Adapted from episode 122 of The Perfect Stool podcast with Dr. Katie Lee, dentist, speaker, author and coach and Lindsey Parsons, EdD, and edited for readability.
Lindsey:
So I know that you had an important personal event that led you down your current career path. Can you touch on that briefly?
Dr. Katie Lee:
Sure. So when I was 14 years old, I was on a four wheeler and crashed into a telephone pole. I broke every bone in my face from my eyebrows down. I had my jaw’s wired shut for eight weeks, and my teeth were all broken and missing when they wired me shut. So as you can imagine, over the next eight weeks of only eating ice cream, pudding, Jello and mashed potatoes, my teeth just kind of rotted and fell apart. And so I had massive amounts of infection, not to mention malnourishment. And so I learned at a very young age just how much your oral health affects your overall health.
Lindsey:
Yeah.
Dr. Katie Lee:
That’s what got me into dentistry and started me down this journey. But yeah, it took four years and nine reconstructive surgeries to fix my face and be able to open my mouth because my jaw was fused shut for about four years. So it was a long journey.
Lindsey:
What a nightmare, but I’m glad you’re better now. I know that bacteria have niches that they like to inhabit. So you might have certain bacteria that are predominant in the mouth, but don’t survive past the stomach acid, for example. So how are the oral microbiome and the gut microbiome related?
Dr. Katie Lee:
Yeah, it’s pretty common knowledge that we get introduced to our first microbiome when we’re born. We go through the vaginal canal, we get introduced to mom’s vaginal microbiome as well as some of her gut microbiome. And then after that there are several ways that bacteria get into the body, and one of the main ways is through the bowel. And so we’re swallowing 80 trillion bacteria a day. Further, if we have leaky gums, which I’m sure we’ll get into later, bacteria from your mouth will go in through your gum tissue, and can circulate to the rest of the body and start occupying areas that they shouldn’t. A major source of your gut microbiome started in your mouth. And so you can’t have a healthy gut microbiome without a healthy oral microbiome.
Lindsey:
Got it. So what are the oral signs and symptoms that indicate an issue with your gut?
Dr. Katie Lee:
Yeah, it’s really interesting because a lot of gut issues start manifesting or showing signs in the mouth. For instance, a really common condition is Crohn’s disease, and we will actually see a “cobble stoning” appearance on patients’ gum tissue, and that’ll tip us off to something being wrong in the gut. And so anytime that someone has inflammation in the mouth, we know that something is wrong with their microbiome. And so if someone comes in with bleeding, swollen, itchy or receding gums, those are all signs that something is going on in the mouth or the gut and manifesting in the mouth.
Lindsey:
I actually had one of my earliest clients tell me that after we had addressed some of the inflammatory foods in her diet and tried to reverse her Hashimoto’s thyroiditis, when she went to her dental appointment, all of the sudden the depth of her teeth was much more normal. Before she had much bigger pockets by her teeth, indicating that they were inflamed.
Dr. Katie Lee:
Definitely, it’s called periodontal pocketing what you’re referring to. We measure the depth of the patient’s gum tissue to their bone level and that gives us an indication of what’s going on, whether the gums are swollen or whether their bone is actually dying off and deteriorating. And what we know is that diet, as much as it affects the health of your gut and your symptoms of your gut, it definitely also affects the symptoms of the mouth. So whatever is going on in the mouth is also going on in the gut and vice versa. And there’s an enzyme that correlates the two, which I’m sure we’ll get into later. But one of the big things in my dental practice was actually having my hygienist spend time educating patients on anti-inflammatory diets because we just saw that much of an impact on patients’ overall health.
Lindsey:
Yeah! So what are the types of oral bacteria that people need to be aware of that contribute to gut health issues? And don’t be afraid to name strains.
Dr. Katie Lee:
Yeah! Ok. Great, good! So there’s two main ones that people should be aware of and it’s Pg and Fn. These are two bacteria that are in the mouth. They are very invasive species. Fn, I call it the “Uber” of bacteria, “Fusobacterium nucleatum”. Everyone has this bacteria, but it’s when it partners up with other bacteria, especially Pg, that it can cause a lot of damage. And Fn can get into the bloodstream very easily and it circulates freely throughout the body. And oftentimes what it’ll do, is it’ll partner up and latch on to another bacteria and then cause disease in other places. So those are the two bacteria that will cause gum infection and periodontal disease in the mouth, and then also affect our gut health as well.
Lindsey:
So Pg stands for…
Dr. Katie Lee:
Porphyromonas gingivalis.
Lindsey:
Okay, I think we’ve all heard of gingivitis, so I’m familiar.
Dr. Katie Lee:
Yes, yeah, very similar.
Lindsey:
Fusobacteria, I’m pretty sure those are hydrogen sulfide producing bacteria?
Dr. Katie Lee:
Yeah, they’re gram negative. They love oxygen-deprived environments. So that’s why they work really, really well in the gut and why they live and can thrive in the gut. And Fn particularly is very difficult to kill off and to lower. So again, it’s not necessarily that the Fn is bad, it’s just in association with other bacteria causing harm.
Lindsey:
Okay. I know that it’s been publicized in the news about the bacteria in your mouth and heart health. So can you dig deeper into that connection, and with other health conditions as well?
