How to Improve Oral Health & Its Critical Role in Brain & Body Health｜Huberman Lab

Welcome to the Huberman Lab Podcast, where we discuss science and science-based tools for everyday life.

I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine.

Today, we are discussing oral health. Now, when most people hear oral health, they immediately think tooth health and appearance and presumably fresh breath or lack of bad breath as well.

And while Of course, tooth and breath, freshness, whiteness, and health is a critical component of oral health.

Today you will learn that oral health, including the oral microbiome, the health of your palate, your tonsils, indeed the entire oral cavity, is an extremely important component of general bodily health.

So much so that today we are going to add a seventh pillar to the so-called six pillars of mental health, physical health, and performance.

This is not a trivial step to add a seventh pillar to these six pillars.

If some of you have been listeners of this podcast for a while, you may recall that the six pillars of mental health, physical health and performance, that is The six things that everyone needs to invest specific protocols into each day are in no particular order, by the way, sleep, sunlight and light exposure generally, which by extension also includes dark exposure, nutrition,

Exercise, which we could also call movement, both cardiovascular exercise and resistance training stress management and relationships and social engagement, including relationship to self.

And today we are going to add oral health and microbiome health.

And I suppose we could generally call this oral and gut health because as You.

No, if you think about it, your mouth, your oral cavity, and your gut are contiguous with one another.

We are going to add oral and gut health as the seventh pillar of mental health, physical health, and performance, because as you will learn today, There are so many aspects of oral health and daily protocols for oral health that extend to cardiovascular health, to metabolic health, and indeed to brain health and to staving off diseases in all of those bodily compartments.

I cannot overemphasize enough how much oral health influences your general bodily health.

So today you will learn about oral biology and health.

We won't go too deep into the biology, but we will go deep enough into the biology that you will learn some incredible things such as your teeth have the ability to literally fill back in cavities that have formed provided those cavities haven't gone too deep into the teeth layers yet.

You will learn that saliva, while most people think of it as just spit, is an incredible substance fluid that contains all sorts of interesting and important things that allow you to rebuild the strength of your teeth and indeed to support the health of your oral cavity and gut microbiome and body generally.

So saliva is super interesting and important.

And today you're going to learn many, many protocols, including zero cost protocols, protocols that will actually save you as well as some low cost protocols to both restore, improve and maintain oral health.

And in doing so, maintain and improve your overall bodily health.

Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford.

It is, however, part of my desire and effort to bring zero cost to consumer information about science and science-related tools to the general public.

In keeping with that theme, I'd like to thank the sponsors of today's podcast.

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Okay, let's talk about oral health. This absolutely critical aspect of not just having fresh, bright teeth and no cavities and fresh breath, or at least lack of bad breath, one would hope, but also total body health.

As I mentioned a little bit earlier, oral health is inextricably linked to all aspects of brain and bodily health, both in the short term and in the long term.

And it is perhaps the most overlooked aspect of mental health and physical health.

So today I'd like to start off with a quiz.

I'm going to ask you which of the following three categories you believe you best The first category is those of you out there who brush and floss every day, probably twice a day. and who make some effort to try and keep your teeth clean, who like the feeling of your teeth being clean and who, pay a fair amount of attention to whether or not your teeth are getting whiter or not getting whiter. maybe whether or not your breath is fresh or not fresh, maybe, okay, these aren't requirements for being in this category, but maybe you're somebody who also uses a mouthwash or uses mints or gums in order to try and keep your mouth smelling and looking fresh and your mouth clean.

Okay, so this first category does not require that you do all of those things, but let's just make a basic requirement of participation in this category that you routinely brush at least twice a day, and that you floss at least once a day.

Okay. If you fall into that category, you are in category one.

And by the way, if you're in category one and you do those things and you do a bunch of other things like tooth whitening and Maybe you go to the dentist, especially often more than the recommended twice per year.

That still puts you in category one. Okay.

Second category are those of you out there who are, let's say a bit more blase about your oral and tooth care.

Those of you that perhaps just brush your teeth in the morning so that your breath is fresh, you can clean out that kind of sticky feeling, in your mouth that's accumulated overnight that sometimes brush and maybe floss at night.

But, you know, a lot of times you fall asleep without doing that or you don't feel like doing it. or perhaps that don't really floss at all, okay? perhaps go to the dentist once every six months, maybe a little less, maybe once a year, once every couple of years.

So while there's a bunch of different things that could put you into category two, let's make a basic requirement for belonging to category two, that you brush your teeth once a day, but not twice a day on a regular basis. or that you brush twice a day, but that you rarely floss.

Okay, that would put you into what I'm calling category two.

And then of course, there's the third category that maybe some of you out there fall into.

And this is the category of people who are extremely diligent, not just about tooth care, but also about oral health generally, about maintaining the microbiome of your mouth, about making sure that your gums are very healthy, about making sure that your soft palate and hard palate is very healthy, about making sure that yes, your teeth are clean, that they're devoid of as much, bacterial buildup and other stuff in there that can cause cavities, but also that you're paying careful attention to your oral microbiome and the overall milieu of your health in the mouth and the fact that your mouth is to all these different aspects of brain and cardiac and metabolic health, okay?

If you fall into that third category, great, but let's be honest, most people, I would argue 95, maybe even 98% of people or more fall into either category one or category two.

So as you're hearing this, you're probably thinking, okay, well, if I'm in category one, I'm good, right?

I go to the dentist twice a year, I brush and floss, I use some mouthwash.

I even brighten my teeth. I make sure that if I had a sugary meal, I'll rinse out my mouth.

I try not to drink acidic foods. Things that we'll discuss today, as to whether or not they actually have relevance for cavity formation or not.

But guess what? If you are in category one, as I described it, or category two, chances are you are doing things to really deplete and disrupt your oral health.

That's right, even if you're paying a lot of attention to tooth health, chances are, if you're like most people out there, simply because you don't have the latest information on what oral health really is and how to best support it, chances are you are doing things that yes, might be keeping your teeth white and clean and you're not getting cavities or you're not being told you have cavities that need to be filled when you go to the dentist twice a year or more, but that you are disrupting your oral health in ways that are depleting other aspects of your brain and bodily health.

And I'm not here to scare you. I'm just here to tell you that If you're in category one, okay, you're clearly doing some things that are beneficial for you, but that there's some additional things that you can do and a few things to avoid doing. that very likely will improve your overall bodily health very quickly.

And the good news is those things are also zero or low cost or in some cases can save you Now, if you're in category two, chances are you are depleting both your oral health and your overall bodily health.

But here's what's interesting. Some of the folks in category two that are not doing as much for the, let's say hygiene and freshening and whitening of their teeth, actually have a healthier overall oral microbiome.

That's not always the case, but often it can be the case.

So what you're going to discover today is whether you're in category one or category two, there are some wonderful and easily accessible practices that are well backed by science.

And by the way, in preparation for this episode, I also consulted with no fewer than five dentists, including a pediatric dentist, I talk to a periodontist, I talk to people who fall into the functional dentist category, I talk to people with a bunch of different orientations who are all heavily qualified to talk about and to make recommendations about oral health and tooth health, et cetera.

And what I'm going to deliver today is essentially the overlap in the Venn diagram of what they all agreed on.

I'll highlight a few differences that they each had and that several of them had, they do fall into different camps, but I was positively surprised how much overlap or consensus there was in terms of best protocols for tooth and oral health.

And by the way, if you're in that third category of the person that's doing a lot for their tooth health and appearance and breath, et cetera, but also oral health and microbiome, I'm sure that today you'll also learn some new health practices and some things that will allow you to expand on your already terrific practices for oral health.

Let's get into the material about oral health, focusing first on tooth anatomy and health and a little bit about mouth anatomy.

I promise to not go into this in too much depth, But we really need to have a firm basis, a foundation of understanding of what the mouth cavity really consists of.

And I'm not just going to throw a bunch of names out there for sake of nomenclature.

I don't need to cloud your hippocampus with that sort of information unless it's functional information.

But it is critical functional information for the rest of our discussion. where we'll talk about ways that you can really build up the strength of your teeth, even if cavities have already started to form and how to really get your saliva to be the best healthiest saliva for your overall mouth and for your gut and for your brain, your heart, et cetera.

Okay. So let's talk just briefly. I promise briefly about the anatomy and a little bit of the physiology of the This stuff, okay?

The teeth, we're all familiar with what teeth are, and the tongue, the tonsils in the back of the mouth.

We have our soft palate, hard palate, gums.

Let's talk a little bit about how all that fits together, centering around the thing that most people think about when they think about oral health, and that's the teeth.

It's just a good jumping off point for us.

Your teeth are layered structures, like pretty much every structure in your body is a layered structure.

It's just the way those structures form cells are born at one location.

They migrate out and form stacks or layers.

And those different layers have different cell types and your teeth are no exception.

So while there are different kinds of teeth in your mouth, teeth have an outer layer, which is the enamel.

The enamel, believe it or not, is not white.

It is translucent. Light can make it through, but it's not transparent.

It's not like a clear window, it's translucent.

Light can make it through, but it's a bit opaque.

Beneath the enamel is a structure called dentin.

Dentin is important for today's discussion because as it turns out, cavities form, not surprisingly, from the outside of teeth inward and cavities as the name suggests are holes that bacteria burrow down through the enamel and If you're unlucky, make it down to the Denton.

Our goal, meaning your goal, is to engage in daily protocols.

That's right, daily protocols that are simple and fast and zero or very low cost. that allow you to avoid the formation of those cavities, yes, but also that can allow you to fill in those cavities.

This is one of the most important things to understand about oral health that frankly, I didn't know until I started researching this episode and talking to all these experts in the field, which is that you can repair cavities that have started to form.

That's right. Your mouth environment based on its chemistry and some things that are mechanical, but mostly based on its chemistry, in particular, how acidic it is or how basic it is. is always in a state of what's called either demineralization or remineralization.

Now those words are hard to say and they're especially hard to say fast. demineralization, remineralization, it's a little bit of a tongue twister.

Today, I'm gonna use a shorthand that's a convention in the dentistry field, which is de-min, or remin to refer to demineralization or remineralization.

Remineralization is good. It is the process by which within the enamel and to some extent in the deeper dentin layer of the tooth, but especially within the enamel, there can be the addition of new minerals that form very robust, essentially, chains of crystals, okay?

If you've ever looked at a crystal of any kind under a microscope, or you've seen a picture of it, They are incredibly well organized.

They form a lattice of very strong, often, although there are weaker crystals too, very strong bonds. and structure, it's like the structure of a really well-formed building, okay?

Remineralization is the process of putting minerals back into that crystal structure, and it's actually possible to fill back in those cavities that bacteria have started to form, especially when those cavities have burrow down into the enamel, but have not yet made it into the dentin layer of the tooth or teeth.

Okay, this is very important to understand.

It's especially important to understand in the context of the fact that Typically, not always, but typically if you have a cavity formed at one tooth, and let's say it's just halfway or three quarters of the way through the enamel layer, that if you have cavities elsewhere in your mouth, chances are that they are at the same depth or level.

Not always, but chances are. And that's great news. those cavities have not yet made it into the dentin layer.

Why is it great news? Well, I don't know about you, but I don't like having my teeth drilled.

I don't like having cavities drilled and filled.

I had a very traumatic childhood with respect to dentistry and oral health.

I'll talk about it a little bit later in the episode.

It's not that I had tons and tons of cavities.

I actually had this other issue where my adult teeth came in behind my baby teeth.

I had all my baby teeth pulled. I had to get a bunch of injections of Novocaine in my mouth.

I didn't like getting injections into my mouth.

