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

26:38I'd like to take a quick break and acknowledge one of our sponsors, Athletic Greens.

26:48Athletic Greens, and all nutritional needs. I've been taking Athletic Greens since 2012, so I'm delighted that they're sponsoring the podcast. The reason I started taking Athletic Greens and the reason I still take Athletic Greens once or usually twice a day is that it gets to be the probiotics that I need for gut health. Our gut is very important. It's populated by a gut microbiota that communicate with the brain, the immune system and basically all the biological systems of our body to strongly impact our immediate and long -term health and those probiotics and Athletic Greens are optimal and vital for microbiotic health.

27:21In addition, Athletic Greens contains a number of adaptogens, vitamins and minerals that make sure that all of my foundational nutritional needs are met and it tastes great. If you'd like to try Athletic Greens, you can go to AthleticGreens .com slash Huberman and they'll give you five free travel packs that make it really easy to mix up Athletic Greens while you're on the road in the car on the plane, etc. And they'll give you a year supply of vitamin D3K2. Again, that's AthleticGreens .com slash Huberman to get the five free travel packs and the year supply of vitamin D3K2. Well, okay. Let's talk about how cavities form because I think this is the major question that people ask when asking about or thinking about oral health.

28:01As I mentioned before, cavities are literally holes. They're fenestrations as the nerds call them, nerds like me, call them. Well, fenestrations will holes down into the enamel that if they make it down to the dentin layer, the tooth most likely do need to be drilled and filled and presumably build. Okay. But your goal, I think all of our goal is to try and keep our teeth in a state of remineralization by keeping the pH that is the relative acid alkaline balance of the mouth such that the saliva supports remineralization. Now, let's think about how a cavity actually forms. Turns out that no specific food, not even sugar, causes cavities.

28:47Cavities are not caused by sugar. Cavities are caused by bacteria that feed on sugar. And now that's not just a little bit of a twist in the mechanism. That's a critical point. There's no specific food, not even pure sugar, not even like a hard candy like a delicious jolly rancher. I used to like those when I was a kid. They get stuck in your tooth that causes cavities. No, it's the bacteria that feed on sugar that then produce acid that burrows down through that degrades, that de -mineralizes the tooth in this very focal area that we call a cavity. Okay. Now, if that isn't surprising enough, get this.

29:29The bacteria that causes cavities by eating sugar and releasing this acid, while there are several of them, the major one is called streptococcus mutants or what I'll call strep mutants for short. Strep mutants is not something you're born with. It's actually a communicable bacteria. That's right. You give it to one another through how? Sharing of glasses, sharing of bottles, kissing on the mouth, etc. Now, I am not here to tell you not to do any of those things. I'm certainly not here to tell you that. However, and by the way, in researching this episode, I did learn that there is a specific category of person out there.

30:09Typically, they are a dentist or married to a dentist that have opted, believe it or not, to never kiss their children near or on the mouth so as to help their children not get streptococcus mutants because almost all adults carry it, not all, but it's communicable, like a STI or like a flu or like a cold. It's communicated between individuals. We are not born with it. Now, that's a whole area of, let's just call it biosocial ethics decision -making that I think most people are not going to be too concerned with, or at least act on because let's face it, most people are not going to change their overall behavior of kissing or usage of bottles or glasses in order to avoid getting strep mutants.

30:56Most people in the world have strep mutants or will get strep mutants and it lives in the mouth. Okay? It just resides there. Strep mutants is there and it's hungry. What's it hungry for? Sugar. When their sugar present, it eats it, it produces acid, the acid produces cavities, taking teeth from a state of remineralization to demineralization, or, and by the way, this is really important if your mouth is already in a state that's more demineralization mode, so to speak, well then it will capitalize on that and it will cause cavities much faster. Okay? So keep in mind that acidity is bad for the mouth.

31:40Does that mean that you should never consume a lemon or, and by the way, yes, I'm guilty of everyone's while chew a lemon slice or drinking water with lemon in it or carbonated drinks or sodas or tea or anything that has acidic flavor? No. Likewise, should you completely avoid ingesting any kind of sugar because strep mutants love sugar? No. Turns out strep mutants like sugars in the form of complex carbohydrate sugars, too. So if you eat pasta or rice or oatmeal or some bread every once in a while as I do, I'm an omnivore. I eat meat and fish and eggs and also starches and vegetables and fruits.