Dr. Katie Lee:
Yeah! So Pg is actually really heavily implicated in heart health, also really heavily implicated in Alzheimer’s. In fact, there’s been some direct links of Pg causing Alzheimer’s. They found Pg in cerebral spinal fluid of patients with Alzheimer’s. So we know that we shouldn’t have bacteria in our brain. So when we have it, our body creates these amyloid plaques and can cause our brain to shrink over time and impair our brain function. And so these bacteria are also implicated in the heart, arthritis and gut and you know as well, anytime you have gut issues, and massive inflammation in your gut, those patients also oftentimes have arthritis issues and joint issues, because of the systemic inflammation that’s going on. And what happens is, and I think what a lot of dentists and clinicians didn’t realize in the beginning is, we know the bacteria in the mouth don’t stay in the mouth, they go into the body, but we never really understood how that happens.
And so now we know that there’s this enzyme called aMMP-8, it’s a matrix metalloproteinase, which is a collagenase enzyme. And what happens is, we get bacteria in our mouth that shouldn’t be there, viruses or fungus or whatever, the body releases the immune system to go and protect us and kill off whatever invader is there. And in order to get the white blood cells to that area, it releases aMMP-8 to go through and cut through the cell junctions to allow the white blood cells to get to the invaders. The problem with that is, now we are breaking down tissue. And so that’s what leads to leaky gums or gingivitis and periodontal disease in the mouth. And that’s what allows the bacteria to get into the circulatory system and cause systemic damage. That’s also the same enzyme that’s responsible for cutting down the tight junctions in the gut too and causing leaky gut. So it’s directly related.
Lindsey:
Interesting. So are there any other strains of pathogenic bacteria that are particularly bad in the mouth beyond those two?
Dr. Katie Lee:
Yeah, we call it the red complex bacteria. So there’s a bunch of bacteria in the mouth that we are really concerned with: Tb, Tf are a couple of the other ones that we’re always trying to lower, so that way we don’t have systemic ailments, but Fn and Pg are definitely the two main ones. Aa, Actinomyces, is another really big one. When it’s present it causes a ton of damage. But fortunately, it’s not that common for someone to have it and that one runs more in families because it’s passed down generation to generation. But what’s really cool about all the stuff that I’m talking about is you can now test, just like you can do microbiome testing for your gut, and do stool testing, we can actually do saliva testing now and test patient’s oral microbiome, and we can actually test the enzyme level, the MMP-8. So we can tell, does the patient have these pathogenic bacteria in their mouth? And what is the enzyme level? And that tells us how freely stuff is going from the mouth to the body.
Lindsey:
And those other two strains you mentioned, can you give me the full names?
Dr. Katie Lee:
Treponema denticola and Tannerella forsythia. We always just say the abbreviation.
Lindsey:
Okay. Tell me the name of the test that does the microbiome of the mouth?
Dr. Katie Lee:
Yeah so there’s several tests on the market. The two that I really like, one is with Access Genetics, and it’s called OralDNA. I really liked that test. It tests for 11 different strains of bacteria. It’ll tell us the level of the bacteria that the patient has, it breaks it down into high risk, medium risk and low risk pathogens. And when it talks about that, the risk is associated to how much bone loss or damage will it cause in the mouth, and then how much is the risk for the rest of the body for systemic conditions. And then it’ll also tell you how to treat those bacteria as well, because that’s what’s important to know. Just because you have bacteria doesn’t mean that it all responds to the same treatment. And so for many years, clinicians made the mistake of, you know, a patient would come in with gum infection, and we just had one kind of “kitchen sink” approach to treating their gum infection. But what we would notice is some people would come back every three months, and their condition never got any better.
And that was for a couple of reasons. One is we weren’t ever looking at gut health or nutrition, or supplementation or systemic issues. But then also, bacteria are not all responsive to the same types of treatments. And so it’s nice to know about microbiome testing, as you can really tailor the treatment to what the patient has. The other test I really like is HR-5 by Direct Diagnostics. It really just hones in on the top five pathogens that cause periodontal disease and systemic disease. So those are the two I really like. And then for the enzyme test, the aMMP-8 test. That’s a very unique proprietary test done by Dentignostics, it’s a German based company, they’ve been doing this test in Germany forever. It just came to the US a few years ago. And that’s a “chairside point of care test”, which is awesome. And so we will call it “fitness”. So a patient would come in, and we’d say, “Let’s measure your oral fitness.” And that would just give us a read on how this patient is doing at this very moment with their oral health and systemic inflammatory levels.
Lindsey:
And are those directly administered by dentists only, you can’t order them yourselves?
Dr. Katie Lee:
So that’s a really good question. The aMMP-8 test is only available at dental offices right now. I know they’re working at trying to do some at-home tests. And then the saliva microbiome testing, you can get through a dentist. You can either go through a dental office; you can ask if your dentist will provide that test. Or, for instance, that’s something that some of us online dentists do so people can go to the website and order the test from the website. And then we will go over the results with them.
Lindsey:
Okay, great. So, to the extent that you haven’t yet, let’s go through the different pathogenic strains and the connection to various diseases one by one of the ones that you haven’t yet mentioned.
