this tea. And for those that are listening, it's like a very dark brown. Um, I've never seen somebody unless they're doing something highly artificial with bleaching. Um, I've never seen somebody 75 or older whose teeth aren't basically yellow to brown.

Darker. And when you look at people when they're very close to death, their teeth often look very opaque. Mm-hmm. Uh, what is that? Is that a blood flow issue? Is it, um, what's going on there? Yeah, it can be a xerostomia or dry mouth. So we definitely lose salivary capabilities as we age.

Very likely more mouth breathing. So mouth breathers will tend to have darker teeth because the teeth desiccate, they dry out. And over time you will experience mineral loss. Um, decades and decades of coffee, tea, wine will do it too. Well, I don't drink the wine, but I've definitely coffee tea since I was a little kid.

I've been drinking latte since I was like five. It's good. Yeah. It's delicious. Yeah. Gotta live life. Yeah. But, um, yeah. And so they're, and they, they're losing minerals too, you know, over time. Your teeth take a beating. I mean, they're, we're living to be a hundred now. Well, that's a long time to maintain this non shedding surface in our body, you know?

So, um, and then it depends on the generation too, but some, some generations, especially as you mentioned, seventies, eighties, I'd wonder about tetracycline exposures when there's certain antibiotics that we don't use anymore that can, um, were known to darken the teeth, which is to hold them from common prescription.

That raises a question I'd never thought about before. So if one takes a course of antibiotics, um, typically the, the advice is to, um, ingest low sugar kombucha, to have some Bulgarian or Greek yogurt, like repopulate the, the gut with healthy, uh, with the substrates for healthy microbiota. Um, we now know because you've told us that the mouth is the gut, which makes perfect sense.

We are but a series of tubes. That's why I was teaching my developmental neurobiology class, but it's true. It's true. And embryology, you learn that we're basically born of a bunch of tubes that are kind of do their thing in development. Um, but the digestive tract obviously starts with the mouth.

So is it the case, um, uh, therefore that we, we should be repopulating the oral microbiome if we take a course of antibiotics? Yes. Yes. Very commonly, um, patients, parents will report, gosh, my child just finished this course of antibiotics and now their teeth are stained or their gums are inflamed or they just seem off.

And it usually is because they've wiped out a lot of the healthy bacteria too. You know, it's all connected. So I do suggest my patients, if I have to write antibiotics, which I try to avoid, but sometimes we have to, that they, they do take a high quality probiotic and increase their probiotic rich fermented foods as well.

So a high quality probiotic pill. Generally. Yeah. Cause it's hard to get in enough, especially in kids. I would argue, you know, kids aren't usually eating a lot of sauerkraut and kimchi and natto and, but you know, you could do kefir, yogurt, as you mentioned, low sugar, kombucha, et cetera.

But usually a high quality gut probiotic will have some benefit to the oral microbiome, but they also do have oral, oral probiotics to focus on the bacteria of the mouth. What about mouthwashes? Yeah. Um, I've never liked them. Um, they feel they burn for one. And then I learned some years ago, and this is just kind of fun to cue to years ago.

It must've been like eight, 10 years ago. I heard, I think on the Tim Ferriss podcast, somebody said, Oh, you know, a mouthwashes will nuke certain chemicals that are essential for cardiovascular function. And so don't, don't use them. Don't use mint mouth strips. Don't use any of that stuff.

And at that time that was considered like clear, quote unquote, pseudoscience. Nobody would like alternative science, outrageous. Now we know this is actually true. And this always, you know, this always, um, delights me and scares me at the same time that many of the things that right now people go, Oh, that's pseudoscience.

I like creatine seems to be a big thing right now. 10 years ago, it was only the gym, gym rats that we're talking about. Now everyone's like creatine, creatine. So, uh, what's the story on, on mouthwashes and mouth strips and mints and things of that sort that again, like people just want to have fresh breath or at least they don't want to be the person with the bad breath.

Sure. Yeah. So Listerine and those stronger rinses in particular, uh, they generally contain alcohol, astringents, really strong antimicrobials. You know, it says kills 99.9% of germs. Well, I think we've learned we're over disinfecting. You know, this is why asthma is up, eczema, allergies are up in our children. We now are saying, get into the dirt, get, you know, get exposed to microbes and things.

Um, so we're carpet bombing the mouth. What we've learned through the data and you're right. There are studies to show that chronic habitual use of these, uh, mouthwashes, including prescription strength mouthwash, like chlorhexidine is a common one. It can damage the, uh, nitrate reducing bacteria. So we have bacteria in the dorsum of our tongue specifically, that is essentially your tongue that reduces nitrate to nitrite, which is a precursor to nitric oxide.

Nitric oxide is a molecule that is really important for cardiovascular health and vasodilation and immune health. Um, so if we're indiscriminately carpet bombing the mouth with these really strong astringents and rinses, we can be affecting our cardiovascular health and their studies to show it can increase blood pressure and potentially cause cardiovascular issues.

So when I hear someone say, but my breath is so bad, you know, I have to use this multiple times a day. I immediately think, well, gosh, why is your breath so bad? It's normal to have bad breath after you eat a garlic, you know, garlic hummus or have a cup of coffee.

But if it's chronic halitosis or bad breath, I'm curious, do you have periodontal disease, which is a chronic inflammatory, um, issue in the mouth, which can have a slew of downstream effects, which we should discuss, um, in a bit. Um, or do you have an infection? It could be a sinus infection, post-nasal drip.

Do you have tonsil stones or tonsillar infection? Like what else is going on in your mouth where you feel you need this multiple times a day to even feel like you can present yourself in public? Um, really strong essential oils and mints. Again, I would be cautious with that every once in a while of throwing in a piece of gum or a mint, of course.

Um, it's really the habitual use of these things that can be damaging. I'd like to take a quick break and thank our sponsor AG1. AG1 is an all-in-one vitamin mineral probiotic drink with adaptogens. I've been taking AG1 daily since 2012. So I'm delighted that they're sponsoring this podcast. The reason I started taking AG1 and the reason I still take AG1 is because it is the highest quality and most complete foundational nutritional supplement.

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And just in full disclosure here, it won't be the disclosure most people are anticipating. What I'm trying to get at here is all the chemical aspects of the chemistry of the mouth. Because when I think about biology, just because of my training, I think, you know, you've got chemical forces and you have mechanical forces.

Like there's stuff that literally like moves or you could, you know, chip a tooth or things that you shouldn't do to protect your teeth. And then there's how to create the right chemistry environment. Yep. So that's really what we're talking about here. And I'm trying to figure out, you know, how could I have the best possible saliva?

Yeah. I want to be the person with the best possible saliva. Good spit. Yeah. Good spit. Don't underestimate your spit. It's true. It's the golden elixir of your body. So if I were to put spit into like under the microscope and then also take some of my spit and put it in mass spec and separate out all the goodies that are in there.

Just give us a sense of the kinds of goodies that are in spit. What's in there? Because it just looks like a bunch of clear liquid to people, but blood looks like just a bunch of red liquid and there's a lot of stuff in there. There's so much in it.

It's so important. So it has bacteria, viruses, fungi, like all kinds, protozoa, hopefully in the right ratios. So we want beneficial bacteria. We all have about 5% pathological bacteria. However, at that ratio, those may not be pathological. Like they are symbiotic at that point. We are still unpacking and learning more about the oral microbiome.

But essentially you'll have bacteria. There's hormones. There's free cortisol. There's hormones. Cortisol is in our spit, folks. Yes, absolutely. There are enzymes to aid in digestion. There are immune cells and there are minerals floating around too. So think about how important saliva is to chew. If you have dry mouth or you're sick, you can't chew and swallow your food.

And this is why a lot of elderly people have a very hard time eating certain foods or if you've undergone cancer therapies and things. Once you get xerostomia, dry mouth, your teeth can degrade so quickly. So your saliva is so important. And so how do we keep it healthy?

Hydration. You know, so many of us are dehydrated. I would argue we aren't getting enough minerals either. So, you know, I suggest to some kids, I can tell in a child's mouth if they're hydrated or not by the way their saliva looks. If it looks more thick and ropey and mucousy, they're dehydrated.

If it looks like water, it's healthy. This is without any tests. So put a pinch of salt in your water or some electrolytes that can really help with bioavailability and absorption. How you're breathing is incredibly important too for your salivary health. So if you're mouth breathing, you will have less saliva.

You know, your mouth's going to dry out. The pH will drop and you're going to be in trouble. You know, dry mouth leads to cavities, dry mouth leads to gum disease. So, and then the foods we eat, of course, too, we want to have a mineral rich diet. So many of us are mineral deficient.

We're magnesium deficient. We're fat soluble, vitamin deficient, particularly vitamin D3, K2. So I think it is good. I like the idea of tests, don't guess. You know, if you have the capability to work with a doctor to see where you are with some of these things to know if you need to supplement or not or how you can change your diet.

Sorry to interrupt, but would I test my saliva specifically? Yeah. Is there a good saliva test out there? That would be a different test. So this would be more of a blood test. Like a standard blood test. A standard blood test. But there is salivary analysis. And we should discuss the importance of testing your oral microbiome.

I think just like so many of us test our gut microbiomes now, you know, GI mapping, stool tests to understand what's happening in the gut. There's salivary analysis now. And this is what a lot of functional dentists are working toward. I do salivary analysis and biomarker analysis in my practice.

We can tell a lot through a patient's saliva and what ratio and types of bacteria are there, as well as fungus and viruses and things as well. So if you have the capability, if you really want to optimize your health, I suggest testing your oral microbiome because there are certain keystone pathogens that you may have that you're unaware of that can lead to many downstream issues.

And we can jump into this now, but the oral systemic connection is really blowing up now and how oral bacteria, specifically pathogens, can contribute to Alzheimer's and dementia and fertility issues, pregnancy issues, cardiovascular issues, autoimmune disease, rheumatoid arthritis, diabetes, obesity, mood disorders, cancers. It goes on and on. All coming back to the bacteria in our mouth.

Amazing. So I really want to, um, not just double click, but really dive into that. No pun intended. Um, I do want to just ask because a subset of listeners will be interested in how they could get their saliva tested. Yes. Um, I've never had my saliva tested. I will say that based on your teachings online, I've made an effort to drink more water in addition to, um, massive amounts of yerba mate and, and small amounts of coffee.

Um, I've made an effort to, well, I switched to a hydroxyapatite containing toothpaste, um, which has been terrific for all sorts of reasons. I've, um, really emphasized nasal breathing. Nasal breathing. That's something I was into before through the sports performance world because my friend Brian McKenzie, who's a human performance expert, was really big on this a while ago.

And, um, and the healthiest my breathing and cardiovascular function ever was, uh, for me was when, um, something I don't suggest people do unless it's their profession. I was, uh, boxing for about a five year span and I had a fitted mouthpiece and I would do my running, my road work with my mouthpiece and breathing through my nose.

Um, and that taught me to like really how to breathe correctly through my nose. And it translated to switching to nasal breathing when I slept, I didn't sleep with the mouth guard in. Um, but I think that breathing through the nose is just so important for the reasons you're describing.

James Nestor has described, and I will share this little factoid and then I'll, and then I'll, um, and then I'll shut up and, and nasal breathe. Um, a friend of mine who is a physician at UCSF, he told me that the methamphetamine addicts that come in have terrible teeth.

Everyone knows this. Meth addicts have terrible teeth, but do you know why it is? He works with the school of dentistry. It's because they're mouth breathing. I've worked, I've worked with that population. Meth doesn't actually deteriorate the teeth. It's the fact that they're, they're, they're mouth breathers. And so I find this fascinating.

And then of course the book jaws, which was published by Paul Ehrlich and Sandra Khan, my amazing colleagues at Stanford years ago. And by the way, when they published that book, people said, Oh, this is pseudoscience. This is crazy. You're saying nasal breathing epidemic of, you know, fear mongering.

Well, we now know this is a real thing. It's an epidemic. So, um, so how do you encourage kids and adults to switch from mouth breathing to nasal breathing? Yes, this is a big part of my practice. So it, you, we need to understand the why, just like anything, why are you a mouth breather?

So humans are obligate nasal breathers where we are meant to be breathing through our nose. Unfortunately, so many of us are mouth breathers. They estimate up to 50% of the population now breathes through their mouth. I personally think that's an underestimate with what I'm seeing at my practice. Um, so why is this?

So the theory is, um, that ancestrally we used to chew and masticate up to four hours a day. This act of chewing, uh, it pushes forces out. It was actually what grows the face, the lateralization of the tongue, the tongue elevating. It would grow the jaws wide, the sinuses wide, including breastfeeding.

Okay. We now flash forward 10, 12,000 years. Okay. So we had the agricultural revolution. We went from hunter gatherer society to agrarian. Then the industrial revolution. We started milling and processing everything. Everything's soft and mushy. Now we used to chew four hours a day. We now chew four minutes a day.

So there's very little, there's atrophy essentially. We slurp our food. We slurp our food. It's like that movie. What was that futuristic movie with the little robot? Wally? I hated that movie. Oh, I cried during that movie. I hated that movie. Um. I was so worried that it was true.

And here we are. Yeah, they were slurping their food. Yes. Lying on recliners. Here we are. They've outsourced pretty much everything. Yes. Yes. So this is many generations of this happening. We're essentially shrinking. James Nestor phrases it. We're dis-evolving. Okay. So faces are shrinking. Jaws are shrinking. This is why we see so much crowding in teeth.

