#298 How to Reduce Inflammation with Dental and Oral Care | Dr Victoria Sampson

Dr Rupy: If I brush my teeth properly can it prevent dementia?

Dr Victoria: Fairly true, it's a small, it's a piece of a much larger puzzle, but oral health does play a large factor in in Alzheimer's and dementia, yes.

Dr Rupy: Okay, good. Don't worry, we're not going to snip this and put this on social media. Dentist says you can cure dementia with your teeth brushing. Mouthwashing every day as general hygiene is overhyped, true or false?

Dr Victoria: True.

Dr Rupy: As in like it is overhyped?

Dr Victoria: It's overhyped.

Dr Rupy: Oh, okay. Flossing damages the gums.

Dr Victoria: False.

Dr Rupy: Toothpaste without fluoride is a waste of time.

Dr Victoria: False.

Dr Rupy: Everyone should test their oral microbiome.

Dr Victoria: True.

Dr Rupy: If my breath smells, it's potentially because my oral microbes are off.

Dr Victoria: True.

Dr Rupy: Interesting. All right.

Dr Rupy: Let's unpack some of this. Let's go through the dementia links first because I don't think people will typically associate oral health with brain health or some of the other chronic conditions that we're going to get to a little bit later. And I know you're dying to unpack that a little bit more and add some nuance to it. So why don't we talk about that first?

Dr Victoria: Yes, so there is actually a very strong correlation between Alzheimer's and oral health. And particularly in the last kind of five or ten years, there's been a lot more research into it. So what we're starting to understand is that oral health plays a large factor in initiating neurodegenerative diseases, but also if you already have a neurodegenerative disease, it can increase your cognitive decline as well. So they, there was a couple of research studies where they looked at oral health and its connections and they found that in a lot of patients who had Alzheimer's, so in over 97% of them, they had a specific oral bacteria which had travelled from their mouth, crossed the blood-brain barrier and had gone into the cerebral spinal fluid. And that oral bacteria is only found in the mouth. And that bacteria is called Porphyromonas gingivalis. So we'll call it PG. And PG basically releases certain virulence factors. So we can both have Porphyromonas gingivalis in our mouths, but I might have an extremely virulent strain of it, you might have a completely healthy strain of it. And these virulence factors can be released and there's a few in particular called gingipains. And these gingipains are the ones that can travel and go through to the blood-brain barrier and have been shown to actually impact neurons in the brain and were the ones that were found in 97% of patients with Alzheimer's.

Dr Rupy: Wow. Okay. So if we were to do a test on someone and we were to find a particularly virulent strain of this bacteria, how certain can we be that this is increasing the risk of Alzheimer's? I.e. if I find it, do I need to do something about it and can I do something about it?

Dr Victoria: So in my opinion, yes. Alzheimer's is such a multifactorial disease and there's so many factors that you can't change. And oral health is one that you can very much change. And so actually there's been a lot of research to look at how we can reduce the virulence of those oral bacteria and basically get rid of gingipains. So there's been research into gingipain inhibitors. So those are medications which might actually just stop the production of gingipains. They're still very much underway and we don't have very much kind of, we don't have any answers on that. But a very natural way of reducing your Porphyromonas gingivalis levels is obviously, yes, taking very good care of your oral health, but also manuka honey and propolis. So propolis is my favourite thing in the world. Yes. And there's been quite a lot of research to show that propolis is extremely effective at reducing Porphyromonas gingivalis and also reducing the virulence of Porphyromonas gingivalis. So I recommend it to everyone, but in particular, if you were to, for example, do a microbiome test and you find out that you do have gingipains, it's not to say that you are going to get Alzheimer's, but it is a risk factor that can increase your chances of it. So just by having some propolis, you can mix it with some water, rinse it and swallow it, or I just go straight. I go straight in the back of my throat. That will definitely reduce it.

Dr Rupy: Okay. So, do we have an idea of how much increased risk you are of Alzheimer's if we are to find PG gingipains in the mouth?

Dr Victoria: No, because it's so multifactorial, it's really hard to pinpoint exactly oral health to and gingipains for Alzheimer's. But I guess with the research on, you know, 97% of Alzheimer's sufferers having gingipains, I guess you can say it's a pretty high correlation or high connection between the two of them. They've also done a lot of longitudinal studies where they've looked at, you know, over 7,000 or 10,000 patients over 10 years and they found that patients who suffered from periodontal disease had a 70% higher chance of Alzheimer's as well.

Dr Rupy: Okay. So we have these associations. Do we have an idea of the mechanism? I understand it's in the mouth, found in 97% of people with Alzheimer's. There is a method by which it can cross the blood-brain barrier and go into the brain. Do we have an idea of the mechanism by which it's causing, potentially causing Alzheimer's, even if we can't say that?

Dr Victoria: So the gingipains have been shown to actually break down brain tissue within the brain. So they've also done some research where they have on mice, however, where they've injected mice with Porphyromonas gingivalis and particularly ones releasing gingipains and they were able to accelerate neurodegeneration in those mice.

Dr Rupy: Wow. Okay. And human studies?

Dr Victoria: I guess we can't do that. I feel like if you ask me this 60 years ago, for sure we would have been able to do that. But unfortunately, not now. But the research on gingipain inhibitors, I think will show a lot. If we can find a gingipain inhibitor which stops the production of gingipains, then we could introduce that medication into patients and see whether or not that stops them from getting Alzheimer's as opposed to an intervention where we cause Alzheimer's in someone. So that's I think where the research is going, but at the moment there isn't one which is which doesn't cause other problems basically.

Dr Rupy: We've got to talk about propolis, okay? Because I, like we've done like deep dives into honey and we looked at the structure of honey and we're like, okay, look, it's 80% sugar, guys, and there's a few antimicrobial elements of it and there's a few micronutrients and stuff. So my read of honey in general, including manuka was, it's probably some antimicrobial benefits. Definitely take it if you've got a sore throat. Other than the flavour of it and using it as a nice sweetener, it's got the same biological properties as sugar. And so I've sort of discounted anything to do with anything, you know, related to Alzheimer's or removing certain bacteria that could be associated or are associated with Alzheimer's. Talk to us about propolis and manuka because this is mind-blowing for me.

Dr Victoria: So actually, I was, I was speaking at a conference in New Zealand and of course, exactly, that's where it all came from. And they're like the home of propolis. And I was getting onto my flight and I was looking around me and literally everyone just had this like little tincture and they're all just dropping little drops of propolis in their mouth. I was like, what are you guys doing? And so I asked a woman, I was like, is there like a prerequisite to get on this flight? Like I didn't know. And she was like, it's super antibacterial. And it's, it's anti-inflammatory. And so if you're getting onto a flight, for example, it just helps you stop getting any sort of bacterial infection or or any problems during your flight or afterwards. And then I'd already heard of a lot of research to look at propolis and mouthwashes. So I did like a very deep dive into it. And propolis, if anyone's ever tried it, it's not sweet. It actually tastes pretty gross. It kind of stings as well, which I quite like that sting because I feel like it's like killing it. Yeah, I'm like, it's killing everything that I don't want. So I really like it, but it does, it's very low in sugar content. So I wouldn't say it's a substitute for sugar for people. But yeah, very, very little sugar. I would say if you are looking at getting a propolis kind of supplement or or what not, make sure it doesn't have any added sugar, but also alcohol. So unfortunately, a lot of propolis, they will mix it with some sort of alcohol. And obviously we don't really want to be putting alcohol in our mouths either. So just be mindful of that.

Dr Rupy: So propolis has this antimicrobial benefit from from what I'm hearing. Why don't, there's probably a skeptic out there saying, well, I'll just use mouthwash. I'll just use Listerine. I'll kill bloody everything. That's a, that's a proper A-bomb going off in my, in my mouth. Why wouldn't I just do that?

Dr Victoria: Because you don't want to kill everything. And I think this whole idea of like antimicrobial mouthwashes, just kill everything. That really came out in like the 1930s, thanks to companies like Listerine, where at that time we did think that all bacteria was bad bacteria. But we now understand that it's such a complex ecosystem and there are really bad bacteria, there are really good bacteria. And a lot of these really strong antimicrobial mouthwashes will strip basically all the good and the bad bacteria and they won't necessarily dictate what new bacteria forms or colonises in the mouth. So with something like propolis, which is, it's a natural form, it's a lot more directed at bad bacteria. It's a much better alternative to a lot of those antimicrobial mouthwashes. And don't get me wrong, sometimes you need those mouthwashes, but it shouldn't be something that we all turn to every day and just use regularly.

Dr Rupy: Yeah, yeah. I remember you prescribed me an antimicrobial mouthwash and I remember thinking to myself, hold on a minute. But there was a reason. So there's clinical reasons as to why you prescribe mouthwashes, but it's not for everyday use. So what I'm hearing is propolis is a gentler, more directed way of being antimicrobial, but it doesn't have a sort of generic effect on every microbe in your mouth.

Dr Victoria: Yeah, and it's very high in antioxidants as well. So it's a great, yeah.

Dr Rupy: I'm going to get some propolis. But it's expensive stuff, right?

Dr Victoria: It can, it's not always. Like I, I've literally tried every propolis now on the market because when I was in New Zealand, I got the best propolis I've ever had and I was like, wow, this is amazing. And like, I've even, I mean, it was like a little tasting session. Like I was like, okay, this is a bit too gloopy. This one's a bit too thick. This one runs out of the bottle because we recommend it a lot, like in our microbiome tests and to our patients. So you can get them for like 10 pounds. So it's, it's not as expensive as people think. You just, there's a couple of really good brands out there. Just make sure that, you know, it does have propolis and it doesn't have alcohol in it. And I like the ones in a dropper as opposed to the spray. But those are for different things. Like a spray is better for a sore throat, but the dropper, you can mix with water, rinse it around and swallow and that's probably better for the oral microbiome.

Dr Rupy: Okay. And so you do that, you do it that way?

Dr Victoria: Okay, I'll do it that way. All right.

Dr Rupy: I'm going to have to get some recommendations for brands as well because I know that within manuka honey, there's a lot of, well, within honey in general, there's a lot of fake honey, right? They just mix glucose syrup, they add a funky label on it and you just don't know what you're getting. So a third-party tested honey, especially if you're going to be investing that much money into it, is probably the way to go.

Dr Victoria: Of course, yeah, yeah, super important. Yeah.

Dr Rupy: Okay, cool. Okay, so that's brain health. Definitely something that we should all be thinking about. What about other chronic conditions that perhaps people don't associate with their with their mouths?