32:16I'm an omnivore, as most people are. Well, then strep mutants has an opportunity to eat the sugars that come from those other carbohydrates. Does that mean that if you were to have a zero carbohydrate diet, no sugars, no starches, etc, you would reduce the opportunity for strep mutants to consume sugar and release acid? Maybe, maybe, however, most people won't do that. And strep mutants is a very clever, maybe even diabolical bacteria. And if you were on a zero carbohydrate zero sugar diet, there's some evidence that strep mutants will figure out ways to feed on other components of food in order to create this acid to then create cavities in your teeth.

32:56So the key thing to understand here is that cavities form not from foods, not from sugars per se, but from strep mutants and other bacteria that eat those sugars and create acid. Hence the critical need to keep your mouth as alkaline as possible, which does not mean that you can ever drink some lemon water or coffee or tea. Here's the key point that everyone needs to remember because this dovetails beautifully into how often you should brush in floss. And when you should brush in floss specifically, the key point is the degree to which your mouth is in a demon state or a remin state and the degree to which cavities have the opportunity to form is dependent on the amount of time.

33:36The amount of time in which your mouth is net acidic or net alkaline. The amount of time that you are in a demonetization mode or remineralization mode. Okay, so it's the amount of time. No one, no one can avoid having their mouth be acidic every once in a while or ingesting a sugar or a food that strep mutants can feed on and produce acid. The key is to try and reduce the amount of strep mutants and reduce the amount of acid in the mouth. That's the best way to reduce cavities and even reverse cavities that have started to form. Now in a moment, I'm going to tell you about fluoride because I know there are a lot of questions about fluoride, but in order for you to understand what I say about fluoride and to make the best decision about fluoride both in drinking water and toothpaste, etc.

34:23for you, you have to understand the remineralization process just a little bit, just a little bit. So a little bit of chemistry here, a little bit of structural biology. And this will be fun. I promise even if you know no biology, no structural biology, no chemistry, you're going to like this part. And it's very simple. Those minerals that form the crystals within the enamel and some of the deeper layers of your tooth or teeth rather, those crystals form through a specific type of bond. And those bonds are very strong. Think of them like Lego chains, but these are not, you know, just conventional Lego chains.

34:55These are Lego chains that when they stick, when two pieces come together, things are tough to pull apart. They're not indestructible, but they're tough to pull apart. And they're also special because unlike a string of Legos, like a single string of Legos, these bonds that form during remineralization of the teeth are interdigitated with one another, or rather are at angles with one another that make those bonds especially strong. Any architect, or somebody that understands structural biology will understand that bonds can be weak or strong, depending on whether or not they're linear, whether or not they're crossed, whether or not they're in lattices.

35:29There's a whole bunch of interesting, you know, angled forces stuff that the architects will understand and the construction workers will understand at a very intuitive and and in concrete level, no pun intended, and on and on. But just think about it. A bond is only as strong as the number of different points at which it can resist shearing and pressure. So the way that these remineralization bonds form is through the addition of specific minerals at specific angles and the naturally occurring mineral that's responsible for the majority of these bonds in the enamel and teeth is called hydroxyapatite.

36:05What a great name if you're talking about oral health, right? Because we use them out for a lot of things. You can think of the small list or long list of those things. There are many of them, you know, depending on who you are and what you like to do with your mouth. But the point being that we do indeed eat with our mouth, appetite is part of eating. So you just remember hydroxyapatite bonds and they are very strong, but they're not indestructible. As they can actually break those bonds. Okay, that's the demineralization process. Now, fluoride is a substance that is not a vitamin. It's not a mineral.

36:36It is not an essential nutrient, but that in the last century, it was discovered, can actually replace some of the hydroxyapatite bonds in teeth and actually make those bonds hyper strong, super physiologically strong. Now, we'll talk about the safety considerations with fluoride in a little bit because there are some safety considerations. But it was decided en masse in the United States and Europe that the addition of fluoride to the drinking water and to many toothpaste or tooth powders would be useful because it creates the super physiologically strong bonds within the minerals of the teeth.

37:14And indeed, it does. It does. Fluoride gets between those legopieces and makes them extra, extra strong. And this is why fluoride is added to the drinking water. But, and this is a very important emphasize, but nowadays, there's a really polarized debate about fluoride because some people out there believe that fluoride can disrupt thyroid health, might even be disruptive for brain health. Certainly, at fluoride levels are too high in drinking water or any substance. It can be very dangerous. It can be a poison. But, of course, the dose makes the poison, right? Fluoride itself may not be poisonous at very low levels, but there are really two camps now that have formed.

