Dr Victoria: What people sometimes forget is that the mouth is the gateway to the rest of the body. So everything that you swallow, you breathe, it's coming into your mouth first and then travelling elsewhere. And so you need to make sure that your mouth is healthy enough to be able to fight off a lot of those viruses and that bacteria and become a strong barrier against kind of travelling further down into the body.
Dr Rupy: Welcome to the Doctor's Kitchen podcast. The show about food, lifestyle, medicine and how to improve your health today. I'm Dr Rupy, your host. I'm a medical doctor, I study nutrition and I'm a firm believer in the power of food and lifestyle as medicine. Join me and my expert guests where we discuss the multiple determinants of what allows you to lead your best life.
Dr Rupy: Today we are discussing the connection between oral health and general health, diving into topics like flossing, Alzheimer's, the oral microbiome and supplements for your teeth. And I'm also revealing my own oral microbiome test results live in the podcast. Trust me, I did not look at them before getting Dr Victoria to reveal them to me live on the pod, and they show some shocking truths about my diet. You won't want to miss it. Dr Victoria Samson has been on the pod before. She's known for being one of the leaders in preventative and holistic dentistry, lecturing globally on the topic and recognised for her achievements by winning numerous awards and ranking in the top 50 most influential dentists in the UK. She's also known for her work in developing salivary diagnostics and microbiome testing, both of which I got to experience at her clinic in London that you can check out at thehealthsociety.co.uk. And fun fact, Victoria also DJs in her spare time and has over 15 playlists that she plays for her patients to enhance their dental experience, and it definitely did. Today we also talk about the reasons why gum recession occurs, such as brushing too hard, abrasive agents that you find in lots of commercially available toothpastes, infections, genes, as well as how to slow gum recessions, including using a better toothbrush, removing such agents and supplements such as CoQ10, vitamin C and more that we discuss on the podcast. We talk about, and reveal I should say, my microbiome and collagen breakdown tests that are salivary tests as well as why mouthwash choice is so important. Today's episode is also perfect for YouTube, as when we discuss my results, they flash up on the screen. So if you haven't checked out our YouTube channel yet, you can head over there using the link in the caption. And whilst you're in the caption, you can also check out the newsletter, the website, the app and seasonal Sundays, which is what we send out every single Sunday where we dive into a seasonal ingredient, teaching you how to use it, the historical use.
Dr Rupy: Dr Victoria, let's talk about the benefits of flossing. We always hear from our dentists, you need to floss, you should floss every day. How many times a day should we be flossing? What should we be using to floss, for flossing? But what are the actual benefits? Let's start there.
Dr Victoria: Okay. So where do I start with flossing? So the most important reason for flossing is because 30% of the bacteria in your mouth is actually in between your teeth. So if you're not flossing and you're brushing like a superstar, you're actually only ever doing 70% of the job. So in terms of how many times to floss, I would, I always recommend everyone to floss twice a day. So in my eyes, you should be flossing at the same time that you're brushing. And the reason for that is because I just feel like it's quite difficult to tell people like, okay, like floss, you know, once every three days, because when do you choose that time to floss? So it's better to just every time you pick up your toothbrush, you also pick up your floss. And that way you're always getting that 100% kind of efficacy and getting rid of all that bacteria. What floss do I like? Let me show you. I've got, so this is satin tape.
Dr Rupy: Uh-huh. Satin tape.
Dr Victoria: I may or may not be in my dental surgery. Everyone's got their preferences. I've not been plugged by Oral-B to say this. But the reason I like a tape over a string is because tape basically slides really smoothly around the teeth, whereas the string can sometimes actually aggravate the gums a little bit and kind of actually, yeah, just kind of saw them and hurt them. So the tape is a little bit more forgiving. And I think it's really important for people to understand how to floss. So I always teach everyone how to floss, no matter who they are. And the reason being is that everyone does it wrong. So it's not just about going kind of click-clack and inside and outside of the tooth. That's not enough. You actually want to go in and slide around the tooth and make kind of a C-shape, if that makes sense. And that way you're getting rid of all that bacteria on either side of that gum.
Dr Rupy: And so with, just on the satin tape stuff, because I struggle to get the floss particularly at the back of my teeth. And that's my excuse as to why I haven't done a very good job, as you told me during our consultation a couple of months ago, of getting all the bacteria and all the plaque around there. Are there other implements that that you would recommend for people like me who can't get the satin right at the back of their teeth?
Dr Victoria: Yes. So you've got definitely, so for example, you can use like a little harp. And so that's like floss picks, like with harp. So you can use that. That one basically allows you to get in between those very back teeth. And it, yeah, it looks like a little saw and you can get there. I don't prefer that for front teeth because I think that you don't have the same kind of control and dexterity as you would do with the string. So generally I say still use the string on all the teeth that you can and the teeth that you can't get to at the very back, you can use one of those little floss pick kind of harps and just get in between there. And then for people who maybe have larger gaps in between their teeth or they can't, you know, they're flossing but their dentist or their hygienist keeps on saying, well, you're not flossing well enough or there's still lots of tartar built up, you can start to think about interdental brushes. So here I have your TP brushes. You've got different colours depending on the size of the space and what you want to basically remove. And so your hygienist or dentist should tell you what colour is right for you. But sometimes that's a better alternative to floss for someone who has a massive gap and that floss is just going to swim in that gap. It's not going to do anything. So you might need a little bit of an interdental brush instead.
Dr Rupy: Yeah, as we'll come to, because I've got quite bad receding gums, I have to use those interdental brushes myself because the gaps are pretty big. Is there any evidence to say that if you floss or you use those brushes that you can exacerbate any gaps or any damage to the gums?
Dr Victoria: Yes. So if you're flossing really aggressively or you're using the string and not correctly, then you can get kind of like, it's kind of like lacerations in the gum basically. And that's just you literally just like cutting into your gums. Or if you're using a TP brush which is too large for the gap and you're just ramming it in there, then actually over time you can destroy the gum, you can also even sometimes create more space in between the teeth. And that's why you want like a nice friction in between the teeth with the TP brushes. You want that, you want to feel it on both sides of the tooth, but it shouldn't feel as if you have to ram it in there or it shouldn't hurt you. And that's why having a dental professional tell you which size and colour to go for would be quite good.
Dr Rupy: Okay. And we'll get onto this in a bit, but I guess, you know, if you start flossing for the first time and perhaps you're not used to flossing, is it expected that you might get a bit of bleeding or is any case of bleeding when flossing or using the interdental brushes something that signals a gum disease?
Dr Victoria: I think if it's like the first time that you've flossed, you're going to make a few mistakes. You might, you know, hurt your gums a little bit a few times and that's fine. It doesn't mean necessarily that you have raging gum disease. However, generally, I would say that if you do get lots of bleeding on flossing, then you should definitely seek professional help. And also more importantly, I think anytime if ever you spit into your basin and you see blood in your saliva after brushing or anything like that, that's a really big telltale that you've got inflammation and you need to go and get probably a hygiene.