Dr. Katie Lee:
For which ones specifically, they’re all kind of overlapped? It’s all those top five, like the HR-five bacteria that I was talking about. Those are the ones that really cause the most systemic conditions. And that’s why Direct Diagnostics focuses on just those five, because those are the ones that we see repeatedly over and over again. So Fn and Pg are the big ones. Td and Tf are also implicated in gut health, but Fn, specifically to the gut, we know that there’s about 20% of colon cancers that test positive for the presence of Fn . And so what happens is Fn gets into the colon, it causes these inflammatory responses, polyps are formed and then Fn kind of aggregates into the center of these polyps. And so we know that patients that have Fn -associated cancer are more difficult to treat, and they’re less responsive to chemotherapy and they’re more at risk for recurrence. So yeah, Fn and Pg are the big ones for gut health.
Lindsey:
Okay. And so what kinds of treatments are you doing? Is it like antibiotics or is it just something inside the mouth?
Dr. Katie Lee:
Yeah, to treat the Fn infection?
Lindsey:
Any of these or any of these infections you’re talking about.
Dr. Katie Lee:
So, for Fn and Pg specifically, what we typically do is we’ll administer scaling and root planing, which is a periodontal cleaning. What a lot of people don’t understand is that aerobic bacteria live above the gum line. And those are a lot less dangerous than the bacteria that live underneath the gum line, such as Pg and Fn . And so you can’t do a super gingival (above the gum line) cleaning if you’re trying to target those pathogens. So you must go underneath the gum tissue and do what’s called scaling and root planing to clean those bacteria out. Now, the bacteria that are resistant to scaling and root planing, you need to go in with some sort of medicaments, or anti-microbials, or lasers to try and get rid of them. So oftentimes, we’ll use ozone therapy. When we’re doing these cleanings, you can do iodine and rinse them out that way, you could do Peridex, there’s all kinds of different chemicals or medicaments to rinse the bacteria out.
And then I love to go in and actually decontaminate the gum tissue, the inside of the periodontal pocket, with a laser. Laser therapy is very, very effective at killing bacteria. Because you’ve got to think about it, you have your tooth, your roots, and then you have your gum tissue. And so bacteria not only live on the tooth root surface, but they also live on the inside of the gum tissue. And if you don’t treat both the root surface, the free floating bacteria in the pocket and the gum tissue, you’re not going to have a clean environment for healing, because what we want to do is we want to clean everything up, we want that gum tissue to shrink and reattach to the tooth and act as a barrier so nothing can get back down in there. And if the gum tissue was not being treated specifically, it’s not going to reattach to the tooth and you’re never going to close that barrier. So laser is really, really effective in treating that tissue.
Lindsey:
Okay, and I don’t know exactly what root planing and scaling is, but it sounds painful. What exactly does that involve?
Dr. Katie Lee:
Yeah, that’s a question that we get a ton from patients. So when we talk about scaling and root planing, essentially what we’re meaning is, scaling just means scaling the teeth. So scraping the teeth, you get that done when you get a regular prophylactic or healthy mouth cleaning. Anyway, root planing just means that the root surface is actually rough. So if you look at it under a microscope, the crown of your tooth is real smooth, it’s like a sheet rock. But then when you go down to the root surface, it’s actually very, very porous. And those porous roots are where bacteria love to stick to and grow and thrive. And the bacteria will actually colonize, mix with the minerals in your saliva and form tartar, or calculus. In there it’s like barnacles attached to the surface.
So when you go in and clean, what you’re doing is you’re scaling all that off, but then we need to take our instruments and go in and actually root plane, so smoothing the root of the tooth to make it nice and slick that way less bacteria and less debris are likely to attach. So thank you for asking me to clarify that, sometimes I forget. Number one, get in and treat it before it gets to a level where you know you have super deep 6, 7, or 8 millimeter pockets, because the worse off that condition is yes, the more painful that the procedure is going to be. Number two, we definitely will numb patients up or anesthetize them because it’s more important to have the patient comfortable during the procedure so that clinicians can do a great job. We’ll have some people come in and say, “Yeah, but I don’t want to be numb.” Okay, well, if you’re moving around and jumping in the chair, we can’t get in and adequately clean. So I always advocate for either a topical anesthetic or doing full dental anesthesia.
Lindsey:
Okay. So cancer is of particular concern to me, and pancreatic cancer in particular, because I know two people who died of it, one of them a very dear friend. So what bacteria is associated with pancreatic cancer, and this is the same procedure for eliminating it?
Dr. Katie Lee:
Yeah, so Pg is the main one associated with pancreatic cancer. And yes, it’s same type of procedure that I’m talking about. If you do the scaling and root planing, if you do the irrigation with some kind of medicament and if you do the laser, that will really take care of everything that I’m talking about and all the different strains and treatment of all the different strains.
Lindsey:
Great. And so how about the connection between oral health and infertility? Is that just for women or men as well?
Dr. Katie Lee:
No! So, this is one of my favorite topics because I have a personal journey with infertility. So, same process, you get bacteria in your mouth and then MMP-8 is activated, the MMP-8 breaks down the gum tissue, and bacteria from the mouth circulate. One of the places Fn loves to go to is the reproductive system. And what we know about infertility is that 50% of all infertility is male and female. So it’s half caused by women, half caused by men, so it’s not just a female issue. And so Fn and Pg for men actually inhibits arginine production. Arginine is the precursor to nitric oxide, which is what is needed for a man to get an erection. It decreases the number of sperm, it decreases the swimming strength of the sperm, if you will, the motility, and it changes the shape of the head of the sperm. Now in women, it causes inflammation in the uterus and the ovaries. So it makes it not a great environment for an embryo to implant. It decreases our ability to ovulate, and then decreases our ability to carry the baby to term. So especially Fn , which is highly evolved in gut health, causes or is associated with preterm birth, low birth weights and even stillbirth. There were a lot of studies done on stillbirth babies. And what they found is that they were all infected with Fn bacteria.