37:56And I'll just illustrate those two camps by virtue of what's happening right now. Right now, in the state of California, there is a major lawsuit against the government because people want fluoride removed from the drinking water because of the long list of bad things that excessive, when I highlight excessive fluoride can do for bodily and brain health, especially in kids, but also in adults. At the very same time, meaning right now, there is also a major lawsuit, this one in Buffalo, New York, from mostly parents who are suing the city of Buffalo, saying that there was not enough, maybe even zero fluoride in the drinking water for some period of time.

38:30And as a consequence, their children's teeth or oral health or both is depleted and they are suing for damages. Okay, so this is a really polarized camp. Now, I did a full episode of the Hubert and Lab podcasts all about water. And I talked about fluoride levels, which levels are thought by the CDC to be safe, which levels are not thought to be safe. I talked about some of the theories as to how fluoride might disrupt function of the thyroid and some considerations there. Please check out the timestamp in that episode. I linked to that timestamp in the caption for this episode. But the important point here is that if you are at all concerned about fluoride in the drinking water, the simple answer is to just filter the water that comes out of the tap.

39:11If you're concerned about fluoride, then I suppose you'd probably want to avoid toothpaste that have fluoride. Indeed, there are some. I will provide links to some of those in the show note captions for this episode. There are a variety of these zero fluoride toothpaste that have started to accumulate. But keep in mind that when fluoride is introduced into the bonds of the minerals of the teeth, they do make the teeth really, really strong. But, and all the dentists I spoke to emphasize this point, the bonds that form are not the natural bonds. Now, the fact that they're not the natural bonds doesn't necessarily mean that they aren't good for us or that they're bad for us.

39:42But the bonds that form when viewed under what's called electron microscopy look different. They look wavy. They're not smooth bonds and they do increase the resistance to different forces, including cavities or acid that would create cavities to be specific. They make the teeth stronger structurally, so resistance to chipping, etc. But there is a growing concern about excessive fluoride, which by the way, if you drink a lot of tap water, you're going to be exposed to more fluoride than if you drink less tap water. That just kind of stands to reason, but people don't really talk about this. We talk about ex amount of fluoride by concentration in a given liter of water or gallon of water.

40:22You also have to ask, well, how much tap water are you drinking every day? You have to ask that question, right? It's not simply the concentration. It's how much you're ingesting overall. And that's something that's much harder to control for. Again, in the water episode, I talk about ways to eliminate or reduce fluoride in the drinking water if that's a concern of yours. But if you want to know why there's fluoride in drinking water, it's because governments figured out, hey, well, if we want to reduce tooth decay, what's the simplest low cost method to do that? Well, it's to put fluoride in the drinking water.

40:50And you now also now know why there's fluoride in a lot of toothpaste. But given the concerns about thyroid health, potential concerns about brain health, now you also know why many people, including some dentists that I spoke to, are not big fans of fluoride, both for children and for adults. So you just have to make a decision for you. I'm not here to tell you what to do. You just have to decide, are you pro neutral or against fluoride in your drinking water? And if so, are you going to filter? Are you going to completely avoid drinking any water, maybe even cooking with any water from the tap and on and on?

41:22But now you know why fluoride is in drinking water and fluoride is in toothpaste. If you're somebody who's concerned about fluoride in either of both of those sources, well, then what you really want to think about and what most of us probably should be thinking about anyway is trying to increase the remineralization state of our teeth and mouth in ways that don't create the opportunity for any other health hazard. And I will say this as well, which is that there's some data, not a lot, but some data that fluoride might not be so great for our oral microbiome. And as we'll soon learn, the oral microbiome is critical for our oral and overall health.

41:59So in a moment, we are going to get into what to do, the two dues, the behavioral to -dos and some of the other to -dos for trying to keep your mouth in the best possible remineralization state, the best pH for tooth health, for gum health, for avoiding periodontal disease, maybe even for reversing some aspects of tooth and periodontal sickness. Because indeed, you can do that if you shift your mouth to the correct pH if you're putting it into that remineralization mode. Okay? However, before we get into the two dues, I think it's very important to discuss the do -nots that every dentist and periodontist I spoke to agreed on.

42:38The quick list, as I'll call it, of bad for your teeth, bad for your mouth, and therefore bad for your brain and body are not surprisingly perhaps alcohol, which by the way, I did an entire episode about alcohol. It's one of our more popular episodes. I'm not here to tell you to never drink if you're an adult who's not alcoholic, but the cutoff seems to be two alcohol -based drinks per week beyond which you run into trouble. And yes, zero is better than any, but here when we say alcohol is not good for oral health and for tooth health, what we're talking about is the disruption that alcohol creates to the microbiome and the way that it alters the pH of your saliva and places the mouth and the teeth into a demineralization state.

