Dr Victoria Samson: We looked at the oral microbiome of patients with kind of mild, moderate and severe COVID-19 to see whether or not microbiome dysbiosis or high levels of bad bacteria could potentially predict the patient's severity of or complications from COVID-19. And we've already, I mean we've got the results back, I can't really talk about them, but what I can say is that it is showing that actually if you have high levels of bad bacteria in your mouth and you've got potentially gum disease, you're at a much higher risk of COVID-19 complications. And another paper came out in February last year and they confirmed that as well, that you're nine times more likely to be in ICU from COVID complications if you have gum disease.
Dr Rupy: Dental health is often forgotten or simplified as a solely aesthetic pursuit. But today's guest tells us why dental health matters way more than we think and deconstructs some myths about oral hygiene. Dr Victoria Samson is a dentist and scientist who has recently been shortlisted as one of the most promising young scientists in Europe for the Forbes Under 30s in Science and Healthcare 2021 awards. And Dr Victoria obtained her Bachelor in Dental Surgery from Barts and The London. She's also known for her work in developing salivary diagnostics, microbiome testing, that's oral microbiome testing, and incorporating artificial intelligence into everyday care. She is part of the future of dentistry and her enthusiasm and passion for the field are truly contagious and will make you want to dive deeper into some of those studies that we mention. She also shares a ton of evidence-based information on her Instagram, making scientific findings more accessible and easy to understand, so please go follow her on Instagram. And in today's show, we talk about the oral microbiome, obviously, how oral health and overall health influence each other in a bidirectional relationship and the potential links between COVID-19 and oral health, fertility and oral health, cardiovascular disease, dementia and oral health, things that I would have not put two and two together. We also talk about measuring the oral microbiome and the biggest dental myths out there that we need to deconstruct, such as should we be using mouthwash? What type of mouthwash? What about SLS, fluoride, the natural toothpaste that I see all across supermarket shelves, which ones are actually clinically validated? And we also talk about some good oral hygiene habits, including how to floss and when to brush. I think you're going to find this a really practical episode and Dr Victoria, we need to have her back on because I'm sure we're going to have loads more questions after this episode. Remember, you can download the Doctor's Kitchen app for free and get access for 14 days on a free trial to all of our recipes where you can filter the recipes according to health goals, brain health, cardiovascular health, and we're also looking at adding new health goals as well. And if you want some health goals, just email me or send me a tweet. And Android users, we're working really hard on an Android version. Remember, you can also check out the Eat, Listen, Read newsletter. Every single week I send you something to eat, a delicious recipe, something to listen to, read, watch, and something to put a smile on your face that people absolutely love. We've had wonderful feedback and I try and get back to everyone's feedback when I can. I really hope you enjoy today's episode and here is my conversation with Dr Victoria. Victoria, thank you so much for making the time. I know you're just about to go to your lecture. How are you doing?
Dr Victoria Samson: I'm good, thank you. How are you?
Dr Rupy: Good, good. This is the first time we're meeting each other in person.
Dr Victoria Samson: In person, yeah.
Dr Rupy: We've done a Zoom thing during the COVID pandemic. The pandemic that we're still in the middle of. The way I think about it, I always think, oh, that was like a couple of years ago, but no, we're still in the thick of it. We're going to talk about COVID-19 a bit. As you know, on the podcast, we talk a lot about the gut microbiota, sort of the focus of a lot of people's attention, it's an influence of health. We don't really talk about the oral microbiota or the oral microbiome much. I wonder if you can give us a bit of an introduction into this field and what you're working on as well.