If you go to the Natural History Museum in New York, Washington, D.C., look at the ancestral skulls. The teeth are pristine. There's no decay. And all 32 teeth, including the wisdom teeth, it perfectly into the dental arches. So that was not that long ago in human, you know, our trajectory.

So what has happened? It's our food. It's how we're chewing. It's how we're breathing. And so if this structure shrinks, the nasal volume shrinks. The sinuses shrink. The airway shrinks. Our tongue has no room in our mouth anymore. So it either sticks out, tongue thrusts, or it falls back, you know, and it's obstructing us.

So there's so much sleep disordered breathing, dysregulated breathing, and sleep apnea. Now that's not getting diagnosed. So if we look at children early and they come into me and I can see it as they walk in, they generally will have forward head posture because they're trying to open their airway.

Okay. Forward head posture. They have dark circles. That's called venous pooling. That's a sign of inflammation secondary to mouth breathing. You can see more of the whites of their eyes. So it has to do with their visual plane. So forward head posture, the droopy eyes from inflammation. You see more of the sclera, the white of the eye.

They just look congested and sick. They just, and their mouth's open. And those kids have major airway issues. And we need to understand why. So it is generally either a hard tissue issue or a soft tissue issue. So what would the hard tissue issues be? That would be the size and shape of the jaws, the size and shape of the palate.

Um, this, the position of the jaws, you know, is your jaw set back? Is it forward like a bulldog? Um, and do you have a deviated septum? You know, they, they asked to me, um, 75% of humans can have some sort of deviated septum and people think that's ridiculous.

It's not just from getting in a fight and getting your nose broken. So think of it this way. If your palate is narrow and I smushed your face like this, the septum has to go somewhere. And so it will can't. Okay. So that's what creates the deviated septum. And so if we expand a face and this is what early functional orthodontists, and this is what I'm doing in my practice or doing in these younger kids, you put in a little retainer that can help expand the face and the septum straightens.

And now we can breathe better. So that's hard tissue. Soft tissues could be enlarged adenoids, enlarged tonsils, um, oral motor dysfunction, low tongue tone, low, low tongue positioning too. How much plasticity is there of the sinuses? So let's say, um, somebody has a partially or severely deviated septum and they, they could get surgery.

And I want to talk about some of the different surgeries. there's a, um, a balloon, uh, expansion thing that online, it looks really cool. I like a lot. I really want this to happen to myself. Yeah. They put the balloon up there. They inflate the balloon. Yeah. They do one that's guided.

Yeah. They numb it and then they take it out and the, you know, this kind of thing. Well, is it actually the appropriate way to do it both, uh, in and out through the nose. But, um, if somebody makes the effort to nasal breathe, so maybe they mouth tape at night, or, um, I'm a big fan of shifting from any mouth breathing to nasal breathing by insisting that I nasal breathe while I do any cardio, unless I'm pushing really hard.

And then I need to bring mouth breathing into it. But I've noticed just because I can measure snoring through, I'd sleep on an eight sleep. I can measure snoring that way. But even if you don't do that, there are other ways you can measure snoring with an app or someone can tell you you're snoring.

Um, so this isn't about a product per se. Okay. But if I force myself to nasal breathe, uh, during cardio workouts, especially kind of zone two, zone three stuff translates to less mouth breathing and snoring and sleep. So the question is, is do the sinuses actually dilate? Or if you have a deviated septum, do you need it surgically or somehow otherwise repaired?

It depends on your age. So most facial development is done around the age of 10. So the, the issue I would say with traditional orthodontics, which is when you wait for all the baby teeth to fall out and then you put braces on, you can't control the, the modeling of the face, the mid face, the jaws, which is why we now are starting with, um, functional therapies as young as three or four years old with retainers.

So in the middle of our palate is a suture filled with cartilage. And so with kids, it's really easy to manipulate and change facial development. If you make the jaws wider, not only is it improving airway, but the teeth will come in straight. Now they have room. The reason they come in crooked is there's not enough room for them to come in.

It's important to know the floor of the mouth, the roof, sorry, the roof of the mouth is the floor of the nose. So if you expand the palate, the sinuses will get wider. The septum is going to upright. Everything's connected. Now, as an adult, um, you, it's really hard to manipulate bone structure just through posturing and habit.

There are myofunctional therapists, which I, they're the best. And they're really important in this conversation. Think of them like physical therapists for breathing, teaching you to keep your lips closed, your tongue up. All of this musculature is really important. Toning it. Um, if you don't use it, you lose it.

So if you're a mouth breather, your tongue will lay low. Your tongue's a muscle. It will get weak. It will get flaccid. So we want to strengthen these muscles to help with lip seal and nasal breathing. But as an adult, if you do have a skeletal discrepancy, usually you need some sort of intervention.

You're not going to just be changing it through lip taping or how you're training or myofunctional therapy. And there are more conservative ways now besides true jaw surgery. There's an appliance called the homeoblock, which I know is what James Nestor used. You can read about it in his book that will actually start to, to change facial structure.

There's less invasive treatments. There's an MSC appliance. It's a maxillary, maxillary skeletal expansion device. It does put these little mini screws in your palate, but it will pop the suture. And adults in this is, you really would have to want this because you're struggling so much. And people who aren't breathing well, they're struggling.

I think it's, it's the most important thing for health is how you're breathing and how you're sleeping. And with children, if they're not breathing appropriately and they're waking up a lot, which is why it would be interesting to get some sort of product on you. On you. I'm just curious.

Do you get into deep sleep? Do you get into REM sleep? I do. And for great. Yeah. I'm measuring deep sleep and REM sleep through the eight sleep or whoop or both. Um, my deep sleep is great. Provided I get to sleep by about 10, 1030, because that's when you capture the deep.

When I capture the deep sleep window, if I go to sleep around 11 or midnight, I lose out on some deep sleep, even if I sleep longer. Um, and my REM sleeps really solid these days. Yeah. I'm struck by how convincing the data are about nasal breathing, improving brain function.

There were a couple of studies that showed that if people either mouth breathe or nasal breathe in a laboratory study, um, the nasal breathers have better memory recall. Um, but those were of odors. So everyone said, well, okay, of course it's a voters and you're breathing through your nose.

And so you can remember those odors. So they've now run these studies on with other types of memory and brain function. And it's just very clear that you oxygenate your brain better and you, uh, you think better. Your cognition is better. Your memory is better for everything, not just odors.

You get 20% more oxygen when you nasal breathe. And this is really important for children in these formative years of brain development. And this is why we're seeing studies, um, showing that children who mouth breathe have sleep disorder breathing. They, they have behavioral issues and many are getting diagnosed with ADHD and, um, arguably potentially put on medications when really, if we'd screened them for airway issues, potentially we could have avoided some of this.

And, and it also has to do, we're not getting into deep sleep. The glymphatic system's not kicking in. Hormone function's not kicking in. So a lot of these children, um, growth hormone is impaired. Antidiuretic hormone is impaired if they're not getting into deep restorative sleep. So that's why we see bedwetting, um, some signs to look for in your partner or your children is tossing and turning, clenching, grinding, snoring or noisy breathing, um, sleeping in really odd positions like craning the neck cause they're trying to open their airway.

Um, spinning around the bed, you know, the child's legs are in and the body's like out of the bed. The bedsheets are everywhere. And then certainly waking up unrested and then noticing behavioral issues too. Well, all you have to do to convince the, um, male half of the audience to, um, focus more on nasal breathing is to tell them and to not use mouthwashes is to tell them that, um, being a mouth breather will, uh, uh, give them sexual dysfunction.

Yes. Um, or we'll, we'll, uh, predispose them to sexual dysfunction and they'll start, uh, working on their nasal breathing. Because of nitric oxide. Because of nitric oxide. So the paranasal sinuses is what will help produce nitric oxide too. So if you're breathing through your mouth, not your nose, you're not getting enough nitric oxide, which is very important in sexual health.

But also we know men who have gum disease are 2.85 times more likely to have erectile dysfunction as well. Wow. So no bleeding gums. So no bleeding gums. We do not want inflamed bleeding gums. Um, flossing is something we haven't touched upon yet, but it's incredibly important, not only for cavity prevention, but gum health.

Um, pink in the sink, any amount of bleeding is a sign of inflammation and it doesn't just stay in the body. It can impact the entire system. So, um, please take your gum health seriously if for nothing else and for your sexual health. Great message. So to shift over to nasal breathing, if somebody is really struggling with this, do you, are you a fan of mouth taping?

Yeah. You want to make sure you can do so safely. So with kids, I always suggest they get screened by an airway focused dentist, um, or potentially an otolaryngologist or an ENT. Um, for adults, there is a test that you can do. Um, it's the three minute test. Can you breathe through your nose without panicking or feeling sympathetically challenged for three minutes?

So you can either put water in your mouth, put a piece of paper, tape, tape your lips and literally time yourself. Um, and if you can breathe through your nose successfully, then you in theory can safely lip tape. There are different tapes that you can do. So you, that there are open in the middle.

So you can still off gas or you feel less, it feels less invasive. Um, and what I suggest if people are interested in it is just start five minutes while you're chopping vegetables for dinner and then move up to 30 minutes while you're watching a show and then watch a whole movie for two hours.

And then if you've been able to tape that long, you can do so at night as well. I will tell you, it is one of the top things that I have done to improve my health. I do see it with my, um, my wearables and my sleep data. Recently, I had the privilege of giving a talk at Stanford with, uh, Renee Fleming.

It's like one of the world's greatest opera singers alive today. And I said, well, what are some things that you do for your breathing? Because I ended up talking a lot for the podcast and she gave me some, um, lung and diaphragm strengthening exercises, but then the one that she, uh, suggested for emphasizing nasal breathing, because there's a lot of nasal breathing that's done quickly and subtly, um, in order to maintain air pressure in the lungs.

And for her craft, which I know very little about, but is instead of like doing weight training for the neck, uh, it's kind of a fun one. It doesn't make the neck big. So people, um, will, who don't want a larger neck will appreciate that. But the, to exercise the internal muscles of the neck and the way you do this is something called kiss the sky.

The boxers will actually know this, the old school boxers. It looks ridiculous, but I'll do it because I look ridiculous on this podcast all the time intentionally. So you look up at the sky and you pucker like you were a puffer fish for 15 seconds per side. Interesting. And she said it builds the, the muscle, the, the muscle, the strength and the neural control over the internal muscles of the neck.

So again, no widening or thickening of the neck, but on the inside, and it makes it much easier to take deep breaths through your nose. It probably increases the amount of resistance so that you can fill your lungs more easily. I've been doing a little bit of like kiss the sky and it looks completely ridiculous.

It's kind of a yoga move too. Yeah. So, and you're just like really like lip smack as if you were going to kiss the sky from side to side, 15 seconds per side, a couple of times per day, or just whenever you remember it. And I mean, her voice is amazing.

Like her speaking voice and her posture and everything. So, um, I borrowed that one from her. You can do a lot to improve your airway health through breathing rehabilitation. So I think that is a big part that's missing in these conversations with airway health. You know, we talk about, well, you need to see the airway trained dentist.

You need to see the myofunctional therapist, the orthodontist, the ENT. That's a lot. Just the, just the scheduling of that alone makes me want to take a nap. But it is, it's a, it's, it's a lot to unpack airway issues. If parents are out there, there's two books, three I'd recommend if you're very interested in the book.

And I think that's a lot to do. I think that's a lot to do. I think that's a lot to do. I think that's a lot to do. I think that's a lot to do. I think that's a lot to do. I think that's a lot to do. I think that's a lot to do.

I think that's a lot to do. I think that's a lot to do. I think that's a lot to do. I think that's a lot to do. I think that's a lot to do. I think that's a lot to do. I think that's a lot to do. What's the title again?

Sleep Wrecked Kids. Sleep Wrecked. W-R-E-C-K. Yes. By Sharon Moore. So it will just help you screen and understand why we're worried about these things more. But yeah, I, we can't overemphasize airway health, especially in our children, you know, and catching it early and intervening early is really important. Great.

In trying to maintain airway health and healthy saliva. And now I'm obsessed with saliva. It's like, cool. It's got all this stuff in it. I was thinking it's just like, we know blood has all these goodies in it. We test blood. We know skin microbiome. We know that, you know, women go to an OBGYN.

They get pap smears. They get a, you know, I mean, they, we know if you've ever raised a kid or changed diapers, you can tell a lot about somebody's health by the fluids they emit and that they have within them. I'd like to place saliva on the list of critical things to pay attention to.

But chewing gum. Is this good for our breathing and for our saliva or not? Um, I, I, not a big gum chewer, but, um, is it good, bad, neutral? Yeah. I think it's time and place can be very beneficial. So where I like it, um, is if, cause I will say, hey, parents, you really need to avoid crackers and chips and granola bars.

And they say, what do I feed my kid? You know, um, so if we've missed the window of, of how to introduce food to children or they just favor those type of foods, what's a good strategy if you're out on the go to minimize decay risk and increase salivary health?

Chew some gum, particularly xylitol gum, because xylitol will inhibit bacterial proliferation. Um, it will reduce strep mutans, which is the bacteria that causes cavities. Um, big fan of xylitol. So offering a piece of xylitol gum after an exposure to some of these snack foods, these fermentable carbohydrates is great.

It will loosen the food. It will increase salivary health. Some people like it to strengthen, you know, mastic gum. I always get asked about that. You can overdo it. You know, I worry about temple mandibular dysfunction. I have bad experience with mastic gum. I was buying it. I love the kind of the, the, um, primordial aspect of it.