Lindsey:
Wow. So important to get this check before you get pregnant, I guess.
Dr. Katie Lee:
Yeah, definitely, people definitely want to get checked before they’re pregnant, or if they’re trying to get pregnant or if they’re having difficulty. I always tell them, anyone thinking about child rearing needs to have an oral microbiome test. And even if you are pregnant, it’s still important to get this checked and treated because if you treat it, you can get rid of these bacteria, or at least get them in check so that you can go on and carry the baby to term and have a healthy delivery. So it’s still safe to get treatment during pregnancy.
Lindsey:
Right. So is bad breath a sign of having these sort of strains in your mouth?
Dr. Katie Lee:
Yes, definitely, it can be. Bad breath is associated with bacteria, periodontal disease, for sure. And all it is, it’s the sulfur byproduct of the bacteria. And so oftentimes when patients come in, there’s a very distinct smell between an abscess usually and “perio breath.” You know, only if you’re a dentist or hygienist would you probably know what I’m talking about. Bad breath can definitely be associated with gum disease and it can be associated with tooth infection. Also, acid reflux is another one that causes bad breath. Sinus issues, if someone has a sinus infection or mouth breathing. Mouth breathing is horrible for your oral microbiome, which is then horrible for your gut microbiome. I don’t know if you ever do anything with the airway, but airway is super important for all of this.
Lindsey:
Yeah, I actually was going to ask you about whether snoring and sleep apnea increased pathogenic bacteria in the mouth?
Dr. Katie Lee:
Yeah. So in our nose we have billions and billions of cilia, little hairs, same in our gut. We have all these little hairs that help filter things out. And that is what our nose is designed for, is to take the air that we breathe, filter it and then put it into our bodies so we can use the purest form of air and oxygen possible. The problem is, when we don’t breathe through our nose for whatever reason, our nasal passages start to get inflamed, because the air that we’re taking in through our mouth is no longer filtered. So we’re breathing polluted, allergen-infested air that then goes into our body. Our body knows it’s not supposed to be there. So we initiate an inflammatory response and now we have chronic inflammation going on everywhere in our body.
And so mouth breathers will say, “Well, I’m a mouth breather because I have allergies.” Well, true. But I wonder way back when you were young, you know, maybe did we have some oral habits, or our jaws and sinuses didn’t develop the way that they should have, and so that causes us to mouth breathe, which then led to those allergies. And so when we are breathing through our mouth, we’re getting dirty air and our mouth becomes very dry. Bacteria love to stick to dry, porous surfaces, which is our entire mouth now. So then we get a shift in our microbiome. So instead of having a healthy, homeostatic microbiome, we now have dysbiosis. And again, we’re swallowing that all day long, and that affects our gut health. So long answer, but yes, it definitely affects oral and gut microbiome.
Lindsey:
Okay, so I have some personal experience with this because my partner snores. He clearly has sleep apnea, undiagnosed or treated. So I told him to get one of these devices that pushes your lower jaw out, to open up the airway. But on the pamphlet, it comes with it says, “Don’t use this if you have sleep apnea.” And I’m thinking, but if you use this, then you won’t have it, will you?
Dr. Katie Lee:
Did he get it on the internet?
Lindsey:
Yes.
Dr. Katie Lee:
Yeah, I think they probably say that because of liability. Because if you have sleep apnea, you need to be treated by a clinician that can treat sleep apnea, because you have to be titrated. So wherever that lower jaw is positioned is dependent on the volume of your airway, the obstruction, how severe your sleep apnea is, and then how well you can tolerate it in your TMJ joint. Sometimes people will buy devices and their lower jaw isn’t moved forward far enough, so it actually is not treating the sleep apnea. So if someone dies in their sleep from having a heart attack from sleep apnea, they don’t want the family to come back and say, “Oh, they got this device to treat sleep apnea.” You know, they’re saying, “Oh, well, it’s not treating sleep apnea.” So it’s a liability thing. But the devices are very easy to get from dentists who treat sleep apnea. And again, the positioning is critical, because you want to make sure that they’re pulling the lower jaw forward enough to open the airway. It’s like a king’s toes, right? You want to pull it open enough to where they can breathe, but you don’t want to pull it too far for to where it changes the bite and causes joint pain.
Lindsey:
Okay, so that’s why I should tell him to take it to his dentist and check it out.
Dr. Katie Lee:
Yeah, yeah, tell him to take it to the dentist. Another important one is we see people oftentimes grinding their teeth, or that they have acid reflux. And that is a tip off that they probably have an airway issue. And so a lot of patients will say, “Well, I have a night guard because I grind my teeth.” Well, I don’t give night guards to patients unless they’ve done a sleep study. Because most of the time those patients don’t have a grinding issue. They have a sleep apnea issue and the symptom is grinding. So if you correct the sleep apnea, the grinding will resolve itself. And the night guards, you don’t want to give someone a night guard if they have sleep apnea, because you actually make the tongue space smaller, and you can make the apnea worse. So it’s really important you get it checked.