Dr Rupy: Okay. Let's zoom in into flossing in a bit more detail. So you said that 30% of the bacteria lies in between the teeth. That's why flossing is super important, which, you know, for me is a stark difference already. Like if you're if you're just brushing your teeth, there's still like a third of your mouth that you're not getting to. What are the specific benefits of flossing that you can we can attribute to this practice every day?
Dr Victoria: I think the biggest one is obviously, if you're, like you said, if you're not flossing, you're only doing 70% of the job. And the important thing is to try and clear all of that bacteria and plaque and food away from your mouth every day. And the reason for that is because most of the time, if you're not clearing the food in between your teeth, then you're increasing your risk of decay, of also gum disease as well. And those, it's because that food and bacteria can just sit there stagnant for often, you know, days, weeks, months, and then that starts to eat away at the tooth or sometimes at the gums as well. And that's where we get local diseases that dentists would be able to pick up on. But then also there has been a lot of evidence to show that actually, not necessarily just flossing, but regular clearance of bacteria and food and etc from the mouth and not having inflammation in your mouth has a beneficial impact on general health and reducing general inflammation as well.
Dr Rupy: Talk a bit more about that general health and the general inflammation piece actually with with flossing specifically because we've talked a bit about inflammation in the mouth and how that relates to heart disease in the past, but I think specifically when it comes to flossing, people are interested in this idea around reducing inflammation in the mouth as well. Is that something that we can attribute to flossing?
Dr Victoria: Yes, so actually the New York Times came out with an article a few months ago and it was the headline was like, flossing can save your life. And floss twice a day to reduce your risk of Alzheimer's. And I mean, it was a pretty strong headline. But at the same time, it definitely, I think, made people think of flossing as a more important thing, not just something that us dentists like to nag you about. You know, there's a reason we're saying it. It's not because we just like to be annoying. And with that article for with the New York Times, what they were basically showing was that if you have lots of bacteria collecting in your mouth and particularly in between your teeth and around your gums, then that can basically increase your inflammation in your mouth. And your mouth is very close to your brain. And so actually that inflammation can travel upwards to the brain and cause problems in the brain and inflammation. But also what they found was that patients who had severe gum disease were at a 70% increased risk of Alzheimer's disease. And they were finding specific oral bacteria in the cerebrospinal fluid of Alzheimer's sufferers. And this was bacteria that only really ever is found in the mouth. And so again, that further confirmed that, you know, I feel like with Alzheimer's, it's one of those diseases which as a society, we're all quite scared of, but we also know very little about because no one can really explain the cause of it or how to reduce the risk of it. And so if something as simple as flossing and brushing your teeth well could improve that, then and reduce your risk, then it's definitely a no-brainer to do that.
Dr Rupy: How how convinced are you looking at the association between people who have gum disease and something like Alzheimer's dementia, uh, combined with the potential bacteria involved, the causative organism found in mouth and also found in the cerebrospinal fluid as a clear indication that the two are actually causally linked? Are you convinced that there is certainly something to be explored further there or you're still sort of on the fence but taking a precautionary approach?
Dr Victoria: I think that's a really interesting question because you're right. I think a lot of the times we can make big claims about two things when actually they're not causative and it's just correlation or, you know, by chance. With the Alzheimer's and the gum disease, I've been looking into it a lot because I was on the fence and I thought, it's quite a strong claim to be making. And generally, I would say most of the research has been more of a kind of coincidence or a correlation between the two. But there have been some studies which have actually looked into the mechanisms behind how oral bacteria could cause problems in the brain. And what they found was that a certain oral bacteria called Porphyromonas gingivalis, which is elevated in patients who suffer from gum disease, it releases a certain toxic enzyme called gingipains. And these gingipains are able to travel through the blood up to the brain and those gingipains basically are enzymes which can break down your your brain tissue and patients who have Alzheimer's have significantly high levels of gingipains. So I think that is one of the main arguments which actually shows that there's a causative element to this and it's definitely not something to be kind of disregarded. But I'm still very much still kind of on the fence. And with all my patients, I still tell them all of this evidence and I say, look, worst comes to absolute worst, there's no causative kind of thing between the two of them. I just made you floss twice a day. That's it. You know what I mean? And I don't believe that. But worst comes to worst and they say, okay, there's no correlation. At least you don't have gum disease and you don't have decay and you've reduced your risk of inflammation. So, you know.
Dr Rupy: Yeah, yeah, yeah. I I haven't actually read that New York Times article about flossing and Alzheimer's, but like, did they speak to any studies that showed like a massive reduction in risk if you were to be in the cohort of people that would be flossing, say, once or twice a day?
Dr Victoria: No, so that's what they hadn't looked at was they looked at patients who had Alzheimer's and whether they had gum disease, but I think the next step would be also to see whether or not, like you said, if someone was healthy, whether there was a reduction in risk of Alzheimer's, but also maybe if a patient had very early onset Alzheimer's, if being able to manage their oral microbiome and improve their oral health and for example, eradicate that Porphyromonas gingivalis in the mouth, whether that would have a direct impact on the patient's Alzheimer's progression.
Dr Rupy: Is is this like a test that's like almost commercially available to look at, what do you call them? Gingipains? Is that is that what it is?
Dr Victoria: Gingipains. Yeah. Yes, so there isn't at the moment, I have not seen anything to show for you to be able to measure the level of gingipains in your cerebrospinal fluid or in your brain. But what I do is I go back a few steps and I look at levels of Porphyromonas gingivalis in the mouth. And and we do oral microbiome testing and then basically if patients have high levels of P. gingivalis, maybe combined with having a family history of Alzheimer's, then we go quite aggressive on making sure there's absolutely no P. gingivalis in the microbiome.
Dr Rupy: Yeah, yeah, that makes a lot of sense. And I think this is a combined approach would definitely be the way to go because I think, and this is a result of headlines like the New York Times where you have like flossing and the association with Alzheimer's is like almost framed as the sole causative organism or the sole causative reason, whereas in reality, something like Alzheimer's is so multifactorial. You have exercise, you have sugar, you have toxic exposure, mould, you have all these different things. So definitely paying more attention to our dental health is part of the part of the solution, but not the the the full solution. So is there any way to determine whether flossing or not flossing lowers your life expectancy? Is there is that a thing or is that is that something that is still sort of hearsay?
Dr Victoria: I think it's it's similar to what you said that, you know, life expectancy and all of that, it's all multifactorial. And I will definitely be the first to say that oral health has a massive contribution to quality of life, to life expectancy, to general inflammation, risk of other diseases for sure. But I don't think I haven't seen a paper as of yet to say that, you know, brushing is going to improve your life expectancy by 4.25 years. I wish that would make my job very easy. But at the moment, no.
Dr Rupy: In the similar vein, like flossing and Alzheimer's and this potential mechanism, super, super interesting. I I I love hearing about these studies. Are there any other associations that you've come across in the literature between flossing and other quite major conditions?