43:26That's very clear. It also kills certain cells of the mouth. Some people, I remember this in college would say, oh, you know, if you've got to scratch in the back of your throat, you're getting sick, you know, you should drink. That's what they said, you should drink, it's going to kill that thing off. Well, guess what? It does the exact opposite. It kills off a bunch of things that you want, like the cells in and around the mucosal layer of the mouth that are actually going to provide immune support and eliminate those bacteria or viruses that are making you sick, et cetera. So alcohol is bad.

43:54I'm not saying you shouldn't drink at all if you're a non -alcoholic adult. You have to decide for you, but just understand that if you're drinking alcohol, that you want to pay extra attention to your oral health and your tooth care practices, especially on the days around that alcohol consumption. And if you're somebody who doesn't want to drink alcohol, now you have yet another reason to not drink alcohol. The second thing on the no -fly list or they're not good for us list for sake of oral health are stimulants. Now, of course, things like methamphetamine, which are severely deleterious, addictive drugs.

44:29For all sorts of reasons, they kill dopamine orgic and other brain neurons. They are highly addictive and on and on. But also stimulants like adorol, vivence, et cetera. Those stimulants, basically any drug that increases epinephrine and nor epinephrine, they're called adrenaline and noradrenaline or the other names for those, are going to have a negative effect on oral health. Does that mean you should stop those medications if you've been prescribed them? No, it means that you should do some other things to try and offset the negative consequence of stimulants. Why would stimulants cause such disruption in oral health?

45:02Well, there are really two reasons. There's a chemical reason and there's a saliva making the mouth more acidic, which makes strep mutants and other bacteria more capable of creating cavities down into the teeth. They take your mouth and your teeth from that remineralization state or as I've been referring to it, mode to that demineralization, demon mode. Demon mode. That's a way to remember it's bad. Demon mode. Demon mode, not good. Maybe in a video game, demon mode is good. Demon mode, not good for the mouth. Demon mode, demoneralization mode. So there's a chemical reason why stimulants disrupt the oral health milieu and cause disruption in tooth health and degradation, demon of the enamel of the teeth and deeper layers of the teeth.

45:53And this is profoundly evident in methodics. But the other reason, and this was a reason that was shared with me by a physician in MD from University of California, San Francisco, who interacts by virtue of his profession with a lot of methamphetamine addicts who have terrible teeth is that stimulants encourage mouth breathing. Watch a meth addict or watch somebody who's on a high dose of stimulants and they tend to mouth breathe because of the shifts in autonomic nervous system function. They tend to be mouth breathers. So it's the drying of the mouth that also shifts the mouth from that remineralization mode to demoneralization mode.

46:32So if you do take stimulants by prescription, I would hope not methamphetamine or listed drugs. But if you take prescription stimulants and by the way things like well butren, Modaphanil, they do qualify as stimulants, even though Modaphanil is a little bit of a special case. Any drug that increases norup and effernepinephrine, any stimulant, and yes, indeed coffee, we'll talk about coffee as well, and tea will make the saliva more acidic and make your oral health potentially less good mouth breathing, bad for oral health, bad for teeth, bad, bad, bad. There's just no question about it. So today's discussion, I'm calling oral health, but that includes oral airway health.

47:09And I've talked before on this podcast about the fact that if you can be a nasal breather, be a nasal breather, please. As long as you're not speaking, as long as you're not eating, try and breathe through your nose. If you're exercising and exercising really hard, like you're running really hard, fine mouth breath. I don't think there's any evidence that staying in nasal breathing mode all the time while exercising is best for performance. In fact, to the contrary, there are times when you need to mouth breathe and there are sports where you need to exhale through the mouth specifically, certain martial arts, for instance.

47:34So not saying don't ever breathe through your mouth, but as much as possible, try and keep the oral cavity moist and closed. This is critical. So stimulants dry out the mouth, they increase the acidity of the saliva. That's bad. Smoking, cigarettes, and yes, also cannabis. And yes, vaping does this too. It's so funny. Anytime I talk about smoking being bad, you're like, well, what about cannabis? Well, I did an episode about cannabis. Cannabis does have certain medical uses that are very interesting and there's good evidence for those. But for many people, cannabis is not a good idea. You can check out that episode to decide for you.