It's like a, it's like a tree sap that you chew on. It comes in this beautiful paper package and, you know, no plastics or anything. You get it going in there and you, you feel like you're really like working it the same way my bulldog Costello would like work.

He stood like teeth on like bricks and like, he was just, and you feel great. And then all of a sudden you'd go and your jaw would kind of stick in then. And then later you're like, whoa, like my jaw really hurts. Or you feel something pop up in your joint.

You feel something pop and yeah, it'll give you that. Uh, you know, these days the, the, the young influencers are so obsessed by this. It'll give you a little bit of a golf ball, um, hypertrophy of your jaw. That's not why I was doing it. But, um, but boy, does it make your jaw feel sore?

Yeah. I'm not a big fan. I like to just explain it. Think of a baseball pitcher. I mean, how many of them go on the disabled list because they're overusing their shoulder? It's, it's a similar joint, you know, rotation. If you're, we're only meant to chew really for sustenance.

That's how we were evolved. So if you're chewing gum all day, it's, it's very likely wearing down the cartilage in your joint. So I'm not a huge fan of it. I just personally don't love gum chewing, but I think time and place too. Especially from a cavity standpoint or, um, hydration, you know, increasing salivary flow, but just, I would just chew it for a couple of minutes.

Throw it out. You don't need to be chewing it for an extended period of time. But chewing food is good. Yes. Yes. Thank you. So the issue, as we mentioned is, you know, we are slurping and smushing our food. I don't, but I don't, to me, almond butter is like never existed in, in nature.

Like the idea that you would take like, I mean, almonds are so delicious. Right. But that you would like, like grind them up and put them into a paste. Like to me, the texture is so aversive. Well, you do that in your mouth. You're supposed to do that through chewing.

The fact that like the peanut butter, like to me, these things make no sense whatsoever. It's go-gurts and apple sauces and fruit snacks. Baby food. Baby food. Exactly. It's for animals and people without teeth. Exactly. So I'm not advocating that one camp or the other, there can be a mix, but you know, there's, there's blended food that's offered, or you can do more of a baby led weaning, which is eating more real foods.

Obviously, please be smart about this. Don't get choking hazards to your children. There's a lot of information out there that you can look on how to safely prepare food for your child. But chewing is incredibly important for facial development. Well, I was thinking for adults. Yes. Making fun of the fact that adults are eating like kids.

Wow. Like they're like slurping their food. Chicken nuggets and french fries. And yeah, we need to chew. When really asked what's gone on with the airway. Why does everyone, why are faces shrinking? It's chewing. We've lost chewing. And then arguably breastfeeding too. We've moved away from exclusively breastfeeding too.

What are the numbers on that? I don't know the numbers on that. How many people, I don't know either. I don't know. But it's certainly down. I think it's making a resurgence. And a lot of people though are doing a blend, you know, and we do what we, what we need to do.

I mean, a lot of women are working. And so it's important to know if you're not able to breastfeed or it doesn't resonate with you or you are working and having a pump that there are fixes. Okay. So this isn't dire, but just working with someone to catch these issues early.

And also, unfortunately, even if we're doing all the things correctly, introducing hard foods, our child's chewing and they're nasal breathing and we're breastfeeding. We, it's hard to combat generations and generations of dis-evolution essentially. So a lot of humans are needing intervention now. I'd like to take a quick break and acknowledge one of our sponsors, Function.

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Again, that's functionhealth.com/huberman to get early access to Function. Earlier you mentioned the many different systems and diseases of the body that the oral microbiome has been directly linked to. I would say in science and medicine, there are direct effects, like this mediates that and then there are indirect effects.

You know, like if a fire alarm goes off in the middle of the night, your sleep isn't good, but fire alarms don't regulate sleep. They just can modulate your sleep. But my understanding, and I'm not deep in this literature, but my understanding is that we now have fairly conclusive evidence that certain bacteria from the mouth make its way to the brain or heart or other tissues and directly increase either the occurrence or the susceptibility of dementia, cardiovascular disease.

That this isn't just a, you know, oh, you broke your ankle. So you move less. You move less. Your heart gets less healthy. Your heart gets less healthy. Your brain gets less healthy. This is kind of what I'm trying to make. But that there's, but that the bacteria in our mouth, bad bacteria, can cause real problems for the brain and heart.

Yes. And many other systems too. So much research. So they're finding 57 diseases are linked back to oral dysbiosis or oral pathogens, which is quite a lot. And different species can affect different parts of the body. So what does this all come down to? It comes down to gum disease.

So it's important to note about 80% of the global population suffers from some sort of gum disease. That's huge, you know, and about 10% of the population will have severe periodontal disease, which is chronic bone loss, tissue loss. And this is where we get tooth loss too. So gum, it's a, it's sort of a continuum, but these all have one thing in common.

It's the type of bacterial species that live in our mouths and when they get out of balance. So there's something called the red complex. This, these are the five bacteria that most influence gum disease and dysbiosis that can affect the heart and other organ systems. The big contenders, P gingivalis, F nucleatum, T denticola.

There's AA and then strep mutans too, is, can affect the heart as well. But why do these bugs, how do they get where, where these other organ systems are and what are they doing? So I like to term this leaky gums. So we've all heard leaky guts. Mm-hmm. So let's say we're just in dysbiosis and probably because maybe our oral hygiene isn't the best as well as some other things.

So we're not flossing, let's say. And our gums bleed. Okay, that's a sign of inflammation. But you now have created a vector, an opening in the skin, in the mucosa, where bacteria can get into the circulatory system, catch a free ride and end up in places they shouldn't be.

And that creates an immune response. So an inflammation. Okay. And then also these bacteria release endotoxins. Okay. They can create cytokine storms, all kinds of things. So the body doesn't like these bacteria to end up where they shouldn't. So heart disease, for example, if you have gum disease, you're twice as likely, two times as likely to have cardiovascular issues.

If you have gum disease, you're three times more likely to have stroke. A lot of this is correlative, not quite causal yet. But some of these are looking to have more influence than others and there's more research that's needed. Fertility is a big one that I like to speak about.

So women who have gum disease can take two months longer to get pregnant and to conceive. And there are studies that show in couples that can't conceive that 90% of the men show some sign of gum disease. And once they go in and get it treated, then their fertility conception improves by 70%.

That's significant, you know? Yeah. And it's not only gum disease, but just any oral infection. P. gingivalis is being linked to Alzheimer's and dementia. You know, these bacteria end up in the brain. They cross the blood-brain barrier. And they create amyloid plaques and inflammation in the brain. And so there have been studies, many studies now.

One big one was out of Harvard, where they sampled the cerebral spinal fluid in the brains and saw that in these plaques, they had P. gingivalis of almost 100% of the patients. And when they tested them against other patients who had passed away without dementia or Alzheimer's, they didn't see any P.

gingivalis. So there's a lot of association and links right now that we need more research on. And the other to be aware of is cancer. And this is why I love people to consider oral microbiome testing. I personally have a friend who we tested her oral microbiome and she was through the roof with F.

nucleatum. Pretty asymptomatic otherwise. But F. nucleatum is linked to increased risk of pancreatic cancer, breast cancer, and colorectal cancer. I mean, we swallow 2,000 times a day. And we know some of these bugs, these bacteria, they can live through the stomach acid and make their way down into the gut.

Pancreatic cancer is, sorry to interrupt, I must say I've had a couple friends die of pancreatic cancer. And while I wouldn't want any cancer, that's the one that I really wouldn't want. Because so many of them are deadly. I have someone really close to me dealing with it right now.

He actually just had his pancreas removed prophylactically because it was pre-cancerous. The Whipple procedure. Yeah. Yeah, if they catch it early enough, it goes anterior to posterior. And if you catch it early enough, they can lop off the anterior portion, the Whipple procedure as it's called. But even a colleague of mine, a brilliant bioengineer a few years ago who had the Whipple done and he was progressing well.

And then he passed away about a year and a half ago. Yeah, pancreatic cancer is no joke. So if you could just test your spit. Yeah. You know, it's a simple test. And I can give some of the tests that I like in the show notes. But you just spit into this little vial and mail it off.

And then they send back your results with you. I mean, that's pretty amazing. You do need to find a dentist who can then guide you. What do you do with this information? A lot of these pathogens, they do need antibiotics. They're very virulent. They're spirochetes. So they're corkscrew shaped and they can just impregnate and wedge into tissue.

And so sometimes we really do need to be pretty heavy hitting with how we treat them. So antibiotics. What kind of antibiotics are used to treat these things? It's usually an amoxicillin type of blend that they'll use. Okay. Radical idea that's going to get me in trouble with my more natural health audience.

But I speak to those who are more pharmaceutical. More nothing. Don't take anything. What is the argument against once every three years as a healthy adult doing a round of antibiotics to kill off unhealthy bacteria, replenishing the microbiome in various tissues. Just preventatively? Yeah, just preventative. Like kill off what might be living in the mouth.

Like kill off what might be living in the prostate. I learned recently that, you know, the prostate doesn't have the same sort of immune system protection. And so a lot of men, you know, while they don't have UTIs, they have a prostitus. And they basically just need to do a 21 day or 31 day round of antibiotics.

And everyone will be like, oh, you're spreading MRSAs with that or something. No, but you can protect against a number of different cancers related to the prostate and things like that. Why don't we do this as a regular practice? Like every three years or so, you just kind of hit the system hard for about a week, kill off a bunch of bad stuff and a bunch of good stuff, and then replenish the good stuff.

Yeah, it's a good question. I mean, I think it's harder to repopulate the gut and the oral microbiome than one might think. I like less is more approach. I think there's better ways to kill off bad things like ozone therapy is being used a lot. I use ozone in my office.

Tell me more about ozone. So ozone, it's O3. Okay. So it's a very unstable molecule. I use it in gas form or water. You can use it as an oil. It's carried usually in olive oil or hemp oil or flax oil. And so it's antimicrobial, it's antiviral, it's antifungal.

And so what I'd use it for is to treat gum disease and periodontal pathogens, but then also under fillings or under sealants or if I'm doing a pulpotomy or kind of a root canal procedure. Because otherwise, we're just blasting water everywhere. Wait, so is this oil pulling? This is the basis of...

I use it as a gas. Okay. It comes out of a machine and I use it in a wand as a gas. Okay. Very localized. I got to try this. But what's the deal with people swishing olive oil and oil pulling? I know this is big in some of the...

I don't even know what to call it anymore. What used to be alternative and it's now mainstream. It sounds like music in the 90s, right? Indie medicine is now mainstream. I love that. They sold out, right? Like the... I'm just joking, folks, but not really. It's... There's so many mimics between the health arena and kind of music and art.

Like what used to be niche becomes trendy and then becomes mainstream. Everyone's cool with it now. Yoga, breath work, resistance training used to be niche. Swishing olive oil, spitting it out. Acupuncturists love this. Mm-hmm. Alternative medicine types like this. Is there any truth to it? Does it relate to ozone?

It can. So you can find ozonated oils on the market for oil pulling. So this is an ancient Ayurvedic practice. Going back to ozone, though, just killing off mycotoxins and bacteria. This can get kind of controversial, but a lot of natural paths will use... They'll use gas ozone either rectally or they'll use the IV too.

You have to go to someone who knows what they're doing. Rectal ozone? Yes. To get all the way up to the oral microbiome? No. It would affect more like the gut area, the pancreas, the liver, etc. Nothing shocks me anymore. It's used a lot with mold elimination, mycotoxin elimination.

You know, I get a lot of questions nowadays about mold toxicity, especially people in Austin. I don't know if you know this, but like it's either theory or real that lots of people who live in Austin or used to live in Austin think they have mold toxicity. Is it because of a lot of new building architecture?

I don't know if it's like the heat-cold variation and the moisture. I don't know. I don't know if this is true or not, but you know, the last thing you ever want to do is tell somebody who thinks they have something that they don't. And I'm sorry, I'm not saying they don't.

I just, I hear this a lot. I've known a number of people that have left the city of Austin because they couldn't deal with the mold. Interesting. Molding can be scary. I mean, we see it affect the teeth. The teeth will just start degrading too in some of the kids who have tested really high in mycotoxins.

So rectal ozone. Yeah. Wild. Well, hey, listen, it's the digestive tract. I mean, you know, we're a health science podcast team. Everyone can look it up on their own, but there are providers out there doing it. So ozone can be great as an antimicrobial instead of an antibiotic. Now going back to oil pulling, oil pulling is an ancient Ayurvedic practice.

It used to be with sesame oil. More people do it with coconut oil now. I oil pull a couple of times a week occasionally. So what does that practice look like? So I put a spoonful of organic raw coconut oil in my mouth, let it melt and just swish it around as I'm, you know, dawdling around in the morning.

Nasal breathing. Nasal breathing. Yeah. Don't spit it into your sink. It will clog your sink. Spit it into the trash can. So what is it doing? Well, it's dislodging the biofilm as you're swishing. Okay. Lauric acid, which is in coconut oil, is antimicrobial. It can help with lymphatic stimulation and it has some anti-inflammatory properties too.

And a lot of people report makes their teeth look brighter and whiter. I mean, you do have great teeth. Well, I'll tell you the story why. I mean, it's in your profession to have great teeth, but I walked in and I met you for the first time in person.

I was like, wow, you have really, really nice teeth. They're not real. I had facial trauma. Should we get into that? Yeah, let's get into that. So when I was 10, it's why I became a dentist. When I was 10, I was trying to gain the attention of my older brother's friends who were very into dirt biking and BMX biking.

