We have all heard to brush and floss our teeth, but what if that's just the tip of the iceberg? In this episode, we'll dive deep into oral health and the critical and often overlooked connection between your mouth and your entire body. From systemic inflammation and heart disease to Alzheimer's and longevity, your oral health might actually be playing a far bigger role than your last dental cleaning suggested.

As Dr. Mark puts it, if you're worried about feeling better, looking better, living longer, quality of life, make sure the mouth is tight and clean and problem-free. We'll unpack exactly how to do that, including what products to be using and stop using. We'll discuss a test that could change your oral health plan.

We'll talk about the right daily habits you need, as well as some that might be silently undermining all your hard work and a lot more. I'm Chris Hutchins. If you enjoy this episode, please share it with a friend or leave a comment or review. And if you want to keep upgrading your life, money, and travel, click follow or subscribe.

Mark, how much does our oral health impact our overall health? It's pretty much in every case, a life and death decision. It is a very prevalent disease, oral health issues, cavities, gum disease, bad breath, however you want to call it. And 80% of us have some version of that.

So if there's a connection to systemic health, because it'll take you down, it'll take other organ systems down, it will, it spreads throughout the body. And so it's a big deal. It's a big connection. It should be a pillar of health. And what's the mechanism by which it connects?

Is it bacteria that builds up from all these things in your mouth or inflammation? It's complicated, as you would imagine. It hasn't been proven in all cases, 100%. But pretty much everyone's behind it. There is a way for bacteria in the mouth to travel throughout the body. There are many different conduits.

It's you can get past the gums, especially if you have gum issues, which again, about after age 45, 70% of us have some form of gingivitis or gum disease. And when you have that, that barrier, kind of like inflammation of the gut, kind of the same concept. These bacteria, and these are different bacteria than you see throughout the body.

There's some uniqueness to the biome or the oral microbiome as opposed to other biomes. But these bugs wreak havoc. I mean, P. gingivalis, one of the big bugs that causes gum disease in the mouth, very prevalent in the mouth. That has now made connections to research and studies as a causative agent, not the causative agent, but one of the causative agents of the stimulus for laying down amyloid plaque, which is kind of in the old days, we thought that was Alzheimer's.

But now we know that's a sign that you're headed towards Alzheimer's. So that's how the body responds to a bug in the mouth. It becomes inflamed and it lays down the amyloid plaque, which leads to a degeneration of all the neuronal pathways that leads to dementia. So plenty of other examples with the heart, cancer, metabolic syndrome, insulin resistance, all of that.

Pretty much everything is connected to the mouth and it can also be bi-directional too. But the mechanism, it's typically through an infection from a bug in the mouth somewhere else in the body. You can just have injury. In other words, it's kind of like you can damage the tissue.

It's not necessarily an infection, but for example, you can damage heart tissue to the point where it can't function anymore. It could be a small part of the heart. And then the last one is inflammation. And if you seed inflammation throughout the body, if it's coming from the mouth and you don't deal with that root cause, then that just continually goes on.

You'll have elevated C-reactive protein index. In other words, your markers will show that you're inflamed. A lot of physicians are sometimes just confused because they're working with a patient, it could be a cardiologist working with a patient on heart disease. It could be an endocrinologist. It could be a nephrologist for kidneys.

And they're looking at that as one of the markers. And then they don't understand or they haven't been taught in medical school. And we have our dark blind spots too in dentistry. And this is the issue. There's no connective tissue between the two, even though it's the same body, you know, there are two different distinct ways of looking at the body and treating the body.

But that nephrologist is going to wreck its brains. If he doesn't know about the gum disease, then he doesn't know where the inflammation is coming from. And he can't successfully treat that patient. So it's really kind of a shit show out there, unfortunately. And then again, our insurance system is different as well.

But the actual way the bugs get into the bloodstream, they can be absorbed through the oral mucosa, which is the inside lining of our cheek, the floor of the mouth. But they're all one cell thick, just like the gut lining. Those bugs can get through to the brain. If it crosses the blood-brain barrier, it gets into the bloodstream.

It can get into tissues, into areas where the immune system isn't very active. And these bugs are there all the time. And in a healthy person, that's fine. For example, when you go in for a cleaning and your teeth are scraped and the gums bleed a little bit, that patient is experiencing a very short-term transient bacteremia, meaning bugs in the mouth are into the bloodstream.

But a healthy person can handle that every once in a while. So these bugs will cross through the oral mucosa between the gum and tooth area. That is a very anaerobic environment. It's different than the rest of the mouth. The rest of the mouth is more aerobic. It's oxygen.

There's plenty of oxygen and pH balancing saliva. But once you get into those deep pockets and the deeper they get, the more oxygen-hating those bugs become, anaerobes, they also become more virulent. And so they're sitting down there. And then there's a breakdown due to a lot of inflammation, increased blood flow.

And the body's trying to manage that connection between the mouth and the inside of the body. And remember, this is the most unique part of the body. You have a hard tissue erupting through the body. And the fingernails don't count. They're completely external. But a tooth has an internal component to the inside of the body systemically.

And it has this external component. It's sitting outside. And you can see them. And you chew on them. And they're inert. So that area, to seal off that area, is complex. And when it goes bad, the bacteria in the mouth get into the body. And then, of course, you know, from there, it can be pretty detrimental to overall health.

So that connection is important. Oral health, systemic health. And is the inverse true? If you have, you know, above average, really optimized and dialed in oral health, can that impact the rest of your body? Can that add years to your life? Yes. 100%. If I were to answer that in one sentence, and obviously we can talk more about it, but it would be nourishing and treating your oral microbiome with respect.

Not taking it down, not disinfecting your mouth, managing that oral microbiome. It's like the gut microbiome. The gut is fine. So is the rest of the body when the gut is well. So that means feeding it properly, taking care of it, making sure the pH is stable, making sure you're not using products, oral care products that actually disinfect the oral microbiome, make it difficult to do what it's supposed to do.

I wouldn't have answered that way 15, 20 years ago. It would have been more, see your dentist twice a month. I mean, twice a year, make sure you're brushing and flossing, eat well, don't eat sugar, don't eat candy. That was kind of the standard answer. It's become a lot more nuanced.

It's also become more factual, more evidence-based. We now have the right information. It's all about the oral microbiome. And is the biggest influence on that food? When you said sugar, I was thinking, you know, as a kid, it was like sugar equals cavities and that is dentistry, right? Like that, that was, that was my understanding as a child.

If the oral microbiome is the most important thing, maybe what are the components of it and how do we influence it? Right. It's all about for good oral health, for optimal oral health, you need to address all aspects, good or bad. If you're doing something bad for the oral microbiome, that has to be addressed.

And then what are the good things you can do for oral microbiome? And it is diet. I mean, it's fermentable, you know, it's sauerkraut. It's, it's not carbohydrates or anything out of a package, obviously, because the bacteria go to town with that stuff. I mean, they overfeed and then they become dominant.

They become bullies in that kind of colony of bacteria. That's not what you want. You're feeding a certain type of bacteria called the S-mutan bug. And by making that a very prevalent bug and a very virulent bug in the, in the biome, you're creating cavities. There are other components though, too.

There's pH of the mouth, there's mouth breathing. There is a, you know, if you run a marathon, you, there's a chance that your, your pH will drop in the mouth. You could be dehydrated. There's certain medications. Uh, there are certain conditions. I mean, the mouth is kind of the pole position in the body.

It's, it opens, I mean, and it's the entrance to the digestive tract. And what's going on with that microbiome every day is that, you know, I've been doing some research in preparation. Is that the D and re mineralization of our teeth or, or what's kind of the day in the life of our oral microbiome?

Yeah, that's a great question. That's one component of it. Every time you have a meal, the teeth demineralize and then the biome that sits on the bio, the biome that sits in the biofilm brings in calcium phosphate, other minerals from the saliva. Again, that's a bank too. And it pulls it past that thin film, the biofilm.

And again, if it's dysbiotic and too thick and you haven't been brushing or you've been feeding it with carbohydrates, that biofilm becomes dysfunctional. It doesn't re mineralize as well, but that's what that little layer does on that inanimate object. It keeps the calcium from getting pulled out. And if it is, it puts it back in.