Dr Victoria: I think the the biggest one that everyone should know about is diabetes. So very, very strong connection between gum disease and diabetes and it's bidirectional. So if you have gum disease, you're over 50% higher risk of having diabetes. And if you have diabetes, you're also about 50% higher risk of getting gum disease. So they they both work in a bidirectional way, but also what we see a lot in our clinic, so we, for example, if you have gum disease, we test your blood glucose levels. And a lot of the time, patients will have diabetes without even knowing. And if we are able to manage their diabetes, the treatment of their gum disease becomes a lot easier for us and we get much better results. So even just having a like a a normal hygiene can reduce your HbA1c levels by 0.5%.

Dr Rupy: Really?

Dr Victoria: Yeah.

Dr Rupy: Just having a regular hygiene, what like two, three times a year, four times a year?

Dr Victoria: Yeah. Yeah. So and it shows you because it, you know, gum disease is an inflammatory condition. Um, which is stimulated by bacteria in your mouth. Yes, but it's it's inflammation at the end of the day. Um, and so it it works in both ways for diabetes.

Dr Rupy: That's incredible. And I also, just to pick up on that, I'm not aware of many dentists that actually do venous blood draws at their clinics, right? So that's very novel with the way you practice dentistry.

Dr Victoria: Yeah, so we we kind of have this philosophy that, um, you know, the mouth is the gateway to the rest of the body, but also that a lot of patients, um, they don't see their doctor very regularly. So, I mean, most patients in in the UK will go to see their doctor when they have a problem. And by that point, it's too late. So at our clinic, we test people's blood pressure, we do blood glucose levels, vitamin D tests. Um, and these are very easy, cheap things that we can do. And the number of patients where we've highlighted that they have really high blood pressure and they didn't know. Um, or that their vitamin D, I don't know, I mean, I'd probably say 90% of our patients are low in vitamin D. And again, those things will help our treatment of their oral health, but also it can flag up a patient who's at risk of having a problem and get them the treatment that they need before it becomes a bigger issue, which will be cheaper and better for the patient.

Dr Rupy: Man, that should be like in every endocrine clinic, you know, this idea of having regular hygiene cleans and reducing HbA1c by that average. Like that's massive.

Dr Victoria: There there are a few new clinics coming up. So there's a few for for, yeah, diabetes where they're now acknowledging that gum disease is kind of the seventh complication of diabetes. And so a lot of GPs now will say, you know, if you have been diagnosed with diabetes, you need to see your dentist and make sure that you're having hygiene regularly and you don't have gum disease. And the same goes for heart disease as well. So there's a lot of um centres for heart disease or cardiovascular centres and um they're now understanding that also having hygiene and maintaining good oral health will improve heart health as well.

Dr Rupy: Let's double click on heart health because I don't think people recognise that as well. I mean, I have my little model heart over there as well, right next to the teeth just to give people a clue as to the connection. Um, is there a relationship there and again, is that bidirectional?

Dr Victoria: Yeah, so again, huge connection. I would say the the two biggest kind of oral systemic links are diabetes and heart disease. They're your your biggest ones. And those have been accepted by every professional body by this point. So with heart disease, there's a few things. So I guess if we start with hypertension, where heart disease kind of starts, which is high blood pressure, what can happen is the bacteria in your mouth can release certain inflammatory markers and those inflammatory markers can travel through the blood and they can disturb um your blood vessels and how they dilate and they constrict. So they'll actually impair vasodilation, which means that your blood vessels are not able to be become larger or smaller and therefore limited blood is able to travel through to the heart. So that's kind of step one of of cardiovascular disease, but also how oral health is impacting that. Um, and then if we look at patients who actually have cardiovascular events, um, there is a very high risk if you have gum disease, there's an increased chance of cardiovascular disease and also increased levels of CRP. So patients who have periodontal disease release a lot more CRP and we know that that's quite a strong um kind of risk factor in cardiovascular disease. And they've now also found that if you have periodontal treatment, that reduces the CRP levels of the rest of the body, which will therefore reduce your risk of cardiovascular disease.

Dr Rupy: Gosh. Again, just same hygiene.

Dr Victoria: Yeah. I hope everyone books a hygiene.

Dr Rupy: It's like, I think what kind of frustrates me a lot, and I think part of it is the dental profession as well, is that we we look at hygiene as this kind of, it's like a beauty treatment. It's it's there to make you feel better and to make your teeth clean and you know, we advertise it as, you know, it we take stains off and it's whitening and it makes you feel fresh. But actually, it's it's so much more than that. And it's reducing your bacterial load, it's reducing your inflammatory load, um, it's improving your systemic health, like it's super important that patients go regularly for their hygiene.

Dr Rupy: There is this sort of um pushback against hygiene and flossing and other dental procedures in general, um, based on this sort of naturalistic idea that we haven't had these kind of interventions for most of human existence. And it only seems to be a result of modern living and modern environments that we have the need for for teeth cleaning, etc. Um, what do you say to people who are like, look, I have a great diet, I have no sugar in my diet, like I don't need these kind of things. And we shouldn't need these these kind of interventions.

Dr Victoria: I think, you know, it some people do say that like, I don't need to floss because I don't have sugar. Um, which I disagree with. 30% of bacteria is in between your teeth. So if you're not flossing, then you're not getting rid of 30% of that bacteria. And it's not just sugar and a great diet that will reduce your risk of oral diseases. It's so many other things that contribute to that. Um, I do agree that our our lifestyles have become more westernised and as a result of that, we increase our risk of a lot of diseases. And therefore, we need to have a lot more interventions to to stabilise those diseases. But for example, they did some research where they looked at the calculus or tartar from um stone age, they found, you know, skeletons and they found this calculus and they broke it down and they looked at basically what the oral microbiome was like, you know, centuries ago. And they found that it was a completely different microbiome to what we have currently. And to those people who say, oh, well, I eat really well now. Yeah, but you know, were you born? Did you have all the bacteria when you were born? Did your mother have all of that bacteria? Did she pass on the right bacteria to you in those first few years? Were you eating correctly? Probably not the same as you would in the stone age days. And it's great to have great habits now, but you still probably have quite a westernised microbiome.

Dr Rupy: Yeah, yeah. We don't really have the choice. Uh, you know, it's funny. We were literally just talking to an immunologist earlier today about how during those formative years, you seed your immune system, your microbiome, your digestive microbiome and I'm assuming also your oral microbiome for life. So the habits in your 20s and 40s, whilst they can be improved and they're always great, like you can't change too much of what's already seeded in your early years.

Dr Victoria: Yeah, so like that core microbiome is established within the first couple of years of of living. And that is dictated by your mother's microbiome. So, um, whether or not you were a natural delivery, were you a cesarean? Were you breastfed? Were you bottle-fed? What type of food did you eat in the first few years? When you got your first teeth, what food were you eating? Were you having hard foods? Like all of those things will dictate the the microbiome from those early stages. And yes, we can we can modulate the superficial bacteria and we can fine tune things. But what we've um found recently is that a lot of patients um who do our microbiome test, a lot of them don't have very much good bacteria in their microbiomes. And that's because of, you know, at birth, maybe they didn't have that good bacteria and they weren't passed that on. And it's very hard to create those good bacteria later on in in later stages of life.

Dr Rupy: One of the team members was just talking about how not to not to like name and shame, but she was talking about how um whenever she goes to see the hygienist, they always talk about how like wonderful her teeth are, but she doesn't go that often at all. And I don't believe she flosses. Are there are there certain people with a genetic makeup or perhaps favourable oral microbiomes as a result of delivery and the microbes that they were passed on passed on by their parents? Are there people who are naturally more resistant to plaque build up and?

Dr Victoria: Yeah, 100%. So there are lots of genetic mutations um which we're learning more about now where, you know, there are some which will increase your risk of decay. So, you know, they it might be that you break down um sugars in a more acidic way than another person. It might be that you crave sugar more than someone else. So if you're stressed out, some people reach for the bottle, others reach for a candy bar. There's mutations which mean that you um need more sugar than the person next to you um to feel satiated. So you have a sweet tooth. You actually have a sweet tooth. Yeah. Yeah. So I have a sweet tooth. You have a sweet tooth. I do have a sweet tooth. Um, but I also like, obviously, I've done every test. Um, and I definitely, I I have a sweet tooth. I um, I I need more sugar to feel satiated. But there are other mutations which mean that you um have more plaque which colonises around your gums and you build up plaque quicker than other patients. And that's where we see a lot of people say, oh, you know, I brush all the time and I have hygiene regularly, but I keep on getting plaque build up or I have this furry feeling in my mouth. A lot of that is dictated by mutations. And then from gum disease, um, there's mutations that can triple your risk of gum disease. Um, there are ones that mean that you're more inflammatory. So, uh, you know, I see it a lot in my clinic where we have patients who they brush five times a day, they they eat well, they're perfect. Everything about them is perfect. But they have raging gum disease. And a lot of that is dictated by their genetics. And even though they try everything to reduce that risk, um, what happens is that even if they have the smallest amount of bad bacteria, their body responds in a hyperinflammatory, aggressive and destructive way that they just have a much higher risk of gum disease than another person.

Dr Rupy: And just going back to the blood pressure, um, uh, association there, do we have an idea of like how much someone's blood pressure could be reduced by having regular cleans, like by number of, um, mercury or?

Dr Victoria: Not that I'm aware of, unfortunately.

Dr Rupy: And another, um, question on that is, a lot of the blood pressure that we see in primary care is what's deemed essential hypertension. So, I, we have no idea why you have high blood pressure, you just seem to have high blood pressure. But the, and there are certain people who are salt sensitive, there are certain people who have a renal reason as to why they have high blood pressure. But a lot of it is unknown. And I wonder how much of that could be, um, explained by poor oral health. Again, do we have any idea of what percentage that could be?

Dr Victoria: I can't give you a percentage. I can give you anecdotally that yes, I do see it a lot where they have an unexplained, you know, high blood pressure and having treatment, be it gum disease or even just, you know, um, infected teeth, um, having abscesses, you know, these all insight inflammatory responses in the body and that inflammation can travel and cause, you know, high blood pressure, um, amongst a myriad of other things. So we do see it quite often in our, in our clinic and, but I wouldn't be able to give you a percentage.

Dr Rupy: We're learning a lot more about how inflammation plays a role in, um, mental health issues as well. I wonder if there is any data that you've come across that that speaks to the association between poor oral health and a higher likelihood of anxiety, depression, and maybe even other mental health issues.