So I opted to have any cavities I had drilled without Novocaine.

It's not because I was a tough little kid.

Although that definitely toughened me up.

It was because I hated having syringes in my mouth.

I might've even bitten a dentist or two or three.

I don't bite the dentist anymore. I thank the dentist.

By the way, I think dentists are wonderful.

Regular cleanings are wonderful. We'll talk about frequency of cleanings, but here's the point.

If you are somebody who enjoys getting your teeth drilled, well, then I don't know what to say.

But if you're like most people out there, with proper wiring of your neurology, well, then you don't like getting your teeth drilled and you can avoid it in many cases by remineralizing that enamel layer of your teeth.

Now, if there's demineralization down to the deeper dentin layers of the tooth, then most often you're going to need it to be Drilled, drilled and filled as they say, or as some people say, which is a bit more cynical,

Drill, fill, and bill, because you get charged for that or your insurance gets charged for that.

Okay, back to some tooth anatomy and mouth anatomy.

We talked about the enamel layer of the tooth on the outside.

I told you that it either can demineralize, demin, or remineralize, remin.

This is a key point. Your teeth are always in a state of either demin or remin.

That's right, either demin or remin. It's not both at the same time, it's one or the other.

And it is largely dependent on the, pH, that is the acidity of your mouth, which is largely dependent on how much saliva you're producing and the mineral content of that saliva.

Keep that in mind, I think it's a very important point.

Now, another key point is that next to your teeth, right, you have your gums, the gingiva as it's called.

Now the gingiva provides a really important role in keeping the teeth stable.

We don't often think of it like that, but even though that stuff seems gummy and soft, it is soft tissue. it is very important for fixing the teeth to the bone.

It's not just about the roots that extend down into the jawbone below.

The gums are very important for keeping the teeth where they are.

There's actually a little ligament too, between gums and the teeth that resides a little bit deeper, but the gums form a critical barrier between the oral cavity and the deeper layers of what eventually is bone and into the general blood flow or bloodstream of the body.

Now, this is so important to understand that the gums are a seal around the tooth.

This is why when you go to the dentist, they're paying attention with that little pick.

They're paying attention to how high or hopefully low the tenting is, the little recesses or pockets of gums along the, Yes, I'll try not to do that during today's episode, point to my teeth so much so that I'm then, you know, you can't understand what I'm saying.

The gums are providing a seal between the oral cavity and essentially the bone and the the general bloodstream.

Now, this is so critical because let's just take a step back and think about the oral cavity and what a remarkable place it is.

Think about it. This is a gaping hole in our body.

Okay, we have some other gaping holes in our body, but those tend to be sphincter-based holes.

Yes, I realize there are probably some chuckles as soon as you say sphincter.

Like, yes, the anal sphincter. Okay, we're anatomists.

We're biologists. We can talk about that.

Stay shut. stuff is generally not going up there, and if it is, not very often, okay?

Your nasal passages, yeah, those are holes, but you know, there's a lot of stuff there.

There's mucus to catch stuff. there's a cribriform plate, there's a bone, there's a bunch of things that act as barriers between the nasal cavities and the brain, which sits right behind it, the olfactory bulb.

And yes, we have eyes and then we have the outside of the eyes and there's a susceptibility there, but we have our blink reflex, There's also an ocular microbiome.

There's a bunch of things there, but think about just this gaping hole in the front of our face that we use to eat and speak and breathe.

Okay, it's a huge hole. And as a consequence, it's filled with bacteria from our outside environment all day long. all day long, sometimes at night, although we're going to talk later about the critical, critical need to be a nasal breather at night. and not a mouth breather, not just for sake of staving off sleep apnea, but also because Turns out the dryness of the mouth is one of the ways that you really can throw off your oral health in major ways.

In fact, it's one of the leading causes of tooth decay in people like methamphetamine addicts, or if you see people that are mouth breathers, their oral health and their teeth generally but certainly their oral health is severely depleted.

So you've got this big hole in front of your face and you're talking and eating and moving about during the day.

Even if you're a nasal breather, when you're not talking or eating, and all this bacteria is getting in.

And it's a really moist environment and it's really warm.

So the combination of bacteria moist and warm means that this thing is like a Petri dish for growing stuff that could potentially be really bad for us.

But it has this incredible feature, which is that if the pH is right, then the bad stuff is killed off, doesn't make it into our system, doesn't disrupt our oral health or our bodily health.

It also has a critical feature, which is that the bacteria that are good for us proliferate and supports the sealing process of the gums against the teeth. and tooth health and tongue health and palate health, et cetera.

Okay, so the oral cavity is amazing by virtue of how vulnerable it is, but also how robust it is.

And the way it stays robust is by keeping the saliva healthy.

Now there are other ways too, but that's one of the main ones.

And it's a huge portal into the rest of the body.

And if the oral cavity isn't amazing to you already, based on what you've heard thus far.

Think about this, if you get a cut on your arm or your hand or your shin, unless you're one of these remarkable people that always heals up without a scar, as long as you're about 25 years or older, Typically, you'll form a little bit scar.

There'll be something noticeable there. The oral cavity also can take cuts and burns and things like that.

Unfortunately, those things occur, but with rare exception, heals up with nearly zero scarring.

Sometimes there's a scar, but nearly zero scarring. which is remarkable.

Why? Well, it's basically an open wound with a bunch of bacteria in it and it's warm. and it's moist.

So clearly there's something special going on in this thing that we call the oral cavity.

There is. And it's anchored in the fact that if we treat it right, you can encourage remineralization How do you do that?

By keeping the saliva healthy. How do you do that?

By supporting the proper bacteria within the mouth and making sure that you're eliminating the bacteria that you don't want, or at least limiting those bacteria.

And today we're going to talk about how to do that.

And by virtue of doing all the things that support tooth health, you're also going to support gum health.

Okay, those gums are critical because they form that barrier that if it gets too big, if those pockets, those recesses get too big, and you're not taking care of the bacteria in your mouth, meaning you're not getting rid of the bad bacteria, those bacteria, worm their way down into the deeper recesses near the roots of the tooth, sometimes into the tooth, we'll talk about that, and can get down into the bone and then can cause serious, serious issues.

This is so-called periodontal disease. And periodontal disease is associated with all sorts of really bad stuff, including Alzheimer's.

Okay. some wellness culture woo science leap to Alzheimer's.

There's literally evidence that the specific bacterias that cause recession of the gums can cross the blood brain barrier if they make it into the general circulation and potentially cause some of the hallmark features of neural degeneration in Alzheimer's, okay?

Probably not the only, but potentially one of the major causes.

This is a new theory, but it's one that a lot of people are starting to pay attention to.

And it's also very clear that bacteria make it down into these deeper recesses near the roots and into the bone that you can end up with issues related to cardiac health and certainly metabolic health.

OK, so again, the goal today is not to scare you.

It's not to spend too much time on all the terrible things that can happen, but rather to emphasize the positive, which is that if you do the right things at the right times, especially if you do them on a regular basis, that you can really improve the health of your total oral cavity and your teeth and your breath and all the other stuff that people care about for aesthetics interpersonal interactions will flourish as well.

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Well, OK, let's talk about how cavities form, because I think this is the major question that people ask when asking about or thinking about oral health.

As I mentioned before, cavities are literally holes.

They're fenestrations as the nerds call them, nerds like me call them. little fenestrations, little holes down into the enamel that if they make it down to the dentin layer of the tooth, most likely do need to be drilled and filled and presumably build.

Okay. But your goal, I think All of our goal is to try and keep our teeth in a state of remineralization by keeping the pH, that is the relative... acid alkaline balance of the mouth such that the saliva supports remineralization.

Now, Let's think about how a cavity actually forms.

Turns out that no specific food, not even sugar, causes cavities.

Cavities are not caused by sugar. Cavities are caused by bacteria that feed on sugar.

And now that's not just a little bit of a twist in the mechanism.

That's a critical point. There's no specific food. not even pure sugar, not even like a hard candy, like a delicious Jolly Rancher, I used to like those when I was a kid, that gets stuck in your tooth that causes cavities, no.

It's the bacteria that feed on sugar that then produce acid that that degrades, that demineralizes the tooth in this very focal area that we call a cavity.

Now, if that isn't surprising enough, get this.

The bacteria that causes cavities by eating sugar and releasing this acid, While there are several of them, the major one is called streptococcus mutans, or what I'll call strep mutans for short.

Strep mutans is not something you're born with.

It's actually a communicable That's right, you give it to one another through how?

Sharing of glasses, sharing of bottles, kissing on the mouth.

Now, I am not here to tell you not to do any of those things.

I'm certainly not here to tell you that.

However, and by the way, in researching this episode, I did learn that there is a specific category of person out there.

Typically they are a dentist or married to a dentist. that have opted, believe it or not, to never kiss their children near or on the mouth so as to help their children not get streptococcus mutans because almost all adults carry it, not all, but it's communicable. like a STI or like a flu or like a cold.

It's communicated between individuals. We are not born with it.

That's a whole area of, let's just call it, bio-social ethics decision-making that I think most people are not going to be too concerned with. or at least act on, because let's face it, most people are not going to change their overall behavior of kissing or, usage of bottles or glasses in order to avoid getting strep mutans.

Most people in the world have strep mutans or will get strep mutans and it lives in the mouth.

It just resides there. Strep mutans is there and it's hungry.

What's it hungry for? Sugar. When there's sugar present, It eats it, it produces acid, the acid produces cavities, taking teeth from a state of, remineralization to demineralization, or, and by the way, this is really important, if your mouth is already in a state that's more demineralization mode, so to speak, well then it will capitalize on that and it will cause cavities much faster.

Okay, so keep in mind that acidity is bad for the mouth.

Does that mean that you should never consume a lemon or And by the way, yes, I'm guilty of every once in a while I'll chew a lemon slice or drinking water with lemon in it or carbonated drinks. or sodas or tea or anything that has acidic flavor?

No. Likewise, should you completely avoid ingesting any kind of sugar, because strep mutans love sugar, No, it turns out strep mutans like sugars in the form of complex carbohydrate sugars too.

So if you eat pasta or rice or oatmeal, some bread every once in a while, as I do.

I'm an omnivore. I eat meat and fish and eggs and also starches and vegetables and fruits.

I'm an omnivore. as most people are, well then strep mutans has an opportunity to eat the sugars that come from those other carbohydrates.

Does that mean that if you were to have a zero carbohydrate diet, no sugars, no starches, et cetera, you would reduce the opportunity for strep mutans? to consume sugar and release acid?

Maybe, maybe. However, most people won't do that.

And strep mutans is a very common maybe even diabolical bacteria.

And if you are on a zero carbohydrate, zero sugar diet, there's some evidence that strep mutans will figure out ways to feed on other components. of food in order to create this acid to then create cavities in your teeth.

So the key thing to understand here is that cavities form not from foods, not from sugars per se, but from strep mutans and other bacteria that eat those sugars and create acid.

Hence the critical need to keep your mouth as alkaline as possible, which does not mean that you can never drink some lemon water or coffee or tea.

Here's the key point that everyone needs to remember, because this dovetails beautifully into how often you should brush and floss. and when you should brush and floss specifically.

The key point is the degree to which your mouth is in a de-min state or a re-min state and the degree to which cavities have the opportunity to form is dependent on the amount of time, the amount of time in which your mouth is net acidic or net alkaline, the amount of time that you are in a demineralization mode or remineralization mode.

Okay, so it's the amount of time. No one, no one can avoid having their mouth be acidic every once in a while or ingesting a sugar or a food that strep mutans can feed on and produce acid.

The key is to try and reduce the amount of strep mutans and reduce the amount of acid in the mouth.