Dr Victoria Samson: So, you're right, the oral microbiome hasn't really had much of the limelight. The gut microbiome kind of took over the limelight and everyone's always talking about the gut and the bacteria. But actually, the oral microbiome is the second most diverse microbiome in the body. It's got over 700 different species of bacteria, which make two billion bacteria. And what's really interesting about the oral microbiome is that because you're constantly breathing, eating, drinking, smoking, kissing, the microbiome is constantly under attack. And so it's ever kind of evolving and changing. And on top of that, because it's the kind of first portal of entry, it can cause problems elsewhere. So every time you're swallowing or inhaling, actually bacteria in your mouth can travel elsewhere and cause problems. So the oral microbiome, it's also very interesting because it's got lots of different niches. So unlike some of the other microbiomes, if you think of the teeth, which are kind of these hard non-shedding surfaces, and then you've got the tongue and then the cheeks and they're all very different types of surfaces, which means that lots of different bacteria can grow on them. And generally, in health, the oral microbiome is great. It's a nice balance. You've got good bacteria, bad bacteria. It's this beautiful balance. But because it's constantly under attack, it means that that imbalance can happen very quickly. And if it does happen, then you've got the classic kind of oral diseases like gum disease or decay, but also more systemic diseases. So there's a very strong link with things like diabetes, Alzheimer's, heart disease, obesity, high blood pressure. And so the list continues and that's something that I don't think the general population or even healthcare professionals or even dentists really actually know and talk about.
Dr Rupy: Yeah, I mean, as an analogy, a lot of classically trained, conventionally trained doctors don't really know too much about the gut microbiota, as it's not part of the education. But from what I've learned from you and having chats with you on panels and stuff, there are lots of associations that we see with the oral microbiome and health. I wonder if you could talk a bit about the links between chronic disease that we might not classically think of as related to what goes on in our mouths.
Dr Victoria Samson: So with the oral microbiome, there's kind of a few different mechanisms that it can impact systemic diseases or problems. So the first is what we call metastatic infection. So that's essentially you've got high levels of bacteria in your mouth and you swallow it or you inhale it and it travels elsewhere and it can cause infections elsewhere. So the kind of biggest link that I can think of is with cardiovascular disease. So there's a certain kind of disease or issue called infective endocarditis, which is where literally oral bacteria, and it's specifically oral bacteria, is swallowed and it can infect a hearty valve of some sort, sorry, a faulty heart valve of some sort. And if that does happen, then you can die from it. So that's kind of like mechanism number one. Mechanism two is inflammation. So similar to, if you had this infection on your toe and it was just constantly infected, it would impact your immune system and it would constantly activate that immune system to fire inflammatory markers and to try and fight this infection. But what's weird is that with gum disease, people don't really think of it as an infection. They're just kind of like, oh yeah, my gum's bleed a little bit or, but actually it's really high levels of bad bacteria at a sustained kind of period of time. And that causes release of inflammation and inflammatory markers through the body. And so if, for example, you have some other chronic inflammatory disease like rheumatoid arthritis or something like that, by having that gum disease, you're just basically adding petrol to the fire because you're adding more inflammation and inflammatory markers and it will basically what we're seeing is there's a bidirectional relationship with a lot of those chronic inflammatory diseases. So if you have rheumatoid arthritis and you also have gum disease, then they will both become worse. And if you improve the gum disease, then your rheumatoid arthritis will also improve. And that's what really started my journey was I was seeing a lot of rheumatoid arthritis patients and what we were finding was that, yes, they were having a lot of holistic care and I was very lucky that I was working with some amazing doctors who were, you know, changing their nutrition and trying to get them off medications. And they were the ones who were like, actually, wait a second, let's see what a dentist thinks. And they would send these patients to me and they all had raging gum disease, terrible. You know, they were losing four or five teeth a year. And their dentist, their classic dentist was like, oh, you've got gum disease, you should come for a clean every three months. And that was it. And then when we started to actually sit there and look at their microbiome, measure what bacteria they had, what inflammatory markers they had, and try and change it and modulate it, interestingly, we were able to get these patients off medications. And this was a combined effort, but also we were able to completely stop the gum disease. And now these patients are in a much, much better place long term. And that's where we can see that, you know, the oral microbiome and the mouth, it's a piece of the puzzle that a lot of practitioners and even, you know, the public don't really think about. And they always think of the mouth as a completely separate entity to the rest of the body.
Dr Rupy: Yeah. And you mentioned this bidirectional relationship we have. Does it stand to reason that if you look after, let's say, an inflammatory condition like inflammatory arthritis better, that would also have a positive impact on your established gum disease?