Dr Victoria: So there's the oral gut brain axis. Um, and that's the idea that your your oral and gut microbiome are very intimately connected. Um, and also your oral and gut microbiomes are connected with your brain. And so therefore, um, the bacteria and the ecosystems that you have in your mouth and your gut can, um, dictate or impact, um, how your brain functions. So there has been research to show that it can increase your risk of depression if you have an imbalanced oral microbiome. Um, but I would say that's usually a side effect of an imbalanced gut microbiome. Um, it's also quite hard to differentiate. It's kind of chicken and egg because a lot of patients who might suffer, um, from, you know, these sort of disorders, often will not take care of their mouths. And so therefore, they they don't brush their teeth, they're not flossing, they're not coming to the dentist. And therefore, it's just contributing and and causing more problems. Um, what I've actually found quite interesting is we've got a few patients who definitely, you know, they have, um, disorders or or they, you know, they're they're going through depression. And actually weirdly, just them coming to the dentist has helped them quite a lot. So for example, um, going through Invisalign. So something where they have to get out of their house, they need to come and see someone and they're held accountable for coming to to a place every month to check in and and see how they're getting on with their Invisalign and also improving their aesthetics can actually have such a big impact generally on their general health and just interacting with people and seeing people, um, has really can really help with them. Another thing with mental health is that a lot of antidepressants, um, they do have side effects on oral health. So the biggest one is dry mouth. So a lot of antidepressants can cause a very dry mouth in patients.

Dr Rupy: Do we know we're talking about SSRIs here or some of the older generation?

Dr Victoria: SSRIs. Yeah, a lot of SSRIs. Um, not in everyone, but in a lot of patients it will. Um, and saliva is the most important thing in the oral microbiome. It's it's what makes everything go round. Um, it neutralises acids, it provides food and protein to the bacteria in your mouth. Um, it washes away food. So if you have a dry mouth, you just automatically increase your risk of gum disease, decay, bad breath, um, and you know, it's it's really hard to maintain good oral health if you have a dry mouth. So for those types of patients, it is really important that they focus on um lubricating their mouth. And there are lots of different oral care products out there, um, which are out there to lubricate your mouth. And it could be something as simple as chewing gum regularly or sipping on water, um, or there are products like mouthwashes which actually stimulate saliva production. So they're like tangy apple flavoured and they make your your saliva ducts, um, stimulate saliva production. So it's yeah, really important.

Dr Rupy: I don't think many people appreciate the importance of saliva and embarrassingly, I don't think I have either prior to speaking to you. I'd love to dive into into that a bit deeper. So saliva is important for your microbes, it's not just, because I think most people think about saliva, they just think, oh yeah, wet your mouth and it's good for, it's got some enzymes in, helps you digest some food and like roll the food into a ball and then you swallow it, but it's a lot more than that.

Dr Victoria: Yeah. It's the, it's what makes everything go round in the oral microbiome. And so, um, you know, I think it's a great diagnostic tool or, you know, you can collect it and you can see so much in someone's saliva and not just to do with their oral health, but for example, if you've ever done like a a cortisol test, most cortisol tests use your saliva. Um, or there's a lot of new tests out there for prostate cancer. And they've actually found that the NHS has now switched to saliva tests for prostate cancer because it's more um effective and efficient than blood testing. Um, but also just for the oral microbiome itself, um, yes, you're right, it it it lubricates the mouth, it stops food from getting stuck in nooks and crannies, it helps you get your food rolled into a ball and you can swallow it. Um, it helps with your taste perception, um, it helps with speech, um, and swallowing. Um, but also it provides all of the food for the bacteria in your mouth. And generally, all the good bacteria needs food. And it's the bad bacteria which are able to survive in worse conditions and they're able to kind of adapt and find a way to survive. And that's when we start seeing a shift in the microbiome to a more imbalanced microbiome.

Dr Rupy: It might seem like a silly question, but how do I tell whether I've got a dry mouth or drier than I should have?

Dr Victoria: So one of the ways that we test it in the clinic, which actually anyone can do is I get, so I've got my mirror and I just put it against their cheek and see whether or not it sticks or not and depends on how sticky it is. And um, people will have different types of saliva. So some will have very thick, mucusy saliva, others will have very liquidy, you know, watery saliva. Um, but also like we also have a questionnaire where it's just, you know, how often do you need to sip water to to lubricate your mouth? Do you feel that your mouth is always dry? Um, do you feel like you need to drink water to speak or to eat? And those are kind of your your big signs of someone who's got quite a dry mouth.

Dr Rupy: Is there a like an online questionnaire that someone could actually download or use on on Google or something?

Dr Victoria: I think there actually is one. Um, it's for uh for Sjogren's. So for Sjogren's where dry mouth is one of the biggest uh side effects, there's a there's a questionnaire there.

Dr Rupy: Okay, that's really interesting because I was just thinking to myself like, are there things that I could be doing to increase saliva production in my mouth and would that even be a good thing? So should I be chewing a sugar-free gum? Should I be having some citrus, you know, at different times of the day to stimulate saliva production? Would that be a good thing?

Dr Victoria: So definitely for example, after eating foods, it is good to stimulate saliva production. Um, just chewing usually stimulates enough saliva. But um, I for example, like I'll have like a neutralizing mint or a chewing gum after food, um, particularly if it's like a bad food, you know, I've had a chocolate cake or I've had something bad, um, then you just want to basically make sure it's all out of your mouth. So you can stimulate your saliva production and then it kind of you'll swallow it or it go away basically.

Dr Rupy: Okay. I love how you had to really think about something bad that you could see with that chocolate cake. Not that you've ever had a chocolate cake.

Dr Victoria: Absolutely never.

Dr Rupy: Okay, so I think by now people have an idea of how important your oral health is and how the association, you know, is far ranging from mental health to brain health and heart conditions. Why don't we talk about some of these signals that your mouth might be sending you that you wouldn't ignore? We'll talk about five. We've talked about dry mouth already, but I'm going to put that one to the side. What what's like what the number one sign in your mouth that you would uh never ignore?

Dr Victoria: Bleeding gums.

Dr Rupy: Bleeding gums. Okay.

Dr Victoria: So, um, I always kind of compare it for patients. I say, you know, like if your eye was bleeding when you woke up in the morning, you would scream and run to A&E immediately, right? It's it's a big deal. Um, but for some reason when patients see their gums bleeding, they don't think that that's a warning sign or a problem. And bleeding gums basically suggests inflammation. And your gums should never bleed. So it's a

Dr Rupy: Should never bleed.

Dr Victoria: No, should never bleed. Unless you're, I don't know, traumatize it on a really crunchy piece of sourdough. Yeah, you know, when it happens, fine, but it shouldn't be something that, you know, when you brush your teeth and you spit into the basin, you should never see blood. And if you do, then you need to go to see your dentist.

Dr Rupy: Okay. So bleeding gums, number one sign, don't ignore it. Inflammation of the gums is the main reason.

Dr Victoria: Infection. Yes, it can be infection, but it's basically the gum disease is it's a spectrum. So, um, on the early stages of gum disease is what we call gingivitis and that's just inflammation of the gums. And that's where if you were to brush or to floss, you would probably get some bleeding gums. And at that point, if you get that sorted, um, you can reverse it completely and you you never know you'd even had gingivitis. But if you don't sort that out, then your gums keep on getting more and more inflamed. That's where we start seeing release of inflammation, inflammatory markers and they're traveling through to the rest of the body. But also we start to see what we call pockets. And pockets are basically where, imagine your gum is like a a tight turtleneck around the tooth. Okay. And food and bacteria, nothing should be able to get into that little uh area. But what happens with the inflammation is that tight turtleneck becomes like an open blouse. So it becomes a bit flappy. Um, and it creates a pocket. So if you've ever gone to the dentist and you start hearing them shouting numbers out and they're saying two, three, four, we're sitting there measuring your pockets and seeing whether or not you have any pockets. And what happens is those pockets start to form, bacteria likes to reside down into those pockets and they sit there and they fester and they keep on releasing more inflammatory markers, we get more bacteria um growing in that area and those pockets become deeper and deeper and slowly you start to um lose bone because uh the bacteria will release certain markers which will break down bone. And at this point, this is where we start properly having gum disease and we can we can stop it, but we can never reverse it completely. And if you still don't get that treated, that's where we start seeing you having to lose, you know, your teeth are being lost, wobbly teeth, infections. Um, so that early sign of bleeding gums is your mouth screaming at you saying, please take me to the dentist. I need to have a hygiene so that I don't get down to a place where I start losing teeth.

Dr Rupy: You know, it's interesting, isn't it? Because we think of our mouths as relatively small and like especially like certain teeth and you're like, you've got like a bit of a bleeding gum, whatever, or like some pain. I don't I think it's hard for for people to compute that that small amount of inflammation over a small part of your anatomy could be having such a drastic effect on the rest of your body and putting you at increased risk of serious, serious conditions. Does that compute?

Dr Victoria: Yeah, I think the the reason really is because the mouth is, yes, it's it's small, but it's very mighty. And it's uh it's got very, very high blood flow. So there's very, very good blood circulation in the mouth. Um, if you've ever, you know, burnt your mouth on a piece of pizza or hurt yourself, you know, um, it will be two days, three days max where it hurts a bit and then it goes away. But if you were to hurt your knee or anywhere else and have the same sort of lesion, it would take minimum a week, two weeks for it to heal. And the reason for that is because the mouth is such a great, you know, it's got such good blood circulation. Um, but also your mouth is it's the entry point for so many other things. So you're swallowing all of that bacteria, you're inhaling all of that bacteria. So it's just an amazing place to just spread everything.

Dr Rupy: Yeah, I've I again, embarrassingly, I don't think I've ever computed that because I remember from my A&E days, when someone had bit their tongue or something or you have like some sort of lesion in the mouth, I remember speaking to the oral facial surgeons or the ENT and like, that will heal. It looks pretty gnarly, but it will heal in a couple of days. And if they don't, then come back. And you just see it heal. It's it's incredible. And I don't I think that parallel with a lesion anywhere else on your body, particularly like, you know, limbs or whatever, and how long it takes is testament to how well circulated, how well perfused that area is in the body. So that makes total sense.

Dr Victoria: Yeah, and another thing as well is that the a lot of gut issues and gut conditions that um people might suffer from, often the first side effect is in the mouth. Um, so for example, if you have Crohn's um or ulcerative colitis, you'll often get ulcers in your mouth before you start having issues with the gut. And the reason for that is because there's such high vascularity and such high cell turnover in the mouth that actually you start seeing those problems in the mouth before you see them in the gut.

Dr Rupy: Gotcha. Is that another sign that you wouldn't ignore?

Dr Victoria: Yeah, so that's ulcers. Yeah, so ulcers are um unfortunately, there are some patients who just suffer from from um aphthous ulcers and there's not much we can do about that. Um, and we still don't really fully understand why it happens. It particularly happens in in young males, kind of like 20s to 35-ish years old. And it's really hard to, they come to me and I'm like, I don't know, like it just it just happens. Um, and all we can do is just try and treat the side effects of that. But there are a lot of patients who um if they're having recurrent ulceration, it could be a side effect of a a gut issue, um an allergy. So we see a lot of celiacs. Um, and we see a lot of refractory celiacs as well. Um, so patients who, for example, when they have chocolate or they're eating tomatoes and they start getting ulcer, that's also a big, you know, sign that they're having problems with their gut or some sort of allergy. Um, and the other is just, you know, poor immune health. Um, and so we I work with a functional medicine practitioner um with a lot of these patients who they've gone, you know, they've gone everywhere. They've tried everything. And we now actually understand that for them, it's actually that their their immune system is just so low that actually by improving their immune health, it'll improve their ulceration as well.