That's that demineralization, remineralization cycle. Again, 15, 20 years ago, it was like you had a hole in the tooth. That was it. You're done. Get a, get a filling. But now we understand it's dynamic. Which means that, that an early cavity might not need to be filled in 2025, like it did in 2005.

Exactly. Okay. And, and is it important to do something? Or if you have that early sign of a cavity, um, do you just wait and let the body do its thing? And it's, it's like a bruise where, you know, I have a bruise on my arm. I don't do anything about it.

I just kind of wait it out. It would help to remineralize that area and, and potentiate the environment for that. So, and I only say that because we're, we're not in a very good state right now. I mean, we're eating junk, we're eating crap. Most of us are sleeping with our mouth open at night.

There are a variety of external epigenetic factors that have caused that in our modern environment. And because of that, uh, and because we're using oral care products that actually are taking down the oral microbiome so that it can't do its job, it's, we're getting cavities. It's the number one disease in the world.

It's the most prevalent disease in the world. And there's a reason for it. So obviously we're doing something wrong. I mean, and dentistry is part of the problem. We've been recommending these products. We haven't been addressing the root causes of what decay is. Uh, I have a list of what causes decay and it was very controversial, um, about 10 years ago, and then it became less controversial.

And then James Nestor, uh, spoke about it in his book, breath that was during COVID. And now pretty much everyone's on the same page. The number one cause of cavities, if you're a mouth breather is mouth breathing. It's not the food you eat. It's not brushing and flossing the lack of it's not oral hygiene.

Uh, so it's really, it's typically mouth breathing, then diet, then brushing and flossing. Again, if you have those first two under control, you don't need to brush and floss. You can see your dentist way less often. And then of course, the last one, which we have some control over there's genetics, and then there's some epigenetics and, and, and, and that all ties in.

So, you know, why are you mouth breathing? It has to do with facial development. For context, James has been on the show. We've talked about a lot of the, the health issues. I don't think we went particularly deep on the issues that are in the mouth when it comes to oral hygiene and, you know, our oral microbiome.

So that's super helpful. You know, for someone who knows that mouth breathing could be bad, understands the impact of cavities. How do you connect those dots? What's actually happening when our mouths open all night, or we're reading through it, that's creating such a, an imbalance in our mouths? Two things.

The most obvious, maybe to most is that your mouth dries out and without saliva or without the right, correct amount of saliva, your pH drops. Saliva is essentially continually buffering the pH in your mouth. The gut, the gut can buffer itself a lot easier because it's inside, but when you're right in front of the outside world and your mouth is open for six, seven, eight hours at night.

And saliva flow rate drops off anyway at night, even if your mouth is closed, the saliva glands shut down. If you're in deep sleep, that's part of the, the, the restorative process. And again, saliva isn't really needed. Your tongue is not moving. If you're in REM sleep, there's not much washing and cleaning going on.

I mean, think of a, of a spin washer, you know, a clothes washer with the, the impeller, and it's not going to clean the dirt and, and do what it's supposed to do if it's not spinning and moving. And if there's not, if there isn't enough water in there.

So it's, it essentially what it does is it allows the bad bugs to proliferate and do more damage. It also drops the pH in the mouth so that you're demineralizing quicker than you are remineralizing. Again, you need a optimal pH for that, that fixing that equilibrium to work. And so at night, I guarantee you, if your mouth is open for more than 15, 20 minutes, your pH is dropping in the mouth.

There's one more reason. It's a little bit, a little bit more subtle. It's not, it's more subtle, but it's as important, maybe even more important. When you breathe through your mouth, you don't, you're losing that feature that when you breathe through your nose, you cannot over-breathe CO2. And so the mix of CO2 and O2 in your bloodstream, again, when we inhale, you know, the, the atmosphere, it's actually very little oxygen.

Um, we want to get oxygen to all the tissues. And so we, we breathe it in, it passes through the alveoli into the bloodstream, and then to release the oxygen to the brain, for example, which is pretty important, right? Or muscle or, or, or an organ, um, you need CO2 on board.

Well, if you're breathing through your mouth at night, that oxygen uptake is, has, has been compromised because you're over-breathing the CO2. Um, so, but if you breathe through your nose, that's all done automatically. And the ratio between the two is optimal. It's actually a three gas system. There's another gas, NO, nitric oxide, but that's, that's something that doesn't get talked about much.

And that's why you want to keep your mouth closed even during the day, if you can, even while you take a brisk walk, obviously, if you're running for your life from a grizzly bear, that's emergency breathing, your mouth is going to be open and that's short term, but long-term you want to keep that ratio of the two together.

How does that affect oral health? It can affect sleep, uh, which indirectly can affect oral health. It affects overall health, obviously, but without, and without the optimal, uh, uh, pH in your blood, you're going to have some issues with, uh, gum disease. And that's a chronic disease that is very hard to get rid of.

Okay. Yeah. I'll, I'll put a link to the show in the show notes to the episode of James Nestor. There are countless examples of ways to help practice and learn mouth breathing. We actually did the episode on the couch behind me in person, and we went through some of those exercises.

So, uh, for people who want to want to check that, I highly recommend it. The one thing I'll ask you is as a dentist, how do you feel about mouth taping? Is that, is that a solution that's pro dental, uh, approved? I'm a big fan. Uh, I've been talking about it for, uh, probably 15 years and I got a lot of flack for it.

Uh, now it's mainstream, but I love mouth taping. Uh, it started out in my practice, uh, as a differential diagnostic tool. I can tell when someone's mouth breathing, I can tell certain parts of the mouth that turn kind of a bright red. Uh, obviously the biofilm is thicker. The, uh, the viscosity of saliva changes.

The patient has a lot of oral health issues. I mean, I can go on, but, um, but if you ask someone, you first have to get someone to acknowledge that this could be a problem before they're open to treatment. Not everyone benefits from mouth taping, but there are a lot of people that, that do and can and will when they mouth tape, but you have to find out.

I'm going to say, go back and listen to the episode, do a little deeper dive, but I I've heard from multiple people in person that that one change of mouth tape changed so many aspects of their health and their life. So, um, to everyone that shared those stories, thank you.

Okay. So you talked about mouth tape, maybe number one, number two is what we eat aside from our childhood learning that, you know, sugar is the bad thing and everything else is okay. What, what is the, you know, decades of research that have come out recently led you to think are things that we should be eating, we shouldn't be eating.

And then, you know, not just the makeup of it, but the consistency of blending things or, um, certain types of food. So many different ways I can answer that. First thing that came to mind was you can eat sugar. You know, if you, if you just go out and have a little, uh, sticky little, uh, uh, gummy or something and it's down the hatch quickly and you drink water, that's not long enough for the bacteria to demineralize your teeth.

The remineralization system will come on board and it'll be fine. Uh, it's more in dentistry and we've known this for a while. It's more about the frequency that you have sweets, not the quantity. Now in medicine, it could be the quantity. You could, you could have a thousand calories of sweets in a matter of minutes.

And obviously that's not good for you because there's a blood glucose spike and, and there are issues there, but in the mouth, a high glycemic food, which medicine talks about in relationship to diabetes, metabolic disease, it has the same effect in the mouth. You're still feeding those bacteria and you're making them more prevalent.

And then the next time you eat that little bit of refined carbohydrates, they're already there in bigger numbers and they're going to excrete more acid. Okay. So I like to pick on goldfish and it could be a saltine cracker. It could be, uh, it could be a pretzel. It could be a healthy rice snack with no seed oils in it.

It doesn't matter. That is a refined product. And the bacteria love that. It's the same thing as eating candy. Um, and so you're eating that. And if you snack on that every day at lunch and you don't brush afterwards, and then you have a long conference call afterwards, essentially mouth breathing, you know, that's going to lead to decay.

Um, so obviously whole foods, uh, paleo diet, uh, uh, you know, leafy green vegetables. I mean, uh, fermented food products. Again, I love sauerkraut. You can eat a pate, which is great. That's high in vitamin K2. There are three dental vitamins, a D3 and K2. Those are the three dental vitamins.