Dr Victoria Samson: Yes. Okay. So there was a lot of research, um, with diabetes is the biggest one. So, um, interestingly, I was reading an article yesterday and they were talking about how they were asking a bunch of doctors and they said, do you know what the sixth complication of diabetes was? And everyone could name the top five. No one could name the periodontal disease is the sixth one. And so a lot of these patient, these doctors are treating diabetes patients, but they're not actually referring them to a dentist. And what the research has shown is that if you are able to improve the periodontal disease and give the patient the treatment that they need, then their HBA1C levels will reduce regardless of any other treatment. Um, and also if you have very high levels of periodontal, you know, pathogens and you've got bad gum disease, then your insulin resistance is even worse as well. So it is really, you know, and if that means that if it's just a small contributory kind of effect, that's amazing just to tell someone, go and get a clean, brush your teeth, maybe floss. It's so much easier than a lot of the other kind of lifestyle changes that we're trying to implement on a lot of these patients.
Dr Rupy: Yeah, absolutely. In terms of the barrier to entry, that's pretty low.
Dr Victoria Samson: Exactly. And it's cheap. It's much cheaper than a lot of these treatments for chronic diseases and it's easy.
Dr Rupy: You mentioned measuring the microbiome. Is that something that most dentists have access to or knowledge about? Is this some commercially available test that people could do maybe once a year or once every six months or do you not recommend that sort of way of keeping an eye on how well your...
Dr Victoria Samson: I do a lot of microbiome testing. So particularly with patients who have some sort of chronic inflammatory disease or any other kind of systemic disease, I will be measuring their microbiome. So there's a lot of microbiome tests available. I use one by Invivo Healthcare, but I'm also one of their clinical advisors. So I feel like I should probably disclose that. And I've helped them make the test. Um, it basically looks at the top 20 bacteria associated with gum disease, decay, but also gives you a kind of little insight into other diseases. So Alzheimer's, oral cancer, diabetes. So I would never be able to diagnose the patient and say, hey, you've got diabetes because of your oral microbiome, but I would be able to say, you've got really high levels of this bad bacteria, you should probably go and see your doctor about this. So I definitely, I do testing a lot on patients. I'm a bit wary of the at-home ones or, you know, patients taking it in their own hands to do because often they don't know what they're looking for. And also what's very important to understand is that the microbiome tests and the results come out, it's kind of like a generalized like results, you know, just like with a blood test, right? It gives you a range and if you're above that range, it says high and whatever. But with the oral microbiome, it's very particular to that patient. And so actually you might have high levels of one bad bacteria in your mouth and in you, that's healthy and it's fine, but in me, it's not healthy. And so I do get patients who go and do their own homework, they get microbiome tests and they're like, oh my god, oh my god, I have high levels of Prevatella or something. I'm like, yeah, but you don't have any gum disease, you have no decay, and you're very fit and well. And if you don't have other bacteria which kind of fit the puzzle, then actually leave it. It's fine. We don't want to kind of ruin the other, the balance otherwise.
Dr Rupy: Yeah, I think this is a really good point, I think, because everything appears to be in the ecosystem of both the gut microbiome and your oral microbiome in flux. And actually, what is generally seen as good or bad can actually have the complete reverse association. Are there, given that I've just said that, are there any particular microbes that point towards a more positive outcome universally across the board? Or is it in the same way like the gut microbiota, you might look at Akkermansia, you might look at certain types of lactobacilli. Are there some like standout microbes that we look for or is it, is it just really context?
Dr Victoria Samson: There are a few, so like, for example, I'll put some of my patients on probiotics. And so those are the kind of, I guess, the good bacteria that we like to add into the microbiome. So there is Lactobacillus KCI. Um, there's quite a few lactobacilluses. Um, or lactobacilli, I think. But generally, I more look at getting rid of the bad bacteria and then putting them on probiotics. So unfortunately, as well, the research is not, I think that because the gut microbiome is a much kind of wider research microbiome, um, the oral microbiome, we know a lot about the bad stuff, but we don't necessarily know what's good, um, and what bacteria is beneficial to the microbiome.
Dr Rupy: Yeah. You mentioned a couple of disease associations there that I think once you understand the mechanism behind, you can sort of piece it together. So things like Alzheimer's, a lot of people recognize inflammation as a hugely important role, cardiovascular disease, metabolic disease. But I looked at one of your recent Instagram posts and you mentioned things like fertility, sport performance, mental well-being. I wonder if we could dive into those and the associations between the health of your mouth.