Dr Rupy: Okay, so we've talked about bleeding gums, ulcers, um, what are some other signs that we shouldn't ignore?

Dr Victoria: Um, coatings on the tongue.

Dr Rupy: Coatings on the tongue. What kind of coatings are we talking about?

Dr Victoria: Um, so there are some white coatings, black coatings, you can have a really sexy one called black hairy tongue. There's lots of different types of coatings. Um, and some of them are completely natural. Um, so I get a lot of patients who get really scared and they come to me and they're like, oh my god, I think I've got some sort of infection, something's going on with my tongue. And often it's actually they're brushing their tongue too hard. Um, and they start to cause overgrowth of the papillae on their tongue. And it can change colour. But, um, you know, Chinese medicine, for example, they say that your tongue is the answer to all of your systemic conditions. And I don't I don't know enough about it. I mean, I think it's awesome. There's a woman actually on Instagram and she apparently she goes and looks at um celebrities who stick their tongues out in a photo and she'll she'll literally diagnose them and be like, this girl, you know, she's low in anemia, she's got this and like she's got endometriosis. So I don't know if we can go to that level with it. Um, it's still fascinating to me, but I'm still not really sure about the evidence behind that for fully. Um, but your tongue can can tell a lot. So if you're dehydrated, um, certain vitamin deficiencies. So for example, B12 deficiency, you get this really big, beefy, red, sore tongue. Um, anemia, you get quite a pale tongue. Um, if it's really thick, white coating and it's very sore, then that can be um a candida or a yeast infection. Um, so yeah, lots of different things on the tongue.

Dr Rupy: Okay. So definitely something to look out for. And I'm really fascinated by that. I can't get away from the traditional Chinese medicine approach.

Dr Victoria: Oh, she's amazing.

Dr Rupy: Because I I remember doing, so I've done functional medicine training, um, uh, as part of the IFM. Um, one of the first modules, um, that I did in Baltimore, years ago now, they talked about the tongue. And they were like, you should always look at patient's tongue. I mean, we do this in conventional, quote unquote, medicine as well. Um, but perhaps with less, um, inquisition. We just look to see whether there are any lesions or anything like that or anything that could, um, signal dehydration. We're not really looking at patterns or anything like that. I find that fascinating. It's almost like the the there's this ancient saying, right, in Ayurveda where, you know, all health starts in the gut. And now we're just moving further and further up the digestive tract to the mouth. And now we're like, no, no, it's in the tongue. It's like right at the top. We're going to get right to the lips.

Dr Victoria: Yeah, basically. Yeah. But it is, um, there's and there's even more, there's something called geographic tongue. Um, a lot of patients who have psoriasis can have geographic tongue. Um, it's a it's a very funky, it literally looks like a map on your tongue. Um, there's yeah, there's so many cool, well, cool for me, but cool things that you can see on your tongue.

Dr Rupy: Yeah, yeah, yeah. What an incredible diagnostic tool. Okay, so white coating or coatings on the tongue, definitely something not to ignore. What else?

Dr Victoria: Um, bad breath.

Dr Rupy: That's something that we get asked a lot about.

Dr Victoria: Bad breath. Yes. So, um, bad breath is an interesting one because it it can be caused, in answer to your question at the very beginning of the podcast where you said, you know, is um bad breath caused by an imbalanced oral microbiome? Um, yes, it can be, but again, it's very multifactorial. So the first kind of cause of bad breath is, yes, there are certain bacteria in the oral microbiome which are called volatile sulfur compounds. So what that means is that they release sulfur and that can cause bad breath. So for those types of patients, um, often using a mouthwash, um, which is aimed at those sulfur compounds or having regular hygiene, um, that can actually improve bad breath quite easily. But also, if you go further back, it can be tonsil stones, um, which a lot of patients don't think about. Um, and then if you go even further down, it can be gut issues as well. So, um, I see a lot of patients who suffer from bad breath and they've they've looked everywhere. They've gone high and low and every and it really impacts their their social life. I mean, I have a patient who he doesn't work because for two years he hasn't worked because he's so embarrassed by his bad breath. Um, and for him it was a gut issue that had just never really been diagnosed properly. So it's important that you look at all of those different areas, but often it can be from the mouth as well and also gum disease too, by the way.

Dr Rupy: Yeah, yeah, yeah. So gum disease, um, the mouth and obviously gastritis, reflux, there are some other uh causes. Um, what about, have you ever had patients come to you with metallic tastes in their mouth? And it can be very troublesome because it impacts like the taste of food and the taste of drinks and what what how do you approach that?

Dr Victoria: Um, yeah, I we see that a lot. Um, so I think, um, I think I've somehow attracted all the weird and wonderful, um, tastes, feelings, everything. I've had patients who've got films on their teeth that no one can see except for them and they can feel it and it's I've got metallic taste, I've got sour taste, sweet tastes, salty, everything. Um, metallic is one that we see quite a lot. Um, and it is often to do with an imbalance in the oral microbiome and certain high levels of certain oral bacteria that can cause that metallic taste. Um, but also for those patients, sometimes gastritis and acid reflux can be quite a big contributing factor to that. And often it could be bacteria actually from their gut which is traveling to their mouth and causing those strange tastes. So it's important to kind of tackle both at the same time in those cases.

Dr Rupy: How do you approach that typical sort of metallic taste? Because that's the first thing that I always think of whenever anyone comes to me with like metallic taste in the mouth, like, okay, let's let's investigate for gastritis, let's ask all the right questions, inquire about diet, etc. Have they recently been on antibiotics? That's a common side effect. Um, how do you approach someone with metallic tasting?

Dr Victoria: Um, so same questions. Um, and then most likely we would do, we would look at their gums, look at their their mouth as well. Um, and then often do an oral microbiome test just to look at what they might have high levels of. Um, in my experience and again, this is anecdotally, but um, hydrogen peroxide, um, seems to work really well for patients who have a metallic taste. Um, or something which is oxygenating. So it's releasing a lot of oxygen, um, will improve those metallic tastes quite significantly.

Dr Rupy: So hydrogen peroxide being like a very, very dilute mouthwash with that in?

Dr Victoria: Yeah. So you can either make it yourself or you can get some. Be careful, but you can. 3% hydrogen peroxide and um, I think it's a ratio of three to one for hydrogen peroxide and water. Doesn't taste very nice. Um, my favourite is there's a mouthwash called Blue M, um, which is very oxygenating. So it releases a lot of oxygen particles, um, uh, and it's ozonated as well. And that seems to have a really good impact on those patients with metallic tastes.

Dr Rupy: But what's that called? Blue M?

Dr Victoria: Yeah.

Dr Rupy: And it's, what did you say? Oxygenated?

Dr Victoria: Yeah.

Dr Rupy: How does that?

Dr Victoria: So, um, I don't know, I'm not very good with the science behind it. Um, but from what I understand, it's ozonated, so it releases oxygen as it's in the mouth. And it's amazing stuff. Yeah.

Dr Rupy: Okay, great. Um, and related to my earlier question about flossing damaging the gums. So is this a thing? Because people are worried that flossing and especially when you're flossing against gums, uh, and perhaps they've had experience where they've got bleeding gums and so it's put them off. Like can flossing damage your gums? Can it cause deepening recessions or?

Dr Victoria: I mean, I guess, yes, if you're doing it wrong, just like with anything, you know, and I I've got patients who I mean, they're going at it with their floss and and you can see lesions, you can see full on cuts on their gums. So, um, it is important that you understand how to floss and you've got the right technique. And using the right floss. So, um, some, like I don't love the string type of floss because it can, you can hurt your gums quite easily. I use quite like a thick, um, kind of it's like woolly floss. Um, so I can give you the recommendations or but there's some really nice ones which are really thick actually.

Dr Rupy: What was the name of it?

Dr Victoria: Um, Super Teeth. So Super Teeth floss.

Dr Rupy: Oh yeah, you're a big fan of that. Yeah, yeah.

Dr Victoria: Yeah, I'm obsessed with their floss. I have no affiliation to them, by the way, but I just I'm absolutely obsessed. And my my um the nurse I work with, she always rolls her eyes because every time a patient comes in and there's a hygiene, we're doing a hygiene, I'm like, look at my new amazing Super Teeth floss. And and then I show them how to use it. I'm like, isn't that amazing? She's like, again, like I say it over and over again because I'm obsessed. But it's thick. So it sucks up all the plaque really well. Um, it can't traumatize your gums because it's like a it's like a thread. It's like a really thick thread. Um, it's much better for the environment and it's also got hydroxy appetite impregnated into the floss. So you're actually whilst you're removing the biofilm and plaque in between the teeth, you're also leaving something good in between the teeth as well.

Dr Rupy: Okay, that's really interesting. I want to talk about hydroxy appetite in a second. Um, so we've gone through four, I believe, signs, bleeding gums, bad breath, coating on the tongue, ulcers. I want to talk about gum recession because I believe that's the fifth sign that we shouldn't be ignoring and that's something that I've suffered with for a long time now. Um, what are the issues with gum recessions?

Dr Victoria: So gum recession is um it's a it's a bit of a strange one because uh the dental profession still don't really fully understand it and there's as in there's so many factors that can contribute to gum recession. So the first is your classic brushing too hard. So just overzealous brushing. Um, and that would be someone who's kind of got recession pretty much generally and everywhere. So always make sure that you're using uh an electric toothbrush with a pressure sensor. Um, and you're not brushing like left, right, left, right, left, right. You're doing more of like soft rotational movements with your toothbrush angled slightly towards the gums. Um, the second is actually poor plaque control. So, um, patients who have lots of plaque colonizing around their gums and they're not brushing their gums well, what happens is that the the gums are irritated and they start to kind of like hide away from the plaque and you can get recession from that. And that leads me to gum disease. So a lot of patients who had or have gum disease, when they get the treatment for it, one of the side effects is their gums recede. And that's because if we go back to my analogy of that tight turtleneck and it becomes all loose and flappy, when it retightens, it usually um loses a little bit of volume and so you'll get recession too. And then the other is orthodontic treatment. So we see it a lot where patients will go through orthodontic treatment. Um, and I'm I hope orthodontists don't hate me here. My sister is an orthodontist as well. So don't get me wrong, orthodontics is extremely important and and fantastic, but one of the side effects can sometimes be gum recession. And that's because if you think of it's hard to explain it, but if you were to chop your lower jaw off, okay, look at it from a bird's eye view.