Dr Victoria: I wouldn't say it's specific to flossing, but it's more to do with kind of maybe gum disease or having lots of bacteria and plaque in your mouth. But there's a lot of associations. So I mean, things, I think we we've spoken about this before, but you know, things like heart disease, high blood pressure, infertility, one that I'm quite interested in at the moment is chronic kidney disease. And how patients who have, yeah, so actually what they found recently is that we know that diabetes can really exacerbate your chronic kidney disease and is a very high risk for having chronic kidney disease. But what recent research has found is that actually gum disease has the same impact as diabetes does to chronic kidney disease. So which is pretty wild. We also know the association of diabetes and gum disease and rheumatoid arthritis. So there's a lot of them coming out and I think right now it's an incredible time to be in our profession because we're starting to see that, you know, dentistry is not just about drill and fill, but actually improving oral health with the aim of contributing to general health and how important it is to have a good mouth. And also obviously making sure you don't have a high load of bacteria or problems in the mouth.
Dr Rupy: So I'm shooting from the hip here. So forgive me because I haven't pre-warned you that I was going to ask you about antibiotic use and its impact on the oral microbiota. But when you were just talking about the gut there, I was just thinking about overuse of antibiotics, particularly in patients who have got heart valves and we want to take quite a proactive approach with ensuring that they don't get any infections whatsoever. And the overuse of antibiotics just generally leading to susceptibility to other conditions, even things like autoimmune conditions. Do you see the same sorts of ramifications in the mouth for people who are using antibiotics for whatever reason, whether it's because of recurrent UTIs or recurrent skin infections, etc? Do you see manifestations of that in their oral health?
Dr Victoria: Yeah, so actually a lot of the time they will have quite a dysbiotic oral microbiome. And and that's just because antibiotics kind of, obviously they're they're needed and we have to take them and they've saved many people's lives. But what antibiotics can do are kind of, I call them like a nuclear bomb. They can just come and they just like get rid of all of the bacteria and they sometimes that's needed. But one of the consequences is that sometimes other bacteria are able to grow in that environment and become like the first early colonisers and start growing and multiplying. And maybe you don't want that bad bacteria in your mouth or in your gut. So it's quite important in my opinion that if you are taking antibiotics that you're taking pre and probiotics as well so you're trying to kind of guide the microbiome after the the detonation of your atomic bomb of antibiotics that you're guiding it into having good bacteria recolonising and and becoming those early colonisers. In terms of, you're right, the susceptibility to maybe other bacterial infections is it is quite worrying and I think I do prescribe antibiotics relatively kind of regularly. But what I do do is I do oral microbiome testing to then see what what antibiotic would be the best for that patient. And sometimes we might do a shorter course or depending on the kind of quantity of the bacteria and also what type of bacteria are there. And I think one of the biggest problems in our society is that we're kind of just throwing antibiotics out, we're throwing out broad spectrum ones for prevention of diseases as opposed to actually seeing what the cause of that problem is and then prescribing the right antibiotic for that infection.
Dr Rupy: Yeah, yeah, that makes a lot of sense. And I think that's testament to how forward thinking you and your the clinic are. Let's let's shift gears and talk about an issue that's close to my heart, which is receding gums. Can can we, I know we can't reverse receding gums, but how do we slow down, well why don't we talk about what what receding gums are first and and and why this might happen in and of itself?
Dr Victoria: Yeah, so basically receding gums are essentially where your gums starts to drop. So you have more tooth exposed and less gum. And it is a very, very, very common problem that people suffer from. And it's one of those kind of frustrating things because you can brush really well and eat really well and you have no dental disease, but you can still have dental pain because of your recession. And there's a couple of causes of recession. And some of them, so the first one is overzealous brushing. So that's the idea that you're basically just brushing really aggressively. And essentially you're brushing away your gums. And the problem is is that your gums don't grow back. So unlike a lot of the other parts of the body where, you know, if you if you grazed your your hand, your skin would grow back or anything like that, your gums don't. So overzealous brushing is the first one. And I would say the way to combat that is by brushing with an electric toothbrush which has a pressure sensor. And that way you should, you know, you can see when you're brushing too hard. Nine times out of 10, most patients are brushing way too hard and they think they're doing a good job. They're like, great, the harder I brush, the better I'm brushing, which is not the case. And you're brushing away your gums. So definitely go get a pressure-sensed electric toothbrush, look at the mirror and brush for two minutes. Don't walk around whilst you're doing the ironing and, you know, putting your stuff away. You know, devote it to yourself and sit and look and you'll be surprised at how often you're brushing way too hard. Another thing is toothpaste. So making sure that you're trying to use a non-abrasive toothpaste. So anything which has like little granules or is a bit crunchy, I generally like, I avoid those. You want something which is quite soothing to the gums and is soft. And that goes as well with trying to find a toothpaste which doesn't have lots of essential oils in it or sodium lauryl sulphate. So those are all things which can actually be quite aggressive to your gums. And I kind of compare it, if you were to get like a peppermint essential oil, very strong concentrated and you put it on your skin, your skin would burn, right? So why is it that we're we're all okay with with brushing with essential oils in our gums, which are so tender and sensitive?
Dr Rupy: That's a really good point. I don't think I've ever thought about that because a lot of the sort of quote unquote natural toothpastes are using cinnamon and ginger and fennel essential oils. And the sort of heuristic is, oh, well, it's a natural product, that that will be fine. But the way you've just put it there, that that makes total sense that it would be pretty harsh.
Dr Victoria: Yeah, it is. I don't know why people, I have so many patients who are like, oh yeah, I'm just brushing with like, I don't know, like fennel mixed with like essential blah, blah, blah. And I'm like, what are you doing? Like, and I said to one of them, like she literally had pure oil and she was putting on her toothbrush and brushing her teeth. And yeah, and then I was like, put some of that on your skin right now. And she was like, no, I wouldn't do that. I'm not going to burn myself. And I was like,
Dr Rupy: Right.
Dr Victoria: So yeah. Okay, so what else? So number two is sometimes when you have gum disease, one of the side effects is recession of the gums. So if your gums have been super puffy and you've had, you know, a lot of infections and inflammation, then once you've had your your gum treatments and your gums have healed, sometimes when they kind of tighten around the tooth again, they actually recede. And that's just an unfortunate side effect of of having gum treatment. It is definitely, you know, the the better thing than suffering from gum disease, but it is a bit annoying for patients who maybe have had gum disease all their life and then they come, they finish and they're stabilised, but then they have sensitivity kind of moving forward. And then the third is just kind of a a genetic predisposition. So, you know, we all have different skin, we have different hair, we have everything, you know, is all a little bit different. And unfortunately, some people have very, very thin and kind of friable gums. And some people also have gums which don't attach to their teeth properly. So they're kind of a bit like flappy. And those are patients who unfortunately, if they brush a little bit too hard or if they have a tiny bit of gum disease or even just, you know, anything, they are at a much higher risk of having that recession. And that's unfortunately just a a genetic thing that that happens. And that moves on to actually the last one, which is also sometimes genetic is basically, if you were to chop your your mouth in half, okay, and then you were to look at your your jaw from like a bird's eye view, okay? I do. Here's a 101, guys, on dentistry. Okay.