Dr Victoria Samson: Fertility is my favourite one. Yeah, yeah. You probably saw my like eyes light up when you said that. Um, fertility is really interesting because it's similar, it's all kind of the same mechanism. It's all to do with inflammation and just that low-grade chronic inflammation. Um, with fertility, I mean, if we start with the woman, um, what we've found and the research has shown is that a woman who have gum disease, um, they are, they conceive much later than women who do not have gum disease. So three months later, actually. Um, and also if they have gum disease whilst they're pregnant, there's actually high risk of, um, kind of low birth or pre-term births and low birth weight as well. And that's, um, what they found was that there are certain oral bacteria in the amniotic fluid and the placenta of these babies who are being born. And these were specific oral bacteria again. Um, so I think that's just fascinating. And again, it's like, just like brush your teeth, go to the dentist. Like it's really, if someone's sitting there struggling to, to, you know, conceive, something so small and simple like that could be a huge impact. Um, and then for the men, it's even more interesting. So, um, there was a study by a man called B and he basically split two groups of subfertile men. And, um, what he found was that in all of these subfertile men, I think it was 97% of them, um, all had some sort of oral disease of some sort. So be it gum disease, decay, um, an infected root canal, whatever it is. Um, and then half the group, he, he went and did, you know, whatever dental treatments were required to get rid of that oral disease. The other half he left as is. And then when he reviewed them, in the group that had all the dental treatment, uh, within eight months, uh, 70% of those men had conceived with their partners. Um, and with the people who did not have any treatment, none of them conceived and they were the same. So it's a, I mean, that's like crazy to me. It's huge. Um, and then so they did the same thing with the group that didn't have dental treatment and they gave them the treatment and the same thing happened. Um, and then on top of that, there's also erectile dysfunction. So, um, men who have gum disease are 2.8 times more likely to get, um, sorry, they have gum disease, they're 2.8 times more likely to have erectile dysfunction as well. And again, it's all to do with inflammation, with blood flow and it's, yeah, it's nuts.
Dr Rupy: Yeah, you can see like, you can see how there is multiple links in between all those different pathologies when you, when you look at the root which could be inflammation, driving cardiovascular disease, driving atherosclerosis, you can understand why there is an association with erectile dysfunction. You've also talked, and this is where we connected, uh, during COVID-19, uh, that there are links there between poor oral health and the, is it the probability of contracting it or the severity of COVID or maybe even both?
Dr Victoria Samson: Severity. Severity, yeah. Um, yeah, that was, that's what really started my whole, um, I guess, delve into the oral microbiome before that, I was a plain old dentist. I kind of, I didn't love dentistry much, like it was okay. I love dentists. Don't play no dentists. No, no, no. We love dentists, but I kind of, you know, like I liked my job-ish, but I didn't really feel like I was making much of an impact on my patients. And also I wasn't able to monitor and track their treatments and I didn't have any quantitative data. So things like microbiome testing and inflammatory marker testing. Now I can see numbers dropping and it's quite fulfilling to see that. Um, but yeah, I wasn't working for a couple of months during the beginning of COVID and I'm someone who is very kind of high intensity, like I love to do things. I was going crazy and I was on a run and I was like, okay, just thinking about COVID and gum disease for some bizarre reason. And I was like, wait a second, all of the risk factors for gum disease are exactly the same risk factors for COVID. Um, so for example, men, old age, um, and then certain systemic diseases like people who had diabetes, heart disease, and I was like, okay, this is a bit strange. I delved into it a little bit more and I realized that the mechanisms were quite similar as well. So with periodontal disease, it's low-grade chronic inflammation and it's this release of inflammatory markers. And the exact inflammatory markers, so they're interleukin 2, 6, 8 and 10, and they're exactly the same inflammatory markers that are heightened in a COVID-19 infection. And then what we realized was that actually with the COVID-19 patients, um, with the cytokine storm, it's the idea that you've got like a crazy release of inflammatory markers. And if you already have that low-grade chronic inflammation, you're just making matters much worse. Um, and so I started just becoming obsessed with research and I was just sitting there every day. It was quite weird. You know, there was that time where like every morning you would wake up and like the Lancet would come out with new research and you'd be like, oh my god, oh my god. Maybe it was just me, I don't know, but. No, I the resonates with me as well. You know when everyone's like sending each other papers and like, wow. And it was all open access and it was really exciting. And, um, so then a lot of research was showing that certain oral bacteria were found in the lung biopsies of COVID-19, um, sufferers. And so, um, I decided to approach, um, UCL Eastman and we, um, did, we started a research, um, trial. And so we looked at the oral microbiome of patients with kind of mild, moderate and severe COVID-19 to see whether or not microbiome dysbiosis or high levels of bad bacteria could potentially predict the patient's severity of or complications from COVID-19. Um, and we've already, I mean, we've got the results back, I can't really talk about them, but what I can say is that it is showing that actually if you have high levels of bad bacteria in your mouth and you've got potentially gum disease, you're at a much higher risk of COVID-19 complications. And another paper came out, um, in February last year and they confirmed that as well, that you're nine times more likely to be in ICU from COVID complications if you have gum disease.