Dr Rupy: So I've I've got some I've got this here, right?

Dr Victoria: Okay, perfect. So let's let's do here. Okay. Um, but for anyone who's listening, I'll still try and explain what I'm trying to say. So you've chopped your lower jaw off, you're looking at your your lower jaw from a bird's eye view and you've got imagine it's kind of like a horseshoe, like a U-shape and that's the bone. Okay. And um sometimes in orthodontics, uh people want these really lovely, wide, big smiles and they want a very toothy grim. So what we often do is we move the teeth, we expand. So we move the teeth out um so that they you see more teeth when you smile. But you're not expanding the jaw. So the teeth move out and they're they're further out in your little horseshoe and the gum doesn't follow. And so you often will get gum recession in those areas and that's really hard to treat actually. Um, so

Dr Rupy: So you're like stretching out the teeth, but the gum is still there.

Dr Victoria: Yeah, basically. Because gum needs to cover bone. And if the tooth is too far out of that envelope, is what we call it, or that U-shape, then the gum can't follow and you start to get recession in those areas.

Dr Rupy: Right. So if uh someone has got children, let's say, um, around the age of, I don't know, 12, 13, is that the ideal time to have orthodontic treatment whilst the gum has capacity to cover the the bone?

Dr Victoria: Um, I would argue younger than that. So for some patients, um, I would I would recommend everyone should take their child to an orthodontist or at least the dentist to have an opinion on whether they should see the orthodontist around like seven-ish years old. And the reason for that is because um around six or seven years old, um, the the jaws are extremely malleable and you can expand really easily. I mean, it's it's phenomenal what you can do at that age. Um, and so you can actually uh create appliances which expand the palettes. Um, and that will reduce the chance of that child needing orthodontic treatment in uh when they're older. Um, but if you know, you miss that and yes, the the child is 11, 12 years old, then that is the perfect time. So ideally right before their growth spurt, you go and see the orthodontist and the orthodontist kind of, I like to think of it like they ride the growth spurt with you and they're kind of working the teeth at the same time so that, you know, it works perfectly.

Dr Rupy: Okay, because if gum recession bingo was a game, uh, I've basically got like a full house here. So I was definitely overzealous with my brushing. I had orthodontic treatment as an adult, like mid 20s plus, and there's probably something going on in my family history or my genetics because I know some of my family members have got have got gum recession as well. So, yeah.

Dr Victoria: So yeah, you probably do and and speaking of genetics, um, a lot of people will just have thinner gums and so it just you've just you've got pulled the short straw. Um, and from a microbiome perspective, we're actually doing quite a lot of research into whether or not there are certain bacteria or certain strains of bacteria which might be um increasing the chance of gum recession as well.

Dr Rupy: Gotcha. Okay. Um, in terms you mentioned just earlier, like dental profession pushback. What where do you get most pushback on some of the ideas that you've just described thus far?

Dr Victoria: Um, I think it's to do with microbiome testing. Okay. And also mouth body connections. So, um, for microbiome testing, um, and I think this is with with the whole of medical, the medical world generally because I know that, you know, I've spoken to a lot of gastroenterologists, for example. And if you spoke about gut microbiome testing like 40, 50 years ago, they all laughed at you and they said, well, there's no point. We we know exactly what we're doing and it works perfectly. So why would we need to implement this? And microbiome testing is a bit strange because there is still no diagnostic microbiome test on the market. And that's for oral, gut, anything. And the reason for that is because we're we're still scratching the surface in terms of evidence and research on the microbiome. We're still trying to understand what is a healthy microbiome. And it is such a complex ecosystem that what is healthy in my microbiome might be very different to what's healthy in your microbiome. So therefore, we can't really create a diagnostic microbiome test and say, okay, well, um, you know, this is what a healthy microbiome looks like, so yours is not healthy. Because that's not the case. And it's actually, you know, this complex interplay between bacteria, um, you know, your genetic mutations, inflammation, um, your viruses, your fungi, everything all into one big bundle. So a lot of people, um, at this point, for example, in the dental world will say, well, what's the point of microbiome testing because it's not diagnostic. We can't it's not going to change necessarily how we treat the patient. But our argument is that, you know, it it shouldn't it doesn't need to be diagnostic. It's about um empowering patients to understand what's going on in their mouths. Um, and it's more of a motivational and educational tool. So if you can see and say, okay, oh my god, I have really high levels of all of these really bad bacteria which are very strongly associated with gum disease and I have 10 genetic mutations that further increase my risk of gum disease, the way that you treat your oral health will be very different to someone who doesn't have all of those problems. And you can reduce your risk of getting those problems in the future. And one thing microbiome testing does allow for is personalization of treatment. And again, that's for oral or gut microbiome testing. So we can start to see that, okay, you have really high levels of this bad bacteria, what can we do to try and improve that microbiome and get it into a more balanced state?

Dr Rupy: Yeah, yeah. Um, I asked you about fluoride a little bit earlier. I want to talk about that before we dive into oral microbiome testing in a bit more detail using me as the guinea pig. Um, but toothpaste without fluoride is a waste of time. You mentioned hydroxy appetite. Are they equivocal? Can you use hydroxy appetite if you prefer a fluoride-free toothpaste? What's your what's your take on that?

Dr Victoria: So, uh, there's a lot of research for and against it. Um, so recently, uh, the US in particular has banned water fluoridation in in most states. And I would agree with that. I think uh fluoride in your water is unnecessary. Um, and basically a lot of people's fear around fluoride comes from research which has shown that there is some neurotoxic um impact of fluoride um in in humans. But a lot of this research was looking at extremely high concentrations of fluoride being ingested. So the fluoride in a toothpaste is topical. Um, it's much lower than any of this research that's been done. And obviously you shouldn't be swallowing it. Um, but with that being said, you know, a lot of people are still, you know, they don't want to do it, which I understand. Um, so on the flip side, fluoride, in my opinion, is the most remineralizing and strengthening agent on the market for in toothpaste. Um, but there are some really good uh contenders now. So hydroxy appetite is one of them. Nano silver is another one. Um, and basically, uh, what I would say is that if if you're listening and you're like, I don't want to use fluoride, fine. That's, you know, I think that dentists need to adapt to how patients feel and they shouldn't shame them and say, no, you have to use fluoride, otherwise, you know, that's fine, but use something else which will remineralize those teeth.

Dr Rupy: Yeah, yeah.

Dr Victoria: So that could be through nano hydroxy appetite, that could be through your uh your nano silver, something like that because what I'm seeing a lot of unfortunately, particularly um mothers who bring their kids in and they're trying their absolute best to, you know, make sure that their children have the best health. Um, and they come in and their kids have, you know, 15 cavities and it's bad, like really bad cavities. And they're super upset about it and they, I, you know, he doesn't eat sugar, he doesn't do this, he, you know, and it's because they're using some toothpaste with chamomile and lavender and and that's it. And so if you're not going to use fluoride, fine, but use something else which will remineralize those teeth.

Dr Rupy: Yeah, yeah. Okay. So hydroxy appetite, nano silver are the contenders that you would say are good, but not as good as fluoride.

Dr Victoria: Yeah, I think there are some which are nearly just as good. Um, but again, it's brand, it's brand by brand. So I'm happy to give some recommendations. Um, also there are some really good toothpastes on the market which are like a really nice middle ground. So they're low in fluoride, but they also have other remineralizing agents like calcium and phosphate. So that's a really nice all-rounder for someone who's like, oh, I don't want too much fluoride, but I'm scared of not having fluoride and I don't want to have cavities. You know, it's like such a um a weird world at the moment in terms of of toothpaste market.

Dr Rupy: Yeah, yeah, yeah, it is. Um, your opinion on water fluoridation, has that changed over the last few years? Because many dentists that I have spoken to in the past have suggested water fluoridation is completely fine, it's harmless, uh, people are overstating the potential negative effects. Has that changed during your course of of research?

Dr Victoria: Um, so there's been some more research recently that has come out to show that water fluoridation is unnecessary. And um that the risks associated with it outweigh the benefits that it could have. Um, another thing is that there I can't remember exactly which city. I want to say it's Manchester, but there are a few cities in the UK which do have fluoride in their water. And yes, they have lower um they have lower amounts of decay in their children in particular. But you can also get something called fluorosis. And this is where you get these kind of white speckly spots on the teeth as they develop. Um, and it's the teeth are fine, but it's not the most aesthetically pleasing thing. And I just personally, I just think that it's it's your it should be your decision what goes in your body. And water is something that, you know, we all need and should have. And whether or not I want to go and put something in my water should be up to me. Um, but it shouldn't be, I think, a decision made higher up than that.

Dr Rupy: Yeah. Yeah, yeah. No, I agree. I completely agree. Um, I've always thought that that was a bit paternalistic to have what is uh not an inert, it definitely has downstream consequences. Um, and if it's already in our toothpaste and we are encouraging people to brush their teeth every single day, that should be enough. It shouldn't be something that we are actively ingesting. Um, so yeah, it's really interesting there because I've always had pushback on my opinion on that because I I you know, I'm a pragmatist. I think it's guilty until proven otherwise. And I think there are safer options for us to look after our oral health rather than doing something as drastic as, you know, a general sort of um application of a of a of a product in something that we consume every single day.

Dr Victoria: Yeah. Exactly.

Dr Rupy: Interesting. Okay. Um, let's talk a bit about oral microbiome testing now because you said everyone should test their oral microbiome. You would say that you've got your own oral microbiome.

Dr Victoria: Yeah, I am biased. I am very biased, unfortunately.

Dr Rupy: Yeah. Um, let's talk about uh the different sort of tests, um, and the reason why you came up with your own one because it was sort of out of a frustration of not having exactly what you wanted in a particular test. So maybe you can walk us through that and then we can go through some of my results.