And we had just watched the movie Rad and I thought I would impress them. And they were all doing tricks out in the neighborhood. And long story short, I fell off my bike and landed on the asphalt in a vault and knocked out my teeth. And I broke my premaxilla and you can see the scars still.

But this is part of my story and it's why I became a dentist because I was in and out of dental offices and oral surgeons and orthodontists. And at the time, I was an art theater kid. I loved working with my hands. But as time went on, I thought, well, gosh, I don't want to be sleeping on couches in New York City.

I need to make sure I make a living. What am I going to do? And I really love science. And I thought, well, how do I work with my hands? It's dentistry and dentistry can be a little creative and artistic, too. So these are not real. But thank you.

You're welcome. And thanks for the full disclosure. They look very natural. Yeah. Unlike some people's falsies, you know, or whatever. What do you call them? I call them falsies because I've got a tooth that was kind of chipped in half from getting hit, honestly. Dumb. You know, if you're going to box, make sure you're getting paid a lot of money.

And you wear a mouth guard. Yeah, and wear a mouth guard. There are better martial arts where you can go full blast, like Brazilian Jiu Jitsu, where you stand less of a chance of brain injury, let's just say. So as a neuroscientist, I can't support boxing. But I remember the movie Rad.

It's so good. I remember the backflip at the end. I remember the whole thing. Yes. I think I was trying to do that. I don't know what I was doing. Yeah. Anyway, didn't land it. Yeah. Didn't land it. Well, you landed it, but on your face. So this is a bridge.

On your face, yeah. You can get implants. Oof. People have flippers. We were talking about hockey players earlier. You'll see them flipping their flippers around with their fake teeth. So a flipper is a retainer with fake teeth on it. There's a lot of different things you can do. Okay.

But what's interesting, I was part of making my teeth. I sat in the lab and helped. That's cool. So I wanted them to look not quite as contrived, I suppose. Well, they look very natural. Yeah. Thanks. And today we're learning all the ways in which teeth are just part of this whole ecosystem that's so critical.

I have to ask, and we will come back to some things related to avoiding really horrible diseases by way of taking better care of one's oral health. Nicotine. These days, everyone knows or should know that smoking, vaping, dipping, and snuffing, and yes, I did say vaping, are all terrible for your health.

The vapors will say it's not carcinogenic, cancer causing. And I'll say, remains to be made really clear, but the whole popcorn lung thing is clearly problematic. But nicotine doesn't cause cancer. It's the delivery mechanism. Yes. But these days, a lot of people, realizing the cognitive enhancement, if you will, I don't even like the phrase, the stimulant effect of nicotine, are using nicotine pouches in particular, gums, let's set patches aside for the moment, and mints and things of that sort.

For the stimulant effect. It's an unusual stimulant because it also relaxes one self a little bit at the same time. So it's kind of that, like, you know, that sweet spot. And I confess, I will occasionally take, you know, one or two milligrams, very low dose. Most pouches are anywhere from three to eight, uh, milligrams rather.

I'll take, you know, like one to two milligrams of nicotine in the form of a gum. I'll just chew it, you know, and then take it out. Take it out. Um, nicotine is a vasoconstrictor. What does nicotine do to the oral microbiome? Are you going to make me quit nicotine?

I don't feel addicted, but every addict says that. So, yeah. The first step is admitting the issue. Um, so I don't want to villainize anything. No, you can villainize it. So I agree with you. I don't think it's the nicotine itself, but like the pouches, for example, are becoming very popular.

So what else is in those? Um, and there's a really interesting case study that maybe we can link it for people to look at, and I'll share it with you later. Um, and then I have colleagues who are reporting this all throughout the globe, but they're one brand in particular, it will have mannitol and maltodextrin in it, which are sugar alcohols and a different carbohydrate and they market them as sugar free.

Well, products are allowed to have trace amounts of sugar still in the product, very small amount and still be called sugar free. And the issue with these products is the duration of action, the contact time. And you're supposed to leave them in for 20 to 30 minutes. Am I correct?

That's right. So it's a long time to have that up in the mucosa along the bone and along your teeth that potentially has some sugar in it. Okay. So it's like if you're sucking on a hard candy. Um, but also we're seeing changes to the, the cellular, um, structure up in that area.

So you can see leukoplakia, which is like white patching, which can be precancerous. So this is why I just like everyone to get checked out. And we are seeing bone loss and gum recession. Um, again, anytime you put anything into the mouth, it's going to change and shift the microbiome.

And that could be a filling. That could be a piece of gum. That could be a toothpick, anything, you know, arguably besides neutral pH water. Um, and so this case study, this gentleman was going in, I believe he was in his mid fifties. He started using these pouches and, and had always had very wonderful dental checkups with x-rays and went in regularly.

And maybe he missed one appointment. And after 15 months of use, the x-rays are outrageous. He has, has rampant decay along the side where he had the pouch very likely from potentially that trace amount of sugar. The microbiome changes. I mean, it looked like mothball chunks taken out of his teeth and he lost some teeth.

Wow. So this isn't to scare people, but if you're going to choose to use these, I just say, know the risks and make sure you're getting checked regularly at your dentist. Don't just ghost your dentist. Um, because if, if they're starting to see cellular changes, recession or early decay, then you may say, gosh, I should really cut back on this.

Or maybe they should, if somebody is really adamant about taking nicotine, they should just take a milligram or two milligram pill of nicotine. Yeah. Or a patch. Right. You scared me with leukoplakia. Yeah. Cause growing up, we were all told, you know, don't, no one really dips in, in Northern California, but, um, you know, like don't dip or, uh, because, and then I saw these pictures of leukoplakia.

Jaw recession. Jaw recession. And it's pretty vile. And, and so you, the design to scare you, it scared me sufficiently. I never wanted to chew tobacco, uh, anyway, but good to know. Uh, coffee. Are you in, do I need to stop drinking coffee? Okay. Thank you. You're from Portland after all.

Or near Portland. Okay. Yeah. You wouldn't be able to return home. Coffee's great. I mean, it will dry out the mouth a bit, just counteract it with hydration and it will stain your teeth. So go in regularly for cleanings and you may want to, I mean, if, if that bothers you, um, there are ways to bleach your teeth or lighten your teeth.

The hydroxyapatite is a wonderful way to improve the brightness and whiteness of your teeth and oil pulling as well. Um, or you can use heavy hitter bleaches to just, just don't overdo it. Everybody's overdoing everything now and bleaching too much can damage your teeth. And cause, um, chemical harm to the, to the pulp or the nerve over time.

And some people will get spontaneous abscessing or need root canals. I mean, these are people who are really like bleaching all the time. The people who you need sunglasses to look at their teeth and it's just not really a natural aesthetic, but some people are into that, but just know what the risks are.

That's what I would say. The two things I've done in the last couple of years that have completely transformed my, um, oral health. So it says my dentist and, um, and how I feel are first of all, I start, I switched a few years ago. I would say really about 14 months ago.

I just said, that's it. I'm not eating processed foods again. I'm just not going to do it. So I eat meat, fish, eggs, you know, fruits, vegetables. And I eat some rice oatmeal and, um, sour, a good sourdough bread, butter, olive oil. I just, which is not to say that I won't have a slice of pizza someday, but I just, I was like, that's it.

Like I'm kind of over it. Yeah. 49 years old. I've eaten enough of that stuff. I'm kind of like bored with it anyway. I hear you. And what was interesting is I used to get a lot of tartar buildup a lot. Um, despite brushing and flossing on the, um, what are the lower front teeth called?

Incisors. Yeah. And it was, and they'd scrape it away. It's a non-issue. Interesting. Like it's completely gone. Yeah. So we have minor salivary glands on the floor of our mouth and that is a common place. People will see calculus or tartars, those lower teeth. That's where you'll feel your hygienist scraping a lot.

But I wonder if it's because you increased your K2 in your diet, which helps with calcium metabolism. And I supplement K2, but I was doing that before. And then I, um, I switched and I have just full disclosure because there's nothing to disclose. I have no financial relationship to the toothpaste that you make or the toothpaste that they, um, that Gator dentist makes.

I don't know who, I actually know his real name, but he hides as Gator dentist. I love Gator. Um, Gator dentist. Uh, but I switched from fluoride containing toothpaste, not because of fear of fluoride, but excitement about hydroxy appetite. So I switched to using your toothpaste and I occasionally, well, I routinely switch back and forth with knobs where I think it stands for no BS, which is Gator dentist, uh, tooth tablet product.

Yes. So I use them and no, neither of them pay me. I pay full price. Um, I don't, they don't send it to me. I purchased it like anyone else. And that's made a tremendous difference says my dentist by no cavities whatsoever. I was constantly battling this when I was a kid and a bunch of oral health issues.

And I don't want to waste our time talking about those right now. Maybe we'll return to them a little bit later, but, um, my teeth and oral microbiome never felt better. Um, it's, it's just remarkable. It's just remarkable. Yeah. It's just remarkable. And I have a family member who has some, um, gut issues, like just digestion issues and it's unclear what's going on there.

And, um, I'm inspired to try and help them address that through the oral microbiome by switching to hydroxyapatite and, and, um, and test their oral microbiome. That'd be very interesting to know what's going on in there. Cause I think you're swallowing. Is there a best test? Sorry. Is there a best test?

Um, like if, cause a lot of listeners are going to say, okay, I want to, if they have the disposable income, they're going to want to test their oral microbiome. Yeah. Is there one that your office uses or that? I use either the SILHA test, which is more just biomarkers.

So it's. How do you spell that? S-I-L-L-H-A. Okay. This is done in an office. Okay. It's just testing basic biomarkers. So I use it a lot as an educational tool. It will show, um, the pH, the acidity, if there's leukocytes, if there's red blood cells, inflammatory markers. So a lot of parents, this is so new to them when I'm talking about this.

So, but it prints out in a graph form for them. It's a cheek swab? Um, spit. Spit. So kid or adult will spit? Yeah. Kids usually won't spit till about four, just physically. It's hard. Yeah. It's hard. Okay. Um, but I really like tests that use shotgun metagenomics because you're looking for the whole array of bacterial DNA.

Um, and so my favorite is bristle, like a toothbrush bristle and it's direct to consumer. So, because the issue is I can talk about all of these things, but sometimes it's hard to it's hard to find providers that are offering them. So I really love people to be able to get the tools to add in their home.

So bristle, um, is a company that people can. It's an oral microbiome test. Yes. And it's really user friendly. Their interface is wonderful and they will give guidance and protocols. Are you affiliated with them? Are you affiliated with them? I should probably ask because some of the audience will.

I am actually. Yes, I am. That's fine. As long as people know. They're oral probiotic. Um, we have a collaboration with their oral probiotic. Okay. But regardless if it's bristle or not, you look for a test that's using shotgun metagenomics. Shotgun metagenomics. Yes. Okay. Um, there's PCR testing too.

And a lot of biological dentists will offer something like oral DNA is the most popular. The issue with that is that it's really only looking at the top 12 pathogens, periodontal pathogens, which is important, but there can be a lot of other information that you're missing. So it's a great place to start and your dentist may offer that.

Um, it's called, again, it's oral DNA and I have no affiliation with oral DNA. Great. Thank you for that. Um, I think people, uh, some people want to test their oral microbiome, um, and, and other things in there, in there. And there's more and more popping up. Like if the oral microbiome is really blowing up.

So for those who are looking for investment opportunities, I'd say look toward the oral microbiome. It's kind of what the gut microbiome was doing a decade plus ago. Yeah. I feel like oral microbiome is so much more tractable. I mean, switch to nasal breathing, get away from alcohol containing mouthwashes, you know, consider a hydroxyapatite containing toothpaste instead of fluoride, which brings us to fluoride.

Mm-hmm. Let's talk about fluoride. I've already been accused of being a sunscreen denier. No, I actually believe that sunscreen exists. I do occasionally use zinc oxide sunscreen a little bit. I prefer a physical barrier. Mm-hmm. Cause I'll wear a hat or something if I, you know, I don't tend to burn very easily, but if I feel like I might burn, I use a physical barrier.

Um, I'm being somewhat facetious here because people will say all sorts of things, but, um, I did an episode about water, a little bit about oral health. Oh, certainly not the depth, uh, or expertise that you're providing today. So thank you. And I said, yeah, fluoride does a bunch of things.

Because my question was and remains, why are we drinking fluoride? But this relates to, okay, I'll tell this story briefly. It's not as cool as your story. I was taken to a dentist when I was a kid and they put me, they put these like a, like a like a mouthpiece with fluoride gel in it on the top and bottom.

And they sat me in a little wicker chair in front of a TV with cartoons. Mm-hmm. And I hated it. It tasted awful. And it kind of like had this sour thing. So I, it was probably six or seven. So I drank it. I just sucked it up, drank it down, turned around, barfed all over the wicker chair.

Oh my gosh. Fluoride's a poison, but everything is a poison at high concentrations. So most everything is a, is a fluoride, is a poison, excuse me, at high concentrations. So I don't have anything against fluoride, but it is a poison. Then the question becomes, if something is not dangerous in a small dose or concentration, what are its cumulative effects?

This is what, this is what I have issues. Like people say, oh, going through the x-ray machine, no big deal. But what if you fly 150 times a year? Yes. Is it cumulative? Like the logic of the, the sort of pushback from the traditional, if I will, uh, community sucks.

Like they're just not logical. These are my colleagues sometimes too, right? Just, you go to the dentist, you get an x-ray. They're like running behind the next wall. With a lead, with a lead wall. Put you in a lead shield. And then they're like, oh no, it's no big deal.