That's the best way to reduce cavities and even reverse cavities that have started to form.

Now, in a moment, I'm going to tell you about fluoride, because I know there are a lot of questions about fluoride.

But in order for you to understand what I say about fluoride and to make the best decision about fluoride both and drinking water and toothpaste, et cetera, for you, you have to understand the remineralization process just a little bit.

Just a little bit. So a little bit of chemistry here, a little bit of structural biology, and this'll be fun.

I promise, even if you know no biology, no structural biology, no chemistry, You're going to like this part and it's very simple.

Those minerals that form the crystals within the enamel and some of the deeper layers of your tooth or teeth rather, those crystals form through a specific type of bond.

And those bonds are very strong. Think of them like Lego chains, but these are not just conventional Lego chains.

These are Lego chains that when they, when two pieces come together, things are tough to pull apart.

They're not indestructible, but they're tough to pull apart.

And they're also special because unlike a string of Legos, like a single string of Legos, These bonds that form during remineralization of the teeth interdigitated with one another or rather are at angles with one another that make those bonds especially strong.

Any architect or somebody that understands structural biology will understand that bonds can be weak or strong depending on whether or not they're linear, whether or not they're crossed, whether or not They're in lattices.

There's a whole bunch of interesting angled forces stuff that the architects will understand.

The construction workers will understand at a very intuitive and concrete level, no pun intended, and on and on.

But just think about it. A bond is only as strong as the number of different points at which it can resist shearing and pressure.

So, the way that these remineralization bonds form is through the addition of specific minerals at specific angles and the naturally occurring mineral that's responsible for the majority of these bonds in the enamel and teeth is called hydroxyapatite.

What a great name if you're talking about oral health, right?

Because we use the mouth for a lot of things.

You can think of a small list or long list of those things.

There are many of them, you know, depending who you are and what you like to do with your mouth.

But the point being that we do indeed eat with our mouth.

Appetite is part of eating. So you just remember hydroxyapatite bonds, and they are very strong, but they're not indestructible.

Acid can actually break those bonds. That's the demineralization process.

Now, fluoride is a substance that is not a vitamin. it's not a mineral, it is not an essential nutrient, but that in the last century, it was discovered can actually replace some of the hydroxyapatite bonds in teeth and actually make those bonds hyper strong, super physiologically strong.

Now we'll talk about the safety considerations with fluoride in a little bit, because there are some safety considerations.

But it was decided en masse in the United States and Europe that The addition of fluoride to the drinking water and to many toothpastes or tooth powders would be useful because it creates these super physiologically strong bonds within the minerals of the teeth.

And indeed it does, it does. Fluoride gets between those Lego pieces and makes them extra, extra strong.

And this is why fluoride is added to the drinking water.

But, and this is very important to emphasize, But nowadays there's a really polarized debate about fluoride. because some people out there believe that fluoride can disrupt thyroid health, might even be disruptive for brain health.

Certainly if fluoride levels are too high in drinking water or any substance, It can be very dangerous, it can be a poison, but of course the dose makes the poison, fluoride itself. may not be poisonous at very low levels, but they're really two camps now that have formed.

And I'll just illustrate those two camps by virtue of what's happening right now.

Right now, in the state of California, there is a major lawsuit against the government because people want fluoride removed from the drinking water because of the long list of bad things that excessive, I wanna highlight excessive fluoride can do for bodily and brain health, especially in kids, but also in adults.

At the very same time, meaning right now, there is also a major lawsuit, this one in Buffalo, New York, from mostly parents who are suing the city of Buffalo, saying that there was not enough, maybe even zero fluoride in the drinking water for some period of time, and as a consequence, their children's teeth or oral health or both is depleted and they are suing for damages.

Okay, so this is a really polarized camp.

Now I did a full episode of the Huberman Lab Podcast all about water, and I talked about fluoride levels, which levels are thought by the CDC to be safe, which levels are not thought to be safe.

I talked about some of the theories as to how Fluoride might disrupt function of the thyroid and some considerations there.

Please check out the timestamp in that episode.

I linked to that timestamp in the caption. for this episode, but the important point here is that if you are at all concerned about fluoride in the drinking water, the simple answer is to just filter the water that comes out of the tap.

If you're concerned about fluoride, then I suppose you'd probably want to avoid toothpastes that have fluoride.

Indeed, there are some. I will provide links to some of those in the show note captions for this episode.

There are a variety of these zero fluoride toothpastes that have started to accumulate.

Keep in mind that when fluoride is introduced into the bonds of the minerals of the teeth, they do make the teeth. really, really strong.

But, and all the dentists I spoke to emphasize this point, the bonds that form are not the natural bonds.

Now, the fact that they're not the natural bonds doesn't necessarily mean that they aren't good for us or that they're bad for us.

But the bonds that form when viewed under what's called electron microscopy look different.

They look wavy. They're not smooth bonds.

And they do increase the... So resistance to different forces, including cavities or acid that would create cavities to be specific.

They make the teeth stronger structurally, so resistance to chipping, et cetera.

But there is a growing concern about excessive fluoride, which by the way, if you drink a lot of tap water, you're going to be exposed to more than if you drink less tap water.

That just kind of stands to reason, but people don't really talk about this, right?

When you talk about X amount of fluoride by concentration in a given liter of water or gallon of water, You also have to ask, well, how much tap water are you drinking every day?

OK, you have to ask that question, right? simply the concentration, it's how much you're ingesting overall.

And that's something that's much harder to control for.

Again, in the water episode, I talk about ways to eliminate or reduce fluoride in the drinking water if that's a concern of yours.

But if you want to know why there's fluoride in drinking water, It's because governments figured out, hey, well, if we want to reduce tooth decay, what's the simplest low cost method to do that?

Well, it's to put fluoride in the drinking water.

And you now also now know why there's fluoride in a lot of toothpaste.

But given the concerns about thyroid health, potential concerns about brain health, now you also know why Many people, including some dentists that I spoke to, are not big fans of fluoride, for children and for adults.

So you just have to make a decision for you.

I'm not here to tell you what to do. You just have to decide. pro-neutral or against fluoride in your drinking water?

And if so, are you going to filter? Are you going to completely avoid drinking any water, maybe even cooking with any water from the tap and on and on.

But now you know why fluoride is in drinking water and fluoride is in toothpaste.

If you're somebody who's concerned about fluoride in either or both of those sources, well, then what you really want to think about and what most of us probably should be thinking about anyway is trying to increase the remineralization state of our teeth and mouth in ways that don't create the opportunity for any other health hazard.

And I will say this as well, which is that there's some Not a lot, but some data that fluoride might not be so great for our oral microbiome.

And as we'll soon learn, the oral microbiome is critical for our oral and overall health.

So in a moment, we are going to get into what to do, the to-dos, the behavioral to-dos and some of the other to-dos for trying to keep your mouth in the best possible remineralization state, the best pH for tooth health, for gum health, for avoiding periodontal disease, maybe even for reversing some aspects of tooth and periodontal because indeed you can do that if you shift your mouth to the correct pH, if you're putting it into that remineralization mode.

However, before we get into the to-dos, I think it's very important to discuss the do-nots that every dentist and periodontist I spoke to agreed on.

The quick list, as I'll call it, of bad for your teeth, bad for your mouth, and therefore bad for your brain and body are not surprisingly perhaps, alcohol, which by the way, I did an entire episode about alcohol.

It's one of our more popular episodes. I'm not here to tell you to never drink if you're an adult who's non-alcoholic, but the cutoff seems to be to alcohol based drinks per week, beyond which you run into trouble.

And yes, zero is better than any, but here when we say alcohol is not good for oral health and for tooth health, What we're talking about is the disruption that alcohol creates to the microbiome and the way that it alters the pH of your saliva and places the mouth and the teeth into a demineralization state.

That's very clear. It also kills certain cells of the mouth.

Some people, I remember this in college, would say, you've got a scratch in the back of your throat, you're getting sick, you should drink.

That's what they said. You should drink, it's gonna kill that thing off.

Well, guess what? It does the exact opposite. kills off a bunch of things that you want, like the cells in and around the mucosal layer of the mouth that are actually going to provide immune support and eliminate those bacteria or viruses that are making getting you sick, et cetera.

So alcohol is bad. I'm not saying you shouldn't drink at all if you're a non-alcoholic adult.

You have to decide for you, but just understand that if you're drinking alcohol, that you want to pay extra attention to your oral health and your tooth care practices, especially on the days around that alcohol consumption.

And if you're somebody who doesn't want to drink alcohol, now you have yet another reason to not drink alcohol.

The second thing on the no fly list or the not good for us list for sake of oral health, are stimulants now of course things like methamphetamine which are you know severely deleterious, addictive drugs for all sorts of reasons.

They kill dopaminergic and other brain neurons.

They are highly addictive. and on and on, but also stimulants like Adderall, Vyvanse, et cetera.

Those stimulants, basically any drug that increases epinephrine and norepinephrine, called adrenaline and noradrenaline, there are the other names for those, are going to have a negative effect on oral health.

Does that mean you should stop those medications if you've been prescribed them?

No, it means that you should do some other things to try and offset the negative consequence of stimulants.

Why would stimulants cause such disruption in oral health?

Well, there are really two reasons. There's a chemical reason and there's a mechanical reason.

The chemical reason is that stimulants change the pH of your saliva, making the mouth more acidic, which makes strep mutans and other bacteria more capable of creating cavities down into the teeth.

They take your mouth and your teeth from that remineralization state or as I've been referring to it, mode, to that demineralization, demon mode.

Demon mode, that's a way to remember it's bad, demon mode.

Demon mode, not good. Maybe in a video game, demon mode is good.

Demon mode, not good for the mouth. Demon mode, demineralization mode.

So there's a chemical reason why stimulants disrupt the oral health milieu and cause disruption in tooth health. degradation, demon of the enamel of the teeth and deeper layers of the teeth.

And this is. profoundly evident in meth addicts.

But the other reason, and this was a reason that was shared with me by a physician, an MD, from University of California, San Francisco, who interacts by virtue of his profession with a lot of methamphetamine addicts. who have terrible teeth is that stimulants encourage mouth breathing.

Watch a meth addict or watch somebody who's on a high dose of stimulants and they tend to mouth breathe because of the shifts in autonomic nervous system function, they tend to be mouth breathers.

So it's the drying of the mouth that also shifts the mouth from that remineralization mode to demineralization mode.

So if you do If you do take stimulants by prescription, I would hope not methamphetamine or illicit drugs, but if you take prescription stimulants, and by the way, things like Welbutrin, Modafinil, they do qualify as stimulants, even though modafinil is a little bit of a a special case.

Any drug that increases norepinephrine, epinephrine, any stimulant, and yes, indeed coffee, we'll talk about coffee as well and tea, will make the saliva more acidic and make your oral health potentially less good.

Mouth breathing, bad for oral health, bad for teeth, bad, bad, bad.

There's just no question about it. So today's discussion I'm calling oral health, but that includes oral airway health.

And I've talked before on this podcast about the fact that if you can be a nasal breather, be a nasal breather, please.

As long as you're not speaking As long as you're not eating, try and breathe through your nose.

If you're exercising and exercising really hard, like you're running really hard, fine, mouth breathe.

I don't think there's any evidence that staying in nasal breathing mode all the time while exercising is best for performance.

In fact, to the contrary, there are times when you need to mouth breathe and there are sports where You need to exhale through the mouth specifically, certain martial arts, for instance.

So I'm not saying don't ever breathe through your mouth, but As much as possible, try and keep the oral cavity moist and closed.