Dr Rupy: If you're if you're listening to this, you want to watch on YouTube to see what Dr Victoria is doing. But yeah, no, we can you can explain it.
Dr Victoria: Okay, so I'll also try and explain it to so for anyone who's listening, but okay, let's go for the top jaw. So you are looking at your jaw from a bird's eye view. And basically, you have something called a bony envelope. And what that is is basically the bone that all of your teeth are encased into. And sometimes some patients, unfortunately, or genetically, their teeth lay a little bit outside of the bony envelope. So again, imagine if you're watching, you've got this U-shape, imagine if this tooth was just out here, right? Then that means that that tooth has a lot less support than the other surrounding teeth. And that means that the only thing that's holding it in is that gum. And that gum will wear away with time. Unfortunately, it's not always genetic, it can also be caused. So a lot of people who have orthodontic treatment and maybe aren't kind of working with the right dentist or orthodontist, sometimes one of the things that we do is we expand the teeth. So we move the teeth so that people have toothy smiles and you can see more teeth. But one of the side effects of that can be sometimes that the tooth is outside of that bony envelope. And again, there's now no bone kind of covering the outside of those teeth. And the only thing that's holding them in is that gum and that gum, it's it's like a little thin piece of tissue. So of course it's going to it's going to kind of grind away. There we go, guys.
Dr Rupy: So I actually counted five things there, right? So there's or potentially six if you want to separate the genes. So brushing too hard, there's what you put on the teeth. So SLS, essential oils, other abrasive materials that you find. There's previous infections. So gum disease that would leave your your your remaining gums more more vulnerable. You've got the genetic component of just having gums that are a little bit weaker. There's another sort of what I I I forget the name, but you the way you described it with the U-shape and and the the actual bony prominence is really interesting. Another genetic component and then orthodontic work as well that could potentially expose that genetic predisposition. The orthodontic work is quite interesting because I've had orthodontic work back in 2009 and that was preceding any sort of recessions. I'm not trying to call out my orthodontist here on the podcast, but it's interesting you say that because I do have like a big wide smile and maybe maybe it sort of revealed the vulnerability in my in my genetics by having that work.
Dr Victoria: Yeah, yeah, some I think nowadays we're seeing a lot more of it than previously because it's, so my sister is an orthodontist and that's why I know a lot more about this because what she was saying to me was that over the past kind of maybe 20 years or so or 30 years, orthodontists are tending to kind of expand the arches and try and and keep as many teeth as possible but to have a really toothy smile and that's just the trend that's in right now. And previously we used to take out teeth and close up the gaps. And now a lot of the time we're like, we can you can keep all the teeth. Don't worry about it. We keep all the teeth but we spread everything out. And actually sometimes your jaw can't handle that.
Dr Rupy: That's yeah, that's so interesting. And with the genetic predisposition, is there any rationale of actually looking for those snips using a consumer genetic test? And is there an association between that and maybe some other things that might be going wrong in the body like your ability to recover from exercise or collagen production?
Dr Victoria: Yeah, so what I'm starting to find and I haven't actually seen any research published on this, but this is just what I'm seeing is that patients who have a lot of recession usually have quite high levels of collagen breakdown. And it makes sense because they're your gums are made out of a type of collagen. And so if you have high levels of collagen breakdown, that usually suggests you have some sort of recession or gum disease. And so in my clinic, we test for collagen breakdown. It's like a saliva test and it's a specific enzyme that causes that breakdown. And what I'm finding is that those patients have high levels of collagen breakdown and maybe their their oral immunity is a little less than average. But at the moment, I don't know of any kind of genetic tests so to say which would show you to be at an increased risk of recession.
Dr Rupy: Gotcha. Okay, that's that's super interesting. I'm chatting to a consumer genetic test company and the founder has got a PhD in genomics and I'll I'll pose that to to her actually. I think she she might be able to find some answers and I'll share that with you. Okay, so as someone, yeah, I will do for sure. As someone who suffers from receding gums, are there any ways to slow down the the process of recession?
Dr Victoria: So the electric toothbrush with the pressure sensor, yes, the toothpaste being non-abrasive and like free of essential oils and all of that. Otherwise, in terms of, I'm supplements, I actually do encourage some supplementation. So I'm a big fan of CoQ10. So that's coenzyme Q10. And the reason being is that part of the reason of gum disease is oxidative stress, but also CoQ10 can help with collagen production. And if your gums are made of collagen, it can improve that too. And there have been some super interesting studies which have been looking at CoQ10 and gum disease and basically reducing gum inflammation. So I would recommend CoQ10 for sure. What else? Is there a particular dose?
Dr Rupy: I think 100 milligrams is usually a good amount.
Dr Victoria: And then the next step is to find a CoQ10 gel, which there have been a few which I'm trying out at the moment. So like a gel that you can apply on your gums. And that would be super cool. So that's something I'm looking into at the moment. I think also what some, what I do sometimes for some patients is if they have really bad recession is we actually make them use a really soft toothbrush. So like a, so you have your electric toothbrush, you brush two minutes, and then you go over those areas of really severe recession with a very, very soft toothbrush and you just kind of massage gently. And that's just to make sure that you have absolutely no plaque and bacteria staying there because the problem is is that it's kind of like a self-perpetuating cycle because you have the gum recession. So then you're scared of brushing too hard in that area. So then you don't brush it. And then you get a collection of plaque and bacteria. And then that plaque and bacteria kind of irritates and disturbs the gum. And then the gum recedes even more. So it's it's super frustrating, which is why that that massaging of a really soft toothbrush around that area to make sure there's absolutely no plaque and it would be maybe a little bit more comforting for you because it's such a soft toothbrush to go in that area and clean it like that.
Dr Rupy: Yeah, that makes total sense. So brushing properly, using non-abrasive products, CoQ10, hopefully a gel coming soon, watch the space. What about protein deficiency? So when I talk about protein deficiency, I'm talking about dietary protein deficiency. Is there any association that you've noted in people who don't consume enough protein and the likelihood of of gum recession?
Dr Victoria: So I've actually, yeah, I've been looking into this again just with my own patients. We make them do a full medical history including their diet. And my idea was to see whether or not certain diets like vegan or vegetarian or or or, you know, carnivorous would have any kind of cause or implementation or, you know, anything like that. But actually, I haven't seen anything. So there's not been any correlation between any of those to be honest with you, which is kind of annoying because I wish there was.
Dr Rupy: Yeah, I know. You just want to put your finger on it and be like, oh, that's it. I can I can advise this. But yeah, okay.
Dr Victoria: Beyond the general recommendations of ensuring protein adequacy and an anti-inflammatory diet, I imagine that would have like general health benefits anyway. Is there any rationale for collagen supplementation? And I'm aware there are multiple different types of collagen supplements out there, whether it be bovine, marine, vegan, but let's just lump them all into one for now. Would there be any sort of benefit in the same way that you've you've seen with CoQ10 supplementation?