Dr Victoria: Yes. So, um, the the idea of oral microbiome testing is, yes, we collect your saliva and then we look at all the different bacteria in your mouth. And so I was doing, I've been doing oral microbiome testing for like long time now, years. And I was using other tests on the market and, you know, they were able to identify the bacteria that you had high levels of. But what I was uh having issues was with was that I would have two patients who would have exactly the same microbiome results, but very, very different um clinical appearances. So one would have raging gum disease and terrible oral health and the other one was completely fine. And this goes back to that idea of, you know, what is a healthy microbiome and what makes it good in one person and bad in another person. And part of that's to do with how your body responds to bacteria and also how virulent certain bacteria are being in your mouth. So again, me and you can have the same bacteria in our mouths, but I might have an extremely virulent, aggressive strain of that bacteria that is releasing lots of virulence factors. I might have uh mutations and clones of other bacteria which can increase my risk of gum disease by 300%. And I might have genetic mutations that again further increase my risk of gum disease and you might not have that. So, um, it goes it stems really to the idea of uh different types of testing of the microbiome. So you can do something called QPCR or you can do shotgun metagenomics. And most tests on the market use QPCR. And that is the idea that you just, you know, I tell the, let's say the machine, I want to look at these 20 bacteria, tell me if the patient has those 20 bacteria. And it says, yes, these are those bacteria, these are the levels of it. But it doesn't dive deeper into the strains of those bacteria, how those bacteria are acting in that patient either. So we went for shotgun metagenomics. And so that allows us to look at 500 different bacteria in the oral microbiome. It allows us to zoom into the top 20 that we know are really strongly associated with, you know, gum disease, decay, bad breath. And then we zoom even further into a couple of bacteria to look at the strains of them and how virulent they're acting in your mouth. And I think that's what's really, really important is, you know, superficially, you know, it doesn't matter if we both have Porphyromonas gingivalis in our mouths. What matters is whether or not your Porphyromonas gingivalis is virulent, how virulent is it being, you know, what is it um releasing. And then we paired it with genetic mutations. So we look at 10 genetic mutations, the ones that we kind of previously covered, um, which look at, you know, how your body responds to those bacteria. So, um, it's a, you know, we pack a lot into it.

Dr Rupy: And all from the same sample of saliva.

Dr Victoria: All from the same sample. Um, and then another thing I had with other tests on the market was that actually, you know, there was no guidance after you got your results. So you just get this kind of sheet and it say you've got all these bacteria, good luck. And that was kind of it. And all these patients were freaking out and saying, oh my god, but I, you know, like for example with Porphyromonas gingivalis, these patients would see that and like, oh my god, I've got Alzheimer's. And they wouldn't and you're like, no, but we don't know if you have that strain and we don't know if you have those virulence factors. And then, you know, it was just not good. So, um, we then created these personalized recommendations. We built an algorithm which looks at the patient's oral um oral health, their age, medical history, their bacteria, genetic mutations, their inflammation, everything to then predict their risk of getting that disease in the future. And then gives them personalized treatment recommendations like take propolis. You know, use this toothpaste or, you know, I think you definitely have gum disease, you need to go and see your dentist immediately. Um, and so it's taken us quite a long time. It was meant to just be like an answer to a problem I had and it wasn't really meant to be anything other than that. But then I ended up putting so much time and money into this little baby that I was like, okay, okay, she needs to grow. Uh, it's a she. So, um, so you know, we've rolled it out and it's now available to um consumers and they can buy it online.

Dr Rupy: Oh, so it's both consumers and uh practitioners.

Dr Victoria: Yeah, so what was happening was we were getting loads of consumers wanting the test. And so interestingly, we did a we did a questionnaire on um all of our users to say like, why did you take this test? Like what was your purpose of it? And you know, like how can we improve things? You know, because it's interesting like we just weren't expecting that type of demand. And what we found was that a lot of patients don't really um they're scared of the dentist. They don't go very often. So they'd rather take a test which tells them to go see the dentist if they need to. Um, or they don't trust their dentist. We've had a lot of patients who have been told they have gum disease and they're like, I don't know, I just I don't know if I believe you. So they take this test and we're like, no, you do have gum disease. And then they'll go and get the treatment that's needed. Um, and we found that over 90% of patients who did our test were likely to book an appointment with their dentist and their hygienist uh within one month of taking the test.

Dr Rupy: Gosh. And that shows you just how empowering a patient and just communicating something can just change your total mindset on something.

Dr Rupy: Yeah. Okay. Um, let's pull up my results. Um, I'm a little bit uh apprehensive. Actually, no, I'm not apprehensive because I know that they're great. But I I you know, there's always like, you know, room for improvement. Um, I'm looking at this and I'm just seeing 9.6 out of 10. So I'm feeling pretty good about my results thus far. Uh, but maybe you can shine a bit more light on on what we're looking at here.

Dr Victoria: Yes. So your score, so we've given, we've got a microbiome score, um, which you got 9.6 out of 10, which is very good. And what that microbiome score is is um a ratio of your good bacteria versus your bad bacteria. Um, and we've compared that to all of our patients and and subjects. Um, and so, you know, a very good microbiome versus a very diseased, bad microbiome. Um, and so based on all of those patients, you scored very well. Um, and you had very good levels of good bacteria compared to uh bad bacteria. Um, and then if we scroll to the next uh page, it's your health risks. So this is what we're talking about with the algorithm. So, um, we've just calculated all of these different risks. So you scored very low on the risk of bad breath, gum disease, decay, and also general inflammation.

Dr Rupy: You can come near me, guys.

Dr Victoria: Yeah, I know. And like I, so I personally go through um every single test. Um, I'm a little bit of a control freak. Um, it's it's not the most sustainable thing. Um, but um the reason why is like at the beginning of each report and you may have seen it on yours, I write like a little comment and I look through everyone's reports. And the reason for that is sometimes like if we've got something really strange, a lot of this is AI fueled, but um if we've got some sort of weird and wonderful bacteria or if someone has a question and they're like, you know, I've got this problem, XYZ, then I can answer it in the clinical bit. So I've looked at a lot of tests and out of a lot of these tests, yours is very good. So you're very, you should be very proud of yourself. Um, and then we scroll to the next one, which is good bacteria. And um another thing that's quite unique about our test is that we're one of the only tests that actually focuses a lot on good bacteria. And um what we now understand is that a lot of people will not have very good levels of good bacteria in their microbiomes. And it could be either that they never got it in the first place in those early ages of development or they just, you know, had some bad habits and they've just completely annihilated the good bacteria in their microbiomes. Um, so we look at quite a few of them and you had very good levels of um good bacteria actually.

Dr Rupy: And so some of these are Abiotrophia, Lactobacillus, uh, Lactobacillus casei, sorry.

Dr Victoria: Yep. And you've also got um good levels of your streptococci as well. So the good ones. Um, so

Dr Rupy: You know, when we talk about good and and bad bacteria, you know, we we've spoken to a few people on this pod, like, you know, James Kinross, who who you've met recently and a few other folks. And they always talk about context. They always talk about like a bug is um neither good nor bad. It really just depends on the environment. Are there exceptions to that general statement with with these particular bugs that we're looking at here?

Dr Victoria: Yeah, so for example, your your streptococci. So, um, there's a few very well-established um good bacteria which um they've actually kind of repackaged as probiotics. So, um, certain ones like your K12, your M18 are um probiotics which you can buy from the store, but actually are also found in your microbiome as well. Um, well, they should be. And um those have been shown to um help with diversity, um, with uh improving, you know, your inflammation, um, and just basically reducing bacterial overgrowth as well. So there are some good bacteria that are well established to be ones that we all want. Doesn't matter who you are, you want them. Um, and actually, fun fact, um, so for K12 and M18, which are um a like a strain of streptococci. So they've been established to be uh kind of the best oral probiotics and the best for for oral health. And actually, um, the the gentleman who created them is an Australian guy. Um, and he basically uh suffered from very bad strep throat as a child. Um, and he ended up uh getting scarlet fever. And that completely, you know, uh it it impacted his life long-term forever. And so he said, you know what, I'm going to make it my life's aim to understand how we can reduce strep throat. So, um, he spent years and years and years, his whole PhD, etc, on trying to um manage strep throat. And he created K12 and M18, um, which are strains of streptococci, which basically um help reduce strep throat. But more importantly, were found to be really beneficial for the oral microbiome. And so he rebranded it for oral probiotics. And it's kind of like a two for one thing because it's also for strep throat as well. Um, so yeah, really cool guy still alive.

Dr Rupy: That's amazing. That's so cool. Okay, so I've got good levels.

Dr Victoria: Yeah, you've got good levels. Um, then we go to pathogens. So these are your bad bacteria. So like I said, we look at over 500 different bacteria. Um, and then we zoom into the top 20 that we know are really bad. And um, as you can see, your page is blank.

Dr Rupy: Yeah, I was going to say there's nothing there.

Dr Victoria: Yeah. So you had no bad bacteria that we are aware of, um, that could be causing any problems.

Dr Rupy: Amazing.

Dr Victoria: Um, and I don't know if you remember, but we've actually done a microbiome test on you like four years ago or something. And at that point you did have high levels of bad bacteria. So it's shown that actually you've really improved your oral health and your oral microbiome, um, significantly. So again, very rare.

Dr Rupy: I remember that was when I was prescribed by yourself a mouthwash, I believe. Um, and I was also given some oral probiotics to swish around. Yeah. Um, so this is great. This is for me as a patient, this is really motivating to like keep up with my, you know, dental hygiene stuff as well as the practices that I do with supplementation and um dental work at home. So, yeah, this is, yeah, this is great.

Dr Victoria: Yeah, exactly. And sometimes I think we don't really think it's doing anything, you know, and it's time consuming and you're like, oh, do I really have to like take this and it's expensive and do I have to do this? So it's nice to see it and I think one of the strange things with dentistry is it's very much like it's always been like dentist knows best. Like we we know everything and we we're like, you're doing well, you're not doing well, you're not flossing, you're you've got gum disease. And you're like, yeah, but I can't feel anything. And that's one of the biggest issues with gum disease is that by the time you can feel it and see it, it's too late. Um, so in my opinion, these type types of tests can just highlight to patients how important their oral health is, just help them fine tune things a little bit.

Dr Rupy: Yeah, it's like blood pressure. You won't be able to feel it until you succumb to a cardiovascular event or a stroke or whatever. But when you see those numbers and you start testing regularly at home or in clinic, then you it becomes tangible. It becomes something that you want to try and do something about and get those numbers down.

Dr Victoria: Yeah. Exactly. Yeah, I say the same for blood glucose monitoring as well. You know, does it necessarily change the way that you might see, like, you know, change your treatment of things? Not necessarily. I did a blood glucose monitor and I thought I was super healthy. I thought I'd be fantastic. And I wasn't. I had actually quite poor um blood glucose control. And I'd never had problems. I never thought I did. Um, and you know, did it change necessarily how I how I've seen food? Yes, it definitely did. Um, but like, you know, the doctor hasn't changed anything. It's something that I personally have done. Um, but then we go to genetic mutations. So, um, out of the 10 mutations that we look at, uh, you only had two.

Dr Rupy: Okay.

Dr Victoria: So you only had two for decay actually. And those two are associated with you having a slight sugar sweet tooth. So it means that you've got decreased sugar sensitivity. So you you maybe need a little bit more sugar than average to feel satiated. Um, but also you have another mutation, um, which means that you um you reduce, you have less antimicrobial peptides in your saliva. So you have um less enzymes which are antimicrobial. Um, which could kill the bad bacteria basically for decay.