This is critical. So stimulants dry out the mouth, they increase the acidity of the saliva, that's bad.

Smoking, cigarettes, and yes, also cannabis.

And yes, vaping does this too. It's so funny.

Anytime I talk about smoking being bad, people are like, well, what about cannabis?

I did an episode about cannabis. Cannabis does have certain medical uses that are very interesting and there's good evidence for those.

For many people, cannabis is not a good idea.

You can check out that episode to decide for you.

Then people ask, what about vaping? Vaping is not as bad as smoking, right?

That's what they say. where they're sort of asking, saying, hoping, wishing, fantasizing.

And the truth is that vaping is terrible for your oral health as well.

Is it as bad as smoking? Probably not. but it's bad for a bunch of other reasons that offset any gain or gains you would get from vaping instead of smoking.

So just know that if you're a smoker or a vapor, or if you vape rather, that you're going to want to pay extra attention to some of the other protocols discussed and that we will discuss going forward in order to try and support your oral and therefore your whole body health.

Okay, so we've got alcohol, stimulants, smoking slash vaping, and by extension dipping tobacco, frankly, not good for oral health or tooth health.

In fact, they can be pro-cancerous to the gum tissue.

It's well-established and they can also cause degradation of the gum tissue and even some of the underlying bone if you tend to do it on the same side all the time or often at all.

So that's not good. We already discussed that sugar is not good for oral health.

Does that mean you can never ingest sugar?

No, of course not. the sweets you enjoy every once in a while, enjoy a nice pastry, you know, do as you will.

If you're somebody who never eats those things, great, but then understand that any carbohydrate Any starch provides a sugar that strep mutans can eat and create acid and demineralize your teeth, create cavities, that is.

So avoid sugar in excess. And if you eat sugar, try and rinse your mouth after, and ideally you would brush, maybe even floss after.

Okay, I do know those people that after every meal they're running, even the middle of the day, they run to the bathroom and brush their teeth and floss, and that's great, but most people don't do that.

So swishing water, rinsing your mouth out.

Again, plain water, maybe with a little bit of salt in it is going to be beneficial.

We'll talk about mouthwashes later, just to give you a little window into where we're headed with that.

Most mouthwashes. terrible, terrible for your oral health, especially alcohol-based or antiseptic-based mouthwashes, except under certain conditions, prescribed or otherwise.

Okay, so if you eat any sugar, and frankly after you eat, anything, it's a good idea to try and clear as much of that food product from your mouth.

You may not think you still have food in your mouth and teeth, but trying to swish some water maybe spit it out, maybe swallow it.

That's up to you. Are you a spit or swallow?

Not my business. Don't want to know. Don't tell me.

Don't put it in the comments. Just decide for you. but sugar and other food products residing in the mouth for long periods of time, not good.

And similarly, acidity. Foods that are acidic.

So certain things like citrus fruits, which I love.

I love oranges. I have an orange tree in my backyard now and I absolutely love it.

I love oranges, grapefruit. I love the peel.

I even eat the peel sometimes. It's so delicious.

And no one's telling you not to eat acidic foods. or to avoid acidic drinks like lemon water or carbonated lemon water.

Some people are really and they decide to just use a straw when they drink those things.

In fact, the dentist I spoke to said, yes, could you ask people please, if they're going to drink acidic drinks, to try and use a straw.

But then I said, well, you know, a lot of straws, they disrupt the environment.

Most people aren't carrying around metal straws or you know, and what about the turtles?

And they said, well, OK, here's the real truth.

The real truth is it's the amount of time that the mouth is exposed to that acid.

So if they're gonna drink it, drink it over the course of five, 10, 15, maybe 20, 30 minutes. and then be done with it.

Rinse out the mouth with a little bit of water and try and clear out that acidity. completely avoiding acid foods or sugary foods or acidic drinks.

It's about, again, limiting the amount of time that the overall milieu of the mouth is acidic because of this whole demin, remin thing, strep, mutans, and the acid, created by strep mutans that can derode the teeth and the fact that if your mouth is kept acidic for long periods of time, you're going to provide the opportunity for faster and deeper development of those cavities.

And keep this in mind, again, anytime we talk about demineralization, the formation of cavities, remember it's like a seesaw.

It's either demin or remin, but not both.

So anytime you're demineralizing your teeth, you're also not remineralizing your teeth.

Okay, so really avoid alcohol stimulants, smoking, vaping, sugar, mouth breathing, acidic foods, acidic drinks, but Many of us, most of us can't avoid any sugars, any acidic foods.

The other things can be avoided, but some of us are prescribed these drugs and need these drugs.

Some people like a drink with alcohol in every once in a while, and it's perfectly fine for them, or they deemed it perfectly fine for them.

In that case, try and rinse the mouth, try and keep the milieu of the mouth as moist and as basic or alkaline rather, less acidic as possible.

So to translate this a bit more to the real world, if you're somebody like me who loves tea, I drink cold brew zero sugar yerba mate.

That's my favorite source of caffeine. I also like a nice black double espresso or coffee every once in a while.

It's fine to drink that. but you don't want to sip on those sorts of things all day and you don't want to sip on them for hours and hours.

And if you're going to combine those things with some acidic foods or with any kind of food, try and get your meals done, wrap them up and rinse your mouth and move to the next part of your day.

And that actually segues into a really important point that came about when researching this episode. that if I had to highlight, boldface, underline and light up one particular protocol that I think most everybody is not thinking about is that there are certain times in the 24 hour circadian period in which your mouth makes the maximum amount of saliva,

Okay, and that the saliva has an opportunity to be the optimal pH that is chemistry, for encouraging remineralization of your teeth.

And that's during the daytime and especially through the middle of the day.

Now, there are a couple of things that can disrupt that.

For instance, eating, anything. I don't care if you're carnivore or vegan, whatever.

Omnivore, when you eat, you change the pH of your saliva and you're introducing those sugars that the bacteria can feed on.

So one thing that became very clear to me when researching this episode, talking to experts, reading manuscripts and also reading some really interesting books about remineralization opportunities for the teeth. is that having a stretch of time of maybe two, four, six hours or more where you're not eating or ingesting anything that's acidic in terms of liquids can be very beneficial.

Now this is a vote in support of so-called intermittent fasting.

This is something that I practice typically by eating my first meal somewhere around 11 a.m. every morning, sometimes earlier.

I'll sometimes have a little breakfast at nine if I'm particularly hungry.

But typically I eat my first meal around 11 a.m. or noon, and then I eat my last bite of food by about 8 p.m.

Not everyone likes to do intermittent fasting.

And I realized for sake of weight loss, it's probably interchangeable with caloric restriction generally.

And there's a lot of debate as to whether or not intermittent fasting is going to extend lifespan. whether or not it's better for metabolic health than simple caloric restriction.

I don't want to get into that debate. Frankly, it's a barbed wire debate that's been carried out on this podcast and elsewhere before.

And I think Is it ongoing? I think it's the best way to couch that debate.

In researching this episode, it became very clear that we have an amazing opportunity during the day, especially in the morning and throughout the day, to create a lot of saliva that's the right pH to support remineralization of the teeth, provided that there isn't a lot of food or acidic liquids in the mouth at that time.

So at least to my mind, this is an interesting opportunity to place intermittent fasting, which again, even just gaps between meals, not constantly snacking or sipping on acidic beverages throughout the day. as an opportunity to create that healthy milieu during which the teeth can remineralize and the overall oral health can improve.

Now, does that mean you should never eat or drink anything during the middle of the day?

No, I'm not saying that. I'm saying that if you're going to do those things, try and clear them from your mouth, as I described before.

Now, many of you will probably say, hey, during the middle of the night, I'm not eating or drinking anything.

For some of you, that might be the only time that you're not eating or drinking anything because you're asleep.

One would hope you're asleep. But here's the interesting thing.

Every cell, tissue and organ in our body is on a 24 hour circadian clock.

I think many of you have heard me say that in the context of viewing morning sunlight and other protocols that I suggest on the Huberman Lab podcast.

But here's the interesting and important point.

In the middle of the night, indeed, you're not ingesting any food or fluids, presumably, but your saliva production is dramatically reduced.

Again, dramatically reduced. And as a consequence, if there's food, or rather, opportunity for strep mutans and other bacteria to feed on and create acid to erode your teeth. the saliva necessary to offset that, to combat that, is simply not present, or at least not present at the same levels that it is during the day.

So this is a sort of two-pronged protocol.

On the one hand, I'm saying you might consider trying to introduce maybe an hour or two hour or longer stretches during the day in which you're not ingesting any food And if you're drinking anything, it's not acidic.

Or if you are, to try and rinse away that acid as much as possible.

So plain water would be great. Avoiding carbonated lemon water would be great.

But if you like those things, and indeed I love those things, I love carbonated lemon water, I love...

Things like yerba mate, indeed, the yerba mate I like is cold brew, zero sugar, but has some lemon and ginger in it. fairly acidic, but then drinking it down either pretty quickly, or if you're going to sip on it, then rinsing it away with some water and not doing that throughout the entire day.

And indeed, I tend to drink my caffeine early in the day and not so much throughout the day, maybe a little bit of mate in the afternoon sometimes.

Okay, so that's one aspect of maintaining or encouraging the correct pH of saliva to remineralize your teeth, right?

Create these windows of opportunity where there's a lot of saliva for long stretches of time during the day. as long as possible while still making it compatible with your nutrition needs and your hydration needs, of course.

The other prong or the other aspect of this protocol is that At night, when you go to sleep, you need to know you're not producing very much saliva.

And that's the critical time to make sure that there is as little opportunity as possible for strep mutans and other bacteria to feed on sugars or other food products and thereby to create acid that creates cavities.

And so this is a very important protocol that every single dental and oral health care professional I spoke to and indeed champions, which is if there is a most critical time of day or night to brush your teeth and floss and clean your teeth,

It's at nighttime. It's at nighttime. Why am I saying this with such whispered importance?

Well, I think there are many people out there, in particular people that fall into that second category that I mentioned at the beginning of today's episode. that wake up in the morning and brush their teeth, maybe even use mouthwash, maybe floss and do a bunch of things to try and get their mouth clean and fresh, especially if they're going to interact with other people during the day. and to get rid of all the kind of stickiness and morning breath, that kind of thing.

But that at night they're finishing dinner, maybe having some dessert, doing some work and passing out without brushing their teeth or flossing, simply getting too lazy to brush or floss.

And by the way, I'm going to raise my hand and just say for many years, I was in that category.

I know, ew, gross, but I was in that category.

I had high motivation to brush and floss, or at least a brush in the morning, very little motivation to do it in the evening.

Every professional said, if you're going to brush and floss just once, per 24 hours, and that is not what they recommend by the way, but if you were going to do it just once, the critical time, the most essential time to brush and floss and clean the mouth and get the milieu of the mouth correct for tooth care and mouth overall oral health. is at night before you go to sleep because you already know the mechanistic backbone for this argument. because at night you're producing far less saliva.

And if there's any food product there that the bacteria can feed on, The saliva isn't there to combat that because it's a constant battle between acidity and alkalinity.

Your saliva is coming in and trying to save everything, and the strep mutans is trying to destroy your teeth. and the acid is the weaponry they use and what fuels that weaponry, what provides them more ammo to destroy your teeth are sugars and acidity.

So, If you were going to brush or floss, and ideally you do both, only once per 24 hours, it would be at night before going to sleep.

Indeed so much so that I would say that nighttime brushing and flossing is perhaps one of the most important things that we can do for overall oral health care.

We'll talk about what to do, what to use for brushing and flossing in a few minutes, but that's absolutely essential.

I do not want that to be translated into you only need to brush or brush and floss once per 24 hours.