Um, you want to have those on board, especially with your kids, cod liver oil there, there, you, you have to make sure that that system that provides calcium, that makes it available in saliva is working. Is there like some sort of test someone could be doing where it's like, how is my oral microbiome doing?

Um, and is that actually necessary if you have a healthy diet and healthy teeth? So there is a test. There's a recent test. It's out of San Diego. It's the first kind of metagenomic, uh, shotgun approach where it measures for every, it looks for every and quantifies every single bug in the biome, in the oral microbiome.

A few years ago, it was 750 bugs. We're probably over 800 now. And so you can test it. They will send you, it's called bristle. Uh, I work with them and I'm an advisor for them. Highly recommend it. I've, I have said, been on record for saying that this will change, or if not should change dentistry, because again, we've been kind of looking at indirect markers.

Oh, you have a cavity that means something's well, I'd rather treat before you get the cavity and know that that it's coming. Right. So this test is available even to the public. You don't have to go see your dentist. Uh, although I would recommend that you go see a dentist and it, it has a bad breath score, which is very popular.

That's where most people go, not the cavity score, not the NO score. Uh, but, and then, but there's a lot of raw data there for your dentist. And so if your dentist is educated, if they're an expert in the oral microbiome, then they, when they treat you, it's a much more targeted way of, of treating that patient.

But there's a lot of indirect, uh, I mean, if you have bad breath, for example, uh, if your gums bleed, when you floss, these are all signs that you have a dysbiosis of the oral microbiome. You have to make changes. And are all those changes medical or could it be diet changes and product changes?

I always tell patients, you know, if you're not willing to get tested, then, then turn all the channels on and turn off the channels that, you know, are, are, we know that are going to give you a problem, for example. And, and, you know, when you go see a dentist, ask for a, a customized approach, tell them you don't want to just come in every two, twice a year.

And, you know, the, the routine stuff and be told to floss and brush, find out exactly, get tested, find out what's going on and find out what those channels are, what those triggers are. Is it your diet? Have a conversation with your, uh, I mean, you're sitting there for an hour with your hygienist, he or she will do all the talking, but that's fine.

You're going to sit there and listen, ask one question, then just say, okay, I'm going to shut up now. Tell me about how, what is the ideal dental diet? And, and then, and then you could go on from there. I mean, uh, you, you really, as a patient these days, you have to be your own advocate.

You really have to ask, what can I do about it? And most professionals will be go like, we'll be like, Oh my God, this is a interesting patient that wants to know. And the floodgates will open. You'll get all the data you need, but there is no rubber stamp to every patient that comes in.

Um, unfortunately it just doesn't work that way. There's individuality in each biome, whether it's a gut microbiome or an oral microbiome. So you really need a customized approach. Okay. Ask for it. Now, before we go past food, are there anything I saw a post you wrote where it was like, you know, 10 things you should stop doing.

One of them I noticed was like, stop using a blender, but are there any kind of quick hits of, you know, aside from switching to whole foods and these big broad scopes, are there some just really bad actors that we can all try to avoid? Yeah. One is kids are not eating what they used to eat, uh, before we had blenders and processed foods and part of their developmental process of getting that jaw to its full width, downward forward growth, which when that develops correctly, uh, then the airway develops correctly, then the nose develops correctly.

Then they become an obligate nasal breather. That development, one of the aspects of getting that to happen by age nine, by the way, 90% of it's done by then, uh, is chewing on meat sticks and really hard, crunchy things, carrots. And I would give them xylitol gum. I'm, I'm one of those parents that say xylitol gum is great.

It suppresses the, the bug that causes cavities. It promotes saliva flow. Instead of having them brush after a meal, especially at school, give them some xylitol gum. They'll chew it. It's sweet. It's wonderful. Um, so that chewing motion actually is key. If, if they're sucking down baby food and, and they're not chewing on a hard crusted bread, or that's going to have an effect on the rest of their quality of life curve.

I mean, obviously if it's in a bag and you're, you know, looking for a pair of scissors or tearing it open, be careful if it's a processed food. Uh, the bacteria love that. That's what turns the oral microbiome into a real hot mess. Um, and if that's a hot mess, then the rest of your body is, is dealing with inflammation, infections.

It's fighting all those bad bugs that in the, from the mouth that are getting into the rest of your body. Um, what else? Uh, mouth breathing obviously is a big one. Address that right away as soon as you can. Uh, that is very, very important. Uh, there are certain medications, actually most medications cause dry mouth and that's a tough one.

Obviously the medication, most people need to be on those medications, but go back to your physician, tell them you have a dry mouth, tell them that your dentist is concerned, uh, and that it could lead to worsening the disease that they're being treated for by that medication. Cause again, there's that oral systemic link and look for a different brand or, or try and microdose it, you know, cut it in half and, and titrate that to see.

And that works well as often, very, very often. And if you can just keep that saliva flow going, that is so important. Choose all a tall gum, easiest hack out there. Gum's getting a bad rap these days because of microplastics. Uh, I do recommend a gum. It's on our website.

It's out of Italy. Uh, brilliant young woman in Montreal is the one that imports it. Um, and it's microplastic free and it has Zolitol in it. Uh, Zolitol can really, it's almost better than brushing. In some cases it is better than brushing. On that same list was, was fruit juice.

Is that, is that a similar, just stop chewing or is it more the concentration of sugars? I mean, fruit juice is bad for you systemically. You know, if you're a blood glucose, uh, a system, uh, insulin spikes, get the fiber, get the fiber, bite into an apple. Uh, that's what your teeth were designed for originally.

It wasn't designed to drink apple juice. You mentioned if you, if you solve the mouth breathing, if you solve the food, maybe you don't need to brush that often aside from food and breathing. What is a proper oral care routine? It varies from person to person. Uh, there are some people probably very few that don't need to do much.

Uh, I would still encourage them to floss. Uh, if they think they have a thick biofilm or they've had a cold for two weeks, they would do a little brushing. You don't necessarily need to use toothpaste, but again, that's probably 1% of the population. And I mean, they're probably carnivores or they're eating a pure paleo diet and nothing else.

And their mouth is shut. They're not, they're sleeping well, they're nasal breathing, but most of us have to brush. They have to floss. They have to address the pH of the, of the mouth. Uh, we have to be careful when we snack, we can't brush too early. We can't brush too late.

So I can kind of go through what my protocol is with a few variations, probably the, the most, uh, precarious time for the oral microbiome is early in the morning. So let's say you've slept with your mouth open all night. There's been very little tongue movement and the viscosity of the saliva has changed.

There's, there's no way around that. Uh, so I will, it depends. I will, obviously I'll get out of bed, stretch a little bit. I'll drink a full glass of water. Remember you haven't had something to drink for six, seven hours. It's definitely something you want to do that does help the, uh, the biome because obviously the pH changes right away.

Then I would scrape your tongue. Uh, the biofilm on the back of the tongue is key for NO production. It can wake you up. NO can wake you up. It can, uh, make your day better. Um, and that's a great place to start. That's typically where the biofilm is at its thickest.

You could also floss in the morning. I know this sounds like a lot, but you can usually do this while walking through the house or, you know, it literally will take less than three or four or five minutes at most. Um, that would be my morning regimen. I did not mention brushing.

I don't think that's necessary unless you were awake all night, asleep all night with your mouth open and you just have this thick layer on your tongue, you know, dry cakey stuff on, on the edges of your, your commissaries here. Then you're, you're going to have to stir things up a little bit.

And remember, brushing is not removing the biofilm. It's just resetting it. And then with the water, then you've got a good start. Then every meal you consume after that, your breath, your NO production, everything will have a good start from that point on. You can brush your teeth after breakfast, but I would wait 30 minutes.

Most of us have something acidic. It could be coffee. If you don't eat breakfast, there's no need to, uh, to brush. And then I would, um, I would chew on gum, xylitol gum during the day. Um, after meals, let's say you have a snack, uh, or the snack could be the xylitol gum, but let's say you have a little, let's say you're at work and they are handing out a little, uh, you know, sports bars or something.