Dr Rupy: Gotcha. Yeah. I definitely have a bit of a sweet tooth.

Dr Victoria: Don't we all? Um, and again, some of these things are quite common. Like, um, like that the G2 gene that you have, like probably I would say like 60% of patients have it. Um, and yes, you can't change your your genes, but just by understanding it, sometimes it's it's just quite reassuring for patients, particularly for um, you know, patients who've had, you know, every time they go to the dentist, they have a cavity and they just don't understand why. Then, you know, they'll they'll say, okay, yes, like I still need to take good care of myself, but I'm not doing anything wrong. I'm just, you know, pulled the short straw. So, you know, so it's it's quite nice for patients. Yeah. Um, gum disease, um, see your test is quite boring, your results because you don't have anything bad. Um, but we look at some quite bad mutations and some of them can triple your risk of gum disease. Um, and some of these mutations are associated with uh systemic health as well. So for example, there's a tumor necrosis factor mutation. So that's for TNF. And if you have that mutation, it triples your risk of gum disease, but also it has a lot of knock-on um impacts on your your sorry, your general health and inflammation generally.

Dr Rupy: Yeah, yeah, yeah.

Dr Victoria: Um, yeah, and then you didn't have any virulent strains of Porphyromonas gingivalis. So we look at about 12 virulence factors. You didn't have any of them. You didn't have any of the clones for um one of the other bacteria. So the JP2 clone, you didn't have that. You didn't have. So you just had a really good microbiome. It was a bit too good. I would have liked a bad one for to explain.

Dr Rupy: And at the end, you know, you've gone through all the organisms that are detected as well. And I I like the fact that that's at the end of the report rather than at the front because I've done a number of these different tests, not oral microbiome tests, but general microbiome microbiota tests and they front load it with all this like overwhelming information. And I think this is sort of presented in a way that's really easy for me to understand as, you know, a medical doctor, someone who who spends a lot of time with this. I think for anyone, it would be very, very simple to understand the way it's presented.

Dr Victoria: Thank you. I mean, we I um it was much longer before. It was like, it was like 30 pages before. And I was like, this is the best test ever. And uh and we got people being like, no one's going to read a 30 page report. I'm like, why wouldn't you? So, um, we've shortened it, unfortunately, and people still want it shorter. But I like the list of all detected organisms because for most people they don't care, but there are some patients who really do care. And what we have found quite interesting is like, I had a patient who um had really high levels, um, of, I think it was really high levels of like loads of different types. Um, and it looked as if she'd had like soil in her saliva or in her mouth, like over 50% of her oral microbiome was a few certain bacteria. And so, um, those weren't necessarily detected for gum disease, but we were like, something's really weird in your microbiome. Like we need to check, like we need to see you, we need to bring you in and we need to take a look at what's going on. Um, so you can detect those weird outliers. Um, or another patient who she um, she had uh throat cancer. And so as a result of that, she had radiotherapy that caused a lot of um candida infections. And what they thought was candida infections and so her doctor kept on just prescribing her more and more antifungals and it was just getting worse and worse. And so she flew in from Ireland to see me because she was like, I don't know, I need a test because I don't think it's yeast. And uh we did a test and she basically had a really, really bad streptococcal infection. And we only found that from the list of detected organisms because she had such high levels of it. So actually for her, she needed an antibiotic, not an antifungal. And that completely changed it for her. So yeah.

Dr Rupy: Yeah. And I think also because this is an ever evolving science, it's wonderful to go back to like this test that I've done a couple of months ago, perhaps with new information about a microbe that we now know is associated or not associated or, you know, whatever, we have some sort of idea of like what was going on at the time. And that was my follow-up question actually about how often, so if we are going to do like a snapshot of our oral microbiota without symptoms, let's say, like how often would an ideal um snapshot be? Like how often should one be thinking of doing this? Is it just a one and and you're fine? Do you only do it if you have symptoms? Like what's what is your opinion on that?

Dr Victoria: I would say for someone like you who had great results, um, maybe every two years or so. Um, just to just to keep track and make sure that everything's going well. If you have a problem, um, or you know, like you have gum disease and you're going through treatment and you want to see whether or not things are improving, then maybe I would say at least six months. So you do need to give your microbiome a bit of time to shift. But yeah.

Dr Rupy: Okay, that's great. Um, let's talk about a toolkit for a healthy mouth to finish off uh with. Um, we had uh a colleague of ours on the podcast talking about when to brush teeth. We had a lot of comments because it was in contrast to what you were suggesting about when we should be brushing our teeth. So, Dr Victoria, when should we be brushing our teeth?

Dr Victoria: Well, um, it depends on what you're eating is the is the answer. So, um, there's no like, you know, before breakfast is better than after breakfast or vice versa necessarily. I would say what's important is what you're eating. So if you're having like, um, I mean, you shouldn't be having this, but if you're having sugary cereal and you're having orange juice and a chocolate bar, then I would prefer you to brush your teeth before you have breakfast, even though it doesn't taste as nice. Um, but the reason for that is because what you don't want to do is grind in all of that sugar and acid into your teeth straight after eating it. Um, if you're having a piece of toast with butter, then yeah, you can brush your teeth afterwards and that's completely fine.

Dr Rupy: How long after?

Dr Victoria: So ideally 30 minutes after.

Dr Rupy: 30 minutes after.

Dr Victoria: But I know that, you know, most people don't have that, you know, luxury or like timing things and you know, so like I personally, I um, I brush when I get to work, but I'm also a dentist who works in a dental clinic. So I have like, I have a toothbrush in like every room. But um, I do that so that I can enjoy my coffee in the morning. I can, you know, and then I can brush my teeth and it also kind of weirdly, it stops me snacking as well because I don't want to ruin that fresh taste in my mouth.

Dr Rupy: Okay, so when, so, so run me through that again, when do you drink your coffee before brushing your teeth?

Dr Victoria: Yeah.

Dr Rupy: Not afterwards.

Dr Victoria: Yeah.

Dr Rupy: And the same rules apply. Is that the same reasoning applies? Is that because you don't want to brush in the coffee into your mouth or the acidic?

Dr Victoria: No, I'm just, I just like the taste of my coffee.

Dr Rupy: Oh, okay. Fine, fine, fine. Okay.

Dr Victoria: But that's the thing, there's no real, um, like there's no research or evidence to show that one is better than the other. So the argument for before is that, you know, you've just had your, you know, you've just slept for however many hours and surely there's new bacteria and you, you know, you want to, you know, reduce that and get rid of all the plaque. Um, but then the argument for after is that if you've just had breakfast, then you don't want all that food to be sitting on your teeth. So it's this constant debate between, you know, dentists. Um, there is no hard and sure answer. It's just about taking care of your teeth and what works best in your lifestyle.

Dr Rupy: I've heard a weird argument for, um, when you wake up in the morning, you swig a, uh, some water before brushing your teeth, swirl it around your mouth and swallow it as a natural probiotic because overnight your microbes have flourished in your mouth and this serves as somehow seeding your microbiota for the day. Is there any sense in that practice whatsoever?

Dr Victoria: I've never heard of that. Um, I can understand why, but I I don't think so personally, just because you like who who is to say that your microbiome is good and you want to be seeding it. Who's to say that you are in a good environment which isn't damp and you know, you've got other things going on or you're a mouth breather or, you know, there's so many other things that could be impacting your microbiome. So I would, I like the idea of rinsing with water, but I would probably spit it out, not swallow it.

Dr Rupy: Not swallow it. Okay. Um, oil pulling, any uh evidence for that whatsoever? This is where you swell coconut oil or whatever around your mouth.

Dr Victoria: So there's a, it's a great Ayurvedic practice. A lot of people love it. Um, evidence-wise, there's no evidence to show that it is beneficial for oral health, but there's also no evidence to show that it's detrimental. So I would say anecdotally, I've had a lot of patients who love it and they swear by it. And if that's the case, like go for it, enjoy yourself. But um to properly coconut oil pull, you should be doing it for about 15 minutes.

Dr Rupy: 15 minutes?

Dr Victoria: Yeah, so that's that's apparently like how you should be really doing it. So if you've got that time, like go for it, enjoy, but it's not, I don't think it replaces any of the the kind of bread and butter um oral care products or routine that you should be having.

Dr Rupy: Okay. Um, rinsing after brushing, we've talked about this before. Are your thoughts still we should not be rinsing our toothpaste off our teeth after brushing?

Dr Victoria: Yes.

Dr Rupy: Both morning and evening?

Dr Victoria: Yes.

Dr Rupy: Oh, okay, right. All right. Okay.

Dr Victoria: So yeah, just uh brush, brush, brush and then spit out the residue and off you go.

Dr Rupy: And then and then walk away. Yeah, yeah. But I always think like I've I've got toothpaste on my teeth in the morning this is. I don't mind the evening, but

Dr Victoria: It goes. How do you I mean, if you really don't like it, then in the morning, fine, rinse with water and then the evening definitely don't. Because I know some people they just like that like cold water, that fresh like wakes them up. Then fine, go for it. But ideally you don't.

Dr Rupy: Okay. Um, mouth taping. Very, very popular. My wife's a mouth taper. I'm just putting it out there. Is there any benefit to oral health from mouth taping?

Dr Victoria: Yeah, there is actually.

Dr Rupy: Really? Oh wow, she's going to be she's going to get one over me on this. Go for it.

Dr Victoria: No, it is. There's actually um mouth taping is really good for for your sleep quality. Um, it it I think it really depends on whether or not you're a mouth breather in the first place. So if you naturally breathe with your mouth closed, you have absolutely no problems, you sleep like a baby, you don't need to tape your mouth, like you're fine. But for people who potentially do, um, then mouth taping can really improve their sleep quality, um, their their concentration, you know, everything. And then from an oral health perspective, um, breathing with your mouth open, it introduces a lot of bacteria into your mouth, it dries your mouth out. And going back to that whole idea of saliva, then that can increase your risk of other problems. Um, I think what's important for people who are interested in mouth breathing is firstly, there's lots of different mouth tapes. Sorry, not mouth breathing, mouth taping. Um, there's a lot of different mouth tapes on the market. So it's not one size fits all. So there's um there's some which just cover the lips, for example, some which are just one little strip here. Um, one which I really like is called Myo tape. So it's like a box which actually goes around the mouth, so it doesn't cover the the lips. Um, and they have a beard friendly one too. And um the what I like about that is that you can actually still slightly open your mouth if you wanted to, but it pushes the muscles in a way so that they feel more comfortable being closed. Um, the reason I like that is just I don't know, just from like a scared perspective, like I don't like the idea of just like taping my mouth shut and going to bed and it just feels like, what if I need to scream? Like I don't know, like something, you know, I can't breathe, then you can still breathe and you can still keep your mouth open. Um, and another thing as well is that if you are considering mouth taping, um, I would try mouth taping during the day just for 30 minutes, um, just to make sure that you can breathe with your nose because this whole trend and excitement of like mouth taping, fine, it's great, but there are a lot of people who cannot breathe with their nose. And that's a bigger issue that they should address. But what you can start to do is literally cause hypoxia and and cause problems um during sleeping and you don't even notice it. And that can be a bigger issue.