Every professional I spoke to and all of the data pointed to the fact that doing it twice per 24 hours is, or perhaps even three times per 24 hours.

But let's be honest, most people are not going to brush and floss three times. every 24 hours.

Some will, but most won't. And now, of course, I've been saying brushing and flossing, but I haven't talked about the incredibly extensive landscape of how to brush and floss.

So now, let's take ourselves back to being little kids, right?

When we were taught to brush our teeth in a particular way, you know, you're supposed to spend a certain number of minutes, set a timer, You're supposed to floss in a certain way.

Every time we go to the dentist, they tell us to floss in a certain way, do this, not this.

What do the data really say? What are the modern health professionals in dental and oral health really suggesting we do when it comes to brushing and flossing.

And fortunately here, There's a near uniform consensus.

There's always that outlier, that person that says to do things a little bit differently or no.

There's in fact one person very prominent in the dental health space that is not a fan of flossing, but they are really the outlier.

The vast majority of dentists out there all say the same thing.

You need to brush, you need to floss, you need to do it twice a day or more. and you need to do it correctly.

So now let's talk about what correct brushing and flossing really is.

Okay, so I'm not going to demonstrate how to brush your teeth, but one very actionable protocol that was told to me by all the dental professionals I spoke to was use a soft toothbrush.

Now, this one hurts or I suppose hurts less.

Anyway, it hurts my heart a little bit because I enjoy very much using a medium or hard toothbrush and really like scrubbing back there, especially in the teeth in the back.

It just feels good. I feel like I'm doing something good.

I get into the the backs of the teeth, the front of the teeth.

I actually enjoy brushing my teeth, especially lately.

Don't ask me why. but I do, but every single one of them said that that very vigorous brushing with medium or hard as they're called bristles, really disrupts the interface between the teeth and the gums in ways that's not healthy for the gums and actually makes tenting of the gums in those pockets, those recesses as they're called, far more likely to form.

And every single one of them said, if you are regular with your brushing, and especially if you're brushing and flossing regularly, that a soft toothbrush that is one that's moved in a circular motion on the fronts and backs of your teeth for all your teeth and that is gentle, you're not providing a lot of pressure, is going to be the best way to break up that biofilm layer each and every time, and promote the best tooth and overall oral health.

So I suppose, manufacturers who are making medium and hard toothbrushes, maybe give us some rationale for that. because the dental professionals that I spoke to, and again, I spoke to a fair number of them, all said the same thing, soft toothbrush, not just better, soft toothbrush best.

Likewise, if you use an electric toothbrush, which I now do, sometimes I switch back and forth, but if you use an electric toothbrush it was recommended that you not provide too much pressure, that you really try and keep the tips of the bristles on the teeth and gums.

And yes, it was also suggested that people brush their gums.

This is interesting. For people out there who have tooth sensitivity, one of the major suggestions from people in the dental and periodontal field, at least the ones I spoke to, was to actually brush your gums lightly to increase circulation of blood and other nutrients to the deeper portions of the tooth that actually extend into the bone.

Now there is a tremendous amount of blood flow to the gums.

Anyone who's, you know, They sort of nicked their gum while flossing or with a toothpick.

I can tell you, bleeds very readily. And that's not a good thing, right?

You don't want to create bleeding of the gums.

We'll talk about bleeding of the gums during flossing in a moment, by the way, so don't jump the gun just yet.

I said jump the gun, not jump the gum, by the way.

If you are brushing your gums, make sure you're using a soft toothbrush. if you're using electric toothbrush, make sure you're going very lightly on the gums.

And because there's so much blood flow to the gums, it does encourage a lot of circulation to, some of the deeper cavities of the tooth, as it turns out.

I don't want to revert to tooth anatomy in any kind of detailed way now, but of course, within You have, again, enamel, you have the dentin, you've got what's called the pulp or the center.

There's a lot of nerves innervating the center. of the tooth.

There's a bunch of other tissues and the bone around it and layers, et cetera.

And when you massage or lightly brush the gums around there, you're encouraging a lot of blood flow to those deeper components of the tooth, which are really the live and active components of the tooth that require blood flow and nutrients.

So this is a good thing. In fact, it's probably such a good thing that most people, perhaps all of us should do it, but most people probably won't take the time to also brush their gums.

But if you have a little bit of time, it can be beneficial, especially if you have sensitive teeth.

The idea that's emerging now in the dental field is that it can help promote resilience or less sensitivity of the teeth to things like hot and cold and maybe even to pressure.

So before we talk about flossing, I just want to reemphasize that the reason to brush your teeth and the reason to brush your teeth lightly or without too much pressure that is, is that If you're regular with your toothbrushing and flossing, the main goal of brushing is to break up the biofilm layer that provides a substrate for strep mutans and other bacteria to layer on thicker layers of bacteria, so-called plaque, that will eventually turn to tartar.

If we really want to gross ourselves out and really motivate brushing and flossing, maybe we should describe that what happens with strep mutans is it forms these strand-like bacteria.

So these are like little cilia. attached to the tooth is the biofilm layer, so like little strands of strings.

But if enough of it accumulates and it gets thicker and kind of mossy, and it's kind of like thicker, it looks kind of spongiform and that's the plaque.

And then if enough of it forms and there's enough acidity in the mouth, Then it forms tartar, which is the hard caked on stuff that requires scraping off by the dentist.

You know, and some people get a lot of tartar, some people have less tartar buildup depending on how diligent they are at removing the biofilm. with brushing.

Now, you can remove biofilm and plaque with brushing, but once it starts to form tartar, that is once it's layered on, sometimes it has a yellowish tint to it, then you really start to run into trouble because brushing and flossing will not remove that tartar.

And that's why the dentist needs to get in there and scrape it away.

So it's ideal to be diligent about removing the bacteria while it's still in that strand or plaque form, ideally when it's still in that strand form, removing that biofilm.

If you've ever been to the dentist, you may recall they'll do this tooth polishing.

You know, they'll do that thing with the kind of gritty stuff on your teeth.

And you wonder, is this to make my teeth whiter?

And indeed, it can create a bit more shine or sheen to your teeth.

But the main reason for doing that, it turns out, is to make the surfaces of your teeth smooth.

After all, they do it on the backs of your teeth too.

If they're good dentists, they do it on the backs of your teeth as well.

Why would they do it there? It can't be for cosmetic purposes.

Well, they do that because the smooth surface makes it harder for those strands, that biofilm to stick and form and certainly for the more dense, plaque and tartar layers to build up on top of it.

So they're making your teeth smooth so that the bacteria can't adhere to it as readily.

But it's the daily protocols of tooth and oral health that are really critical.

We'll talk about dental visits and frequency of dental visits and what a dental visit is really about.

Is it always about cleaning or filling, et cetera?

But in the meantime, brushing and brushing often enough such that you don't get any buildup of biofilm for very long periods of time, Eliminating or reducing the amount of plaque and tartar that builds up is going to be your best strategy for improving tooth health.

Now, what about flossing? There's a little bit of debate about flossing in the dentistry field.

Some people say, If your gums bleed when you floss, you need to floss more.

In fact, most dentists I spoke to said that. but they also emphasize that you need to floss correctly.

You can't just pull the floss down onto the gum in between the tooth.

You need to glide down the side of the tooth, get a little bit underneath the gum and use a circular motion and then lift up. from between the two teeth, which frankly is a lot easier if your teeth aren't very, very close together, right?

Some of us have teeth that are very close together And when you try and bring it up through the teeth, it's more of an effort, okay?

But they really all emphasize trying to not drop this rather sharp, And, you know, here we could also be talking about the toothpick-based floss where there's a little arc with a, with a little bit of floss across from it, the ones that you can buy.

Some people actually use toothpicks. their old fashioned method.

Frankly, most dentists I spoke to don't want people jabbing their mouth and gums with toothpicks.

I don't know, you can decide for yourself, but almost all of them except for one felt that flossing is a great idea for tooth health and that if your gums bleed, when you floss correctly, as I just described what correct flossing is, that your best strategy is to floss at least twice a day between all of your teeth.

And if you're not going to floss twice a day for whatever reason, in protest or for lack of time, at least once a day.

And when would that once a day be? It would be at night before going to sleep for the reasons we talked about earlier.

And several dentists I spoke to said that using a water pick is going to be better than using more typical floss or using those toothpick-based floss approaches because it's gentler on the teeth.

I personally have not used a Waterpik, but I'm sort of intrigued by the concept because it sounds like it's much harder to damage the gums and teeth by doing it, and that it is at least as efficient as standard flossing.

For those of you that have the disposable income and the interest in using a water pick, sounds like it could be a really good idea for the vast majority of us, like me, just getting some traditional and using dental floss at least once a day at night and ideally also in the morning after brushing.

That seems like the most direct and low cost strategy.

I should just mention that the pediatric dentist that I spoke to mentioned that flossing is really about removing food product from between the teeth. and therefore children younger than six who typically have big spaces between their baby teeth and their adult teeth have not yet come in.

In fact, that's what those spaces are about, by the way, unless you're me.

And when you were a kid, your teeth were too close together and all your adult teeth came in behind those teeth.

It's a miserable experience for me. Most kids, their baby teeth are spaced out a bit in order to allow the adult teeth to come in, to erupt, as it's called, such a dramatic word.

I love reading this literature, you know, when the molars erupt, it's like, whoa.

No, it's just come up through the gums. Those spaces are really there for the adult teeth to come up through the gums.

And so it was suggested that children who have those spaces between their teeth and the spaces are big, don't need to floss between those teeth because it could cause some damage to the gums.

Rather, they should just focus on their brushing.

Now let's talk about some protocols that involve changing the chemistry of your mouth, not just immediately after meals or during brushing or flossing, but really around the clock.

And one of the key protocols that I'd like to discuss is the use of an artificial sugar called xylitol.

Xylitol is a very low calorie sweetener.

I can place it among the other low calorie sweeteners like aspartame, sucralose, stevia, et cetera.

But what's unique about xylitol is that very much like standard sugar or any kind of carbohydrate sugar, The bacteria Streptococcus mutans loves to eat xylitol, but when Streptococcus mutans eats xylitol,

It doesn't, meaning it cannot produce the acid that normally would demineralize the teeth and create cavities.

In addition to that, when streptococcus mutans eats xylitol, it kills streptococcus mutans.

So what this means is that if xylitol is present in the oral cavity, say in the minutes and hours after a meal, then any strep mutans that happens to be there is going to preferentially feed on the xylitol, not other sugars, and it won't be able to release acid.

And because xylitol can actually inhibit the growth, and that is the proliferation of more strep mutans, We've got a twofer, we've got a situation where strep mutans can't release acid to demineralize the teeth and potentially cause cavities. and the total amount of strep mutans that can grow, that can proliferate in what are called colonies. literally the bacteria colonizes on the teeth and forming that biofilm, well, then that can't happen.

So, xylitol is a very potent tool for improving oral health in this way, in addition xylitol reduces inflammation of the gum tissue and other soft tissues of the mouth.

And so Xylitol is providing an array of positive benefits especially when it's present to the mouth immediately after meals.

And for that reason, there are a number of different dentists that have created Xylitol products in the form of gums or in the form of mints, specifically to be used after meals.

So by chewing a few of these xylitol mints, or by chewing a xylitol-based gum immediately after a meal, you're taking substantial steps towards improving the chemical milieu of your mouth and inhibiting the proliferation of cavity forming streptococcus mutans. also find some literature on other proposed benefits of xylitol such as you know improving overall microbiome uh such as reducing inflammation in other tissues besides the gums and within the mouth.