How many, you know, maybe how many times a year can you do this before it becomes ideal? Sure. So my question is, what is the rationale for putting fluoride in water, in drinking water, given that the contact time in the mouth is so short? Mm-hmm. And then what, what's the cumulative effect of bringing fluoride into the gut over and over?

And then earlier you said something and I've never thought about this. The bones contain hydroxyapatite. 60%, I think you said. Mm-hmm. 60% of your bone minerals are made from hydroxyapatite. Fluoride infiltrates the minerals of the teeth and replaces it. So is fluoride going into our bones? Skeletal fluorosis. Skeletal fluorosis.

Okay. So I'm not trying to paint a scary picture here, but, but frankly, and people can probably tell my blood pressure goes up a little bit when people say, oh, you know, you're anti-fluoride. I'm not anti-fluoride, but I just don't get the logic. It doesn't make sense. You're thinking critically about the, about it.

Like, why would I continually bombard my system with fluoride at the level of the gut, at the level of my bones? If it's good for me, tell me it's good for me. But they're saying, oh, it's so that poorer populations don't have decaying teeth. Sounds like a good argument, not even counter-arguing it.

But I can't piece together the logic. And like most public health arguments, I feel like neither side is, is explicitly clear about what exactly they're arguing about. And that's part of why I have this podcast to try and get clarity on things. Okay. I'll do my best. Yeah. Don't worry that you're going to offend anyone because I'll offend everybody.

And they've already said anything they, everything they possibly could. And they'll, and they'll say more. So I'm not afraid to open up these topics anymore. Okay. Well, I appreciate that. And I'll take the heat. I, well, I will get it too. Don't worry. I've already, I have thick skin at this point.

But you have great teeth and they don't. Yeah. And I haven't had a cavity for multiple decades and haven't used fluoride. And Portland isn't fluoridated. Portland is not fluoridated? It is not. So let's talk about that. Okay. So fun story. Back in 2011, 2012, I was working on the pro water fluoridation campaign, volunteering in Portland, picketing and handing out educational flyers because I thought we needed it in our water.

And this is because that's how it was trained. And I just never questioned it. I never picked up a journal to look at the other side. I thought anyone's speaking out against water fluoridation. That's the tin hat brigade. That's the woo woo caucus. All the things. I was that person.

The woo woo caucus. Yeah. That's pretty funny. I like that. So I went to a debate in Portland, pro versus against. I don't like those terms, but it's just the easiest way to describe it. And I was sitting kind of on the pro side and just waiting to see these pseudoscientists come out to speak.

And I was so profoundly impressed with what they said and also had no idea that there were any concerns with fluoride. I had never been taught that in dental school. The endocrine disruption, the neurotoxicity, the skeletal fluorosis. I knew about dental fluorosis, but I at that point was of the mindset, well, it's just aesthetic, you know, but your teeth are stronger and the microbiome issues too.

So it didn't take long. I just started rabbit holing and there's so much literature. And this, again, this was quite a while ago. And more and more data in literature is coming out to question the practice. So it's important to go back to the history of water fluoridation. I'll try to be brief.

But in the early 1900s, there was a dentist in Colorado Springs, Frederick McKay, who noticed his patients had mottled brown spotted teeth, but they were really strong. They weren't getting decay. And so this kind of spread and they started kind of trying to understand the why. And they realized there was a really high concentration of fluoride in the natural water supply that this community was drinking.

And this just kind of spread like wildfire with very little evidence-based medicine to back it because this was in the early 1900s. Now it was like the 1930s. So no long-term safety studies or efficacy studies. And it was put in as an experiment in Grand Rapids, Michigan in the mid-40s.

After about a decade or so, they noticed that carries rates, cavity rates were going down. And so based on this observation, it just went like wildfire throughout the United States. And I believe about 80% of the United States is fluoridated. So the pro-advocates, if you will, will say it's the greatest public health movement of the century because decay was such an issue.

It's important to know dental decay is the top chronic disease globally in children and adults. It's almost entirely preventable. I think we've just normalized it. You just get cavities. But I'd like to point out we're one of the only species to get dental decay. Wild animals don't get decay.

Our domesticated animals do because of what we're feeding them. The kibble, you know, processed animal food. So here we are. So it's been controversial from the beginning. You know, epidemiologists, endocrinologists, neuroscientists have always challenged it saying this is a bad idea. It's a highly reactive element. You know, the fluoride ion can interfere with iodine uptake.

And again, skeletal fluorosis, neurotoxicity, et cetera. So about seven years ago, there was a federal trial in Northern California, but it was federal. The people versus the EPA. It was a TASCA trial. And this has been ongoing for the past seven years. And basically they were saying, where is your safety data, EPA, on the long-term effects of water fluoridation?

So the idea was that if we put it in the water, it's not a very efficient way to get fluoride to people, but eventually it will make itself into the saliva and have a topical effect coming out through the saliva. They used to think systemically it was actually incorporating into the developing teeth in children, making the enamel stronger that way, but that's been debunked.

So now it's most likely still a topical benefit, maybe a little bit of a systemic benefit touching the teeth. And we do know fluoride really needs to work topically. We don't need to be ingesting it. And that is all through the data. And they're teaching that in dental schools now too.

Okay. But this is the easiest way to get fluoride to the masses because caries or cavities are such an issue. Now, my first comment on this is we're not addressing the root cause of dental decay, which is our food. It's all the ultra-processed foods. Again, we didn't really see dental decay in humans until the agricultural revolution, the industrial revolution, and now the ultra-processed food craze that's been happening the past many decades.

Okay. Is that right? So if we look at skeletons from dead people, obviously. Okay. Well, you can look at skeletons in live people. Skeletons in dead people from dead people that died prior to 1900. How are their teeth? 1900, they would have decay. But if you looked at about 10,000 years ago, very little.

You know, unless they lived in an area with a lot of fruit abundance or honey, like where are you getting your sugar from? You know, and you go pick some berries on a bush, you're competing with the animals and the birds. We didn't have much opportunity to overconsume sugar.

But, you know, there was the sugar trade and then we just, sugar was a sign of wealth and royalty and people's teeth just rotted out. And it was because of our diet. So that's the root cause issue that no one's talking about. You know, we're just saying, let's slap fluoride on it.

How about we educate and teach people what is really causing cavities. But anyway, okay. Okay, so the TASCA trial was going on and the judge, Judge Edward Chen, was waiting for this national toxicology programs report, which was under the Department of Health and Human Services. And this is, it reads like a soap opera, to be honest with you.

And it kept getting delayed and postponed and they wouldn't release it. And finally, under the Freedom of Information Act, he said this needs to be released. And it said there is a strong correlation between increased fluoride consumption and IQ issues in children. And so with that, he took this information and he made his ruling.

Now, this was after years of expert testimonies as well, okay, saying there's an unreasonable risk to current water fluoridation practices in the United States. This was his ruling that just happened late last year. I mean, this is very new. And EPA, you now need to fix this. You need to regulate this better.

What people will argue is a lot of the studies they were looking at that are showing lowered IQ in children or neurocognitive issues. It was at 1.2 or 1.5 milligrams per liter of, you know, that was the concentration. The United States, we now do 0.7 milligrams per liter. But what this, that's per liter.

Okay, so how many liters of water do you drink a day? This is the controversy. So, for example, the American Academy of Pediatrics generally recommends pregnant women drink two to three liters a day. You might be cooking with fluoridated water, making your pasta, making your soup. How do we really know how much someone's getting exposed to?

What's their body composition? How much do they weigh? What are the other outside sources of fluoride? Are they swallowing their toothpaste? Fluoride is in many pharmaceuticals because it helps increase bioavailability, especially SSRIs and Prilosec. A lot of these have fluoride in them. Really? Yes. Ultra-processed foods will have fluoride.

So, the factory that's making your rock star energy drink or your high C or, you know, whatever you're consuming, they're not using reverse osmosis to filter the water. So, you're getting fluoride that way. It's naturally found in green tea and black tea. And this is not to make people worried about green and black tea.

I still consume them. It's more to say, how are we really understanding how much is exposed to? And so, they were finding that pregnant women, they follow, there's many studies now, but a famous one was a Rifka Green study out of Canada, and they followed about 520 mother-child pairs.

They tested urinary fluoride, and the mother per trimester averaged it, and then followed these children to the age of 3 or 4 and did IQ tests and found that mothers who had higher concentrations of urinary fluoride, the children tested lower on their IQ tests, up to 5 to 7 points, and that's on par with lead.

Okay? On par with lead. On par with lead, yes. And so, that was in 2019. There's been so many more studies now. So, the judge ruled, EPA, you need to regulate this better. In that amount of time, there was a meta-analysis that came out that further supported the NTP report by JAMA Pediatrics.

Okay? And this is very controversial for these editors to be putting out, by the way. So, I commend them. And also, a Cochrane report came out, Cochrane Collaborative, which has said, this, again, was very recent, looking at all the data from water fluoridation, water fluoridation. Water fluoridation isn't reducing decay like we thought it was.

It's only reducing decay by about one-quarter a cavity per person. One-quarter of a cavity per person. So, that's not statistically significant. So, people will say, well, what gives? Why were cavity rates going down when we added fluoride to the water? Well, it's hard to say. Maybe they were already just going down due to education, more access to dental hygiene and toothbrushing, flossing.

But also, we now have fluoride everywhere in our toothpaste. So, fluoride was put in the water in the 1940s. It wasn't added to our toothpaste until the 1960s. Now, it's everywhere. We get fluoride everywhere. Rinses, the varnishes that made you vomit at the office. And by the way, that's very common.

That's very common. And it's because a lot of those fluoride varnishes, number one, fluoride, you know, it does have a poison control label on it. You're not supposed to swallow it. But these varnishes also have polyurethane and hexane derivatives in them. It's what makes them so sticky. I still loathe going to the dentist.

I know that flavor. I think it's because of that early association. Yeah. So, it's very controversial. And unfortunately, we've lost sight of the science. It's getting buried in politics right now. And it really upsets me because it's not a political issue. We just need to look at the data.

And I feel like we're losing sight of the scientific method. You know, the American Dental Association, the American Academy of Pediatrics is doubling down on saying we have to put fluoride in the water. And for nothing else, I think it's important to know 97% of the world does not fluoridate their water.

This is a very United States controversy. Many countries removed it and found, I think it was Denmark, Germany, Japan. They have very low decay rates. And why is this? Well, they educated their population on what's really causing decay and also made fluoride toothpaste accessible. And I have Danish relatives.

They have very nice teeth. If you told me that there's no fluoride in the drinking water in England, I might be like, well, you know, sorry, my English friends. But that's the stereotype, right? That their teeth are bad. I don't think that that's true any longer. I think that that was true at one point.

I think they're crowded and crooked, too. And a lot of that has to do, I think, with facial development as well. I think we see a lot of Western European, they do have that kind of dysmorphic face, if you will, probably from nasal breathing. Who knows why? Industrial revolution, allergies, mouth breathing, et cetera.

Why does it seem more prevalent there? So that's the take, the quick take on it. And so I just think it should be a personal choice. You know, if you want to use fluoride, you can go out to the store. I mean, you can get fluoride toothpaste at the dollar store now.

They give it out for free at many clinics. To me, I just think it's a medical ethical issue. We're mass medicating a population without their consent. And then the even bigger issue for me is no one's talking about this, nor can I find any literature on it. What is it doing to the gut microbiome?

Because it is an antimicrobial. So that would be a wonderful study, NIH, if you're listening. Can we test, you know, people that live in fluoridated areas versus those that don't? Can we follow them? Maybe it's a prospective cohort study to just see how their microbiomes are different. Because it just doesn't make sense to me.

And why would we ingest something systemically with all these potential risks when we could just use it topically or actually talk about what's really causing decay? If fluoridation worked, cavities wouldn't be the top disease in our country, in our children. And many worry, well, if we take it from the water, decay may go up.

And it may. I mean, there's been, they did this in Calgary, Canada, where decay rates went up. If you actually look at the data, the decay rates were already going up when they removed it. But they only show you the data that they kind of want to show you for that.

So, but again, it's a risk benefit analysis. I mean, I think dentists tend to be too focused on teeth. And so you mentioned, like, if they say it's good for me, I'll do it. Well, good for what? Good for your teeth or good for your whole body or good for your brain?

I think that should be an individual choice. Are you, for as a parent, do I want to choose one quarter less cavity in my child? Or do I want to preserve their optimal brain development? I mean, the data that show deficits on par with what one sees with lead exposure.

That's the most striking thing to me. Yeah. And I'm a dentist. I was trained to fix teeth. I can fix a one quarter cavity in a tooth. I can't fix a developing brain. We have one shot to develop a brain. We have one shot to grow a face. You know, it's really important.

Well, I really appreciate you taking us through the full arc of the history of it. I think it's extremely important that people take that in so they can start to form their own opinions. And you pointed out a number of logical flaws in just the way the whole system is arranged right now, which is this mass treatment of everybody with a potent chemical, especially given the amount of water that people drink and cook with, etc., without their consent.

And without a risk assessment. So your low decay rate, I might be a really high decay rate. You don't need anything extra. Your diet, your balance, your microbiome is great. I'm not eating well. My hygiene is terrible. You know, we we can't just blanketly be treating everyone the same.

We're supposed to be doing risk assessments. I'd like to take a quick break and acknowledge one of our sponsors, Element. Element is an electrolyte drink that has everything you need, but nothing you don't. That means the electrolytes sodium, magnesium and potassium all in the correct ratios, but no sugar.