48:09Then people ask, well, what about vaping? Vaping is not as bad as smoking, right? That's what they say. They're sort of asking, saying, hoping, wishing, fantasizing. And the truth is that vaping is terrible for your oral health as well. Is it as bad as smoking? Probably not, but it's bad for a bunch of other reasons that offset any gain or gains you would get from vaping instead of smoking. So just know that if you're a smoker or a vapor, or if you vape rather, that you're going to want to pay extra attention to some of the other protocols discussed and that we will discuss going forward in order to try and support your oral and therefore your whole body health.

48:44Okay, so we've got alcohol stimulants smoking slash vaping and by extension dipping tobacco, frankly, not good for oral health or tooth health. In fact, they can be pro -cancerous to the gum tissue, as well established. And they can also cause degradation of the gum tissue. And even some of the underlying bone, if you tend to do it on the same side all the time, or often at all. So that's not good. We already discussed that sugar is not good for oral health. Does that mean you can never ingest sugar? No, of course not. Enjoy the sweets you enjoy every once in a while. Enjoy a nice pastry. You know, do as you will.

49:20If you're somebody you never eat so things great, but then understand that any carbohydrate, any starch, provides a sugar that strep mutants can eat and create acid and demineralize your teeth, create cavities, that is. So avoid sugar in excess. And if you eat sugar, try and rinse your mouth after. And ideally, you would brush maybe even floss after. Okay, I do know those people that after every meal that run in even the middle of the day, they run to the bathroom and brush their teeth and floss. And that's great, but most people don't do that. So swishing water, rinsing your mouth out, again, plain water, maybe with a little bit of salt in it is going to be beneficial.

49:55We'll talk about mouth washes later, just to give you a little window into where we're headed with that. Most mouth washes, terrible, terrible for your oral health, especially alcohol based or antiseptic based mouth washes, except under certain conditions prescribed or otherwise. Okay, so if you eat any sugar and frankly, after you eat anything, it's a good idea to try and clear as much of that food product from your mouth. You may not think you still have food in your mouth and teeth, but try to swish some water, maybe spit it out, maybe swallow it, that's up to you. Are you a spit or swallow, not my business?

50:25Don't want to know. Don't tell me. Don't put in the comments. Just decide for you. But sugar and other food products residing in the mouth for long periods of time, not good. And similarly, acidity, foods that are acidic. So certain things like citrus fruits, which I love. I love oranges. I have an orange tree in my backyard now and I absolutely love it. I love oranges, great fruit. I just can, I love the peel. I even eat the peel sometimes. It's so delicious. And no one's telling you not to eat acidic foods or to avoid acidic drinks like lemon water or carbonated lemon water. Some people are really extreme and they decide to just use a straw when they drink those things.

51:04In fact, the dentist I spoke to said, yes, could you ask people please if they're going to drink acidic drinks to try and use a straw. But then I said, well, you know, a lot of straws, they disrupt the environment. Most people aren't carrying around metal straws or you know, and what about the turtles, this kind of thing. And they said, well, okay, here's the real truth. The real truth is it's the amount of time that the mouth is exposed to that acid. So if they're going to drink it, drink it over the course of 5, 10, 15, maybe 20, 30 minutes. And then be done with it. Rinse out the mouth with a little bit of water and try and clear out that acidity.

51:32It's not about completely avoiding acid foods or sugary foods or acidic drinks. It's about, again, limiting the amount of time that the overall milieu of the mouth is acidic because of this whole demon, remin thing, strep mutants and the acid created by strep mutants that can derode the teeth and the fact that if your mouth is kept acidic for long periods of time, you're going to provide the opportunity for faster and deeper development of those cavities. And keep this in mind again, anytime we talk about de -mineralization, the formation of cavities, remember, it's like a sea saw. It's either demon or remin, but not both.

52:09So anytime you're demoneralizing your teeth, you're also not remineralizing your teeth. Okay, so really avoid alcohol, stimulants, smoking vaping, sugar, mouth breathing, acidic foods, acidic drinks. But many of us, most of us can't avoid any sugars, any acidic foods. The other things can be avoided, but some of us are prescribed these drugs and need these drugs. Some people like a drink with alcohol in every once in a while and it's perfectly fine for them or they've deemed it perfectly fine for them. In that case, try and rinse the mouth, try and keep the milieu of the mouth as moist and as basic or alkaline rather, less acidic as possible.

52:49So to translate this a bit more to the real world, if you're somebody like me who loves tea, I drink cold brew, zero sugar, year bimote, that's my favorite source of caffeine. I also like a nice black double espresso or coffee every once in a while. It's fine to drink that, but you don't want to sip on those sorts of things all day and you don't want to sip on them for hours and hours. And if you're going to combine those things with some acidic foods or with any kind of food, you know, try and get your meals done, wrap them up and rinse your mouth and move to the next part of your day. And that actually segues into a really important point that came about when researching this episode that if I had to highlight boldface underline and light up one particular protocol that I think most everybody is not thinking about is that there are certain times in the 24 -hour circadian period in which your mouth makes the maximum amount of saliva.