Dr Rupy: I do also recommend collagen supplementation as well, like the powder form. I think that and I do recommend it to a lot of my patients just just to use, especially if they have gum disease or recession, why not? Because your gums are made of collagen. And you're right, it's a different type of collagen, but it definitely does still contribute. And then generally what I say for for patients like overall oral health, I always say vitamin C, D, K2 and calcium. And again, vitamin C is a precursor for collagen as well. So that helps with with that side of things. And having low vitamin C can actually cause a lot of problems with the gums too. So those are like my general, every patient has that in their treatment plan, like you should be taking these things. And that's why we also test for it now too. And the crazy thing is is that I would probably say like 90% of my patients have low vitamin D levels, lower than they should be.
Dr Victoria: Wow.
Dr Rupy: Yeah, and I I was like, I called the the the machine company up and I was like, there's something wrong with your machine. Everyone's low in vitamin D. And he was like, you live in London, right? And I was like, yeah. And he's like, no, everyone's low in vitamin D. I was like, oh my god. Yeah. It's it's really worrisome how how low we all are.
Dr Victoria: Yeah, yeah. It's because we spend a lot of time indoors and just not getting the adequate amount of light as a result of living in the UK, unfortunately, which is why we should all be prescribed holidays. Vitamin C is really interesting because I was going to I was literally the next thing I was going to ask you about actually as it pertains to collagen production. What is there a particular dose that you're a fan of for a sort of like entry level or maybe a higher dose if someone does have like raging gum disease or or or recessions?
Dr Rupy: So we do 1,000 milligrams of vitamin C. And that's kind of been, I prefer either the spray or a pill form as opposed to the effervescent tablets just because they're fizzy and they've got sugar in them. But yeah, so that's my my general one. Another thing which some patients I do is liposomal glutathione as well. And that's again just a really strong antioxidant and it helps with general oxidative stress. But it's also it's because it's something that you pump into your mouth. So we we ask patients to do two pumps a day. So either they do two pumps, I actually get them to swill around with it and then they swallow it. And that again has been quite beneficial for patients too.
Dr Victoria: That's super interesting. Okay, so I've got my supplement stack here that I'm putting out. So I've ticked off a couple since you told me to do CoQ10, started that. Vitamin C, I feel like I'm adequate because I have a very green diet, but you know, you probably could do with just topping myself up on days that I don't get my my 10 a day. And then the K2 and D3, I've been taking as well. So specifically MK7 is the version of vitamin K2 that's usually combined in vitamin D3 preparations these days because of the calcium recycling requirements that you need when whenever you're taking vitamin D3. And the dose I'm using is 1,000 IU, which I think depending on, you have to titrate this, I guess, to to where your patient's at in terms of how deficient they are. I think 1,000 is probably like a a base requirement. I know in the UK, our government guidelines are like 400 IU, but the the reference ranges are quite low in my opinion, like 25, which is a low reference. I'm assuming you're using a higher reference range or?
Dr Rupy: Yeah, so we actually use the German reference ranges. And or also there's like a, I can't remember, but I think the there's like a functional reference range, which is actually where your level of vitamin D should be to have um, kind of more healing, if you want to call it. It's not just like the bare minimum to live. It's actually when you start feeling the benefits. So and the German and the the functional medicine ones are pretty much the same. So we use those and then yeah, we calculate how much vitamin D you would need based on how much you have currently. But I agree with you. I think 1,000 IU is is kind of like a a minimum for me. I I use patches a lot. So I use like these transdermal patches that you just put on your stomach and it's got a 5,000 IU. And so sometimes I use that like once a week or something. Yeah.
Dr Victoria: In terms of, so we've gone through a whole bunch of different supplements there, which I think are super interesting. Are there any other like more quote unquote natural remedies for recessions? If I ask my mom or anyone in my family, they'll reel them off. But I I want to ask you and your professional opinion. Are you have you come across any any more natural remedies for for recessions?
Dr Rupy: I actually haven't. The only thing I've seen some patients do is they get a CoQ10 tablet and they cut it in half and they put the the inside of the tablet or the supplement on their gums and they say it works perfectly. But apart from that, yeah, which I mean, I I'm not recommending anyone to do, but I can see why they would do it. But apart from that, honestly, I wish I could say that I've got some, but there's not been anything that I know of or have heard. Oh, well, actually, with like the diet side of things because is manuka honey and propolis. So, yeah, so not don't don't rub the honey on your gums or anything like that. More just having a just a kind of like a teaspoon of manuka honey a day has been shown to be very antibacterial and particularly against Porphyromonas gingivalis. And we all know Porphyromonas gingivalis is the one that we don't want. And on if you want to go one step further, propolis is the best. So propolis is basically it's bee pollen, but it's kind of the unrefined version essentially. And you can get a propolis spray. You can even get the propolis itself to eat, but it tastes pretty gross. So you can just use the spray and again, spray it in your cheeks or on your gums as well and that just apparently helps, but I can't, you know, there's not been any research to show it. This is just what some people have told me.
Dr Victoria: Fair enough. Fair enough. Yeah. Okay, cool. Well, that I mean, yeah, as long as people aren't going to be like rubbing this stuff on their gums because it is sugar, guys. So it's definitely definitely not advised to rub. I just did a little bit of looking up actually on the reference ranges that the Germans use. And I can't find, I think the the safe upper limit is 2,000 IU, but actually there's an organisation called the German Nutrition Society and they they state it should be like 4,000 IU per day. So I don't know, there's a bit of discrepancy there, but we'll find it and we'll put it in the show notes for sure.
Dr Rupy: So I know that what I do know, like which I'll tell you afterwards, which I just can't remember it is the actual reference of how much vitamin D is like how much you currently have and how much you should have as a like I wouldn't know on a daily supplementation thing because I think that needs to be calculated per patient, but what we do, I think is like 80, 80,000 for example, and then we like calculate how quickly you could get there. But I'll send you the calculation and also our references for that.
Dr Victoria: Let's turn our attention to me. So we did a whole bunch of tests, including the collagen breakdown test. So maybe you can walk us through that because that's an in-clinic test, isn't it?
Dr Rupy: Yeah, so it's point of care, so you get the results after 10 minutes. And basically, what it's looking at is an enzyme called AMMP8, and that stands for activated matrix metalloproteinase 8. And that is an enzyme which causes collagen breakdown and particularly the collagen that your gums are made out of. So if you have high levels of AMMP8 in your saliva, then that means that there's a lot of collagen breakdown. And the reason that this test is very interesting and the reason that I've decided to use it is because a lot of the time gum disease is it's quite invisible and we don't often see gum disease until it's too late, until destruction has occurred. And so this is a way of being able to flag up those patients who might be at an increased risk of recession or even just just, you know, gum disease, but they don't have any symptoms in their mouth yet. And sometimes it can take six months for those symptoms to actually start to to show clinically in the mouth. So by being able to flag them up earlier on, we can then be like, hey, you know, your collagen breakdown is slightly elevated. I would recommend that, you know, you come maybe more regularly for a hygiene or we switch your toothpaste or whatever you need to have done to basically get that collagen breakdown level low again. And the beauty of it is that we can retest. So most patients we we do the same test on them every time they have a hygiene, for example. And then if their levels become less than 10, which basically means undetectable, then we're like, great, you're stabilised, you can go back to maybe coming every four months or every six months for your hygiene. And, you know, crisis averted, we're out of the gum disease area. So yeah, so that's a it's a really good test.