There is some evidence that it can support the gut microbiome because of course the oral microbiome and the gut microbiome are contiguous.

They have different compartments. I mean, you might even be surprised to learn that within your mouth, there are different niches as they're called.

For instance, there's different microbiota that live on the gums versus the hard palate versus the soft palate. back in the throat, and then as you descend into the gut, et cetera.

And it does appear that xylitol has certain positive benefits for all of those different gut microbiome niches.

But the literature on that is less well substantiated than, for instance, the literature showing that if xylitol is put in as a surrogate sugar substrate for strep mutans, that it disables strep mutans and can prevent the formation of cavities.

Now, as far as I know, when consumed in mint form or gum form, I'm not aware of any specific side effects or bad effects of xylitol provided that it's not consumed in excess.

But as with everything, dosage matters. So if you're somebody who wants to explore the use of xylitol gum, or xylitol mints after a meal.

I wouldn't suggest going from consuming zero xylitol mints to consuming 50 a day or something like that. or even 10 a day.

You might start off slowly and just consume one or two after a meal, maybe just your morning meal, maybe just your evening meal. something of that sort rather than chewing xylitol gum all day long, et cetera, et cetera.

I'll just mention one other positive benefit of xylitol gum, which is if you use xylitol gum after say your noon meal or your early day meal, it further increases the production of saliva, which as we talked about before is a great thing because one of the best ways to support oral health and tooth health is to have a long stretch of time in the middle of the day where you're producing a lot of healthy saliva in large amounts, because again, saliva is this incredible stuff that's supporting remineralization of the teeth.

So lots and lots of reasons to think about, maybe consider using xylitol gum or xylitol mints.

There are a number of different ones available out there. zero, again, zero financial relationship to any of those mint or gum companies.

I'll provide a link in the show note captions to One source, the company and the products were developed by a dentist, Dr. Ellie Phillips, who is quite prominent in the public health education space around dental health.

Some of her views. are a little bit controversial like her views on flossing other of her views i find frankly quite ahead of their time in that she's been talking about a number of these things like promoting the health of the oral microbiome and the potential value of xylitol gums and mints, et cetera, for some period of time.

Most of the information that she puts out there is supported by other dentists and she still suggests regular dental visits.

So, you know, nothing renegade out there or heretical.

Again, there are other sources of xylitol gums and mints that you could consider.

I'm simply putting a link to the one that I use because I happen to use them and like them.

So I'd like to use the discussion about xylitol as a segue into a discussion about toothpaste, because There is a lot of controversy out there about which toothpaste are better for us, maybe even bad for us and best for us.

I think it's fair to say based on what we all now know about xylitol, that if you can find a toothpaste that contains xylitol as a sweetener, that can only be a good thing.

And indeed, there are a number of them out there.

We'll talk about specific sources in a little bit, but let's just put Xylitol on the short to not so short list of things that would be great to have in a toothpaste for all the reasons that you now understand.

The real big question with toothpaste is always, should I use a toothpaste that has fluoride or avoid toothpaste that have fluoride?

And in order to answer that, we have to go back to our earlier discussion about fluoride.

It really depends on whether or not you're somebody that thinks that fluoride is great because it creates these super physiologically strong bonds within our teeth.

The crystal structures are that much stronger than when formed by hydroxyapatite. or whether or not you're somebody who is wary of fluoride, that you're concerned about potential brain health issues or thyroid issues.

And here I think people really do fall into either camp or the camp frankly of, I don't know, should I be worried?

I don't know if I should be worried. I personally grew up using fluoride toothpaste.

We had the kind of standard name brand fluoride toothpaste. in our bathroom.

I brushed my teeth with those for years.

Whether or not that negatively impacted my health or not, I don't know.

Get my blood work done. My thyroid hormones are normal.

My brain works at least reasonably well.

But I do realize that some people are very concerned about fluoride and they just don't want it anywhere near their kids.

They don't want it anywhere near themselves.

So if you're somebody who's going to err on the side of caution with fluoride and you are seeking a non-fluoride containing toothpaste, there are such toothpaste out there.

And most of those, if not all of them, contain, you guessed it, hydroxyapatite.

They contain the minerals that naturally form the bonds that create that additional enamel that can potentially fill in cavities by remineralization of the enamel. and some of the deeper layers of the tooth.

So if one is seeking toothpaste and you want to avoid fluoride, you'd want to find something that ideally had hydroxyapatite and something that had xylitol.

And they often also contain some sort of mild abrasive.

Okay, not a really scratchy abrasive substance, but a mild abrasive that can really allow for breaking up of the biofilm that we talked about earlier.

Now I've provided links to a couple of sources for such toothpaste and also for these little toothpaste tablets that I've been using lately as well.

I sometimes switch back and forth between the two.

These are tablets that you chew up and then you brush your teeth immediately after with your wet toothbrush.

Both of them work quite well. Again, I want to be clear that the companies that I've provided links to in the show note captions are companies for which I have absolutely zero financial relationship.

I do know some of the people that started these companies.

I actually discovered these companies because these people are dentists or periodontists. or other people in the oral health field.

But I also want to be very clear that there was no exchange of promotion of their products for information or otherwise.

I simply tried and liked the products. And I just so happened to have learned some things about oral health care from these people, separate and away from anything about toothpaste or xylotols, et cetera, okay?

So I want to be very clear. that I do believe these are quality sources.

These are the toothpaste and tooth tablets that I happen to use, gums and mints that I happen to use. large part as a consequence of researching this episode.

But I pay full price for them. I'm certainly not suggesting that anyone else has to use them.

They just represent one option if you're looking for non-fluoride containing toothpaste and some other things to promote oral health.

And I'm sure there are other sources out there and If you'd like to refer the various viewers and listeners of this podcast to those sources, because you feel very strongly about those other sources, just put those in the comment section on YouTube.

Okay, let's talk about mouthwash or mouthwashes, plural.

At the beginning of today's episode, I said, Let's determine what category of oral health you are in.

Are you somebody who pays a lot of attention to oral health.

You brush and floss at least twice a day.

You're using mouthwashes, tooth whiteners perhaps as well.

Or are you in category two or three? Well, Here's the deal.

Most all, most all, not all, but most all mouthwashes, especially those containing alcohol are terrible for oral health.

Simply put, they deplete, certain components of the mucosal lining of the mouth and they disrupt the healthy components of the oral microbiome.

So for those of you that rely on such mouthwashes, I would really encourage you to learn more about them.

You're about to do that now. You're already doing that now. and to really consider whether or not they are helping or harming your oral health.

Now, I'm not suggesting that you create a scenario where your breath is causing other people to dissolve into a puddle of tears or back away from you quickly.

That's not what you want, that's not what I want, that's not what anyone wants.

But I think it's important to realize that these alcohol-based mouthwashes are not good for us.

In addition, there are antiseptic mouthwashes, some of which contain alcohol, some of which don't. sometimes are prescribed for very serious bacterial overgrowth and infections of the oral cavity.

If your dentist or physician or periodontist prescribes those, I certainly am not going to try and get in the way of that prescription.

That's between you and your healthcare professional, but you would be wise to ask them whether or not these chlorhexidine type mouthwashes, et cetera, are potentially bad for other components of oral health. or microbiota in the gut generally, because in some cases they have been shown to be not good for us.

At the same time, we don't want overproliferation of really bad bacteria in the mouth, so we don't want infections to run wild either.

Most people, however, are using mouthwashes to freshen their breath and to kill off additional bacteria in the mouth that they might believe they couldn't get with brushing or flossing.

If you are somebody who really wants to use a mouthwash for that reason, I encourage you to try and find a mouthwash that is not alcohol-based and that is not a strong antiseptic, or that if it is an antiseptic, that it's not alcohol-based, okay?

And such mouthwash, exist out there. They're a little bit hard to find.

I'll provide a link to at least a couple of them in the show note captions.

Here, I have to say, I have not tried those mouthwashes yet.

They do come from sources in which they were developed by licensed dental health care professionals.

But this is always the case when somebody selling something, it's worthwhile to do diligence.

Now, as we talk about toothpaste and mints and gums and mouthwashes, I think it's worth taking a step back and also asking the question, are there any zero or very, very low cost or even cost-saving alternatives to any of this?

And the great answer is yes. There are actually a number of things that you can do with basic over the counter stuff from the grocery store that all the dentists I spoke to said, yeah, that's a pretty good option.

It's not the best option available perhaps, but it's a pretty good option.

And in many cases, it's better than the typical commercially available toothpaste or mouthwash.

For instance, I would imagine, based on everything I now know about the structure of teeth, that using something like baking soda to brush the teeth would indeed scrape off the biofilm perhaps even whiten the teeth a little bit.

Although as we talked about earlier, you're not really whitening the teeth.

You're actually just changing the reflectiveness and some of the, composition of that enamel, which is translucent so that you can see the underlying components better.

Well, I talked to several dentists and they told me that baking soda actually is fairly low on the abrasiveness rating scale.

They have a specific rating scale for this that we don't have to go into, but it's actually considered quite safe for the enamel of the teeth, especially if you're brushing with a soft toothbrush and you're not like really grinding the stuff against your teeth at maximum intensity or even near maximum intensity.

So it turns out that baking soda in water is actually a pretty good if you're not going to go buy a toothpaste.

So that's good news. Now you may have heard that you can make a sort of mouthwash or mouth rinse with baking soda, water and a little bit of hydrogen peroxide.

I want to emphasize a little bit, but I'm also going to emphasize, I don't think this is a good idea at all.

Why is it not a good idea at all? Well, first of all, when we were kids, we used to take baking soda and hydrogen peroxide and put them together to simulate volcanoes.

So That tells you right there the kind of chemical reaction that you're going to get.

But in addition to that, it's pretty clear that hydrogen peroxide unless there's a specific medical recommendation to do so, is not something you want to introduce to the oral cavity.

Now, this is something that I'm very familiar with because when I was a postdoc, so this is in the 2005 to 2010 stretch, I started to get some pretty bad canker sores.

I don't know about you, but canker sores feel awful to me.

I hate them. When you eat, they hurt. When you swallow, they hurt.

When you do anything, they pretty much hurt.

And someone gave me the recommendation to use a little bit of baking soda dissolved in some water and a little bit of hydrogen peroxide and to use that as a oral rinse and of course then to spit it out.

And I did that. And actually what happened to me is I got, almost quarter size ulcers on the roof of my mouth and on the sides of my mouth.

It took those little canker sores, which were annoying and kind of painful and turn them into full blown ulcers.

I know this because when I stopped using it, those healed up almost immediately.

And then when I spoke to some dentists and periodontists, they said, oh yeah, yeah.

Hydrogen peroxide is just far too abrasive for the mouth cavity.

And the reason I raise this is because I don't think I'm alone in that if you kind of venture into some of the, let's call it alternative recommendation space for oral health, You may hear that things like hydrogen peroxide can be useful for gargling with or swishing with if you are starting to get a little bit of a throat tickle, maybe an infection.

It turns out it's a really bad idea. Now, if there are physicians or oral health experts out there, that strongly believe in the use of hydrogen peroxide rinses or gargling with it to promote oral health for any reason, let me know in the show note captions.

I don't want to go against any of those recommendations, This now considered kind of old school recommendation of creating one's own mouthwash with a little bit of baking soda, some hydrogen peroxide and water. does not seem like a good idea, not just based on my experience, but every one of the dental professionals that I spoke to.

That said, it does seem that creating a high salt solution Okay, so taking some salt, putting it into water, dissolving it, and then finding the point at which it won't quite dissolve because the concentration of sodium is just high enough and using that as a of course, not something to swallow, but rather as a dental rinse.