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I also drink Element dissolved in water during any kind of physical exercise that I'm doing, especially on hot days when I'm sweating a lot and therefore losing a lot of water and electrolytes. They have a bunch of different great tasting flavors of Element. They have watermelon, citrus, et cetera.

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I think this is going to be a very important aspect of public health in the year to three years to come with this new administration and Bobby Kennedy paying a lot of attention to fluoride. And I really like what you said about trying to remove the political aspects of this.

If this becomes a blue versus red, left versus right thing, we're never going to get to the heart of the matter. Yeah. And that would be really sad, and the ones that would really suffer would be kids. Kids, the children, yeah. So a nonpartisan look at this, which is how I heard everything that you said, just seems really critical.

Where are they getting the fluoride? So water fluoridation, the fluoride that they get is a byproduct of the phosphate fertilizer industry, and it's called hydrofluorosilicic acid. So as a byproduct of the phosphate fertilizer industry, it's considered a hazardous waste, and it's very expensive to dispose of. But they have found that if diluted, in theory, it's an acid, first of all.

So if it's put into our water system, it is so diluted that it becomes safe. But I will say, you know, everyone can go research this and look at themselves, but it does come in like cement bags with skull and crossbones on the front, and they do have to wear hazmat suits to put it into our water.

And they're supposed to titrate it, and I think what's interesting, you know, we're supposed to target 0.7 milligrams per liter. So I've been involved in some educational campaigns and have tested communities surrounding Portland. It's very hard to keep it in range, you know, and so there are some communities testing as high we've seen as 2.2 milligrams per liter, which definitely falls into, based on the science and literature, more concerning zone for neurocognitive issues and other health issues.

So if you're concerned, you can call your local water bureau, municipality. I will say I don't think the federal government is going to have much control over this. It would be nice if the EPA stepped in. They have appealed, by the way, but it will come down to more like on the state level and local level.

And we're already seeing states like Florida and Utah have run it through and initially done a, we're going to ban this as a mandatory thing in our state. And I think it's North Dakota, Kentucky, there's other states picking this up too and other communities that are removing it or not adding it to their water.

So it's an interesting time to observe all of this. Super interesting. I will resist the temptation to ask questions about why it sounds like mostly red states are the ones doing this as opposed to blue states. Although Portland is in a blue state. Portland's traditionally- Blue city for sure.

Blue city. Yeah. Right. Blue city in a- Red state. When Oregon went red this last election? The cities make up, it's kind of like many states. So Eugene, Portland, Bend tend to be pretty blue. And I think the surrounding is more conservative, but no, it's shifted a bit, but not enough to shift out of voting liberal.

All right. Well, we'll do another episode in 2090 about politics. Meanwhile, back to the oral microbiome and otherwise. I'm very interested in the relationship between oral health and what you described as fertility, pregnancy and hormones. And obviously hormones can be about men or women, but let's talk about oral health and fertility.

What, if any, knowledge is there about how oral microbiome or oral health would be impacting egg health, fertility, ovulation, ovarian reserve? Is that sort of the level that the regulation of fertility is thought to occur? What's known about the link? Yeah. So again, it ties back to that translocation and creating an immune response and inflammation, as well as the endotoxins that are released.

With men particularly, they're seeing increased on sperm challenges with sperm motility and sperm mobility as gum disease and periodontal pathogens increase. And again, it probably, it has to do with the inflammation. And with women, you know, we can show that women take about two months longer to become pregnant.

So it does affect ovulation, egg quality, but also we know it can lead to miscarriages and low-term birth, low-weight birth, preterm birth, and just pregnancy complications as well. And so we are finding oral bacteria in the placenta. You know, we're finding there's different microbiomes everywhere now. The breast has a microbiome.

The placenta has a microbiome. And so oral bacteria can end up in many of these places and just create that cascade of inflammatory events. And so certainly it's an exciting time to be alive because of all the research happening. And right now it's, again, not causal. There's a lot of correlation.

But I would love to see fertility clinics focusing more on oral health. Like how amazing would it be if they started testing the microbiome of patients and if they realize they're really high in P. gingivalis or F. nucleatum and they eradicated or less in that bacteria. I mean, it'd be interesting to see how pregnancy and fertility outcomes would change and possibly improve.

Great. What are some of the mechanical as opposed to chemical things that we can do to improve our oral health? So we were all taught brush and floss twice a day. I even have a colleague who can be caught in the bathroom brushing his teeth after lunch. So he's brushing three times a day.

I don't know what motivated that. I do that too. Do you? Okay. Great. So what's the deal with brushing? When, let's say, kind of like exercise. Let's say if someone were going to only brush once a day, better to brush in the morning or at night. Obviously, people should brush twice a day or more.

But if one could only brush once a day, would it be morning or night? Yeah, I guide parents on this a lot because brushing a child's teeth can be challenging. Nighttime is always the most important. One, you're removing the food particulate matter from the day away. You're disrupting that biofilm so that you're not sitting, sleeping all night, 8, 10, 12 hours if you're a child with that sticky, potentially disbiotic biofilm on your teeth.

And then you add in maybe your mouth breathing that's going to shift the microbiome and drop the pH more. So it's really nice to go to bed with clean teeth. So I suggest focusing on the nighttime. What does drive me a little bonkers is the fact that we tend to focus so much on brushing, but we leave out flossing a lot of the conversation.

So thank you for mentioning that. If you read children's books, you'll see they all say go brush your teeth, but never floss. So we need a revamp there. Most cavities that I see in children, and this translates to the adult population as well, are in between the teeth or interproximally in the molars.

And it's really common. So a lot of parents will bring their kids in. They think they've been doing everything correctly. They haven't been flossing quite yet. And we take x-rays for the first time and the children have eight cavities, which sounds like so many, but it's really common because we have eight molars.

And so it happens between the teeth where you're eating those goldfish crackers, those pretzels, those chips, they get stuck in between the teeth. The bacteria come to feed, the acid gets released, and it just sits there hour after hour, day after day, arguably week after week if you're never flossing.

So I really like flossing to be part of the routine too. Again, if you can only do it once a day, that's great. That's fine. Do it at night. I like to floss first, then brush. You're dislodging the food in between and kind of brushing it away. There's actually studies to support this too, that order.

However, beggars can be choosers. Just do it. You know, some people get a suction cup mirror. They'll do it in the shower. Some people do it in their commute in the car. I'm not going to be picky about it. I will also say as we age, flossing doesn't always cut it by itself.

So think about a little string of floss. You know, we want to put it between the teeth and they suggest you do a C and a backward C. You're scraping the sides of the teeth to disrupt that biofilm. But as we age, we all lose a little bone. So you get this little pocket where that string isn't cleaning the bacteria out of and that's where a water pick can come in.

And so if you really want to be an overachiever, I do love a little water picking too. I personally will alternate. So one night I might floss. The next night I might water pick. This works really well in patients that can't put their hands in the mouth. They have like an aversion to that sensory children often will struggle with flossing.

So water picks can be fun. You can do it in the bathtub so it doesn't get totally messy. Or in the shower, they make cordless versions. But I can't overemphasize how important flossing is. That interproximal cleaning, it stimulates the gum tissue and you're less likely to have gum disease as a result.

What about those little toothpicks with a little sling of floss across? The trees? You know, the hard picks. Yeah, floss picks. Floss picks. They're great, especially in kids. It's the only way to floss a child's teeth, first of all. So I want parents, as soon as teeth touch, they should be flossing.

That could be the anterior teeth. Our jaws are shrinking. Our teeth are crowded. It's rare for me to see a child with space in their front teeth. That is how we should be developing because adult teeth are wider than baby teeth. They need more room to come in. But very often we're crowded.

So anywhere teeth touch, we should be flossing. But usually around the age of two and a half, the molars are in touching. And parents look at me like I'm crazy, but we really should be flossing. And so if you start some of these behaviors early, it becomes easier and easier.

We know kids that floss become adults who floss. Also, floss picks are fine for adults, too. Some people have big hands. It's hard to get floss in. I have to use them. I can't get my hands into my mouth. They're fine. Yeah, okay. You just want to try not to just go straight up and down.

Just kind of angle, angle if you can. And then maybe a water pick, too. And I was told by my dentist, soft toothbrush. Yes. Because I tend to get in there and, like, I'm hearing all this stuff about how the, you know, oral health is so important for the brain.

And that could lead some people, including me, to get in there and just start, like, scrubbing and scrubbing and trying to get everything out of there. And that's not the right approach, right? And brush stroke. Very gentle. So you want to do gentle, circular movements. You don't want to wear away your enamel.

This is also important. Many people will eat and then run to the bathroom and brush their teeth. Every time we eat, our teeth demineralize a little bit, right? Remember I mentioned it takes about 20 or 30 minutes for that remineralization to begin. So if you're immediately going to brush, you could be, your bristles could be damaging your enamel and creating, just wearing it away and creating little marks and lead to sensitivity recession.

So if you can, try to wait 20 or 30 minutes after you eat or drink to brush. This includes with vomiting, the same thing. So we all want to brush our teeth after we maybe get sick. Try to just maybe rinse your mouth, maybe with a little baking soda.

A lot of this is perfect world, okay, and I get it. But just, I like people to have the information. You said marking, and I meant to ask something earlier, not to return us to the fluoride conversation, but you said that the person who initially had the idea to include fluoride in treatment of tooth decay noticed that kids' teeth had dark spots on them.

Does fluoride cause darkening of the teeth? It can. So I believe it was his pediatric and adult patients. It was just this whole community had these spotted teeth. So that is something called dental fluorosis. Spots and markings on the teeth can be many different things. One is fluorosis. One could be hypoplastic enamel.

I think we should touch on that. So fluorosis can be mild, moderate, or severe. When it gets more severe, that is where it can be dark, spotted, orangey, brown. Mild fluorosis usually is more brighter white. You often see it on the incisal tips or on the cusp tips of the molars.

It's not a very attractive feature. It's not. And it is a sign that you've had excessive fluoride, you know? And I will say 40% of teenagers now have dental fluorosis. That very likely means they also have some degree of skeletal fluorosis as well. So for all the challenges that the debate around fluoridization of water has, I am willing to bet a significant amount of my savings that this issue will end up being the linchpin issue.

It might seem crazy, right? Like here's the substance that may or may not be safe that we're ingesting for various reasons. And there's a history there, which you beautifully described. But having been in this public facing health education game for a little while now, for the typical person who's like, yeah, whatever, I've been drinking water and I feel fine or my kid feels fine or there's nothing I can do about it now.

They're 15, maybe they're, you know, 10 IQ points down from where they would be. But if you tell people, what I find so interesting about human psychology, if you tell people, did you know that fluoride not only might have some neurodevelopmental impact, it's probably getting into your bones, just like it's getting into your teeth.

But you know that those spots on your teeth that are those white spots or dark spots that are really unattractive. That's because of fluoride. Now you've got everybody. Aesthetics. Aesthetics. And, and it's, it's either a shame or whatever that this is the way that people, people are. But the moment that people realize that something that either is good for them or was intended to be good for them might be bad for their long-term health, you sort of got them hooked.

But these long-term correlations are very hard to, to motivate human behavior. But those white spots, nobody wants those dark spots on the teeth. Nobody wants those. And I, I'd be willing to bet that that becomes one of the key issues. And if people go, Oh, listen, it's actually making my teeth uglier.

Yeah. Maybe stronger, but uglier. Um, I, I bet you this becomes a wedge in the conversation. That will come from the public. But I will tell you, I have dentists when I speak as I do about water fluoridation and in fluorosis specifically say, well, it's just aesthetics. At least their teeth are strong.

Like they're making the decision for, for the patient. And I think that's not our right as providers to make that decision for someone, but it's really common. Um, fluorosis is very common. I I've even seen late, more recent data saying as high as 60%, but the 40 is kind of the standard number that we go with of teenagers with fluorosis.

There is something called hypoplastic enamel. And this is something I'm very passionate about. Um, this is under mineralized enamel. And I believe it's a silent epidemic in children. I see more and more children whose, their teeth erupt and they're mottled and chalky and some are so severe they're crumbling.

And I've seen a big uptick in this in my 20 year career. And the data is starting to show this as well. Um, and so unfortunately, so many parents, their kids will get decay. It's really common and they get shamed and blamed. Like, what are you feeding them? You're not brushing and flossing their teeth.

You're neglecting them. Um, or they're told to stop breastfeeding because that's what's causing the issue. But it's really that the teeth, the enamel didn't form properly and it's not as acid resistant. It's more fragile. It's more pickup sticks than the Lincoln logs. Okay. And, um, I believe in colleagues globally agree that it's very likely due to all the mineral deficiencies that we're seeing globally and the vitamin D deficiency that we're seeing globally.

You know, we're inside all the time. We're not outside all the junk light that we're getting the blue light. It can also be from environmental toxins, high fevers, viruses. Um, but it's a real concern. And so many children are under having to undergo general anesthesia now to get their teeth fixed.

The study I read said about a hundred to 150,000 a year for preventable issues. You know, there's risk to general anesthesia. And this is where I do love to consider a more conservative approach. Like, can we remineralize these teeth? Are there strategies that we can do to even just kick the can so the child's older so they could sit for treatment so that we're not putting so many children under anesthesia?

Because I don't think we have the data for all the long-term potential cumulative effects. And we've, we talked about this earlier. It's not just one exposure, right? It's not just one exposure from an x-ray or one exposure from fluoride or one anesthesia exposure necessarily, but it's that cumulative effect that we don't have enough data on.