And it has, it's based on oatmeal. Oatmeal is not the best food for your teeth. It's not paleo, right? It has a glycemic index. And so you have that. There's obviously some sugar in there. It could be rolled oats with maple syrup, that kind of thing. Uh, don't brush your teeth right away.

That's what most people do. And that alleviates their guilt of having had that, that bar. No, you're scraping off enamel because there's an acid attack and a low acid event going on in your mouth and that's it's, and calcium is lifting off the teeth. If you're going to get in there with nylon bristles, you are helping remove more calcium than you would if you didn't brush.

So xylitol gum just brings on, uh, more saliva that changes, that helps balance the pH a lot quicker. And then the remunerization moment is more likely to happen. And then brush your teeth, maybe 30 minutes later. And then dinner, maybe brush after dinner, especially if you've had wine or, or tea or something, uh, wait for 30 minutes and then just brush right away.

Don't wait till bedtime. You haven't had anything to eat, anything to drink for a few hours. Um, you don't want to be using a very strong minty toothpaste. Uh, so brush after dinner. And sometimes by brushing, people are less likely to snack because they don't want to go through the, uh, motion of, uh, you know, the activity of, I do this so many times, but for that reason, not, not because a dentist told me, but it's like, as soon as I'm done with dinner, if I brush my teeth, there's not going to be the late night.

Oh, let's go. Uh, let's go have a cookie. Let's go have some ice cream. And does it work? It works great. I don't think I've brushed my teeth twice more than once in a year because it just, it works really well. This episode is brought to you by stable, which is a company that has really made my life better this year.

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Again, that's chrishutchins.com slash Daffy or the link in the description for a smarter way to give when it comes to brushing. How do you feel about regular versus electric toothbrushes or favorite brands? Again, it depends on the patient, but electric toothbrushes do have and they've been around a long time and the studies do support the efficacy of a sonic toothbrush or an oscillatory rotary type, a back and forth type movement.

It has to be a high quality head. You have to replace it often. Nylon becomes very abrasive. Always use the extra soft brush, which is usually not the default or stock toothbrush head that comes with it. And if it is an abrasive or a cheap toothbrush head, the fact that it's mounted on a motor means it's going to be, it's going to cause a lot more damage and cause sensitive teeth, gum recession.

So it depends. I mean, most of us are not brushing correctly. Walk people through what that means. You see people in films. I think on our website, we have a video of Natalie Portman brushing her teeth and she's just in there scrubbing. And that's every time I see someone brushing their teeth in a scene, they've got this hammer grip.

I mean, hold it like it's a pencil. And what you're doing is you're aiming for the gums and you're just jiggling the bristles. You're not sweeping them or sawing them back and forth. You're jiggling them right at the gum line. Make sure it's a nice sized head, not too big, but more round or oval.

The long rectangular ones sometimes don't, if you're aiming for the gum, they don't get the bottoms of the teeth. You know, if they were upper teeth, they don't get too far down on the gum. Make sure it's ultra soft. Make sure you replace it after three or four weeks.

I mean, the nylon becomes abrasive and then you go in there and brush back and forth. You are gouging your tooth surface. I mean, the teeth are hard. The roots are less calcified, but that can lead to problems. So I think depending on whether you have gum disease, whether you have open embrasures, crowded teeth, maybe you're not a flosser, Sonicare is best.

I always recommend people over age 40, 45, start using a Sonicare toothbrush. But again, hold it lightly and just, just guide it over the teeth because the electric toothbrush is doing all the work for you. And then people tend to underbrush with a manual toothbrush, although you can be very adept and you can, you can have full, the full therapeutic effect with a manual toothbrush.

It may take a little bit longer, but for young people, I would say a manual toothbrush is fine. Just make sure it's a high quality one. And we have recommendations on our website. And so it's funny because I was looking at toothbrush heads just for a quick second. I was like, you know, if you're replacing your toothbrush head every, you said three or four weeks.

So maybe once a month, you know, that's, it's probably, you know, an expensive undertaking. I know there are tons of much less expensive than, you know, from Phillips or whatever brand of toothbrush Oral-B that on Amazon, would you say avoid those kind of discount cheaper toothbrush heads and go for the brand name?

Yeah. There's no guarantee that they're, they're, they're well-made. I would use the ones that are recommended for use for the toothbrush. Again, I have no affiliation with them, but remember dental care is expensive. It depends on, you know, how you want to look at it, uh, short-term gains or, or long-term gains and, and less costs, less time in the chair.

Yep. That makes sense. Especially, and we're going to talk a minute about dental insurance and costs, but if you could avoid all of those extra costs, other than your preventative work, you can save a lot of money. It's so funny how the length of time you have a toothbrush head wasn't really compounding or making sense because I didn't really think why now that I understand that the bristles could be, could be not as soft and that could be causing problems.

It makes a lot more sense. Yeah. There are a lot of people out there that are trying to use the, the bore, wild bore bristles, but they don't hold up and they don't really work well. I mean, the nylon bristle is effective, but make sure it's has the end rounding procedure.

Okay. And on floss, um, how often are you flossing and what kind of floss and how do you think about floss picks versus threaded floss? Yeah. I love flossing. Make sure you're not using, um, and before microplastics were big, I kept telling people don't use nylon floss. We don't know where those little nylon particles are going.

So, uh, silk floss, uh, you can buy silk floss. Again, we have examples on our website. Um, and, and that works well, uh, learn how to become a good flosser. Most of us will never become good flossers. And there's now a new, uh, device out there called the slate flosser, uh, electric flosser.

And I absolutely adore that thing. Um, I do, uh, do ads for them. Uh, I absolutely think that's a game changer before an electric toothbrush. I would invest in a slate electric flosser. Okay. It's, and I know you've put out a bunch of videos on how to properly floss and how people are doing it wrong.

So, um, if I can find at least one of those, I'll put that in the show notes. What about those water pick flossers? How do those fit in the game? They're great. A well-made water pick used properly is the equivalent of flossing. And in certain patients, it could be better.

If you have a lot of bridge work, a lot of nooks and crannies, gum recession, open embrasures, IE, you've had some gum disease and the gums have receded. Uh, they can be very, very effective. Is it redundant to do both? Oh boy. Uh, I mean, you're asking the wrong person.

I would say there's no redundancy when it comes to keeping your mouth clean, but I would say yes. Um, again, there could be some cases where both would work, but you're fine with either one. Okay. In most cases. Yeah. Now I know the, the ultimate bias that you could have in this space is, is toothpaste.

Cause you, you've co-founded a toothpaste company, but let's talk about toothpaste. Absolutely. Um, uh, a necessary evil, uh, you know, the food that we're eating and the environment we live in, uh, devoid of minerals, uh, you know, uh, high decay rates. Uh, we do need toothpaste. Uh, toothpaste was invented, uh, before world war one, I think it was Pepsodent.

And that's when the GIs had terrible, uh, teeth and they were, you know, on the front line in Europe and also in, in, in, in the Pacific theater. And they literally couldn't do their job because they were in so much pain, uh, never underestimate, uh, odontogenic pain, dental pain.

Uh, it has changed world history. It really has. And so the armed services, uh, to their credit, uh, they, they were the ones that came up with all these ideas. They did a little research and they got the private industry, uh, uh, investing in this. And, and that's where toothpaste came from.

Now, before that we had balms and we had essential oils and, and that was actually the wrong thing to do. And in fact, a lot of that carried over into toothpaste. Then we added fluoride and emulsifiers and surfactants, which are ingredients that are added supposedly for foaming the toothpaste, but that's a, uh, a, a result of the emulsifier and surfactant.

And the only reason they put that in there so they can make large batches that mix well so that when you mix, when you fill a tube, it's all homogeneous. I mean, it's all, every mix is, is similar. So, so really, um, the toothpaste industry is changing. Fluoride is on its way out.

There's been a successful lawsuit tried against the EPA. They lost their case. They couldn't defend it. Couldn't defend the efficacy and safety, um, of fluoride. And that was a seven-year case that went, started before COVID and ended, uh, this last August, August 24th. Um, I, I literally teared up when I heard the news.