Lindsey:
And why would the grinding be caused by the sleep apnea?
Dr. Katie Lee:
Great question. So when you fall asleep, what happens? OSA, obstructive sleep apnea. What happens is you essentially choke. Most of the time you’re choking on your tongue and your airway gets pinched, or your soft tissues kind of collapse the airway. And it always gets worse as we age. And so what happens is, when you stop breathing, your brain says, “Oh, my gosh, we were not getting any oxygen. If we don’t get some oxygen up into our brain, we’re going to die.” And so there’s a rush of adrenaline that’s sent to our brainstem. And that causes us to start grinding our teeth forward to open our airway. So what we’re trying to do is push our own jaws forward, so we start grinding back and forth to open the airway and unkink it. So that’s where the grinding comes from.
Lindsey:
Interesting.
Dr. Katie Lee:
It’s a self preservation system. But, a lot of people have heart attacks and strokes in their sleep. And most people die between two and six in the morning. Because that’s when people are in REM sleep. When you’re in REM sleep, you’re more likely to have apneic events, because you’re paralyzed since we’re dreaming, and we don’t want to be acting out our dreams. So the body gets paralyzed, you stop breathing, you choke on your tongue or whatever, and you don’t wake up, and then that’s when you can have a heart attack and stroke. So sleep apnea is very important to get treated. Untreated sleep apnea is fatal. It’s just a matter of when, if it’s not treated.
Lindsey:
Wow. Okay. Sounds like serious business.
Dr. Katie Lee:
I’m not trying to scare anyone. It’s just such an easy thing to treat. And it’s not painful. 70% of people who have sleep apnea are undiagnosed, so people need to take it seriously.
Lindsey:
Yeah. And snoring is a sign of it.
Dr. Katie Lee:
Yes, definitely. It can be a precursor to sleep apnea or a direct sign that someone has sleep apnea.
Lindsey:
Okay. Got it.
Dr. Katie Lee:
But not all snorers have sleep apnea. I want to make sure I say that.
Lindsey:
Right. But the people who make gasping noises in the middle of the night probably do, because I hear that.
Dr. Katie Lee:
Yeah if they’re gasping, they for sure have it.
Lindsey:
Yeah. Okay, so are the strains that cause diseases also the ones that cause cavities?
Dr. Katie Lee:
Great question. No one’s asked me this actually. And no, they’re different. So the red complex bacteria, the five main ones that I was talking about, those are the ones that are implicated in periodontal disease and systemic disease. The ones that mainly cause cavities, there’s a few of them, but the one that everyone talks about is Streptococcus mutans. So that’s a very specific bacteria and the reason why it is concerning is because it will ingest the carbohydrates that we have in our mouth. So that could be sugar, it could be processed foods, pastas, crackers, anything like that. Thats what it feeds off of, and then it basically excretes acid onto the teeth and that’s what causes cavities. That same bacteria is also implicated in causing problems in our hearts. So when you hear about patients having heart valve issues or something like that, the cavity causing bacteria in the mouth can go to the heart and cause heart valve issues.
Lindsey:
Interesting.
Dr. Katie Lee:
So, a lot of times patients need pre-medication before they come in to the dentist, and that’s from the “Strep mutans” or the strep family.
Lindsey:
Okay. So are there beneficial strains that we want to have in our mouths?
Dr. Katie Lee:
Oh, yes, just like the gut. So we want to have plenty of Lactobacillus bacteria or the Bifidobacterium, those are really good. I’ve been doing a lot of studying with the Akkermansia strain*. Have you?
Lindsey:
Yeah, I’m taking Pendulum Metabolic Daily Pro*. I started that about two days ago.
Dr. Katie Lee:
Yeah. So I’ve been taking that too, we’re finding the Akkermansia is very beneficial in the mouth as well. So whatever is going to be good for your gut, it’s going to be good for your mouth because again, the mouth is benefiting the gut. So yes.
Lindsey:
Okay. And are there any dental probiotics that you recommend?
Dr. Katie Lee:
Yes, but understand that I’m not paid by any company, this isn’t an ad or anything like that. But there’s lots of products on the market that are really, really good. There’s this product called reviten*. It is really, really good. It’s a toothpaste, it’s all natural. It’s even food grade, so you can actually eat it. What I love about it is it has prebiotics, which is as you know what we need to feed the good bacteria in our mouth and in our gut. And it also contains some vitamins that are essential for oral health. We need to stop over cleaning and over sterilizing our mouth, because the mouth is an ecosystem. And for years I was trained this way in dental school. You know, “kills 99.9% of germs” and “the burn from the mouthwash is good, it means it’s cleaning”, and “we should use triclosan in our products because it’s antibacterial.”
I don’t like that logic because the good bacteria, the anaerobes, are so much easier to kill than these pathogenic bacteria that have learned to survive throughout the rest of the body. And so when you take those harsh products, you’re for certain killing the good bacteria and maybe doing a little bit for the bad bacteria, but what you’re doing is you’re setting up an environment for the bad ones to thrive. So I always tell people, use gentle products. The Tooth and Gums Company* is another really good one. Boka* is a great company, I love them. Invivo has a lot of prebiotic and probiotic mouthwashes. Again, not paid by any of these people, I just really like their products. A really good one that people can get is Tom’s. Tom’s is great. I actually love the Tom’s product line.