53:40Okay. And that the saliva has an opportunity to be the optimal pH, that is chemistry, for encouraging remineralization of your teeth. And that's during the daytime and especially through the middle of the day. Now there are a couple of things that can disrupt that. For instance, eating anything. I don't care if you're carnivore or vegan, whatever. Omnivore, when you eat, you change the pH of your saliva and you're introducing those sugars that the bacteria can feed on. So one thing that became very clear to me when researching this episode, talking to experts, reading manuscripts and also reading some really interesting books about remineralization opportunities for the teeth is that having a stretch of time of maybe two, four, six hours or more where you're not eating anything or ingesting anything that's acidic in terms of liquids can be very beneficial.

54:38Now this is a vote in support of so -called intermittent fasting. This is something that I practice typically by eating my first meal somewhere around 11am every morning. Sometimes earlier, I'll sometimes have a little breakfast at 9 if I particularly hungry. But typically I eat my first meal around 11am or noon and then I eat my last bite of food by about 8pm. Not everyone likes to do intermittent fasting. And I realize for sake of weight loss, it's probably interchangeable with caloric restriction generally. And there's a lot of debate as to whether or not intermittent fasting is going to extend lifespan, whether or not it's better for metabolic health and some caloric restriction.

55:10I don't want to get into that debate. Frankly, it's a barbed wire debate that's been carried out on this podcast and elsewhere before. And I think it's ongoing. I think it's the best way to couch that debate. But in researching this episode, it became very clear that we have an amazing opportunity during the day, especially in the morning and throughout the day, to create a lot of saliva that's the right pH to support remineralization of the teeth, provided that there isn't a lot of food or acidic liquids in the mouth at that time. So at least to my mind, this is an interesting opportunity to place intermittent fasting, which again, even just gaps between meals, not constantly snacking or sipping on acidic beverages throughout the day, as an opportunity to create that healthy milieu during which the teeth can remineralize and the overall oral health can improve.

55:56Now, does that mean you should never eat or drink anything during the middle of the day? No, I'm not saying that. I'm saying that if you're going to do those things, try and clear them from your mouth as I described before. Now, many of you will probably say, hey, during the middle of the night, I'm not eating or drinking anything. For some of you, that might be the only time that you're not eating or drinking anything because you're asleep. One would hope you're asleep. But here's the interesting thing. Every cell tissue and organ in our body is on a 24 -hour circadian clock. I think many of you have heard me say that in the context of viewing morning sunlight.

56:28Another protocol is that I suggest on the Hubertman Lab podcast. But here's the interesting and important point. In the middle of the night, indeed, you're not ingesting any food or fluids presumably, but your saliva production is dramatically reduced. Again, dramatically reduced. And as a consequence, if there's food or rather food opportunity for strep mutants and other bacteria to feed on and create acid to erode your teeth, the saliva necessary to offset that, to combat that is simply not present or at least not present at the same levels that it is during the day. So, this is a sort of two -pronged protocol.

57:09On the one hand, I'm saying you might consider trying to introduce maybe an hour or two hours or longer stretches during the day in which you're not ingesting any food. And if you're drinking anything, it's not acidic or if you are to try and rinse away that acid as much as possible. So, plain water would be great avoiding carbonated lemon water. Be great, but if you like those things and indeed I love those things. I love carbonated lemon water. I love things like yerbamate. Indeed, the yerbamate I like is cobrou zero sugar, but has some lemon and ginger in it. That's fairly acidic. But then drinking it down either pretty quickly or if you're going to sip on it, then rinsing it away with some water and not doing that throughout the entire day.

57:48And indeed, I tend to drink my caffeine early in the day and not so much throughout the day. Maybe a little bit of a mate in the afternoon sometimes. So, that's one aspect of maintaining or encouraging the correct pH of saliva to remineralize your teeth. Create these windows of opportunity where there's a lot of saliva for long stretches of time during the day as long as possible while still making it compatible with your nutrition needs and your hydration needs, of course. The other prong or the other aspect of this protocol is that at night when you go to sleep, you need to know you're not producing very much saliva.