It was, uh, something I've always been against. There's so much data now. It doesn't really work when it's in the water and it causes brain damage with kids. That's all you, it's all you need to know. And if you need to know more, reach out to me, go to the fluoride action network site, go to the NTB, a government agency.

I mean, it's all there now. And this is fluoride in water, or this is fluoride. I remember putting those trays in my mouth that I feel like I thought those have fluoride as well. They do a lot of fluoride in the tens of thousands of parts per million where toothpaste is 0.7 to 1.2.

Um, and it doesn't really work in toothpaste, but topically fluoride does have a chance of working, uh, topically meaning it's, you put it in your mouth and, and it actually binds with calcium and it creates this kind of Frankenstein, uh, mineral called fluorapatite. And it is useful. It was useful in that regard.

Um, but now that we have other alternatives, actually, they've been around for a long time in Japan, uh, for 50 years. Now we have natural remineralizing agents that can replace fluoride and they're much safer, uh, and they work better and they make for a smoother surface so that you have more reflectivity on your teeth.

Uh, and that's the hydroxyapatite that everyone's talking about. And if that's so much better, I have to assume all these tubes of crest and, you know, whatever Colgate, are they still all using fluoride or, or is this a shift across all of these major brands as well? So the shift hasn't quite occurred in that realm and they're, they're making so much money.

They're not going to change their formula until they, until they see a real shift in the patterns of buyers, but it's, it's happening. It's beginning to happen. A lot of the boutique brands have been bought up by the big boys. Um, but for right now they haven't really budged.

Uh, I speak to some of them. They call me sometimes we do a little focus groups and, uh, it's all about, it's all about the bottom line. And that is, I mean, it costs, uh, Colgate and crest. It cost them about 35 cents to put a tube of toothpaste on the shelf.

And that includes everything buying the shelf space, the packaging, the marketing, and then they sell it for four to $6. And this is one of the easiest ways to, to, to make money in the world. And everyone's using it like clockwork, uh, twice a day. Uh, so that change will come.

Uh, and I think they will shift away from fluoride, but for right now they like their ADA seal of approval, all the, the American dental association, all, all that the ADA looks at is that it has fluoride in it. They have dug their heels in so far. It is so deeply.

It is, it is shocking actually. And how, you know, you say it's better to use these other things. If someone out there is like, well, I'm using my, my crest Colgate. Is it like drop everything, go change it, or it's okay, but there are better options. You know what?

I would say drop everything. And it's not just the fluoride. Um, I mean, you're using a toothpaste that it was designed like the early versions of toothpaste and the versions before that it's essential oils, bactericidals, uh, emulsifiers and surfactants. Those are the ingredients that help make large batches, but an emulsifier will break down a lipid layer.

Guess what your cell wall is made up of a lipid layer. So you don't, you're taking down bacteria. How do you know you're taking down the right ones? We don't. And that's never a good approach because sometimes a bug can have a good purpose or a bad purpose. It depends on how it's fed and the environment that it's in.

I would say, drop it, drop it. It's the best thing you can do. It's one of the best things you can do. If you have oral disease, first thing you should look at is what are you using to prevent it? Yep. Okay. And what ingredients should they be looking for when they're shopping for toothpaste to find something that's better?

There are very few. I, and I'm shocked that there are so few, but I think the basis for the success of our formula, and I'm not talking about people liking it. I'm talking about clinical studies that we've done at the university of Texas that we'll be presenting soon. The first study was just presented in New York at a big craniofacial kind of dental nerd researcher meeting.

So a toothpaste will work very well and will feed your good guys. It will nourish your oral microbiome. And again, remember we talked about that earlier. The oral microbiome is online. There's no chance of oral disease. Everything's going to work well, even systemic diseases down the road. So how do you do that?

Well, first of all, don't get in the way of the oral microbiome by taking it down. So look for a toothpaste that has no essential oils, no botanicals. Again, there's no data that supports that. Those are important. Most of the time, a, whether it's a cosmetic, uh, manufacturer company or toothpaste, they add those because it's a natural way, or it's a way of hiding the fact that they're trying to preserve their formula instead of adding other preservatives.

So an essential oil, could it be acting as a, like the emulsifier? It's there for the manufacturing process and to give it a long shelf life. So, but eucalyptus oil, like in Listerine can, is one of the most bactericidal essential oils. It will kill a bug. It's cytotoxic. It's bactericidal.

So no essential oils, no botanicals, no emulsifiers, no surfactants. Those four are the first things you want to look for. And that's what's unique to our formula. I think it's the first time that's ever been done with a remineralizing agent in place. There are some very natural toothpaste that maybe are just like coconut oil and, and, and maybe like a calcium, a calcium carbonate or, or like a xylitol or glycerin.

And then obviously no fluoride. And if you're, you need a remineralizing agent, you need some calcium in, I mean, if you need the same ingredient that's in your teeth, in your saliva, which we all do, don't use fluoride. Fluoride will bind with calcium and do the job, but it also gets into your bloodstream, to your brain, especially if you're pregnant, especially if you have young children, do not use fluoride.

There's no need for it. So then if you need a remineralizing agent, then think about nanohydroxyapatite. And other than flavor, you really, you don't need much. Don't overthink toothpaste. It's not a magic bullet. But most of the toothpaste out there are actually doing the exact opposite. They're actually harming your oral microbiome and therefore your oral health long-term short-term.

I imagine a lot of people listening are going to think, okay, if it were really true that most of the toothpaste out there are hurting your teeth, why would my dentist not be telling me why would they even be allowed to be sold? So is this cutting edge science or what's behind the probably large number of skeptics listening, thinking is Mark kind of way off the deep end telling us that this thing, they're all doing that my dentist approves and even probably gives me in a little bag every time I go, it's hurting me.

Great question. First of all, toothpaste is regulated under the category of cosmetic products. There is no FDA approval unless it has fluoride in it. That's carefully regulated. So the reason dentists do this is because they are so frigging busy running their own business, high overhead business, sole proprietorship, keeping up with the new techniques, continuing education.

They just kind of go with the flow. I mean, what they're taught in dental school and that fluoride is this miracle product. It's been around for 75 years. No one's ever questioned it. There's no hard data that supports it. They just kind of go along with it. It's easier to do that.

And then if you're against fluoride, you're part of this conspiracy group or whatever you want to call it. And that was the right thing about this lawsuit. Seven years of back and forth, expert testimonial. It proved that fluoride is bad. So that's one thing. Dentists really kind of go with the flow and whatever the ADA says, that's what they're going to do.

There are many dentists that are against this and understand this. These are what I call functionally minded or integrative dentists, biological, holistic. I prefer the term functional that covers all of that. And they're looking at Ruca's reasons for why oral disease is the number one disease in the world.

We're recommending all these wonderful products, toothpaste, floss, mouthwash. Mouthwash actually causes high blood pressure. Two thirds of Americans have high blood pressure. Two thirds of Americans use a conventional type of mouthwash. I mean, we're just, we're just not understanding the science in our profession. We are not an evidence-based profession overall, overall.

So, so it's kind of, it's laziness and it's kind of ubiquitous, but there is an arm of dentistry that is seeing it for what it is. And again, it's all about the oral microbiome. When that came online, now we understand all the, a lot of the recommendations we've been making have been incorrect based on the knowledge of this new biome.

Yep. Do you think in five, 10 years, most dentists will stop, you know, handing out a little tube of crest toothpaste with fluoride? Probably not. I'd be happy with a 50, 50 mix, but remember private equity is buying dental practices. And again, it's just, it's whatever's cheapest. And unfortunately, a lot of this is cost-driven.

Uh, my toothpaste costs $14 a tube. That's what it costs to make. I have the same margins. Actually, I have less of a margin than Colgate does, but you know, Colgate is much cheaper. Uh, and especially if you go to Costco, right, you're, you're not going to see my toothpaste at Costco, uh, not anytime soon.

So, so a lot of it is, is economics. Um, I would say, and here's, here's a bold statement for you. I would say instead of using Colgate, you're better off not using toothpaste at all, just floss and brush the mechanics of just that alone is fine. Okay. So you talked about, you know, perfect world, 50, 50 functional dentistry.