So going back to this relationship between oral microbiome, oral health and hormones, um, and focusing specifically on female hormones, um, the menstrual slash ovulatory cycle that occurs each month, as well as perimenopause, menopause, um, about half of our listeners are, are women. I'm curious, are there certain phases of the menstrual cycle or certain, uh, uh, perimenopause, menopause, or prior to it, uh, in which women should pay particular attention to their oral health?

Is it like, is it like, is there a known association with like, uh, you know, when estrogen is rising or falling that the oral microbiome tends to be more vulnerable and they perhaps should spend a bit more attention on their oral health? Yes. So we see it both ways rising and falling.

So around puberty, we'll see changes to gum health. So a lot of young girls will have more gingivitis or, um, gum inflammation. And, uh, you know, and certainly if they're on oral contraception, that can change things too. And, and they'll go into the dentist and be accused of maybe not brushing and flossing appropriately, but it's really a hormonal issue.

So it's important to know that. Um, as well as women who are pregnant. Who are pregnant, pregnancy gingivitis affects 50 to 70% of women, 50 to 70. It's a lot. Wow. Yeah. And it usually goes away once you have the baby and you've gotten through some breastfeeding and hormones regulate.

Um, but it's important to know that you can also have relaxin can, you know, it helps us prepare for childbirth, but it can shift teeth. We have a ligament around our teeth, much like we have ligaments in our, in our pelvis. And that periodontal ligament is impacted by relaxin.

So you can see teeth shift and move. And women may sometimes say my bite is different now. Um, my gum health is different. So it's very important. Preconception is certainly during pregnancy to, to be really on top of your oral hygiene as best as possible and see a dentist regularly.

And then perimenopause and menopause. There's a whole slew of issues that happen to women. Um, and from an oral health perspective with hormonal shifts, you know, decreases in estrogen and progesterone can impact collagen synthesis. So more TMD, more headaches, um, certainly gum inflammation, dry mouth, burning mouth syndrome, um, more bad breath, taste changes too.

And so what if it's just so powerful to be able to have these conversations with women rather than just say, well, just use this product, brush and floss more. Maybe we could talk, be speaking of it from a hormonal lens. Like, is hormone replacement therapy appropriate for you? Or how can we help support you in other ways?

Maybe you should see the dentist every two or three months instead of every six months. And also just the mental health component to say, hey, this isn't something you're neglecting. This is a change your body's going through. And so how can we support you from a dental community? Yeah.

Thanks for that. Um, more and more, I'm getting asked questions on social media and elsewhere about, you know, like what, how is this different for women versus men? Um, and in particular different phases of the cycle and, um, perimenopause menopause and, and essentially the entire lifespan. So appreciate that.

Yeah. I, I get burning mouth question a lot too, from my community sounds awful. So your mouth feels metallic and it truly feels burning almost like itchy. I think I haven't experienced it, but that's how it's described to me or kind of like a dry mouth. It can be a sign of zinc deficiency or vitamin B deficiencies.

And we can see changes in, in that, um, in those with perimenopause and menopause. I think it's important to know the mouth is the gateway into the body and we can see nutritional deficiencies in the mouth as well. So cracks in the corner of the lips can be a zinc deficiency.

Um, it's the same with white striations on the line or your fingernails. That can be a zinc deficiency. B vitamins can be burning mouth or, um, geographic tongue is something people experience. Um, What is geographic tongue caused by? I don't have it. I have a family member who has it and it's a, it's, it's permanent.

Cause they're, they're, they're quite, um, you know, far along in their life now and still have it from childhood. Um, we're told in dental school, it maybe has changed, but it's benign, you know, and just tell patients to avoid citrus and acidic foods. Um, it is cross-linked to, um, latex allergy and psoriasis.

So it's, it's a autoimmune issue. Um, it can be a sign of nutritional deficiencies, usually zinc, B or iron. Um, and also it can be a sign of celiac Crohn's or gut issue. Again, it's all connected. And so a lot of times when kids see me, I will send them to a functional medicine doctor or naturopath to just make, to rule that out, you know, and there's genetic predispositions too.

As we progress further along in this conversation, these ideas popped to my mind that I'd never thought of before. Like, um, because I don't tend to use them like, um, lip balms, lipstick. Um, I don't use lipstick. I don't use lip balm. I suppose I've put like one of those sunscreens when I went skiing or snowboarding years ago on my, uh, and, um, now I'm wondering like, was that just a terrible idea?

Um, but more often people are going to use, but I suppose specifically like lipsticks, are they safe for the oral microbiome? Well, I don't think it's getting into your, I mean, hopefully you're not eating it that much, but I mean, we need to be mindful of our products. You know, there's a petroleum based products, a lot of lipsticks, lip balms, they have nasty ingredients in them.

We're learning more and more and, you know, they're not necessarily as regulated here from a cosmetic standpoint as they might be in the EU. So read your ingredients, but a lot of petroleum based products will actually cause more dryness, you know, and it has a reverse effect, which is why people get addicted to chapstick.

I think they just, their lips dry out more, but when I see chronic dry lips, I'm thinking dehydration and are you mouth breathing? Cause when you mouth breathe, all the tissues dry out. So if a kid comes in with chronically dried lips, I do wonder if they're a mouth breather.

Another way to, to assess if, if you have a mouth breather on hand is do you, are you always asking someone in your life to chew with their mouth closed? So when we're chewing, we have to breathe. So you should chew lips closed, breathe through your nose. But if you can't, because of an obstruction, deviated septum, inflamed nasal turbinates, you'll have that kid, his mouth's always open and they tend not to chew enough.

They kind of mash food and swallow it because they, they're worried about oxygenation. They feel like they're going to choke. These kids tend to get picky eaters because they stay away from meat, carrots, apples, things you have to chew a lot. And they eat more chicken nuggets, mac and cheese, because you can just mash it and swallow it.

That can be a sign of oral motor dysfunction in adults and kids. So if, if you have a hard time chewing with your mouth closed, that's something you can explore and get help with. Should we be able to chew equally on both sides of our mouth? You should chew equally on both sides of your mouth.

So if you're chewing just on one side, not only will you get hypertrophy of the muscle on that side, but it can cause a shift, especially in kids, of the way you're growing. But I would want to know why. Why are you chewing that way? Is your occlusion or your bite off?

Are you avoiding a tooth because you're in pain? It can be a bad habit. There's ways to retrain, but everything should be symmetrical. So you should kind of chew-choo. Your tongue should move the bolus of food to the other side. Choo-choo. So if you can't do that, it can be a sign of oral motor dysfunction too.

Maybe your tongue doesn't have good range of motion or mobility. Maybe you have a tongue tie or low tone. So there's a lot that can go into that. And this is where seeing a myofunctional therapist could really help. You said it, so I'll have to ask. Tongue tie a few years ago, this was a controversial area.

Tongue tie being the stretch of skin between the bottom of the tongue and the bottom of the – what is it? Bottom of the – Floor of the mouth. Floor of the mouth. Uh-huh. Thank you. And this idea that in babies it should be cut. Other people say it shouldn't be cut.

And then everyone starts looking. I mean, I think mine just seems to have naturally torn back some distance. But, you know, what's the deal with tongue tie? Should it be cut? We're going into all the controversial conversations here. I'll take the heat for it. So that's called your frenum.

Okay? So we all have a frenum. It's the band of tissue that attaches our tongue to the floor of the mouth. We also have a labial frenum. And sometimes you have little buckle frenums up here in the vestibule. Okay? The cheek. Mm-hmm. If you put your finger up in your mouth, you'll feel – Oh, yeah.

Yeah. You may have them. You may not. When they dried my teeth out for something once they pull it back and you see it's – yeah. It's like webbed. Yeah. So the whole thing with this conversation is all about function. Okay? So does your tongue and do the oral structures function appropriately?

In which case, you're good. You know? What's hard is something to be mindful of. You can't diagnose anyone from a photo on social media. So I see a lot of parent blogs who are saying, my child has a tongue tie. My child has a lip tie. You can't tell.

We have to look at function. So is it impairing or impacting breastfeeding? Can the tongue not lift appropriately? It's all about lifting, elevating, and lateralizing. So many think tongue tie impacts you sticking your tongue out. We don't care as much about that. What grows the face and the palate in utero and then beyond is that tongue lifting, elevating, and spreading that palate almost like an expander, like an orthodontic expander.

And so if it can't lift, that's the first sign. And that means it can't pull in the breast tissue and breastfeed appropriately. Babies might have a lot of reflux. Women will have pain. Okay? So that's one of the first things we look at. But then as children get older, we look, well, is there a tongue tie that is potentially leading to mouth breathing?

So when your lips are closed and you're breathing through your nose, your tongue should be up at the palate and it should have enough tone to stay there, ideally while we sleep too. But if your tongue is tethered, it can't lift up, your tongue is going to lay low and you're going to have more of the Napoleon Dynamite look.

Okay? So that open mouth forward head posture, that's just because the tongue can't lift. Many times when people have tongue tie, their palates are narrow too because in utero, the tongue wasn't up to grow the face optimally. And this runs genetically in families as well. The predisposition. So then the next thing we look at is speech, you know, and is it impacting speech or is it impacting chewing and swallowing?

So if all of those things are fine, if it looks like there's a tongue tie, but you're thriving, you're doing great, assuming you're not compensating and using other muscles and now having other downstream effects like shoulder pain, headaches, postural issues, you're great. But if a child is having issues and you've gone through the right screening and had the risk benefit discussion with the parents, I do think a phrenectomy is indicated, you know, and I myself have had one and it benefited me a lot.

My issues were neck strain and a lot of shoulder tension that really, there's a lot of fascial tissue that's impacted with a tongue tie or can be. And so it helped me a tremendous amount, but nothing's one size fits all and we're all different, you know? So this is where you do want to work with someone with additional training to see if you have a tongue tie, you know, how are they assessing that?

And then is it impairing function? And then do you actually need a procedure done? Sometimes just working with a myofunctional therapist or different body workers, a chiropractor, a craniosacral therapist, an osteopath can be enough to create balance again. So it's not always a surgical intervention. In your case, was it a general anesthesia or a local anesthesia?

I had my tonsils out also very recently, just a few years ago. Um, and because I'd chronic tonsillitis, um, and so I knew I had a posterior tongue tie and I just told the surgeon, just go ahead and do it. I'm already getting my tonsils out. Sure. You're already in there.

Yeah. Already in there. But for most people, it would be a general anesthesia. Usually, no, um, usually it is local. It's really not bad, especially they're using lasers now for their procedure. It's pretty straightforward. Yeah. That can cauterize as you make the cut. Exactly. You do want to generally suture and you want to make sure you're working with a myofunctional therapist before and after for optimal outcomes.

It's like, think about if I went in for a knee replacement, I wouldn't just walk into the operating room. Here's my knee. Usually there's physical therapy before and after to make sure you're optimized. And so it's the same with a tongue release. Peptides and red light therapy. Now we're in the, um, sort of specialized, uh, next, um, sort of cutting edge of, uh, health and self-directed health, um, or self-directed slash working with a, working with a professional like yourself, um, oral health care.

So, um, can red light therapy, like shining red light and near infrared lights, a long wavelength light into the mouth provide any benefits for a person that doesn't have any other issues like they just want to maximize their oral health. Is that something that can be helpful? What else is it potentially helpful for?

Yeah, it certainly couldn't hurt. I haven't seen any solid data on that, but, um, it would reduce inflammation, improve, um, blood flow, you know, so I'm not opposed to it. It's wonderful post-surgery, you know? So if you have wisdom teeth out or a periodontal surgery, a lot of, um, dentists and specialists are using red light therapy extraorally or intraorally to help expedite healing, collagen synthesis, et cetera.

Um, peptides are newer and exosomes as well that are being used, particularly in root canal therapies and maybe cavitation surgeries and things. Um, again, just to help with inflammation, healing, collagen synthesis, um, it's pretty cool. It's very cutting edge and it's very new and there's very few out there doing it right now.

There's a couple in LA that I know are, so I can share names. But, um, the idea is to regenerate tissues, specifically with peptides. It can, when put down in the pulpal chamber, potentially can help, um, build up the dentin within the tooth and maybe help increase vascularization, get some more vitality back to the tooth too.

So it's pretty cool. Yeah. All right. So we'll stand by on that. Yeah. Stand by. Should we be concerned about metal fillings? Um, whatever. I don't know what material they use for the other, uh, fillings. And sometimes they'll use quote unquote sealants. Like they'll see a pit, they'll put some sealant in there.

Um, and retainers are made from plastic. Now everyone's worried about plastic. So, uh, what gives? So the best dentistry is no dentistry. I will always say that. So that's why we always want to take a preventative lens as best we can, but that's not the reality since 90% of us have suffered from some sort of dental disease in our life.

Um, so mercury fillings, this can get controversial. Um, I think the first thing to do, I don't love mercury amalgam fillings. And I, I, they were recently banned in Europe. Um, I think if you're getting a new filling, I would try not to have mercury placed. That would be my recommendation.

Try to use a composite, ideally a ceramic based biomimetic material. But if you have existing mercury fillings, amalgam fillings, and you're concerned, the first thing to do is, is get a test, get a blood test to see what are your mercury levels. If they're within normal, I wouldn't worry too much.

If you have mercury toxicity or mercury through the roof, then you probably should have that conversation with your dental team and your medical team to see, could this be coming from my fillings? Um, and certainly if a filling is breaking, um, damage, it needs to be replaced, maybe considering not doing an amalgam metal filling.