Dr Rupy: Going back to some of the mechanisms you were talking about, it appears to be all interlinked as well. So it's not necessarily that the oral microbiota might be causing these issues, but it's certainly because of that bidirectional relationship that you outlined earlier. I want to talk, before we talk about tips and things that you should do, that I'm sure you're going to tell me that I should, I do floss, I do use a TP, I brush twice a day, I do lots of things that are great. Um, we for a lack of appreciation of the oral microbiome, uh, have been indiscriminately using products that are quite harsh. Um, we don't have to name any names, but there are certain mouthwashes, certain toothpastes that are pretty strong when it comes to their antibacterial activity. What do you or antimicrobial activity, I should say. What kind of things do you think we've changed our mind on over the last couple of decades that we should really be embracing when it comes to products that we allow to use on our mouths?
Dr Victoria Samson: So mouthwash is the most important one, I'd say. Um, there was a time where, um, mouthwash which was like the coolest thing and everyone was being told to use a mouthwash. Um, and now we're realizing that it's, in my opinion, the way I explain it to patients is that it's kind of like putting perfume on. It's not really doing much. Um, and actually, no, it's, it's worse than perfume because, uh, you've got an anti-kind of microbial effect, um, but also a lot of these mouthwashes contain alcohol. And the oral microbiome, I mean, if you, if you just think about it, I mean, the tongue and the cheeks, they're, they're very, it's a very soft tissue. And so it can absorb things very easily. So, um, alcoholic mouthwashes is very, very aggressive. It can strip the kind of outer surface of the mucosa in the mouth. Um, it can cause a lot of problems. So definitely steer clear of alcohol containing mouthwashes. And generally, I don't really think any patient needs to have a mouthwash unless their dentist has prescribed it. So there are certain times where I will tell a patient, okay, you've got gum disease, I'm going to put you on this mouthwash for three weeks, um, or, you know, if they have other medical issues and they can't brush their teeth, then maybe we put them on a mouthwash, but it's not something that the average person should go and be using. Um, another thing is if you are going to use mouthwash, it should be at a different time to when you're brushing your teeth because the mouthwash and the toothpaste will actually kind of cancel out their effects. Um, apart from that, what other kind of myths can I bust about dentistry? I think that's the worst. Oh, SLS. Um, so similar to a lot of kind of soaps, um, toothpaste has SLS, which is sodium lauryl sulfate. It's the foaming agent. Um, it makes your toothpaste nice and frothy, but it's extremely unnecessary and it can actually be, um, some people have allergies to it. So I, for example, have a really bad allergy to SLS. Um, but even if you don't have an allergy, it, it can impact the, the, the outer layer of the cells in your mouth, um, and basically destroy them. And it's unnecessary just for a little bit of a foamy toothpaste. It's just, so I'm SLS free and I try and get my patients to be off that as well.
Dr Rupy: Wow. So there's two things that I remember from our conversation. Uh, one, I don't rinse after brushing my teeth because you told me, it makes total sense, why would you wash it off? I use a toothpaste that doesn't have SLS in now and it's actually a lot less irritant. Um, a lot of toothpastes have SLS.