How should someone listening, you know, find a dentist? What questions should they be asking their existing dentist? And if they need to find a new dentist, what questions should they be asking to find them? It's not easy. So I, we, we created a directory on our website. It's not a big directory.

Uh, there are other directories. Um, I think really what you need to do, and I mentioned it earlier, you need to advocate for yourself. You need to educate yourself. It's the same thing with your financial part of your life, uh, health. Certainly you need to become informed. You need to go out there and find out what is the right thing.

And it's not necessarily the norm dentistry and medicine. They're 20 years behind what the new research is talking about. So I would say find a, find a influencer that you like and trust that's been around for a long time. Um, that's a great source because it's free. All you have to do is listen while you're running, going on a run or driving in your car, commuting.

Also go to the internet. The internet has democratized healthcare. Not all of it's correct, but most people can pick through what's right and what's wrong. You can even read studies. Now you can take a study and drop it into chat GPT or LM notebook. It will pull out all the main points.

You can ask chat GPT. Is this a good study or bad study as a lay person? I mean, this is not out of the realm of the lay person anymore, but it does take some work. The other thing you can do is ask around, you know, find out, find out from your coworkers, friends, family, uh, other than just seeing the hygienist.

When I had my cavity done, the dentist told me how not to get the next cavity. They explained it. They didn't give me fluoride. These are all questions you can ask behind the scenes. And then your friend or coworker will say, yeah, this is how it went. Just know what questions to ask.

We have a list of questions on our website, ask the dentist. We have the directory on, on our website. It's, and we also have a blog post on how to get a good referral from a loved one or a family member. Again, it's work. It's work. You can't just, don't just take, take the list that you're given by your employer and, and go down the list and pick the one that's closest to you.

Yeah. You're, you're playing with fire. Yeah. I mean, a couple of things I learned. So one, the reason we even got connected was I was at the dentist's office and I was asking my dentist a question that I learned to ask my doctor, which was, you know, if I was going to spend a little bit of money out of pocket, not covered by insurance, what should I do?

And my dentist's answer was get a third cleaning. You know, your insurance will cover to get a third one. It's about $120. And I was like, well, that doesn't seem that expensive for if the best thing I could be doing for my dental health is $120 a year. That seems wild.

Um, and, and then I asked him, you know, who should I, who do you look up to in the space as someone you respect in the dental world? Because I'd love to do an episode on it. He suggested you and here we are. So I've got a handful of questions, but first off, we talked about all the things in your oral health routine.

We didn't talk about dental cleanings. How important is that process? So that twice a year was completely arbitrary, uh, way back when 20, 40, 50 years ago, again, dentistry as a profession was thinking, well, how, what's the biggest bang for the patient's buck? In other words, how can we treat everyone the same and guarantee that we can stop, you know, gum disease in its tracks?

And they came up with twice every six months. It was easy. Insurance had something to do with it, uh, as well. Uh, it's just an easy formula. Uh, again, as I said earlier, look for a customized program. Uh, most people don't do well with, every six months. It could be every three to six weeks.

That actually is something that we do recommend for some patients. Um, and again, at $120 a cleaning, deep cleanings are, it costs more just to let you know, they're quite a bit more, but insurance, uh, will cover 80% of that. If you have dental insurance and up to a maximum, of course, when you first mentioned that that's a great suggestion.

And what's going on in that cleaning that is beyond what, you know, is happening at home that would make it something worth doing. You're scraping off a toxin. It can be tartar. It can be a biofilm. Uh, it can be some bugs that are in those pockets. They are, they're continually and more often removing the source of this inflammation.

We haven't really used the word plaque that often, but is that when you say, is that plaque? Yep. It's plaque, plaque and tartar, calcified plaque. Those are irritants. I mean, the body responds to that. It's a foreign body and it starts bleeding and sending blood to that area. And those aren't things we can easily remove at home.

Not really. No. Once it forms, it's very difficult. I have some patients that buy instruments on eBay and they're in front of the mirror and cutting themselves. And you can't, I can't even do it. You just can't work on yourself. Uh, you really need someone else to come in with a mirror and good lighting to be able to get to all the different, uh, there's so many little nooks and crannies in the mouth in between the teeth.

And so a good cleaning can accomplish that. Now that doesn't necessarily address the root cause of why you need three or four cleanings a year. That also has to be addressed, but that was a good answer on his part. It was, that is a quick and easy way. No brainer.

Don't even think about it. Just come in a third time every year. So I have a lot more questions for him the next time I go in, which will be sooner than six months now. Another thing I learned, I went really deep on dental insurance because we were on a Cobra policy that included a dental and then we had to shift and now we were responsible for deciding whether we wanted our own dental insurance.

It was a little mind blowing how dental insurance works because unlike medical insurance, there's always some sort of cap. And the cap in my mind was relatively low one to $2,000 for most of the plans. So, you know, no matter what best dental plan you had, I didn't really find a plan that would cover you for more than $2,000 of dental cost a year.

And if your employer is paying for it, of course, why not? But if you are, you know, those plans costed anywhere from, you know, probably on the low end $30 to $50 a month. You could make a case if you have good clean health that self-insuring might actually be a more appropriate path here because your maximum out-of-pocket loss was $2,000.

But with a lot of these dental plans for anything that is beyond cleaning, you know, there's like a tier one, 80% covered, tier two, 50% covered. So you're going to be paying a lot even if your dental insurance is kicking in. So I'm not going to tell people not to get dental insurance, but definitely take a look at it.

It's significantly cheaper to get dental plans that are preventative only. And I guess people don't get their annual cleanings because it is cheaper to get a preventative only dental plan that covers two cleanings and x-rays than it is to pay for two cleanings and x-rays. Presumably because people aren't using it.

Right. It's a very well engineered product. It is not an insurance product. It's more of a service. If your employer pays for it, try and get a high quality product. There are deductibles. Even the first moment you walk in, there's a, even for preventative work, not always, it depends.

Low maximums. It's designed for very, they control the utilization of the plan very well. It's actually a more lucrative product, not in overall dollars, but per plan. There's very little, there's no loss really. Um, so, uh, we have a blog post. It's quite old now, but we call it the margarita plan where we would always encourage our patients to do this, uh, depending on what the payout and what plan they had, especially if they're paying for their own plan, put the money aside, put a hundred dollars aside and you, you have the same maximum almost, maybe a little bit less, but you can spend a hundred percent of it.

It's not limited by those different tiers that you were mentioning. So there's not a 20% copayment. So it's a tricky product. Again, if your employer pays for it, uh, hopefully it's a good plan. If it forces you to go to a kind of a capitation or a DSO type of office, maybe you'd want to get paid a little bit more instead of getting that dental plan.

Uh, and then talk to your employer about that before you get hired. Medical insurance, of course, is very, very important that protects you against catastrophic financial loss. If you were to get into a car accident, Chris, and, and this, I see this happen a lot, the damage to the teeth and the face, but mostly the teeth easily exceeds 20 to $60,000.

Your insurance will not pay for that. Even if you over a period of 10 years, it won't because it's limited by the year, the maximum. So it's really not an insurance product. There are a lot of issues that we've really never addressed in, uh, this schism between, uh, dentistry and medicine.

And, and anyway, um, it's, it's, it's a very interesting area. This episode is brought to you by Copilot. If you're looking to get your finances organized this year, you have to check out Copilot. It's one of my favorite apps and I check it almost every day because it makes it so seamless and easy to manage your money and track your spending, which for us has resulted in a huge boost to our savings.

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Two more little things I learned in the process. One, many, not all, but many dental plans offer out-of-network coverage. And I was surprised to see that a lot of the out-of... In a lot of medical plans, you'll see, well, we cover... You have a 20% copay in-network, maybe you have a 40% copay out-of-network.

A lot. I probably looked at 9 or 10 different dental provider options. And it was more common than not that the out-of-network coverage equaled the in-network coverage. So if that's the case, by no means restrict yourself to the dentists that are on the list. Does that mean you might have to file your claim yourself?