58:21And that's the critical time to make sure that there is as little opportunity as possible for strep mutants and other bacteria to feed on sugars or other food products and thereby to create acid that creates cavities. And so, this is a very important protocol that every single dental and oral healthcare professional I spoke to supported and indeed champions, which is if there is a most critical time of day or night to brush your teeth and floss and clean your teeth, it's at night time. It's at night time. Why am I saying this with such whispered importance? Well, I think there are many people out there in particular people that fall into that second category that I mentioned at the beginning of today's episode that wake up in the morning and brush their teeth, maybe even use mouthwash, maybe floss and do a bunch of things to try and get their mouth clean and fresh, especially if they're going to interact with other people during the day and to get rid of all the kind of stickiness and you know, you know, mouth, you know, morning breath, that kind of thing.

59:22But that at night, they're finishing dinner, maybe having some dessert, doing some work and passing out without brushing their teeth or flossing or simply getting too lazy to brush your floss. And by the way, I'm going to raise my hand and just say for many years, I was in that category. I know, it gross, but I was in that category. I had high motivation to brush in floss or at least a brush in the morning, very little motivation to do it in the evening. Every professional said, if you're going to brush in floss just once per 24 hours and that is not what they recommend, by the way, but if you were going to do it just once, the critical time, the most essential time to brush in floss and clean the mouth and get the milieu of the mouth correct for tooth care and mouth overall oral health is at night before you go to sleep because you already know the mechanistic backbone for this argument because at night you're producing far less saliva.

1:00:14And if there's any food product there that the bacteria can feed on, the saliva isn't there to combat that because it's a constant battle between acidity and alkalinity. Your saliva is coming in trying to save everything and the strep mutants is trying to destroy your teeth and the acid is the weaponry they use and what fuels that weaponry, what provides them more ammo to destroy your teeth are sugars and acidity. So if you were going to brush your floss and ideally you do both only once per 24 hours, it would be at night before going to sleep. Indeed, so much so that I would say that nighttime brushing and flossing is perhaps one of the most important things that we can do for overall oral health care.

1:00:53We'll talk about what to do, what to use for brushing and flossing in a few minutes, but that's absolutely essential. I do not want that to be translated into you only need to brush or brush and floss once per 24 hours. Every professional I spoke to and all of the data point to the fact that doing it twice per 24 hours is best or perhaps even three times per 24 hours, but let's be honest, most people are not going to brush and floss three times every 24 hours, some will, but most won't. And now, of course, I've been saying brushing and flossing, but I haven't talked about the incredibly extensive landscape of how to brush and floss.

1:01:33So now let's take ourselves back to being little kids, right? When we were taught to brush our teeth in a particular way, you know, it's supposed to spend a certain number of minutes, set a timer, supposed to floss in a certain way. Every time we go to the dentist, they tell us to floss in a certain way. Do this, not this. What do the data really say? What are the modern health professionals in dental and oral health really suggesting we do when it comes to brushing and flossing? Unfortunately, here, there's a near uniform consensus. There's always that outlier that person that says to do things a little bit differently or no, there's in fact one person very prominent in the dental health space that is not a fan of flossing, but they are really the outlier.

1:02:12The vast majority of dentists out there all say the same thing. You need to brush, you need to floss, you need to do it twice a day or more, and you need to do it correctly. So now let's talk about what correct brushing and flossing really is. Okay, so I'm not going to demonstrate how to brush your teeth, but one very actionable protocol that was told to me by all the dental professionals I spoke to was use a soft toothbrush. Now this one hurts, or I suppose hurts less. Anyway, it hurts my heart a little bit because I enjoy very much using a medium or hard toothbrush and really like scrubbing back there, especially in a teeth in the back.

1:02:53It just feels good. I feel like I'm doing something good again in the back of the teeth, the front of the teeth. I actually enjoy brushing my teeth, especially lately. Don't ask me why. What I do, but every single one of them said that that very vigorous brushing with medium or hard, as they're called, bristles really disrupts the interface between the teeth and the gums in ways that's not healthy for the gums and actually makes tenting of the gums in those pockets, those recesses as they're called, far more likely to form. And every single one of them said, if you are regular with your brushing, and especially if you're brushing and flossing regularly, that a soft toothbrush, that is one that's moved in a circular motion on the fronts and backs of your teeth, for all your teeth, and that is gentle.

1:03:38You're not providing a lot of pressure is going to be the best way to break up that biofilm layer each and every time and promote the best tooth and overall oral health. So I suppose manufacturers who are making medium and hard toothbrushes maybe give us some rationale for that, you know, because the dental professionals that I spoke to and again, I spoke to a fair number of them all said the same soft toothbrush, not just better soft toothbrush best. Likewise, if you use an electric toothbrush, which I now do, sometimes I switch back and forth, but if you use an electric toothbrush, it was recommended that you not provide too much pressure, that you really try and keep the tips of the bristles on the teeth and gums.