Dr Victoria Samson: They do. Yeah. Yeah. Pretty much, I would say like 90% of the toothpaste on the market do. And then because I work with a lot of dental companies, they're always sending me toothpaste and I have to try them. I tried one last night and I know it's going to like harm my mouth and I know like it hurts, like because I, I'm allergic, so I get like really red tongue, I get ulcers and stuff. And I was trying it. I was like, why, why are we still doing this? Um, but there are, I mean, I can name a few, so Zendium, um, Biomin, Sensodyne has a few as well, which are SLS free. And it is the general trend and Colgate has just come out with one as well. So there are some, um, and they usually advertise that they're SLS free as well.
Dr Rupy: Okay. And any other products like chewing gums or uh, certain sort of drinks that we should really be steering clear of. I mean, obviously like sugar sweet and beverages, obviously, I know you're going to tell me that. But any other uh, things that you think are pretty ubiquitous in terms of what people consume on a daily basis that we should be careful of?
Dr Victoria Samson: Um, I mean, I mean, yeah, like the classic, like fizzy drinks, um, you know, even alcohol, like sugar containing alcohols, um, but no, there isn't kind of one food or drink which I feel like people, I, it's kind of the classics, I'd say. Chewing gum, if you're going to have chewing gum, make sure it's sugar-free. Um, and there are some really good chewing gums out there which have a, like a probiotic element to them. So that's what I, I use probiotic chewing gum. Um, and they've got some pastels as well. So they're like, I use this one, it's called Lovebiotics and they've got these really nice pastels and just like, it's like a mint, basically, and it just, I pop one in and actually I eat one after I know I've had a bit of a bad meal. So like if I've had a really big sugar attack, I just have a little probiotic pastel. I don't know. I think subconsciously I think it's helping me.
Dr Rupy: I was going to ask, are there, is there any evidence base around introducing oral probiotics through pastels or chewing gums and that kind of stuff? Does that been shown to have a beneficial effect?
Dr Victoria Samson: Yeah, so it has. So I mean, depending on which probiotics you're talking about, some are more for the decay, so anti-kind of cariogenic, so to reduce your risk of cavities and decay, others are for gum disease. Um, but it's, it's a really emerging market. And again, a lot of the dental companies are jumping on that because they're realizing how important it is to enrich your toothpaste or your, you know, your chewing gum or your pastels with some good bacteria as well.
Dr Rupy: Yeah. Talking of enriching, so fluoride, what are your thoughts on fluoride? Fluoride is a very controversial subject. I'm going to get asked about it, so I'm going to deflect this to you. Uh, what, what are your thoughts on fluoride?
Dr Victoria Samson: Ah, well, um, it's weird because I'm, I'm known to be a functional, holistic dentist. And so with that comes this assumption that I don't like fluoride. Um, and I have a lot of patients who are fluoride-free. And it, initially I was kind of, I would do this whole spiel where I say, fluoride's good for you, it helps remineralize the teeth and blah, blah, blah, blah, blah. But what I've realized is that patients who are fluoride-free are fluoride-free for a reason and they're very, um, kind of stuck in their ways. And so what I tell them now is, you know, you do you, you know, I'm, I, I can give you my professional opinion, which is that fluoride is good for your teeth. And I can immediately see when a patient is using a fluoride-free toothpaste from the kind of structure of their enamel and how essentially stronger or weak their teeth are. But if you're not going to use fluoride, then you need to make sure that you're using a toothpaste which is got other, um, kind of remineralizing agents. So calcium, phosphate, hydroxyapatite. Um, what annoys me is that there's a lot of these fluoride-free toothpastes which are just filled with like essential oils and like chalk. And, and that's what annoys me because that's not doing anything. So if you're going to go for the fluoride-free option, my favourite toothpaste is Biomin C. So Biomin has a fluoride version, which is Biomin F, and then they also have one which is fluoride-free, which is Biomin C. And that's got, um, a really great technology. It's got calcium and phosphate and, and that's the one that I will recommend for patients who are fluoride-free. But if you're still, if you're using fluoride, please continue. It is a good, good thing to have.