Not always. Some dentists will even take care of the out-of-network claim management also. Correct. So I would say, don't be restricted to the list you see on your dental network plan. And then my dentist, they have their own dental plan, which costs, I think, $375 a year. It includes your x-rays, two cleanings, and then they give a 25% discount on any dental work you have to do beyond that.

And so we've decided, let's self-insure our dental with a plan from them. And I did the math. And the number of scenarios where we would end up better with dental insurance was like only the scenario where we exactly had $2,000 worth of dental work. But if we had $1,000 of dental work, nope, we were better paying ourselves.

And I'm surprised for the sake of dentists around the country, getting my teeth, a cavity filled with a dentist and a hygienist, both there in the chair for almost an hour is a few hundred dollars. I know. Whereas last night, unfortunately, we took my daughter to urgent care to get an x-ray for her leg, which may or may not have resulted in a fracture from a gymnastics trampoline.

Turns out we might not know for three days. We have to go back to get another x-ray if she's still hurting. I am almost certain that the cost behind that, where we engaged with the doctor for minutes, is going to be over $1,000. Oh, I would say it's probably more.

That will be billed to, well, in our high deductible health plan case, us to some extent. But it's just mind-blowing that healthcare has gotten so expensive and dental care relative to the number of minutes you're sitting down with someone who's gone through rigorous education seems relatively affordable. And I know that there are lots of people that can't afford that in their budget, but relative to medical, it seems like I was surprised at how affordable it was once I started looking at covering it ourselves.

This is a perfect illustration of a question you asked earlier, what to look for in a dentist. That's another thing to look for. If your dentist is basically looking at you when they look in your mouth as just an insurance plan, and you could be a really good insurance plan, you could be a very poor insurance plan, they are literally indirectly being influenced by that insurance plan.

If you have a great plan, they're going to think, oh, that patient's more likely to go for the crown. And that's not the kind of dentist you want. You want to see the guy, the dental clinic that you're seeing. That's a brilliant move. And that should be an indication to the patient that they are immune from the influences, the external influences of a dental plan.

Most dentists practice based on what kind of insurance you have. And if you're a cash patient, they're just used to not getting paid or to being turned down on the correct treatment plan, which may seem expensive to begin with, but it's the right one, whatever that may be. Do you want to be seeing an extension of an insurance plan that's reducing utilization, or trying to increase profits if it's a private equity owned corporate kind of dental insurance?

Or do you want to be seeing a mom and pop that really has some flesh in this game, and they want their kids to be dentists and work in this practice, and they've set up a system, like what you mentioned, their own dental plan, or, which is what I did for over 36 years is I would ask for the cash up front.

I was tired of chasing down the insurance companies that cost me money. So I charged my patients less, I would ask for everything up front, and we would bill their insurance for free. And guess what? Insurance companies are regulated in the state of California, I'm sure it's in every state, and a payment has to be made or denied within 30 days, right?

Well, if you play the regular game that most dentists do, where you just bill the insurance, you wait, and then you bill them a second time, and you get on the phone, you pay someone to get on the phone, and get that payment, usually it's 90 days out, right?

And no one ever prosecutes them or slaps their hand, and that kind of thing. Why not let the dentist regulate their cash flow in a very expensive, high overhead business, and give them the cash at the time of service. And then you wait for the insurance payment. Here's the kicker.

When we did that, when we switched to that, we had to drop Delta Dental to do that. The punchline is this, the insurance payment came to the patient like 1315 days, every single time, which by the way, is probably before the credit card bill they paid on was due.

And you know, for anyone listening that likes points and miles, let's say you have $1,000 of dental work a year, if you pay for it, you get points on $1,000, the dental insurance reimburses you. If you go direct to the insurance company, now you don't get that spend. So it's an extra 1000 or two or 4000 points that you might have running that model.

We were happy as a profession to help support that point system. Yes. That next flight to Europe or whatever it may be. Yes, that's dental insurance. I'm sure we could unpack that a lot deeper. Oh, yeah. It's a fascinating subject that does not get talked about often enough. One other thing.

I remember a time where my sister went to the dentist, and the dentist was like, I think you have four cavities. And she was just blown away. It was a new dentist. So she went to another dentist dentist and got a second opinion. And they were like, you're fine.

Right? How important do you think someone who gets a diagnosis from a dentist of something like three, four cavities, or even one? Is it worth getting another opinion on either whether these are real cavities, whether they could be something treated in other ways, like just letting your body remineralize the area?

How should someone react when a dentist tells them they need work? This happens a lot. Unfortunately, a lot of the new patients I would get would be second opinions with outrageous treatment plans. I don't know if you remember, but a lot, maybe 1015 years ago, there was a Reader's Digest article on and the, the journalist went to eight or nine different practices in in her area.

And she literally got, you know, every treatment plan was way different than the other one, not just in cost, but in terms of which tooth was being treated. And that was a real problem for the profession. And there were a lot of explanations given, and then it popped up again later.

Someone else, you know, had a slow day in journalism. They tried the same thing and it happened again. So this is a problem. So we have a blog post on this on our website. It's pretty simple. Gut feeling, you know, if you've been going along every, every twice a year and you get a cavity once or twice a year or less, or you've never had a cavity and all of a sudden something has changed, uh, definitely get a second opinion, uh, because this does happen.

And everyone quote unquote has a different philosophy. A lot of dentists say, well, if there's any chance of a cavity, I want to go in, well, I can keep it small. Well, but if there isn't a cavity, is that ethical? I mean, and what if the cavity never occurs?

Sometimes, um, uh, sometimes root canals are, are jumped to. In other words, there's no need for the root canal. The tooth is hurting, but it's reversible pulpitis. That's a diagnostic code. And if it's reversible, that means that it could recover. But then the dentist says, yeah, but the patient's in pain.

They're going to Barcelona next week and we don't want it to blow up in Barcelona. I mean, this is the kind of reasoning that goes on either upfront with the patient or without a lot of knowledge for the patient. The patient's just taking the word of a dentist. So if it seems a little out of whack, like in the case of your sister, all of a sudden four cavities, absolutely.

Those could be cavities that didn't exist to begin with. Um, or it could be a cavity that could be reversed. Uh, so definitely get a second opinion. And you know what, if they resist or get a little funny or, or just throw you a set of records, or you don't get copies of the x-rays as quickly as you would like, and it's a difficult process, or you pay an exorbitant amount for those copies, then you're probably better off moving on.

There's something wrong there, or they just don't like to be second guessed. A lot of dentists don't like to be second guessed. Yep. And I'll just remind everyone that as much as it might seem in the medical world, like a second opinion is a pretty expensive process. If you're able to get your x-rays from your dentist and you're taken to another dentist for a second opinion, even if it weren't covered by insurance, my guess is that second opinion is going to be in the low hundreds of dollars, if not as much as you might think.

Um, right. So as a policy, I'd never charge for a second opinion unless we had to take another x-ray, but if it's just a quick look, it's 15 minutes. I did that for the betterment of the profession. I did. I wanted patients to do well through the process and it wasn't because I wanted them to stay with me.

A lot of the time I would send them back and say, you know what, they're right. Or it would be a lot of these second opinions are about bad dental work. And then I would send, I would give them an option. There's a very inexpensive option. Instead of hiring a lawyer, there's a peer review system.

And I would hook them up with that. Every dental society has a peer review system. They go in, they have three dentists look at it. If it is bad dental work, then the, it gets written up and those that their, their membership is at risk. So they return the money and then they move on.

It's way better than handling it with attorneys and, and the result is better for the patient. So yeah. Uh, if that happens, gut, I mean, follow your gut instincts. If it doesn't feel right and, and, and ask for the x-rays right away, say, I just want to run this by someone else.

And for the cases where maybe it is the case that you need a lot of dental work, whether it's a root canal crowns, bridges, you know, the accident you mentioned, but maybe, maybe not in an emergency sense. I did an episode recently on medical travel and I, I, we talked about turkeys well-known for hair transplants and there's all kinds of procedures that people can travel for where the healthcare system isn't like the healthcare system in the U S where things can be quite expensive.