Lindsey:
Alright that’s great. Even the fluoride-free?
Dr. Katie Lee:
So here’s the thing about fluoride. Fluoride is a neurotoxin, we know that fluoride is toxic when ingested. But if people are going to choose to go fluoride free, they need to make sure that they have practices in place to prevent cavities. Because a cavity and a dental abscess is way more toxic to the body than fluoride. So fluoride-free is great. I’m an advocate for that, but make sure that you’re using products with “nano hydroxyapatite” and not “hydroxyapatite”. It needs to be “nano hydroxyapatite*” that way it’s absorbed into the tooth structure. Make sure you have products that have some sort of cavity-fighting product in them, so “nano hydroxyapatite”. Another really good one for preventing cavities that a ton of research is done about and is also great at preventing sensitivity or treating sensitivity is arginine. This is where I really like Tom’s toothpaste* because they are really high in arginine in their formulation. So nano hydroxyapatite is good. Arginine is really good. MIpaste is really good. So yes, you can go fluoride-free, but make sure you do something else. Lay off the Coca Cola and Starburst if you want to be fluoride-free.
Lindsey:
And does the Tom’s of Maine have that nano hydroxyapatite in them.
Dr. Katie Lee:
No they don’t have nano hydroxyapatite but they’re high in arginine.
Lindsey:
And that can take the place of it?
Dr. Katie Lee:
Yeah, absolutely. Yeah. Arginine has a ton of research, so I’m totally into that.
Lindsey:
Okay, great. I was going to ask about that, because I didn’t know if the dentistry world would be like “fluoride-free toothpaste! Oh, no!”
Dr. Katie Lee:
I’m totally fine. You know, I would just have patients that would come in, and they’d be like, “I stopped doing fluoride six months ago.” And I’d be like, “Okay, well, now you have 12 cavities.” So now I have to put materials into your mouth. Of course, I’m going to use as biocompatible materials as possible, but still, let’s change lifestyle, let’s change what we’re going to do if we’re not doing fluoride. So, yes, fluoride-free is fine. Just make sure you’re set up for success.
Lindsey:
Okay. So if you’re kissing somebody who’s got pathogenic strains in their mouth, will you necessarily take on those strains? Or might your better strains fight them out?
Dr. Katie Lee:
No, no. Unless you have some superhuman oral bacteria, or oral microbiome, the oral microbiome is very fragile. And, you know, just as something as little as eating processed foods for a week or rinsing with alcohol mouthwash…you’re going to kill it off. So again, bad bacteria are much more powerful than good. So if you’re kissing someone, eating after someone, around someone with a lot of pathogenic bacteria in their mouth, it’s going to transfer to you. So especially in patients who are doing fertility treatments, we test not only the wife, or the husband, but we always test the spouse as well. And your kids are going to get your microbiome, so when babies are born, you get your first introduction through the birthing canal. But then the microbiome is not really that diverse in the beginning. And that’s why babies are so prone to infections when they’re young, because their microbiome is still developing in diversity, and they’re going to get it from their environment. So if mom and dad’s microbiome or their nanny’s microbiome was not good, your baby’s going to get that.
Lindsey:
So it sounds like no to mouthwash, or at least not the really strong mouthwashes at least. How about fluoride rinses?
Dr. Katie Lee:
So again, the fluoride rinses are just there to put extra fluoride into the teeth. And there’s other things that you can do. And I would always ask people, what’s your purpose for doing the fluoride rinses? So if someone has really high cavities, and every time they come in they have high cavities and they’re a teenager, they’re eating sugar and drinking Coke, and I can’t get them to make behavioral modifications, like teenage boys…they’re really tough. Maybe a fluoride rinse might be good for them, as long as they’re not swallowing it. If someone does not have a high cavity risk and a good lifestyle, they don’t need the fluoride rinse. They can use Tooth and Gums Tonic* or something like that.
Lindsey:
Yeah. So in terms of changing your breath, what’s a good option that’s not too expensive?
Dr. Katie Lee:
Yeah, the best thing someone can do is number one, Tongue Scraper*. I am a big proponent of tongue scraping. People’s tongues are filthy; they don’t clean them off. Just buy a U shaped scraper on Amazon, it’s a couple bucks. And after you’re done brushing, scrape it off. That will improve breath tremendously. The other thing is, I would for sure go see your dentist, make sure you don’t have a gum infection or a tooth infection. And if they have microbiome testing available, get it, because you might have the periodontal pathogen bacteria and they’re producing sulfur compounds causing that bad breath. Another one I would check is mouth breathing, that will cause a lot of bad breath and so will acid reflux. I don’t know if you’ve ever tried mouth taping*, or have you ever tried it or heard of it?
Lindsey:
Yeah, I recommend it to any client who says they snore.
Dr. Katie Lee:
Yes, it’s amazing. So for someone who says, “Oh, I can only breathe through my mouth,” I’ll say okay, during the day start training yourself to breathe, and then use it at night. So that way people don’t freak out they’re going to choke to death and stop breathing at night. And usually just by closing their mouth during the day, that’s enough to start triggering the inflammatory response to calm down. But breathing through your nose will actually make your breath a lot better because your mouth isn’t dry.
Lindsey:
If somebody has just eaten a lot of garlic or whatever the situation is, are there any mouth rinses that are okay, that aren’t hurting bacteria?