Dr Rupy: Yeah, yeah. I do you share any concerns about the impact, the antimicrobial impact of fluoride on the gut or the irritant effect on the gut at all? Or are there other...
Dr Victoria Samson: I'll be honest with you, I don't know enough about the impact of fluoride on the gut. Um, I kind of, I leave the guts to the, to the doctors. Um, but it's actually a very interesting, um, question. But I would, my kind of two cents is that if, I mean, you're not meant to be ingesting the fluoride, so it shouldn't really be impacting the gut from my understanding. It should just be staying in the mouth. Um, and then for those people who I think are on the fence of like, I'm not sure about fluoride, fluoride-free, or should I use a low-level fluoride toothpaste? Um, again, sorry, I'm really plugging Biomin, but I have no association with them. Like I just like their toothpaste. Biomin F has, um, low levels of fluoride. So the average toothpaste has around 2,000 parts per millimeter of fluoride. Um, and theirs has about 500 parts per millimeter. However, it's still got the same effect and impact, um, as the high fluoride toothpastes have. Um, because of the technology that they've used, it's kind of like a slow release and it, and it impregnates the enamel. So if you're on the fence, I would go for that toothpaste.
Dr Rupy: Epic. Uh, I share the same concerns with you as well about fluoride-free toothpaste because when I look at the ingredients pack, you're right, it's a lot of essential oils, it doesn't have any of those things in. You already answered the question about hydroxyapatite, which I'm seeing as a common replacement for fluoride because of its remineralizing effect. Xylitol and erythritol, I'm seeing a lot of chewing gums being advertised as something that has a positive effect on the microbes. Is that something that you, you share?
Dr Victoria Samson: Yeah, so I, um, I, I mean, to an extent, I think like some people go overboard with the xylitol toothpaste or the pastels and whatever. Um, but I'm actually, I'm doing a trial at the moment and we're looking at the effect of erythritol in particular on the oral microbiome because as a, um, chemical or as a molecule, erythritol is antimicrobial, anti-adherence, it's got some really great properties. And so actually, um, there are some specific dental treatments which are starting to incorporate erythritol into them, um, to allow for, you know, balancing of the oral microbiome and and to help. So I love erythritol and xylitol and I would definitely say yes to them.
Dr Rupy: Okay, great. That's fab. Quick fire questions. Should we floss?
Dr Victoria Samson: Of course.
Dr Rupy: Okay. How is that a question?
Dr Victoria Samson: How should we floss? That should be the question.
Dr Rupy: How should we floss? Um, it's difficult to explain in words. Um, but what a lot of people do, um, is they, they get the floss and they just go up, down, up, down, up, down, which is actually not what you're meant to do. You're meant to kind of shimmy it up and then make a C-shape, um, with the, the, the floss and you slide it up. So you'll be, you'll be shocked to see how far the floss can go up your gum without hurting you. And then once you've gone to as far as you can go, you go down again and then you slide it the other way. So it's kind of like a reverse C-shape. Um, and the idea is that you're trying to like respect the gums is what I tell my patients. If your gum, if you think, if you look in the mirror, you've got like a triangle of gum in between the teeth and you want to basically slide the floss on each side of that triangle of gum. You don't want to go straight at the tip of the gum.
Dr Rupy: Okay. Tongue scrapers, are they useful?
Dr Victoria Samson: I think it's dependent on the patient. Um, so everyone's got a different tongue. Um, some patients, you know, there's some strange ones out there. There's something called black hairy tongue. There is, you know, some people have blue tongues. There's lots of different tongues out there. Um, generally, um, I do like tongue scraping, um, but you need to use a specific tongue scraper. Don't go and use your toothbrush and brush really hard because sometimes you actually, um, will irritate the taste buds and they will overgrow and they will cause more problems. So if you have like a hairy tongue, you need to be quite gentle and use a nice tongue scraper. I like the metal ones, which are kind of antibacterial and just do it, you know, maybe a couple of times a week. You don't need to do it every day.
Dr Rupy: Okay. Electric toothbrushes and the firmness of the bristles. What are your thoughts?