Dr Victoria: Yeah. And and in mine, I can't remember now, but was it elevated?
Dr Rupy: I'm going to check. I have your You have permission to share my data. Let me see. I think I remember it being slightly high. Yeah, so yours were yours were high. It's it's a spectrum. So less than 10 is obviously undetectable. Then you've got 10 to 20, which is like, a little bit. 20 to 50 is like, you've got gum disease. 50 and above is like, you've got gum disease and you're probably have some sort of general disease or systemic problem that you're also fighting. People who have like rheumatoid arthritis or, you know, they're in the middle of chemotherapy or something like that, they often have like off the charts levels. And then again, in those cases, it's quite nice because you can flag those patients up and be like, hey, I think you should maybe see your doctor because these levels aren't going down and you have no problems in your mouth. So yeah, so yours were yours were in the 10 to 20 range. So you just had a little bit of gum disease or kind of inflammation or some sort of collagen breakdown, but it wasn't anything too dangerous.
Dr Victoria: Okay. And with the stack of things that I could be doing to slow recessions, would that have an effect on that result? And is it worth repeating in let's say three months time?
Dr Rupy: Yeah, definitely. So it would definitely be recommended to repeat that. And then also for a patient like you who, you know, you are at a high risk of recession and you have a little bit of collagen breakdown currently, and because of that recession, it's more difficult for you to brush, I would definitely say that you should come more regularly for a hygiene. So we do a treatment called guided biofilm therapy. And that's basically like a more kind of non-invasive option for a hygiene treatment. And it's where we disrupt the biofilm, we we show all of the bacteria first, and then we remove it using an antibacterial spray. And it's very gentle to the gums. And so that's again something that you could have done every month if you wanted to, and it wouldn't cause any damage. And it would mean that you would never get that plaque build up around those gum recession areas.
Dr Victoria: Yeah, yeah, which is something I because I I hate going to see the hygienist. It's usually like a really painful experience. And I kind of put it off and then like, you know, a year's gone by and I'm like, oh, this is worse because I should have just gone more often and just bit the bullet. But I remember when I had the hygiene session with yourself, it was a lot, and I'm not just saying this because you're my mate, but it was really nice and gentle. And I could see myself going back, you know, every two, three months or however often you recommend for me. So yeah.
Dr Rupy: I'm coming soon. Yeah, no, I I really do believe it. I think I feel like because, you know, I've done hygiene on with using lots of different instruments and stuff. And every time I'd have a patient with recession, I'd be like, oh, this is going to be a nightmare. They're going to hate me. I'm going to, you know, and then now that we've got this machine, it's like just a dream because the water is warm. We're able to remove like 70% of the plaque without even really touching your tooth because it's just like a jet spray of, you know, of powder. So it actually is really, really good for the gums. So anyone who's got recession, definitely get guided biofilm therapy.
Dr Victoria: And what what is the antimicrobial solution that's actually being sprayed? Do you know what what is what is the actual product?
Dr Rupy: It's erythritol. So it's a very, very fine parts like it's I can't remember the microns, but it's a really, really small version of erythritol. So it's so small that you could literally spray that powder on, it's powder mixed with water, but you could spray that like directly on your gums and it wouldn't make your gums bleed. But it's still got a large enough particle size that it's able to remove the biofilm and the bacteria and plaque and also staining as well.
Dr Victoria: And do we have some gum, sorry, chewing gum that's made out of the same product?
Dr Rupy: I think it's mainly more like xylitol and I don't actually there was an erythritol chocolate that came out. I know that, but erythritol then had a bit of a bad rep. So there was a study that came out, I think like two years ago or something or a year ago, which said that erythritol is not good for you and it could increase your risk of cardiovascular disease. The research is not in my opinion the most evidence-based, but also for anyone who is worried and is listening, the erythritol that we're using is not being ingested at all and it's such a small particle size that it's actually a completely different, it's not worth comparing to the erythritol that was in the study.
Dr Victoria: Okay. And I guess the consumption rates of that, if there was to be anything ingested would be a lot lower than than, you know, daily use, I guess.
Dr Rupy: Yeah, I think you need to be eating like a tub of erythritol and then you might have some problems. But like having a little bit of powder, they've done the company has done a lot of research on it and they've found there's absolutely no problems with it. So that's all good.
Dr Victoria: Yeah, yeah. I think it's a good point to note because people get very sort of antsy around any suggestion that there could be a negative side effect. I mean, if you look at aspartame and the arguments that are raging as a result of the latest association with cancer, you know, you have to be consuming quite a lot of this product to actually have any potential negative ramifications. And I'm not saying that aspartame is completely inert. It most probably is not, but like just taking the precautionary principle without getting too caught up in the narrative that anything that is toxic is something that you have to completely remove from your surroundings. You know, we're very resilient beings. So let's let's talk a bit about the other test that you you've done. So I'm I'm nervous about what you're going to tell me because I looked through the results. I don't understand pretty much any of it. I recognise some of the microbes that are on the on the report, but I'm hoping you can provide some clarity. So what what is the test that you you you did first of all?
Dr Rupy: So we did an oral microbiome test on you. So we were basically looking at the bacteria in your mouth. And the microbiome test that we did was looking at pretty much like the top 20 bacteria which are associated with gum disease, decay, but also can give indications of gut problems, systemic inflammation, and also it looks at fungi as well. So it looks at fungal infections too.
Dr Victoria: Okay. And how was the test performed?
Dr Rupy: So we basically make you spit in a cup. So you're not allowed to eat or drink anything for 30 minutes before. And then we get you to spit into this cup. It's like a test tube. And then we send that off to the lab. And then we analyse the the saliva for all of the bacteria. And then a couple of weeks later, we get basically a full panel of the bacteria in your mouth.
Dr Victoria: Okay. And so I'm looking at this panel right now. I see some red in the ranges saying high, which is not what I want to see or always raises alarm bells with me. I recognise some of the organisms like Enterococcus faecalis. I'm pleased to report there's none of that in my mouth. At least I don't think so anyway when I'm looking at this. And yeah, but but there are a few a few organisms that say high. So maybe you can talk us through my my results live.
Dr Rupy: Sure. Okay. Right, let's start with the easy ones. So you've got high level of strep mutans and high levels of lactobacillus.
Dr Victoria: Okay.
Dr Rupy: So what strep mutans is is a bacteria which is associated with decay and a high sugar diet. So when you see lactobacillus and strep mutans together, that means that patient's eating a little bit too much sugar.