So putting your mouth and swishing it around and then spitting it out, and it's going to taste very salty.

And then taking a swig of water, you know, just plain water and then swishing it around and then spitting it out.

That actually provides a really nice milieu for the production of healthy mouth bacteria.

It's near zero cost. I suppose you need a little bit of salt, a little water and a glass to put it in, but it's basically zero cost.

And if you think about it, that high saline or high salinity solution is a lot like the sort of brines and the liquid that comes from these low sugar, probiotic foods that earlier I was suggesting and in other episodes I've suggested could be really healthy for swallowing for the gut microbiota.

But again, I want to be very clear, do not Do not swallow high salt. concentration fluid.

We're talking about a swish and then a spitting it out as a way to improve the overall milieu of the mouth to get their pH right, to promote the proliferation of healthy microbiota components.

Okay, so we've talked about some commercially available gums and mints containing xylitol.

We've talked about some commercially available toothpaste.

Indeed, some toothpaste that almost fall into the very boutique category because they have all these things that are known by dentists and periodontists to be great for oral health, but those can run some cost, right?

And so I do think it's important that we also talked about the use of just baking soda with a soft toothbrush and some water and gently brushing the teeth. as a great way to disrupt the biofilm and clean your teeth and a high salt solution as a swish and spit followed by, you know, swish and spit with clear water, clean water, no salt in it as a essentially very low cost or zero cost mouthwash, far and away different from the heavily scented alcohol-based antiseptic mouthwashes that are commercially available and that we know are basically not good for our oral microbiome.

In addition, I'd like to point out that those alcohol-based mouthwashes that many people in the world use, are also known to reduce the amount of nitric oxide that's produced in the oral cavity.

And that's very important for the production of nitric oxide elsewhere in the body.

Why is that important? Well, nitric oxide promotes vasodilation, not just within the blood vessels that line and feed the oral cavity, but also the throat. also in the nose, also in the brain, also in the heart.

So what we're talking about here is a substance that is indeed increased when we for instance, nasal breathe, we know that dramatically increases nitric oxide.

We're talking about a substance that when the oral microbiome is preserved in its healthy state, tends to increase in production.

And we're talking about a substance that's really good for small capillary vein and arterial health. because it allows for the passage of blood, both for the delivery of oxygen and other nutrients to tissues, but also the removal of waste products from tissues.

So we don't want to do anything that reduces nitric oxide unless there's some specific medical condition that leads us to want to do that.

So, for most people, increasing nitric oxide or keeping nitric oxide levels stable is the state that we want to seek.

And these alcohol-based mouthwashes are known to deplete the production of nitric oxide.

So there's yet another reason to avoid the use of these alcohol-based more typical over-the-counter mouthwashes.

By the way, this is not a scare tactic against mouthwashes.

I'm sure that if you use mouthwashes, you're still producing some nitric oxide.

But I think nowadays many, hopefully all of you are interested in doing whatever you can to improve your mental health, physical health and performance.

And if there are things that you are doing that are inhibiting those in any way that you potentially want to at least think about those, maybe remove them from your protocols, especially if there's a cost to them that you can remove.

In other words, you can save on costs. So again, lots of reasons to move away from the alcohol-based standard antiseptic mouthwashes. aside from the improvement in your breath, that by the way, can be better achieved by supporting the oral microbiome other ways that we've discussed, there's really no clear advantage as to why one would use one.

And there apparently are a number of Now, earlier we talked briefly about canker sores.

They are really uncomfortable. There are a lot of theories as to why canker sores form.

And there are a lot of products and theories as to how to get rid of canker sores.

Well, indeed, there are some ways that we can prevent the formation of canker sores and accelerate their healing, and that actually has to do with promoting the health of the gut microbiome.

So there's a clear link between gut microbiome and oral microbiome in a way that can either promote or reduce the formation of canker sores and can actually help heal canker sores.

To my knowledge, the best way to support a quote unquote healthy gut microbiome is to consume at least one to four servings of low sugar fermented foods per day.

I mentioned what some of those are. a little bit earlier.

I also did an entire episode about gut microbiome.

We've hosted expert guests on the microbiome, including Justin Sonnenberg from Stanford School of Medicine.

And for sake of time, I can just briefly list off the things that are known to promote a healthy gut microbiome and that would indirectly support the healing and prevention of canker sores.

And those are consuming one to four, servings of low sugar fermented foods per day, for instance, consuming enough prebiotic fiber.

So consuming enough fiber in the diet through fruits and vegetables or perhaps supplementing prebiotic or probiotic fiber.

And in some cases, if somebody is really dysbiotic or if you've been taking antibiotics, actually taking a pill form or capsule form probiotic.

But it's not something that I recommend people take consistently, and I certainly don't.

I think by ingesting those low sugar fermented foods on a regular basis, by trying to make sure that you're getting enough sleep each night.

This is key. Probably should have mentioned this earlier in the episode.

But one of the folks who I have great respect for in the public health discussion around dental health is Dr. Mark Burheen.

He goes by askthedentist on Instagram. He's actually a retired dentist, but he's been deeply involved in the kind of evaluation of the consumer product space as it relates to dental and oral health care for a number of years.

And Mark Burheen, in addition to discussing all the various topics that we've talked about today, such as xylitol and fluoride yes or fluoride no, et cetera, et cetera, has also been a big proponent of people paying attention to that first pillar of mental health, physical health and performance, which is sleep and pointing out that when people get fewer than, their necessary allotment of sleep each night.

So typically most people need six to eight hours, some people need more, some people need a little less. getting at least six to eight hours of quality sleep per night, which supports the health of the gut microbiome and oral microbiome, and thereby indirectly supports the health of the entire brain and body.

Dr. Burheen and others have talked about this, but I really appreciate that he's championed the importance of sleep among other things, but certainly sleep as a way to support the oral microbiome.

So we talked quite a bit about teeth and gums, a little bit about mucosal lining and throat.

One thing that we haven't talked very much about is the hung, the tongue.

Your tongue is obviously a very important component of your mouth.

And as I mentioned earlier, Different niches, different locations within the mouth have different microbiota living on them, both good and quote unquote bad. meaning ones that we'd like to promote the proliferation of because they reduce bad breath and promote oral health and all that good stuff.

And quote unquote, bad bacteria because they make our breath smell bad and because they deteriorate the various tissues of the mouth.

I looked pretty extensively into this issue of tongue scraping, and it's an interesting one.

And every licensed dental healthcare professional I spoke to in preparing for this episode agreed that yes, it can be a good idea to scrape the tongue.

And each one of them cited the fact that a number of unhealthy bacteria can build up on the tongue across the course of the day and throughout the night, much in the same way that biofilm can build up on teeth, although through a different process, different bacteria, and that scraping the tongue or brushing the tongue can be advantageous for removing that bacteria.

What was interesting is that several of them pointed out that lightly brushing the tongue may in fact be better than scraping the tongue, because they argue that, especially when people use those steel tongue scrapers, that Few people know how to use them with sufficient force to remove the bacteria, but not so much force that they don't damage the tongue tissue.

And the tongue is a very fragile, soft tissue.

So the recommendation that they relayed to me was to suggest once or twice a day brushing of the tongue.

But here's an important point. They all suggested that you use a separate toothbrush to brush your tongue than you would to brush your teeth, okay?

So if things weren't complicated enough already, talking about using a separate toothbrush, Why?

Well, they gave two reasons. One is they want to prevent crossover of the bacteria between those two different tissues. especially if one is brushing the tongue too vigorously.

You don't want to introduce bacteria from your tooth brushing. onto your tongue.

Of course, you can rinse it in between, but the ideal situation is to use a separate toothbrush for the purpose of brushing the tongue.

Now that opened up a whole exploration and discussion about toothbrush care.

We can probably do a whole episode all about toothbrush care, but we won't.

Suffice to say that when you brush bacteria off your teeth, or tongue and presumably the toothbrush gets moist if by no other means means, certainly by means of your saliva being on it.

Then you rinse it off. And then even if you were to dry it off with a clean some sort of clean towel or something like that, and you set it out, a lot of bacteria are going to proliferate on that toothbrush.

So this opened up a whole discussion about, should you cover your toothbrush or let it dry out in the air?

Should you use UV irradiation to sterilize your toothbrush?

And frankly, took us, me, down the rabbit hole of toothbrush care so far that at one point I just screamed like, uncle, like enough.

I think one has to decide how much bacteria they are willing to tolerate living on their toothbrush in between toothbrushes.

Anywhere from zero where you use a new toothbrush or toothbrush head every single time you brush, that seems unreasonable or at least economically unreasonable for most people. versus replacing it once a week versus once every two weeks.

Really, there's no specific recommendation I can make.

All I can say is be aware that bacteria are growing on the toothbrush head.

Try and avoid contact between the toothbrush head and any unsanitary surfaces, try and rinse and dry off the toothbrush head.

All these things are recommendations that were relayed to me and that just make good common sense.

Now, prior to this episode, I put the call out on social media for questions about And one of the questions that came back from many hundreds of people was, what about fillings?

What about metal fillings? What about sealants?

Are they safe? Well, most dentists will tell you that sealants are safe.

They are now made from compounds that are generally not thought to cause any major issues.

To be honest, I did not do a deep dive into the chemical composition of different sealants because it turns out that different dental practices use different sealants.

I'm sure that if I looked hard enough, I could find some really bad stuff in sealants.

I'm sure I could also find some reassurance that at the concentrations and conditions that they're introduced to teeth, that they are a better alternative to having deep cavities into the teeth And that actually gives me an opportunity to raise something that I perhaps said earlier, but I want to reemphasize, which is,

I've been talking about how you can remineralize the teeth and how that's critical if you want to maintain and build up your tooth and oral health.

But it's very clear that if the cavities get down into the dentine layers of the tooth, that in most cases, there is no remaining opportunity to remineralize the teeth using the sorts of practices we're talking about today. and that indeed it's very likely that those cavities need to be drilled and filled.

Now that's not always the case. And this is one reason why I highly recommend that if you've listened to this episode, and if you're here at this point in the episode, then you've listened to the episode. that you talk to your dentist, ask them if they say you have a cavity, how deep are these cavities?

Do you think there's an opportunity for me to remineralize the teeth if I do the following things?

And if they tell you, Look, you have a cavity or cavities and they're simply too deep into the tooth. that you can't remineralize your teeth and fill those in, well then, you know, you should trust them. dental professional.

If you don't, then you should find a different dentist.

However, they may be surprised and who knows, pleasantly surprised for you to say, hey, you know, I heard that you can actually remineralize teeth and if I've got a cavity, but it's still not through the enamel layer, you know, if I'm really diligent and, you know, use some xylitol and maybe some hydroxyapatite and avoid certain things and do certain things discussed in this episode that I could remineralize and fill in those cavities.

That said, there of course will be situations where you need to get those cavities drilled and filled, especially if they make it into the deep, deep layers of the tooth and you do not want those cavities to persist and for bacteria to proliferate in those deeper layers of the teeth and down into the bone that is oh so bad for reasons we talked about earlier, not just for your mouth and your teeth, for your general health and brain health included.

So for that reason, and also because the history of dentistry was such that early part of the last century, if you had a toothache in a cavity, what did they do?

They pulled the teeth, they extracted the teeth.

Then at some point, this business of filling teeth became industry standards.

So people would get metal fillings. Now the types of metal fillings that people had and have depend on when they got those fillings.

There were, believe it or not, lead fillings.

This is not good. You don't want lead in your body for all sorts of reasons.

It is terrible for brain health. That's why it's now illegal to contain in paints and many household goods.