So that's kind of my stance on that. Um, composite fillings, you know, they are plastics essentially. Most are BPA free, but that is a bit of a marketing idea. You know, there's still other plasticizers in there, BizGMA, et cetera. So, um, I do really like ceramic based materials. If you can find them, nothing is perfect.

You know, this is the best available that we have regarding retainers. I get this question a lot too. Um, acrylic retainers. Those are the pink retainers. What's interesting about those methyl methacrylate can have gluten in it. So if you are celiac, um, there have been case reports of, of teens, especially who they keep having GI distress or rashes because celiac often, often come out, can come out in the skin.

Um, and they can't figure out why. And it ties back to the retainer. So just be aware of that. And then people will ask, well, about Invisalign. And again, nothing's perfect. Um, usually most of these retainers and things you're only wearing for a short period as you're trying to correct your airway issue.

So lesser of two evils. I mean, I'm a big airway advocate. I want people breathing optimally. Um, that is the most important thing for your health, in my opinion, is optimized oxygenation and breathing and rest and recovery. So, you know, I, I am an advocate for expansion and some of these materials and products, um, for short durations if necessary.

So we can't take all the risk out of everything. Right. And this is why the host making sure your immune response is optimized, your detox pathways are open, your phase two liver detox is optimized. You know, that's ideal. So, yeah. Cruciferous vegetables, uh, sulforaphane supplementation, maybe. Dandelion. The same things that were recommended in the microplastics episode that I did that, um, other people have touched on.

So things like sauna, sulforaphane. Yes. Binders. Cruciferous vegetable intake should help bind to some of the microplastics that surely we are ingesting. Everyone has them. Yeah. So you just try to minimize your exposure. Um, and then sealants, I am an advocate of sealants. They, they really do reduce cavity risk.

Um, they're usually put on the molars in the grooves and the fissures of the back teeth. Um, but again, I use, so I, I use, um, spectrometry to make sure I'm not sealing in bacteria. So it's an image that shows me if there's like caries or cavity there. I'm using ozone, sometimes I'll use my laser, which helps disinfect too, to open the groove up.

And then I'm using ceramic based materials too. Um, so I think there's, it depends on your risk as well. If you're low risk, you're not eating a lot of these ultra processed foods, you're probably okay. Um, but a lot of kids, you know, we have control over our children's diets only to a certain point and then they go off to middle school and start eating the Takis and the Doritos and, you know, they make maybe some bad choices.

And so if you want their teeth as protected as possible, I'd suggest sealants. A somewhat unpleasant topic, but something that I've heard repeatedly, and I don't know if it's true, is that dentists more than people in any other profession commit suicide at very high rates. Um, and then there's this very dark joke that people make, well, you know, their hands are always in other people's mouths, so they don't have anyone to talk to, you know, like, or, you know, like, or, and then I always think, well, the logic's wrong there.

They actually could talk as much as they want. It's the patients that can't talk. So, you know, setting aside that kind of like, um, you know, gallows humor, which I don't, it's not my style of humor. Um, do dentists kill themselves more than people in other professions? Yeah. Thank you for bringing this up.

I think it's important to talk about, um, dentists do have a really high rate of depression, anxiety, and yes, suicide too. I always heard this too, even before I became a dentist and, um, it's a really hard profession. And so we tend to be the brunt of the joke, you know, we're in the, the song, um, there's songs like, I'm afraid of dentists in the dark, you know, by Vance Joy and like Steve Martin playing the eccentric dentist in multiple different movies.

I think. A little shop of horrors. A little shop of horrors, um, horrible bosses. There's like a crazy dentist. There's always like horror movies have dentists. I mean, we are the brunt of the joke a little bit. And, um, so that's hard. And, and unfortunately there are just so many negative childhood experiences at the dentist.

And this is partly why I went into pediatrics is that I was an adult dentist for many years. I felt very dissatisfied with my career because I just felt like I wasn't making a difference. You know, dental disease is so prevalent and, and unless we're talking about it from this root cause lens, we're not going to move the needle, but it's very hard when you get in the system to get out of it.

You know, the way our appointment times are set up and the overhead is crazy and the student debt now and, and the pressures and the things with dentists is we are the clinicians, but we're also kind of the CEOs of our businesses. Like many of us have private practices.

So you're wearing two hats. So when you're done with treatment all day and seeing patients all day, then you're sitting in front of the computer and you have people to help you, but you're trying to manage the business. And we didn't go into school for that, you know, looking at spreadsheets, HR issues, et cetera.

Um, and many of us are in solo practices, so it can be very lonely, but also, um, we tend to be more type A personalities, perfectionists and dentistry is hard, not it's, there's a lot of unknowns. There's a lot of variables. You know, I can put a filling in your mouth, but I can't guarantee that you're going to brush floss, follow my rules, not, you know, not eat ultra processed foods.

You're breathing through your nose, what's your microbiome like. So then you're doing all of these things that I've instructed you not to do. And then you come back because the filling fails and we're the ones to blame for that. And don't get me wrong. There's all very variations of providers out there and there's people doing excellent work and people doing not so excellent work.

But I do think it's important for everyone to know that many dentists are having a hard time with work, especially post COVID. I would say there's a lot of pressures. Dental insurance is very challenging. You know, it's not truly insurance like medical insurance. It's really a benefit package. And so you tend to only get a thousand or twelve hundred dollars a year and then everything else is out of pocket.

And so people kind of look at us like that's kind of a scam, you know, like it's so expensive. But what they don't realize is many of these dental supply companies, they have essentially monopolies on us. Like our equipment is outrageously expensive and prices keep going up and up and up.

But what isn't changing are insurance reimbursements. OK, so where does that delta come in? And usually it's coming out of the dentist's pocket, too. So it's it's why corporate dentistry is taking over in a lot of ways, kind of what happened in medicine. But I would just say be kind to your dentist there.

Just recently, this is very timely, but I don't know where this came from. Maybe it was like a tick tock thing, but there were letters being mailed on specifically. I saw in the Pacific Northwest, Oregon and Portland that dentists were receiving these these hate letters saying dentists are scumbags and they should all kill themselves.

So I think it's important for people to know what we kind of deal with behind the scenes, you know, and to just be kind to your dentist. And I would say if if if someone doesn't resonate with you, if their personality doesn't resonate with you, just go find a different dentist.

And I will I do want to understand there is a lot of post-traumatic stress disorder from from patients who truly fear the dentist. It's usually from experiences in childhood. And that's what I wanted to change, too. I just said it doesn't have to be this way. We can make dentistry a very positive place, a safe place so that children go into adults without dental disease, but also that find the dentist to be a safe, comfortable place to go.

So I mean, some people, if you're really that fearful, you know, maybe considering therapy or, you know, some sort of anxiolytic, like, do you need something to help you feel calmer at the dentist? But I encourage everyone to go to the dentist. Don't avoid the dentist, but also trying to understand it.

It is a challenging profession. Well, thank you for being an incredible ambassador for dentistry and no small part that comes from your, like, obvious kindness and goodness and also the rigor with which you approach it. So the two are certainly not incompatible. You're proof of that. Thank you. I wonder if now would be a good time for us to just sort of summarize the top 10 or top 12 things.

There are a bunch of don'ts. Maybe we can leave those out, like avoid sugary, starchy, floury foods that get stuck between teeth, that kind of thing. But maybe I'll fire off a few and you can tell me what I'm missing. Be a nose breather, not a mouth breather. Unless you're eating or speaking, keep your mouth shut, basically.

Right? Absolutely. Or you're exercising really hard and you need to suck for some air. Or you're scuba diving and you would drown otherwise. Eat non-processed, minimally processed foods. We're hearing that over and over again these days. Brush twice a day. Floss twice a day. Water pick if you can.

Yeah, that's loading a lot onto people. I would say floss at least once a day. Flossing twice a day is extra credit. Great. Yeah, because a lot of people don't floss. So we want to start out reasonable. Before sleep. Yes, ideally. So it's brush then floss. Floss then brush.

Floss then brush. But however you can do it. No, no, no. I didn't get it wrong on purpose. I also like tongue scraping. We forgot to talk about tongue scraping. Yeah, so I want to add in these things. So maybe oil pull three times a week. Put some coconut oil in there.

Swish it around. Practice your nasal breathing while you're doing it. That's right. But not in the sink. Not in the sink. And why just a few times a week? I don't know if I was clear on that. It's because coconut oil is antimicrobial. So I'm erring on the side of caution because it will target more anaerobic pathological bacteria.

But less is more. We don't want to disrupt the oral microbiome too much. So just a couple times a week. You don't need to do it daily. Great. Soft toothbrush. Be gentle. Avoid alcohol-containing mouthwashes for all sorts of reasons. Pay attention to the fluoride debate. Yes. Consider hydroxyapatite if you're concerned.

Great. I love these hydroxyapatite toothpastes. Yours and Gator Dentist's one. Love them. I don't get paid a dime for it. I pay my own money for them. I really love them. My teeth are so much healthier now. I just like them too. I like that I can – they taste good.

I don't actually rinse afterwards. We didn't talk about that. But ideally, you don't rinse after you brush. Correct. So think about if you were a big advocate for sunscreen or a lotion. You put it on, you immediately jump in the shower. You're washing it all off. So it's the same with your toothpaste.

There is a duration of action that it takes for maximum efficacy. So if you're brushing for two minutes and spit and rinse, all that goodness is getting rinsed down the drain. So it really should – you can still spit. People get confused by this. You can still spit, but try not to vigorously rinse everything off.

You do want to try to sit on the teeth and in your saliva a little bit. Avoid nicotine. And alcohol. And alcohol. Hydrate well. Yes. Electrolytes. Keep your – electrolytes. Keep your saliva abundant. Yes. Especially for older people. Yes. Yeah. Yeah. The nasal breathing during sleep, we can double click on that one because that's going to get your sleep right.

Because that just checks so many boxes. I'd say optimized minerals and fat-soluble vitamins. This is kind of Weston Price stuff. I'm trying to think here if there's anything I missed. Well, we could say tongue scraping. Tongue scraping. Excuse me. I do like tongue scraping. So again, Ayurvedic, you know, Chinese medicine will look at the tongue from a health standpoint.

If you have a white coating on your tongue, that's a sign of dysbiosis. You could have candida. This is important to touch upon. Strep mutans gets blamed for cavities so much with kids especially. But with children, we really need to be focusing on fungus too. So candida is really prevalent in early decay in children.

No one's screening for this or treating it. Candida loves sugar, you know. And this is also with diabetics. We're seeing a bidirectional relationship with gum disease, periodontal disease, and insulin resistance and blood sugar imbalances too. But so tongue scraping, and it will do a better job than your toothbrush.

People always ask because it is removing the biofilm as the toothbrush is kind of moving it around. So it's taking off that film of bacteria. I know it's kind of gross, but they tend to be anaerobic. And that can help with nitric oxide production too, because the good bacteria on the tongue tend to live down more in the crypts.

So you don't want to scrape too hard, but just get that film off. You'll also notice improvement in your taste perception too, because you're getting food remnants and things off as well. I really want that. Yeah. Oh, I love it. Once you start tongue scraping, you usually, most everyone's a big advocate for it.

Thank you so much. Thank you, Andrew. You know, really extensive and exceptionally clear voyage through oral health. I am sure that people are going to take away many, many things that are actionable. And I really appreciate that you've been such a strong advocate for pointing out that oral health is not just about teeth.

It's not just about breath. It's about that. But it's also about your whole digestive tract and about brain health and about heart health. And we have a lot of control over this particular aspect of our body, as opposed to like heart health, which we have to get to indirectly unless we're a heart surgeon.

Yes. Or gut health, which we have to get to indirectly unless we're a gastroenterologist. What other biofilm do you have access to? I mean, it really is a window into the body. So if you have gum disease or cavities, that is a sign of a metabolic imbalance in your body.

So not to make you panic, but I just want people to take it seriously that it is a window into other things that could be happening deeper within the system. Well, I absolutely love the work that you're doing. I couldn't think of a better person to bring on here to educate us all.

And like I said, you've given us so many valuable tools and we will provide links to all the incredible resources that you continue to put out into the world. So thank you for doing that. Thank you for coming here. Thanks for it's clear that this is a labor of love for you.

It's not just about like cleaning teeth or something. So yeah, people probably can't see, well, certainly if they're listening, they can't see the incredible extensive notes that Dr. Whitman brought with her and her incredible handwriting. Goodness gracious. What beautiful handwriting. Thank you. So I could read it later. Not all doctors have bad handwriting.

No, they're notoriously have bad handwriting, but yours is certainly offset whatever failures of handwriting the other physicians have. This was really fun. Thank you so much. Thanks. Well, we'll do it again. And I'm really grateful for you coming on here today. Thank you. Thank you. Thank you for joining me today for my discussion with Dr.

Stacey Whitman. I hope you found it to be as interesting and useful as I did. To find links to Dr. Whitman's work and the various resources we discussed, please see the show note captions. If you're learning from and or enjoying this podcast, please subscribe to our YouTube channel. That's a terrific zero cost way to support us.

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It's my very first book. It's entitled Protocols, an Operating Manual for the Human Body. This is a book that I've been working on for more than five years, and that's based on more than 30 years of research and experience. And it covers protocols for everything from sleep to exercise to stress control, protocols related to focus and motivation.

And of course, I provide the scientific substantiation for the protocols that are included. The book is now available by presale at protocolsbook.com. There you can find links to various vendors. You can pick the one that you like best. Again, the book is called Protocols, an Operating Manual for the Human Body.

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Thank you once again for joining me for today's discussion with Dr. Stacey Whitman. And last, but certainly not least, thank you for your interest in science. you