Dr. Katie Lee:
Yeah, I like Tooth and Gums Tonic. That’s a really good one. Tom’s mouthwash* is really good. I really love Closys*. That’s a really good, gentle mouth rinse that people can use. It used to be by prescription only but now it’s over-the-counter, which is great. Anything that’s alcohol free. Alcohol will kill the good bacteria and it will dry out your mouth, which makes your breath worse.
Lindsey:
Okay, great. So if you’re somebody like I am that produces a lot of plaque as soon as I eat anything with sugar in it, is that a cause for concern?
Dr. Katie Lee:
So it can be, you just have to be way more diligent with oral hygiene. So when you have plaque on the teeth, it can be for several different reasons. A lot of it can just be your own mineral content that you have coming through your saliva. When you say you cause a lot of plaque, do you mean you get a lot of hardened buildup on your teeth…like “hairy teeth”.
Lindsey:
Yes.
Dr. Katie Lee:
Yeah. So, you just want to be really diligent about your oral hygiene, because when plaque is soft it starts forming 20 minutes after you finish eating. Plaque is soft, it can be removed. The problem is, once that plaque is allowed to stay on the teeth and mature, and then it mixes with the minerals in your saliva, it hardens, and then becomes a safe haven for bacteria. And you can’t remove that hardened plaque on your teeth. That’s called calculus. So not a concern as long as you’re being diligent and taking it off. I always tell people after you eat and drink, make sure you wait at least 30 minutes to brush your teeth. Because if you eat something acidic, or sugary, or something like that, and you brush immediately after eating, you’re actually brushing that into the teeth and can cause damage. So wait about 30 minutes, let the pH level of your mouth rise because that’s the other thing, once you finish eating, the pH in your mouth drops because we need to start to break down and digest our food so that we basically start the digestive process in the mouth. And so you want to wait 30 minutes, let the pH come back up, let the food pH kind of normalize, and then brush your teeth.
Lindsey:
Okay, great. So I’m not sure, did you actually answer about whether there’s any dental probiotics that you like or use?
Dr. Katie Lee:
Oh, probiotics? Yes. So I really love the Invivo line.
Lindsey:
As a probiotic?
Dr. Katie Lee:
Yep, they have a really good mouth rinse too. It’s a powder that you just mix with water. And then you can rinse with that, that can be your mouth rinse. If you go to Primal Health*, they have really great products as well that I like that are non-toxic.
Lindsey:
Okay.
Dr. Katie Lee:
And another really good one for plaque. And to prevent cavities, is actually chewing Xylitol gum*. So have you heard of xylitol?
Lindsey:
Yeah, I have gum with it too, all the time.
Dr. Katie Lee:
Perfect. Okay, good. So another cause of the hairy teeth feeling is one, the teeth could just need to be polished. So when you go to your dentist, ask them to polish them and smooth the teeth out so that they’re not so sticky. And number two is dry mouth. And so if you can keep your mouth more moist, and so you can do that by drinking tons of water. If that’s not working, then I always advocate for chewing Xylitol gum, because number one, the Xylitol will kill any Strep mutans bacteria. So cavity causing bacteria, the bacteria will ingest the Xylitol thinking it’s a sugar but then actually starve to death because it can’t metabolize it. And then also it causes secretion of saliva which bathes our teeth, and actually prevents the bacteria and plaque from adhering to the teeth. So that’s another really good option.
Lindsey:
Great. I’ll link to this gum I use and all these other things. I’ll find them and link to them in the show notes. So have you ever heard of Biocidin products? They have a dental rinse called Dentalcidin* and they have a toothpaste*.
Dr. Katie Lee:
Yes, I actually really liked them. Thank you for bringing it up. I believe they’re doing Akkermansia stuff now too.
Lindsey:
Really?
Dr. Katie Lee:
I saw a webinar and Biocidin was sponsoring the webinar and they were looking at the Akkermansia line. So that was kind of my first tip into Akkermansia. And then I found Pendulum, which was great. But yes, I really love Biocidin as well.
Lindsey:
Yeah, I use that Dentalcidin rinse*. I’ve seen studies showing it helps with the pathogenic bacteria as well.
Dr. Katie Lee:
Yeah, they’re a great company. They’re all natural, science-based, which I love. You’ve got to be careful because a lot of things that are out there don’t have the science to back it up. And so you just have to be a little leery of it.
Lindsey:
Yeah. So how about the connection between dementia and oral health? You did mention Alzheimer’s.
Dr. Katie Lee:
So, same process. Bacteria in the mouth, inflamed gums, aMMP-8, leaky gums, the bacteria Fn and Pg go into the brain and they can cross the blood brain barrier. And that’s really scary because that barrier is there to protect our brain. And essentially what happens is once Pg is in the brain, the brain knows it shouldn’t be there and so it starts creating these beta amyloid plaques around the neurons to protect itself from this bacteria and in essence starves the neurons. And so they begin to die. And then that’s how we develop Alzheimer’s and dementia. So the brain is actually trying to protect itself, but then it ends up harming itself. Fn, what we know is, Fn brings Pg to the brain, but then Fn also accelerates Pg’s pathogenicity in the brain. So again, those two bacteria are highly correlated to Alzheimer’s and dementia. Same with herpes viruses, there’s a lot of research coming out about HSV going into the brain and causing neuro inflammation. And so that’s one thing I always tell patients when they would come in is, you know, “do you have a history of cold sores?” And they would sometimes would say “yes or no, why do you care?” And I said, “Well, we need to put you on an antiviral or do something to try and get these under control.” Because every time you have an outbreak, we’re causing neural inflammation and damage.