Dr Victoria: I've been found out. You're exposed. Do you want me to stop or should I continue? No, you can carry on.
Dr Rupy: So yeah, so that's how I usually find out if a patient has a high sugar diet. And sometimes it depends on how if they're combined. So if you have lactobacillus alone, that means different things. If you have strep mutans alone, that's different. But yeah, so yours is a little bit of sugar, high sugar diet and potentially some decay as well. Prevotella intermedia. So that is a bacteria which shows up in patients who have a lot of chronic inflammation. And that can be localized to their mouth, but it could also be potentially general as well. So it could be that you have just a tiny bit of inflammation. And your level is not that high. Like I know it says it's high, but it's it's not. So I'm you're actually I wouldn't be too concerned by that. But usually patients who have high levels of collagen breakdown will have high levels of Prevotella intermedia and it's because you've got some sort of inflammation, you've got maybe some gum disease or something going on. Then if we go into, oh, this one's interesting. Okay. So you you've got your red complex pathogens.
Dr Victoria: Okay, yeah.
Dr Rupy: So these are basically the bacteria which are the worst in the mouth. And they're the most pathogenic against particularly for gum disease. So if you have high levels of these red pathogens, that means most likely you have some sort of gum disease or it could be that you had gum disease in the past and that gum disease, the the bacteria is still there. So in yours, you have ever so slightly high levels of Tannerella forsythia. And again, I would disregard it. I mean, you want zero and you're at 0.3. So I'm not worried about that. Then you have another one.
Dr Victoria: And what is Tannerella again?
Dr Rupy: Tannerella forsythia, it's one of the red complex bacteria. So that's to do with gum disease.
Dr Victoria: Oh, okay, fine. So it's just an organism. I haven't I haven't come across that before. That's yeah, it's a new word for me.
Dr Rupy: It's just a, yeah, because it's mainly it's always in the mouth and it's just to do with gum disease. And then the other one that you had is Actinomycetemcomitans. I can never pronounce it, but AA is what I call it.
Dr Victoria: It's a really long name. It's like 20 letters in that in that.
Dr Rupy: Yeah. So AA, we we call it AA is what I call it. And you do have slightly elevated levels of that. So generally, if you had if you had really bad gum disease, then and you had high levels of AA, then I would be worried that you have maybe quite an aggressive form of gum disease and it's quite fast and it's quick and we need to get going quite aggressively. Because you actually didn't have any signs of of active gum disease in your mouth, you didn't have, you know, bleeding gums or pus or anything like that, it could be that you just maybe had it in your your microbiome. But also there's a couple of different serotypes. So you've got some serotypes which are actually not that bad. And then there are some serotypes which are really bad. And so it could be that you actually had a not bad serotype in your microbiome. And again, it's nothing to be too worried about. So again, that's why I think it's really important for anyone who's out there who's listening that your microbiome test, a lot of people get excited and they're like, oh, I'm going to go do a microbiome test and learn all about my my bacteria. And that's great, but it has to always be paired with a clinical examination because what you have in your mouth does not necessarily mean that you have diseases or problems. And they have to all be paired with what's inside like clinically in your mouth. And it's again because of those serotypes, it's about the combinations of the bacteria. And what we see. And then the last one which was interesting is you had a slight
Dr Victoria: Sorry, just to just to underline that point, I think that's a really, really important point to make because like you said, a lot of these tests are becoming available to consumers. And I think without the clinical input of, okay, yes, that's high, but you don't have past your your your gums aren't like super inflamed, they're not bleeding, all the rest of it. It's something that you can have a measured response to, whereas if you're just trying to do this yourself and and you know, even more so in the mouth where you can't like properly examine yourself. So yeah, I just wanted to underline that point.
Dr Rupy: Yeah, and and it it is kind of frustrating. It's it's nice that people are taking health into their own hands and I'm fully up for that. But at the same time, again, the mouth is something that you can't see your own mouth usually. And so starting to do things based on that bacteria is not recommended. So please, please don't try this at home. So then the last one is you had slightly elevated levels of candida. So you have a very, very slight candida infection in your mouth. Now, again, what is interesting in your case is when I looked in your mouth, you didn't show any signs of a candida infection. And you don't have any symptoms of a candida infection. You never said to me, oh, I have a sore tongue or I can't, you know, nothing like that. So again, this is another example of when someone might have high levels of something in their microbiome, but don't jump and get excited and start doing things because of it. Now, in your case, I basically, I mean, I think you do have candida and that combines with your high sugar diet. So it means that the candida is feeding on that sugar. Sorry. Your mildly high sugar diet. Just once in a while on holiday.
Dr Victoria: The mouth does not lie. The mouth does not lie.
Dr Rupy: The candida might be feeding on some of that sugar. And so part of your recommendations was to reduce your sugar input and and to try and yeah, not eat so much sugar. But also, some more kind of natural things. So I wouldn't jump and give you antifungals yet because I think that's a bit too aggressive. Your your levels are not that high, but they're high enough that something does need to intervene before that candida is allowed to grow and cause more problems.
Dr Victoria: This is so interesting. This is super interesting because like, you know, if I just do something that I do with patients, which is a 24-hour recall of like what I had for breakfast, lunch, dinner, what did I snack on, what did I drink? I had a little bit of ice cream yesterday. I had a little bit of healthy chocolate in the afternoon by healthy, I mean like above 75%. But then there's also some refined carbohydrates there that, you know, will turn to sugar in the mouth after after chewing. So, you know, it might not even be like what we think of as sugar, like candies and sweets and all that kind of stuff. It could also be just, you know, refined carbs in the diet. So, yeah, I definitely have to look at that.
Dr Rupy: But also, I think it's it's how people eat sugar as well. So, for example, and I don't know if you did this, but if you had your little bit of ice cream, if you had your bowl of ice cream over an hour and you're just having like a spoonful every five minutes, that's much worse than if you were to just have it all in one go. And it's more about how many sugar attacks you have a day as opposed to the quantity of the sugar. So generally, I always recommend that, you know, if you're going to have your bag of M&Ms, eat them all in one go and then, you know, rinse with water and call it a day. It's probably not what you recommend, but I would prefer that than someone who has two M&Ms every 10 minutes for the, you know, and they're just grazing and they're like a squirrel all day because their saliva and their mouth can never ever relax and get back to a healthy state.
Dr Victoria: That's super interesting. Yeah. And in terms of like some of the other bugs, I can't remember, did we talk about Capnocytophaga gingivalis that also was high on on my
Dr Rupy: No, we didn't. So interestingly, this is again something that I'm seeing a lot with recession patients, such as yourself, but also some gum disease as well. So this is more of a bacteria for gum disease. And it's not to be mistaken with Porphyromonas gingivalis, which some people get worried and they're like, oh, I've got one of the gingivalis in my mouth, but it's it's different.
Dr Victoria: Yeah. Okay, so that's another association. And and in terms of like some of the other bugs that I don't have, what are they show? Like are they ones that you're specifically looking out for for particular disease states?