I know traveling for dental care, maybe not your, your preventative care, but for, for really expensive things is, is a possibility. How do you feel about that? Do you have any thoughts? Yeah, that's called dental tourism. Again, we have a blog post on that. Um, that was a difficult one to write and we did a lot of research and we spoke to a lot of patients, some great success, uh, success stories, huge, uh, Hungary.

We listed some of the countries that we would recommend. We would not recommend Mexico, uh, Canada. Uh, there are differences, local regional pricing, uh, take advantage of an exchange rate. For example, the problem is, and again, we mentioned this in the, in the post, a lot of dental work needs a follow-up.

Are you willing to travel back? And then what about the follow-up and the care? And then if you go to a new dentist, then, you know, they're, they're, they're taking over that dental work. It's going to be more expensive. So there are some issues with that, but people have had success stories.

I know people that have had their hip transplants done in Belgium. I had a lot of patients that did that. And that typically is a good example of why you'd want to do it. It's cheaper. You get better physical, uh, you get better PT, physical therapy afterwards. And then after that, you're done.

Okay. All right. So I was thinking at the end of this, cause we're about to wrap is maybe I could just rapid fire a few topics and you could say, because I imagine any of these, we could talk for a long time. Um, so I'm going to run through a few.

So when it comes to gum recession, is that reversible? Is it how important is it? What should we be doing? Typically not reversible. Try and prevent it. Okay. If you're aware that it's happening to get on that bandwagon right away, prevention, find out what the root cause is. Is it your brushing?

Is it grinding? Is it trauma? Is it orthodontic trauma? 10 years ago, there are many, many reasons for it. Okay. Next one's orthodontia. Um, you know, we, we have kids under, under five right now, so it's not something we're thinking about, but there was that age when I was a child where it's like, well, everybody goes and gets their braces, anything, you know, people should be thinking about in today's world with orthodontia.

The problem with the current model is that we wait too long right now. The, the new model and the, um, the functional model is get an assessment by age two or three years old. And by age nine, the development is done. So you want to be intervening at age five or earlier or slightly later.

So orthodontia is very important, but the generalized form. And again, I get a lot of flack for this, but it's pretty much a racket when you wait for all the adult teeth to come in, or even with phase one, phase two therapy, that's not the way to go. It doesn't give you a good result and it doesn't fix the, the bigger issues.

And that is the size of your airway, the shape of your face and all of that. So start early. And for adults with unstraight teeth, you know, any, is there anything they should be thinking about other than, you know, there's a lot of companies now offering trays as an alternative to braces.

Right. Right. Expansion maxillary expansion. Uh, my daughter's going through it right now. She's 27 years old as an adult. You can, it's harder to do. It's easier to do on a child because they're soft and malleable and it goes a lot quicker, but you can do that on adults.

Expand the maxilla to make room for those teeth. Even expanding the maxilla will help increase the size of posterior nasal apertures. You can breathe better through your nose. It helps in so many different ways beyond oral health. Uh, yes, it can be done as an adult. And then on the note of children, any other thoughts on, you know, oral hygiene, dental care for kids?

Chew gum, keep throwing gum at them, get, find a healthy gum. That is the best thing you can do. There are plenty of studies out there. In fact, if mom, a pregnant mom chews gum and when the baby is born, her child will have, I think it's 64% less chance of having a cavity by age six.

If the kid is chewing gum, I think it's like a 93%. There we have, I have a podcast episode on that, on, on those studies. And so brushing your kid's teeth is difficult. Flossing. It is difficult. Reminding them to do it is difficult. They're not going to do it correctly.

Um, you know, mouth breathing is, is tough on teeth and it promotes decay. Diet is tough to regulate. Xolotol gum is a no brainer. It's so easy. Have it stashed everywhere after every meal, or if your kid is wakes up with a dry mouth, Xolotol gum. Okay. And then the last one I have is a teeth whitening.

I know it's kind of a, you know, they, you talked about, you're not going to have your toothpaste at Costco. I always see the white strips at Costco. I know people are, are very concerned about their appearance and their breath and how does teeth whitening fit into functional dentistry?

It was kind of like the diet industry. Everybody wants to be thin before they're healthy and, in overall medical health or overall health. Um, it's the same thing with whitening. In fact, a lot of dentists jump right to it and they see some yellow teeth. They know that the patient's probably concerned about it.

Even before they mentioned cavities and other things, whitening is a big moneymaker. You know, it's, it's not readily known, but there's no regulation of dental whitening in the U S in Europe. It's heavily regulated. In fact, you can only use a 10% gel. We're handing out, you can get it on Amazon here.

We're handing out 35, 40%, uh, concentration of gels. Uh, also it's, it's age gated. You cannot whiten a kid's teeth. You have to wait till they're 18. And there's a reason for that. Pulpal sensitivity, et cetera. It's the wild, wild west out here in, in the U S with dentistry.

So whitening is fine. It works. Make sure you do it correctly. Make sure it's a tray that's cut away from the gums. An Invisalign tray is the ideal, uh, tray for whitening because it only holds the gel on the teeth. If the gel gets out, it's going to affect the oral microbiome because it's, it's bactericidal.

It's hydrogen peroxide. It creates free radicals in your mouth. The last thing you want, but, and if you whiten too often and too aggressively, you're going to have issues, even permanent ones. Um, so I would just make sure you're doing it the European way. Again, we have a blog post on this.

I think I have a podcast episode on this. Do it slowly. I mean, if you waited to the last minute, you're getting married in four days, yeah, we can whiten your teeth. We can do it, but it's going to come at a cost, not just financial cost, a lot of sensitivity, uh, damage to the enamel.

Be careful. Yeah. Yeah. You're probably better to use Photoshop in that case. Uh, okay. I think I hit so many of the things in here. I have a lot of takeaways for me. Uh, one that I, we didn't explicitly talk about, but it sounds like there's a lot going on in your oral microbiome snacking throughout the day, you know, give your teeth some time to go through these processes throughout the day.

Is there, is there a window of time that you might need to say, Hey, make sure every day you've got two or three hours, two or three times to kind of do their own thing. Right. Again, it's that frequency issue. Uh, and that's why intermittent fasting has its, uh, advantages to oral health as well.

I mean, if you keep snacking all the time, then think about it. Your, your teeth are always trying to remineralize and, and that demon is, we call it the Stefan's curve. It's a, it's a graph and it, it, you know, it based on pH and how often you eat, there has to be a recovery time.

Otherwise the body cannot keep up with the fixing of the teeth and the remineralizing of teeth. So if you could eat two or three meals a day, six hours, four to five hours apart, if you're eating two meals a day, uh, I think the best way to intermittent fast is to eat a good breakfast, maybe an hour or two after you wake up, not immediately, uh, have a big lunch like the Europeans do, and maybe just some protein powder for dinner.

That is a great way to go when it comes to teeth. I know that doesn't sound ideal for a lot of people, but it's kind of what my grandkids are doing. That's what my wife and I do. And it works and you can enjoy that if you're snacking all day long and you're really not aware of it and you're drinking, sipping a Red Bull and, and diet sodas, regular sodas, coffee, all of these beverages, uh, your, your teeth don't have a chance really to recover.

You will pay the dentist. Great. Um, this has been fantastic. Uh, we referenced a lot of blog posts. I'm going to try to put as many of them as I can or podcast episodes in the show notes, but for people who want to go deeper on everything you're doing, where do they find you?

Instagram, ask the dentist, uh, our website, ask the dentist.com. You could go to our toothpaste site. We've got a lot of information there. It has its own separate, uh, Instagram site. Fig F Y G G stands for feed your good guys. Um, we're on Tik TOK. Uh, we've just kind of started.

Um, uh, I have a book on sleep. Uh, again, that's something we didn't talk about, but probably better to see your dentist first, rather than a physician. When it comes to sleep, we can see it decades before a physician can. It's not because they're dumb or stupid and, and, or we're super smart.

We just have a different training. We see it differently. Um, so yeah, I would say start at the Instagram channel and, and probably the website. All right. This has been fantastic. Thank you so much for joining me. Thank you, Chris. I enjoyed it.