Lindsey:
Yeah. And that’s super prevalent. I think something like 80-85% of people have it.
Dr. Katie Lee:
Totally. Yeah, very, very common.
Lindsey:
So I hear a lot of biological dentists recommending removing root canals and crowns and such, but what do you put in their place if you do that? And is that something you’d recommend?
Dr. Katie Lee:
Oh, gosh, you’re opening up Pandora’s box here. Here’s the thing, I don’t portray myself as an all-natural, biological dentist. Root canals can be very deadly and harmful because once the tooth is dead, it cannot heal itself. And so if the root canal is not done properly, or if the patient has gum disease, or if they have cavities, teeth are like organs. And so when they are getting insults, they can fight off those insults and heal themselves. When you have a dead tooth, you have no immune system on that tooth. And so that tooth can then develop latent chronic infections. And because there’s no nerve on that tooth, the patient can have this massive abscess and never know about it.
And if they’re not being checked by a dentist who uses this 3d imaging Cone Beam technology, they can go years with these latent infections that are causing systemic inflammation and draining all this bacteria into their bloodstream and never know, because there’s no symptoms. That’s the danger of it. Number one, prevent root canals. Get treatment before it gets to a place of root canal. Number two, if you need to have a root canal done, make sure it’s done by a specialist or a general dentist who mainly focuses on root canals and uses microscopes or high technology CBCT to make sure they’re getting into every nook and cranny of the tooth. And then number three, make sure you’re getting them checked. Because the moment they start to show that they’re getting reinfected, now it’s time to take the tooth out and move on to something else, like dental implants or what have you. Oh, so it’s not as easy as saying all root canals are bad, extract all the teeth.
Lindsey:
Yeah that helps, that helps a bit. So basically just get checked with that 3d x-ray or 3d imaging…?
Dr. Katie Lee:
Yeah, 3d x-ray. You know, I tell people, if you go and rip out all your root canals, now you have to replace the teeth, because there’s lots of studies showing that the less pairs of teeth you have, the more it impairs your cognitive function, and the more it decreases your lifespan. So the magic number is having 10 sets of teeth or 10 pairs of teeth. And so if you take a tooth out, you need to replace it. Because otherwise teeth are going to shift, you’re going to get gum issues, you could get jaw and bite issues. And so now what do you replace it with? And so most often, people will do implants. Well, now you’re introducing a foreign body into your jaw, into the bone, into the blood, bone marrow, into your bloodstream. You don’t know how your body is going to react to that. Is it going to accept it or cause another inflammatory response? So the short answer is not just rip out all your root canals and replace them.
Lindsey:
Right, right. So I actually have all of my wisdom teeth. Is that super unique?
Dr. Katie Lee:
It is unique because over time, back a millennia ago, we needed all of those molars to digest our food and break down the sticks and twigs and the meat and the bones that we were eating. Unfortunately, with the high processed diet and the agricultural shift in our food and farming, our foods are a lot softer unfortunately. And so our jaws have gotten a lot shorter and so there’s not enough room for those teeth anymore. And the shrinking of jaws is also why we have a lot of airway issues and so it is very unique. So congratulations. I think that’s awesome that you still have your wisdom teeth. I wish more people had room.
Lindsey:
I think it must have been because my parents made me eat very tough meat as a child. I had to tear apart things.
Dr. Katie Lee:
That’s great! There’s a lot of advocates actually out there for developing jaws through these myofunctional kind of habits like that of eating harder stuff when you’re young so that you actually get proper development of your jaw. So good for your parents. That’s awesome.
Lindsey:
Not just all processed foods, like eating real food.
Dr. Katie Lee:
Yeah, that’s great. Yeah.
Lindsey:
So how can people find a dentist who’s doing this kind of advanced testing and treatment? Is there any website or…
Dr. Katie Lee:
There’s a lot of advocates out there that are really promoting this type of treatment. I’m sure I’m going to miss a lot of them, but there’s an organization out there called the American Academy of Oral Systemic Health. People can go on there and type in a provider and some people are linked there. You can go to “Access Genetics website”, or “oraldna.com“. That’s the saliva test, and type in find a provider. And there’s all of the Instagram influencers. So askthedentist.com, that’s a really good website. He has tons of followers, but he has a directory of people that you can search. I think Living Well with Dr. Michelle is another one. But I think it’s pretty easy to find these days a doc that will do this.
Lindsey:
Okay, cool.
Dr. Katie Lee:
Yeah, people can just ask for microbiome testing. That’s kind of the key word to ask for.
Lindsey:
Right. Right. Okay, awesome. Well, thank you so much! This was super informative. Any final thoughts?
Dr. Katie Lee:
The whole point of me doing what I’m doing and writing the book and everything is I feel the more we can educate the public on how the mouth is actually connected to the rest of the body, and how it will affect your overall health, by arming patients with the right information, I feel like they can then find providers that will give them top quality care that they need to be well. So I just hope people take the information, they can do with it what they want, but I think it’s really beneficial for people to know this.
Lindsey:
Awesome, well, thank you so much.
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