Dr Rupy: So, Campylobacter rectus is something that you don't really, you shouldn't really be finding in your mouth. So that's something that maybe a patient has some sort of gut problems. And some of the other ones are again to do with with gum disease, but varying levels of gum disease. And again, I think it's really, it's mainly to do with the combinations of the bacteria. So it's if you have high levels of, for example, all four of those red complex pathogens and you've got gum disease that I can see in your mouth, then that's going to mean maybe potentially antibiotics. It might mean that we're super aggressive because the bacteria in your mouth is very stubborn and not easy to get rid of. So, yeah, and then we we also, so we're actually going to hopefully be changing this panel anyway. So we're going to be adding a few more in there, which are going to be indicators of more of a healthy microbiome because it's not always about the bad bugs, but it's also about your diversity and and essentially the balance of good and bad bacteria.
Dr Victoria: Yeah. Okay. Well, when I repeat this and I go on a strict low sugar diet, A, how long between the test should I leave it or should a typical person leave it? And B, when is that test available? Because I'd love to show you some good marks as well as the the bad marks.
Dr Rupy: So, the generally, I would recommend six months between microbiome tests. And that is with you having done two guided biofilm therapy treatments between that. So for a patient like you, I would ask for you to come back for that hygiene treatment that I would do for you twice. And then maybe a few weeks after the second time, then we would get you to do another microbiome test and see whether things have changed. In terms of when the new test is out, it's taking a long time. So everything's a bit of a nightmare when you get into the medical diagnostic side of things, but hopefully soon.
Dr Victoria: Okay, that's great to know. And I think, you know, just as we're talking about organisms and bugs and fungi and all this kind of stuff in the mouth, the natural inclination for someone listening to this might be to grab a bottle of Listerine and ensure that they're nuking everything in their mouth that could be causing a problem. And I can see you shaking your head there for anyone that's not watching on YouTube. Tell us about mouthwash and why people should not be using mouthwash.
Dr Rupy: So, mouthwash is basically, I mean, usually it's more of like an antibacterial nuke that kind of just kills all of the bacteria in your mouth. Some mouthwashes have alcohol in them, which can actually damage the mucosa, so all of the cells inside your mouth as well. So definitely always avoid alcohol mouthwashes. So I generally, I actually really like mouthwashes, but it has to be personalized and specific to the patient. So that's what I think a lot of people don't realize. And like you said, they run and they go get the the first Listerine that they can find off the shelf and they start using it. And the problem with that is that you might actually be, your your microbiome in your mouth might be perfectly balanced. And then you're actually imbalancing it because you're starting to use mouthwash that you never needed. Also, again, a lot of them have alcohol, so you don't want to be using that. I so for me, I recommend specific mouthwashes to patients based on their microbiome results and what bacteria they have so that the mouthwash works for that bacteria. And often we might not even recommend any mouthwash and actually everything's great. So that's kind of my my kind of thought on on mouthwash generally. So it's not for everyone. It should be prescribed essentially by your dentist and it should be thought out. It's not just jump and go get something. And obviously we've all had bad breath before. If that happens to you, fine, go do it. But it's not something that you're doing on a daily basis thinking this is going to improve my oral health and I'm going to be much better for this because it's not.
Dr Victoria: Okay, so with mouthwash, definitely avoid the alcohol-based ones, the quite strong ones. What should someone be looking for if they are going to be using a mouthwash or does it always have to be prescribed by someone like yourself or a hygienist?
Dr Rupy: I generally would prefer people not to start using random mouthwashes. So it's not, yeah, so that's my general. If you really, really, you're dying to use a mouthwash and you really don't want to come and see one of us and and see which one's right for you, then maybe a probiotic mouthwash would be the best because you there's very little risk of you causing any harm to your microbiome. So I like one by InVivo. They do Biome Oral. It's like a powder that you mix with water and that activates the probiotics and then you rinse with it and then you swallow it. So it's like a two in one and it helps the gut too. Or Lovebiotics as well.
Dr Victoria: Oh, right.
Dr Rupy: Yeah, it's really good actually. Or Lovebiotics and they do another probiotic mouthwash which is great too. So those things won't cause you any harm. So I'd prefer that than jumping at it. And another thing as well is actually people often will use mouthwash immediately before or after brushing their teeth, which they should not be doing. So you want to be using your mouthwash at a separate time to brushing. Generally, I recommend lunchtime. So keep it at your office and use it after you have your lunch. And the reason being is that your your mouthwash and brushing your teeth, they kind of counter balance each other. So they cancel each other out. So all of that goodness that you've just spent two minutes brushing your teeth with, then is all cleared out by the mouthwash and actually the chemicals sometimes in the mouthwash and the toothpaste kind of don't mesh properly together. And you're basically back at zero.
Dr Victoria: Right. Okay. So don't use a general mouthwash, separate your mouthwashing if you do choose to mouthwash, try and get prescribed and try and go for a probiotic one. The antimicrobial elements in a mouthwash that you might be prescribed, what what are those? Are those the actual probiotics that are displacing any pathogenic microbes or do they have an antimicrobial element in them as well?
Dr Rupy: So no, they've got antimicrobial elements and that's why I don't like telling people to to use like a blanket mouthwash. So you've got some, you've got things like sodium hypochlorite, so we've also got chlorhexidine, we've got loads. There's lots and lots of different ones that and those are all antimicrobials which are aimed at specific bacteria. So some of them are oxidizing, so they basically create and release oxygen and that kills the bacteria that hate oxygen in your mouth. There are some which are really, they have very good substantivity, so they kind of can sit under the gums and around the teeth and kill the the bacteria over a longer amount of time. So they're all, that's why I mean, you really want to go and use one that has been recommended to you because of what you need rather than just jumping and getting something.
Dr Victoria: That makes total sense. It's almost like you're getting prescribed an antibiotic really. And that and that it sounds like it's being used in that targeted way, particularly if you're using something like chlorhexidine. You know, you're going to be targeting a certain microbe. So with regards to general dental advice, is mouthwash part of that stack or is it just proper toothpaste, flossing, interdental brushes if needed, and obviously brushing as well with the appropriate toothbrush?
Dr Rupy: Yeah, I think mouthwash is an add-on. And if you if you brush well using what you just said, good toothpaste, good toothbrush, and you're flossing and you have a good diet, that should be usually more than enough. I like to keep it very simple for patients and just get them to do the basics but really well, as opposed to being like, oh, use this and that and try these and, you know, it it shouldn't be rocket science. It should be a lot easier than I think sometimes we are made out to think it is.
Dr Victoria: Brilliant. Well, on that bombshell of finding out about my diet, I'm going to leave you there. I've got I've got a ton more questions. I would love to do this again actually with my results in the next like six months or so. In the meantime, I'll have my second hygiene appointment. I'm going to book in now with your with your staff and and yeah, and get that get that sorted for the next time. But that's definitely given me the motivation I needed. My pleasure. Thank you so much, Victoria. This has been brilliant. Thank you so much for having me. Thank you.