Dr Rupy: Yeah. Super interesting. I've I've even seen these mouth tapes online which are infused with collagen to help give yourself a little bit of a boost.

Dr Victoria: There's one called hostage tape. I'm like, that's a really bad name. I'm like, you might as well just use duct tape at that point.

Dr Rupy: Yeah, exactly. Yeah. Gosh, that is uh that yeah, that's really aggressive marketing. Um, one thing I have tried using actually without mouth taping is um a nose tape to help me because I'm quite nasally and especially during um hay fever season, I tend to get nasal congestion. Any benefits to those? Same rules apply, I'm assuming.

Dr Victoria: Well, if you can, it will help you to breathe with your nose. So that definitely helps. Um, and it might be that you need to mouth tape and nose tape. Yeah, yeah. Um, but it I think most people, I think I do really like the nose tape. I think it's a it's a great idea and I I would say maybe I prefer it a little bit to mouth taping in a way because it it promotes you to do a good thing as opposed to stopping you from doing a bad thing. So it does help.

Dr Rupy: But I've been finding fascinating is like this has become such a big trend on Tik Tok. And like, um, you know, like I was like with some family friends and they're like 18, 19 years old. And they're like, oh, like I use this mouth tape and I'm thinking like, I want to mew a little bit more and I'm mewing now and I'm this. And it's crazy. Like, I mean, it's great, but it's so weird to me that like it's become such a big health hype.

Dr Rupy: Yeah. Let's talk about mewing. It wasn't on my list, but uh, what is mewing? I I'm hearing about it, but I I just don't understand.

Dr Victoria: So it's basically the idea of like, um, over using or stimulating your the muscles in your jaw. Um, and basically getting them to be stronger. It could be getting your tongue to get to the top of your mouth like this. And a lot of the reason a lot of boys or men do it is because it can make them have a stronger jaw line.

Dr Rupy: Oh, it can?

Dr Victoria: Yes, but the reason for that is just because you're working out a muscle. So it's just like, you know, if I went for a run every day, I would have really strong calf muscles. Um, if you, if I told you to chew on something all day and to constantly use your tongue and and posture it, then you would get really strong masseter muscles. So, um, at a small, you know, a little bit here and there is fine. And um, for example, um, there's myofunctional therapists who they don't do mewing, but they they promote um the use of your oral and facial muscles in the correct way. And a lot of us don't use our oral and facial muscles correctly. We don't really know how to swallow. Um, particularly a lot of kids, they don't know how to swallow, even their speech is impacted. Um, they have tongue ties, so their tongue doesn't reach the top of the tongue. All of those things, um, which I totally agree with. Um, mewing is more just practicing that jaw clenching and and kind of, you know, the that's fine, but if you overdo it, then you can get TMJD. So that's temporomandibular joint disorder. So I've had a few young guys who have um clicking joints, they have problems opening their mouth. Um, they find it hard to eat hard foods now because their muscles are tired. So they're kind of accelerating, it's like they're clenching and grinding at a much faster rate than they should be. So again, you know, everything with a in in moderation is okay, but don't go overkill with it and it's definitely not the way to, you know, get a chiseled jaw line that's going to, you know, woo the girls.

Dr Rupy: So the objective of mewing from what I'm hearing is purely aesthetic rather than a functional um uh objective. So something to improve speech or improve swallowing. It's different to um some of the therapies that are out there.

Dr Victoria: Yeah, exactly. So it is more um at the moment, it's more of an aesthetic thing a lot of people are doing. Um, but some of the the tongue exercises are good for for general health as well. So

Dr Rupy: Gosh, I'm going to start doing tongue exercises because that might help with my oration skills actually, given that I am a podcaster. So, okay. Um, you mentioned chewing a few times in terms of chewing gum to produce saliva, maybe even aesthetics as well. Um, are there particular gums that we should be looking out for and um if we're going to go sugar-free, which I'm assuming that you are going to suggest, are there certain sweeteners that you think are uh neutral in terms of a potential negative effect on the oral microbiome or the gut microbiome?

Dr Victoria: So, um, yeah, definitely sugar-free. Um, xylitol or or erythritol are good um substitutes. Um, I can show you the my options. I I don't so I can um I can write them down or something. I think so there's a few um I'm trying to think of the ones that I like. There's one which is actually not a gum, it's a mint, but you chew it. Um, it's called Dr. Heff's and that's my favourite mint actually.

Dr Rupy: Dr. Heff's?

Dr Victoria: Yeah, it's my favourite. So, um, again, no affiliation. Um, but they, um, it has green tea extract in it and it's got xylitol. Um, and it's got a few other goodies in it. So it helps to remineralize the teeth, it neutralizes acids in your saliva. Um, and it's antibacterial. Um, so green tea has been shown to be particularly effective against certain oral bacteria. Um, but neutralizing the acids is really good. So if you're having a sweet treat, for example, then uh your saliva becomes extremely acidic and this neutralizes the acids really quickly so that you don't start getting decay.

Dr Rupy: Wow. Okay. So there's some mints, chewing gum, propolis, green tea. I drink coffee. Any benefits of coffee to my oral microbiota or is it something like damage limitation?

Dr Victoria: I don't know. Not that I know. I think I think I'm going to say that the benefits are from the oral gut brain axis because it makes you happy. That's all I know.

Dr Rupy: I love that. Okay, great. Um, and what ingredients should we look for uh in toothpaste and ones to avoid in toothpaste? I'm seeing a lot of toothpaste these days that are like, you know, phthalate-free, SLS-free, etc, etc. Which which ones are hype and which ones do you think actually are reasonable things that we should be avoiding?

Dr Victoria: So for things to avoid, so um SLS or sodium lauryl sulfate is the biggest one. A lot of your um classic toothpastes do have sodium lauryl sulfate in them. It's what makes them foam. Um, but it's quite unnecessary. So, um, what it can do is it can strip your mucosa. Um, it can, a lot of people actually have allergies to SLS. So if you are using a toothpaste and you feel like your mouth is super sore, um, or you start feeling like shredding of your gums basically, then that could be that there's a high content of SLS um in your toothpaste. So like I for example have a really bad SLS allergy. So the moment I try a toothpaste, I like I'll know immediately like that's got SLS in it. And a lot of people have it and they don't even realize they have it. And you can get the allergy randomly as well. So that's another thing because some people will switch toothpaste and be like, but wait, I've always used SLS. Why is this one different? So that's one. Um, unfortunately though, the SLS free toothpastes are not foamy. So people sometimes it takes them a while to to change and get into that. Um, phthalate-free, yes, parabens-free, yes. Um, so all of those are definitely big nos. Uh, in terms of things to include, um, I think the most important thing is just that it has some sort of remineralizing agent. So that could be fluoride, it could be your hydroxy appetite, it could be your nano silver. Um, and then, you know, each toothpaste, I like to think of toothpaste as like skincare products. It's something that should be personalized to that patient and and their needs. So for example, if you have uh a really bad sensitivity, you might want to use a toothpaste which is uh more strengthening and remineralizing and desensitizing. So something like uh Biomin is really good. That's my favourite. Um, and uh even actually there's a few Sensodynes which are SLS free as well. Yeah, so I think it's Sensodyne uh Pronamel is SLS free. So you could also try that or uh Regenerate is really good. Um, and then uh if you have gum disease, for example, you might need to use a toothpaste which yes, is remineralizing, but also has some sort of antimicrobial effect. Um, so it, you know, again, there's quite a few out there, but there's Curaprox has a really good toothpaste. Um, even Corsodyl has a good toothpaste. Um, and there's a few other kind of more natural ones which use like silver. Um, so we've got Periobiotic has a really good one and Biocidin. So again, it it's depends on what you want. And then the other option is just an all-rounder. So yeah, if everything's good and you just want to maintain, um, then I would go for something which has just got a little bit of everything. So again, your Biomin's great, Super Teeth is great. Um, yeah, I can write a whole list if you'd like of all the options.

Dr Rupy: This is great because I think I like the analogy of toothpaste being like skincare. Everyone's different. You really need to personalize it because you know, the pushback might be, well, Dr Victoria, I saw an advert and it said 99% of dentists recommend this particular brand of toothpaste and it's got SLS in it, it's got phthalates in it, it's got parabens, if you read the ingredients. So I think this is where there is a bit of distrust actually amongst dentists. I mean, it's it's generic across many medical professionals, but when you see these like blanket recommendations and it's not actually personalized and people, you know, find out SLS is actually completely unnecessary. It's just an agent to make you feel that you're getting clean teeth because of the foaming. You know, you can see why there is this growing distrust of of medical professionals.

Dr Victoria: Definitely. I think the the bigger kind of your your big oral care brands in the game, like your your Colgate and your Oral-Bs and you know, they're aware of that and they are coming out with a lot of toothpastes which are free of all of those things. I think one of the the biggest issues and and is a it's a big one is just the idea that a lot of these toothpastes that I'm recommending, they're expensive and not everyone can afford a toothpaste which is SLS free and it's got prebiotics and hydroxy appetite. You know, those are like 10 pounds. And so it's I think that those big oral care brands do still have um a big role to play in improving oral health and those toothpastes still do great things um overall. And I think they are trying to veer off a little bit and try and make cheaper options which still have all those good stuff in them. Yeah. Um, but like I said, like all the options I gave you, some of them are 4 pounds and some of them are 12 pounds. And it kind of depends on where you are and and and how much money you're willing to spend on your your products, like in anything else.

Dr Rupy: Yeah, yeah. Um, awesome. Look, I've got like a whole long list of shopping now to do. Propolis, green tea. I mean, I've already got the like vitamins and and stuff which are personalized to me, like vitamin D3 and K2 and you've got me on CoQ10, um, because of my gum recession, that's nice and stable. Uh, but I am due uh a hygiene appointment. I'm going to be running to book one straight after this. And uh I'm assuming people if they're interested in the uh oral microbiome test and get it from the website, Health Society?

Dr Victoria: Uh, no, so from THS Labs.

Dr Rupy: THS Labs. Okay, great. Um, that that's my uh reminder to do my eye drops. So, uh, right in time, we're going to end the podcast there, but honestly, Dr Victoria, you're incredible. I really love your work and I can't wait to see what you come up with next after this test. It's amazing.

Dr Victoria: Thank you so much for having me. Thanks.