Dr Victoria Samson: Uh, definitely electric toothbrush is a must. Um, I think that's one great development for dentistry. Um, it does most of the work for you. Um, and it times you as well. And it should be a toothbrush that has a pressure sensor. So it should blink green when you're brushing at the right pressure and red when you're brushing too hard. So that kind of answers in turn your question about how hard the bristles should be. Um, it's more in my opinion, how hard you're brushing. Um, so I don't like very soft bristle toothbrushes because sometimes I just feel like they're like sweeping the food back and forth. Like they're not actually removing anything. Um, so you want a medium to even a hard bristled brush, um, but it's more about looking in the mirror when you're brushing your teeth and making sure you're not brushing too hard.
Dr Rupy: Okay, fine. Um, when should we brush our teeth? That's a common question, a common issue. Is it after breakfast? Is it in between every single meal? Uh, you already talked about separating rinsing with mouthwash if you choose to use mouthwash outside of the brushing time. What, what are your thoughts on that?
Dr Victoria Samson: Um, so I say it should be the first thing you do when you wake up and the last thing you do before you go to bed. Um, whether, I mean, some people are like, oh, but I like to go to work with a fresh mouth. Um, then go for it. You know, you do you. But what I would say is that if you're someone in the morning who has like a citrusy, um, breakfast of some sort, if you're having orange juice or, um, you know, high acid, then you don't want to go straight away and brush your teeth straight after because you're going to be essentially brushing that acid into your teeth. Um, so that's why I usually prefer that patients brush their teeth first thing in the morning and then they eat their breakfast and they go to work. Um, but it, it, it depends on, on who you are. And if you are going to have a high acid diet or, you know, you have a lot of sugar or anything in the morning, wait 30 minutes, um, between eating and brushing your teeth to allow for the mouth to stabilize again.
Dr Rupy: Okay, great. Um, last question. This one's for me. So I've got receding gums pretty badly to the point where, uh, I'm considering grafts. Uh, so I'm, I'm seeing a, I see my hygienist, I do everything that you're saying, but, um, it's still an issue, unfortunately. Are there any practices that I should be steering clear of given, uh, the recession of gums in terms of things I drink, I drink black coffee every day, uh, and things that I should be thinking about in terms of my diet as well to support recession, receding gums, or is it literally like, there's nothing you can do?
Dr Victoria Samson: There are some, so receding gums, it depends on the cause of the receding gums. If it's because you're brushing too hard, which is often, um, why, then it's just, you know, changing your toothbrush, again, looking at the pressure sensor. There are some certain things that I do recommend for patients who have, um, receding gums or even just early gum disease. So certain supplements. So CoQ10, um, or coenzyme Q10 is great for collagen production and also it's got very antioxidant effects. And so your gums are essentially made out of collagen. So what you want to do is kind of strengthen those gums a little bit. You'll never, if you have recession, you'll never be able to regrow the gums, unfortunately. But what you can do is try and strengthen what gum you have left. And I mean, it sounds like in your case, maybe it's a bit beyond repair. If you, if you're getting, if you need surgery, then that's something. But if you've just, if you're looking in the mirror and you're like, ooh, I've seen a bit of recession, then you start thinking about, maybe I should strengthen the collagen, you know, so CoQ10, collagen supplementation as well, I like. Um, the classic vitamins as well, vitamin A, C, D, K2. Um, and then diet wise, again, just, you know, rich in, in anything rich in collagen as well. Um, but yeah, unfortunately there's no easy fix for recession.
Dr Rupy: Yeah, I know. It's one of those hard bits and I've been told many times. We're going to let you go, but I think we're going to have to do a part two because I definitely want to speak to you a bit more about supplements, particularly vitamin K2 that a lot of people don't really know about, um, and, uh, collagen supplementation as well. We've talked about it in the podcast in the context of skin, but I think in the context of gum health and dental health, I think it's really important. So, appreciate your time, Victoria. You are a superstar. Thank you so much for bringing the, the energy and this information. I'm trying to bring the oral microbiome back into the limelight. That is my, my job in life. Absolutely. Awesome. Awesome. You know, you are, you've definitely taught me a lot. That's great. Appreciate it.
Dr Victoria Samson: Thanks for having me.
Dr Rupy: No, my pleasure, my pleasure.