You don't want lead fillings, but some people had lead fillings. or silver fillings or a combination of lead, silver, and other things, and many metal fillings, that were given and sometimes are still given depending on where you live in the world and country and the kind of, healthcare and costs that you have available to you contain mercury.

Now, I asked several dentists about this and said, Well, if somebody has a metal filling that likely has mercury in it, do they need to have that metal filling removed?

All of the dentists I spoke to said, it depends, but generally the practice is to leave those fillings in and try not to disrupt them.

Now, they also provided a important recommendation, which is if you have metal fillings that contain mercury or that you think might contain mercury, to avoid disrupting those fillings through the use of things like mastic gum.

We haven't talked too much about mastic gum.

I've used mastic gum before. not for long periods of time, it's a very thick gum.

You know, the original use of mastic gum and the kind of Origins of mastic gum are like a tree sap kind of substance that you chew on.

It's supposed to strengthen your jaw, et cetera.

I don't use it any longer. I use it for a short while.

It doesn't taste like much of anything. Some people believe there are certain anti-inflammatory and other health benefits of mastic gum.

I haven't really explored mastic gum in enough depth or detail to comment on any of that, but a number of dentists said, well, if you have metal fillings chewing on things like mastic gum or hard candies where you're really chewing on that hard candy, which by the way, you're supposed to suck the hard candy of the Jolly Ranch.

You're not supposed to chew on them. but that some people will do that, they'll just naturally chew on those, can actually disrupt and liberate some of that mercury, and that would be bad.

And keep in mind also that when mercury is contained in a metal filling, it's not really bioactive in that mode, But if it's liberated, then it can get into the bloodstream and potentially cause other issues.

So this is a somewhat controversial topic, so much so that in certain countries, and I believe in the EU, somebody check me on this, but I believe that in the not too distant future, metal fillings will no longer be used in the European Union. perhaps elsewhere in the world.

They're sometimes still used in the United States.

There's a lot that's changing in this landscape around fluoride, around metal fillings, et cetera.

So it's a very dynamic landscape right now.

I think suffice to say that if you have metal fillings currently, try not to disrupt them in a way that could liberate that mercury.

However, if you have them and you're really concerned about them, talk to your dentist, ask what the various options are, see whether or not they could be replaced with something. safer, and if the process for replacing them is really worth the trouble.

And again, to just go back to the larger point of whether or not you should get cavities filled, whether or not you need that root canal, that was a very common question.

A lot of people said, Do we really need to drill cavities?

You know, my observation based on now having talked to a number of different practitioners in this space who really pay a lot of attention to the peer reviewed research, the old school practices, the new practices and where everything is headed, is that you You know, there are indeed instances where people need root canals.

There are many cavities that are just too deep into the teeth that remineralization of the teeth through the sorts of protocols that we're talking about today is not going to cut it, that they really need to be drilled and filled.

And of course, we hope those dentists are doing that as little as is required to maintain dental health.

I also would hope that dentists are talking to their patients about ways that they can improve their oral health.

And indeed, there are a lot of cases reported online where people will go in, get x-rays, and an exam, they'll talk about all these cavities that they have and then they go home and they do a bunch of practices and they are able to remineralize their teeth and to essentially reverse those cavities.

I certainly don't doubt those stories, but it's simply not always the case that we can remineralize our teeth and fill back in our cavities.

Cavity recesses are too deep into the teeth.

They need to be drilled and filled. Now that raises a final set of questions and points, which is, do we really need to go to the dentist twice a year, every six months.

That's the general recommendation. And this was a tricky one to ask dentists because, of course, dentists are highly incentivized to see their patients.

And I'm not somebody that believes that everything is, you know, is an attempt to make money.

But look, when money is involved, things can get complicated.

Now, what was really great is that the feedback I got from dentists was very balanced.

I mean, I must say that the community of dentists seems like a really wonderful community.

I don't know how they treat each other, but they were very kind, very generous with information.

And at the end of this episode, just before wrapping, I'll refer you to a couple online oral health and dentist educators that I think are providing some really useful content on a consistent basis.

And I'll provide links to those in the show note captions.

But Here's what the consensus was. This business of going to the dentist twice a year makes sense.

It makes sense from the perspective of quote unquote routine cleanings, but everyone acknowledged that those routine cleanings, while they can remove tartar that's built up, that would be very, very difficult for people to reverse or eliminate at home.

And while they can identify cavities and tell you how far a cavity has developed into the tooth, et cetera, Every one of those dentists agreed that those routine cleanings are not actually going to help remineralize your teeth, except to the extent that they remove existing bacteria, plaque, and tartar.

All of them said that they wish for and that they really strive in their own practices to promote more oral health daily protocols of the sort that we've talked about today, which I think is just great.

I think obviously I believe in medical professionals providing routine care.

I also believe in each and all of us doing things for our health, not just oral health, but sleep health, mental health, physical health, et cetera. to try and not just maintain, but really bolster our brain and body against disease and also to bolster our vitality to feel healthy. really great energetic focus, sleeping better, et cetera.

So it was refreshing to hear that they feel that way as well.

And in addition to that, All the dentists I spoke to said that, you know, setting aside situations of like reconstructive surgery for the mouth or periodontal surgery, which often is needed if those recesses into the gums and gingivitis and worse have started to really develop and proliferate.

All of them emphasize that the twice a year dental visit is not just about getting the cleaning. it's really the checkup to evaluate how those daily practices are emerging.

So it's sort of like going to the doctor for a checkup on your BMI, on your blood pressure, but also things like blood tests, things that typically we don't do at home unless we're accessing those through particular sources.

But all of them emphasize that going to the dentist twice a year is not just about those cleanings.

It's also about establishing what the baseline level of health is in one's mouth and teeth, and having that on record and in a very detailed way so that one can check back routinely twice a year and discover whether or not in fact,

They could get away with perhaps one cleaning a year because you're so diligent about your brushing, flossing, xylitol, not being a mouth breather and on and on. or perhaps if you're not being very good about those protocols or, and this is important, if you have some of the genetic variants that create an overproliferation of certain bacteria that predispose you to gingivitis or that predispose you to excessive buildup of tartar.

This is the reality that some people have genetic variations that create a susceptibility to certain things, both bacteria and other conditions in the mouth that make it such that those people perhaps need to go to the dentist, not just twice a year, but perhaps four times a year or six times a year.

Indeed, there are some individuals for whom either because of lack of diligence to protocol and or genetic issues actually need to go to the dentist every single month for major cleanings.

But fortunately, if We are diligent about these daily protocols, nighttime protocols, and we really are paying attention to the components that can create healthy saliva and remineralize the teeth. and that can fill in any cavities that begin to form and we're staving off the production of strep mutans and we're scraping away that biofilm on a regular basis. that we are going to prevent the need for so many routine cleanings.

And even if we are still getting those two year for those out there that are fortunate enough to have that covered by insurance or can afford it.

Well then, all the better, because as I mentioned at the beginning of today's episode, Oral health is not just about having clean, straight white teeth and fresh breath.

It's not just about that. All of those things are great to have, but oral health is about all of that, and it's also about reducing cardiovascular disease.

It's about reducing irritable bowel syndrome.

Yes, I know that we haven't done an episode about this yet, but I get Oh, so many requests to do episodes about irritable bowel syndrome and other colitis type bowel and gut issues that people have.

And it's so clear that oral health and promoting oral health has been linked to promoting positive gut health as well. reducing and possibly eliminating some of the symptoms of irritable bowel disease.

Because again, the mouth and the gut are contiguous with one another.

They're related, and a lot of the bacteria that can cause things like gut issues are making their way into the body, not directly through the gut, but through the oral cavity because of the richness of blood flow to that region.

So again, today we've talked about a lot of different protocols ranging from cost saving to zero cost to low cost to let's just be frank, higher cost products and protocols such as water picks, et cetera,

The point of today's discussion was essentially threefold.

First of all, to really tamp down in our minds the importance of oral health, not just tooth health, but oral health on the whole, because of its relationship to brain and body health on the whole. so much so that I'm placing it right up there next to the other six pillars of sleep, nutrition, movement, stress modulation, relationships, and light as the seventh pillar of critical to attend to on a daily basis in order to promote our mental health, physical health, and performance.

The second point is that there are many things that we are probably doing currently that we could do differently, either by doing them more or perhaps less, or eliminating them altogether.

Things like considering whether or not these antiseptic alcohol-based mouthwashes are good for you or not.

They're not, they're bad for you in my opinion, but you can decide for you.

How often do you brush? When you brush? Whether or not you decide to use Xylitol et cetera, as ways to improve your oral health.

And of course in doing so, the strength of your teeth, the brightness of your teeth, the freshness of your breath, et cetera.

But through some means that I think for most people, they weren't aware of.

I certainly wasn't aware that we could remineralize our teeth at any moment by changing the acidity, the chemical milieu of our mouth, and that they're very straightforward cost savings, zero cost and low cost ways to do that.

And then the third point is that today's discussion by no means was exhaustive, right?

You may be exhausted, but it was by no mean exhaustive, meaning we simply don't have time to go down the rabbit hole of, all these other promoted health practices, such as for instance, oil pulling.

A lot of people out there believe that if you take olive oil and swish around your mouth and spit it out, that that's good for your mouth.

And indeed, some dental healthcare professionals, I should say licensed dental healthcare professionals said, yeah, I think there's some benefit to that.

There's the whole story about vitamin D and whether or not we're getting enough vitamin d can indeed impact our tooth health so make sure your vitamin d levels are sufficient make sure you're getting some sunlight again this ties into some of the other six pillars Am I suggesting that everyone do oil pulling?

No, I don't think the peer reviewed evidence on oil pulling is sufficient to suggest that people do that.

But as a practice, considering that it's, you know, essentially near zero cost, you know, taking a little bit of olive oil and swishing around your mouth and spitting it out. a couple cents maybe.

You know, if that's something that you feel benefits you, great.

If you are aware of some terrific peer reviewed research on that, and you want to put a link to that in the comments on YouTube, great.

Please send them my way. I'd love to review them.

But my point is that there are a lot of different practices that have been promoted, including oil pulling and a bunch of other things that start to get pretty far into the esoteric, which doesn't necessarily mean that they don't have merit.

But today I've really tried to focus on the major ones, the ones that relate to what most everybody could and should be doing like brushing and flossing, rinsing, getting the oral microbiome healthy, reducing the amount of strep mutans and the opportunity of strep mutans to create that acid that's going to deplete the enamel of your teeth and lead to tooth decay. trying to limit the amount of recessing of the gums and periodontal disease, and for all the reasons that we talked about before. keeping a healthy mouth, including healthy teeth, healthy tongue, healthy gums, healthy palate, and all the rest. is oh so important, not just for your mouth, not just for speaking and smiling and looking the way you want to look, but also for your also for your gut, also for your, believe it or not, your skin.

Didn't have time to go into this, but it directly relates to skin health and for your brain health.

So I strongly suggest that all of us take a look at what we are currently doing for our tooth and oral health and consider what modifications are best for us.

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[구강 건강: 전신 건강을 위한 제7의 기둥]-[How to Improve Oral Health & Its Critical Role in Brain & Body Health]

📋 Summary

구강 건강: 정신과 신체 건강을 위한 새로운 핵심 기둥

치아의 생물학: 재광화(Remineralization)의 힘

구강 건강을 위한 핵심 프로토콜

1. 나이트타임 케어의 중요성

2. 올바른 칫솔질과 치실 사용

3. 화학적 환경 개선: 자일리톨(Xylitol)과 식단

4. 피해야 할 것들

결론

🎯Key Sentences

📝Key Phrases

📖 Transcript