1:04:21And yes, it was also suggested that people brush their gums. This is interesting. For people out there who have tooth sensitivity, one of the major suggestions from people in the dental and peridontal field, at least the ones I spoke to, was to actually brush your gums lightly to increase circulation of blood and other nutrients to the deeper portions of the tooth that actually extend into the bone. Now, there is a tremendous amount of blood flow to the gums, anyone who's, you know, sort of nicked their gum with a while, while flossing or with a toothpick can tell you bleeds very readily. And that's not a good thing, right?

1:04:57You don't want to create bleeding of the gums. We'll talk about bleeding of the gums during flossing in a moment, by the way. So don't jump the gums just yet. I said, jump the gums, not jump the gums, by the way. If you are brushing your gums, make sure you're using a soft toothbrush, if you're using an electric toothbrush, make sure you're going very lightly on the gums. And because there's so much blood flow to the gums, it does encourage a lot of circulation to some of the deeper cavities of the tooth as it turns out. I don't want to revert to tooth anatomy in any kind of detailed way now. But of course, within the tooth, you have, again, enamel, you have the dentine, you've got what's called the pulp or the center.

1:05:35There's a lot of nerves innovating the center of the tooth. There's a bunch of other tissues and the bone around it and layers, etc. And when you massage or lightly brush the gums around there, you're encouraging a lot of blood flow to those deeper components of the tooth, which are really the live and active components of the tooth that require blood flow and nutrients. So this is a good thing. In fact, it's probably such a good thing that most people, perhaps all of us should do it, but most people probably won't take the time to also brush their gums. But if you have a little bit of time, it can be beneficial, especially if you have sensitive teeth.

1:06:07The idea that's emerging now in the dental field is that it can help promote resilience or less sensitivity of the teeth to things like hot and cold and maybe even to pressure. So before we talk about flossing, I just want to re -emphasize that the reason to brush your teeth and the reason to brush your teeth lightly or without too much pressure, that is, is that if you're regular with your tooth brushing and flossing, the main goal of brushing is to break up the biofilm layer that provides a substrate for strep mutants and other bacteria to layer on thicker layers of bacteria, so called plaque that will eventually turn to tartar.

1:06:42If we really want to gross ourselves out and really motivate brushing and flossing, maybe we should describe that what happens with strep mutants is it forms these strand -like bacteria, so these are like little celia, so they're attached to the tooth as the biofilm layer, so they're like little strands of strings. But if enough of it accumulates, then it gets thicker and kind of mossy, it's kind of like, you know, thicker, it looks a kind of spongy form and that's the plaque. And then if enough of it forms and there's enough acidity in the mouth, then it forms tartar, which is the hard caked -on stuff that requires scraping off by the dentist.

1:07:16You know, and some people get a lot of tartar, some people have less tartar build -up, depending on how diligent they are at removing the biofilm with brushing. Now, you can remove biofilm and plaque with brushing, but once it starts to form tartar, that is once it's layered on, sometimes has a yellowish tint to it, then you really start to run into trouble because brushing and flossing will not remove that tartar. And that's why the dentist needs to get in there and scrape it away. So it's ideal to be diligent about removing the bacteria while it's still in that strand or plaque form, ideally within this, when it's still in that strand form, removing that biofilm.

1:07:50If you've ever been to the dentist, you may recall they'll do this tooth polishing, you know, they'll do that thing with a kind of gritty stuff on your teeth. And you wonder, you know, is this to make my teeth wider and indeed it can create a bit more shine or sheen to your teeth. But the main reason for doing that, it turns out, is to make the surfaces of your teeth smooth. After all, they do it on your backs of your teeth too, right? If they're good dentists, they do it on the backs of your teeth as well. Why would they do it there? It can't be for cosmetic purposes. Well, they do that because the smooth surface makes it harder for those strands, that biofilm to stick in form and certainly for the more dense plaque and tartar layers to build up on top of it.

1:08:28So they're making your teeth smooth so that the bacteria can't adhere to it as readily. But it's the daily protocols of tooth and oral health that are really critical. We'll talk about dental visits and frequency of dental visits and what a dental visit is really about. It's always about cleaning or filling, etc. But in the meantime, brushing and brushing often enough such that you don't get any build up of biofilm for very long periods of time, eliminating or reducing the amount of plaque and tartar that builds up is going to be your best strategy for improving tooth health. Now, what about flossing in the dentistry field?

1:09:09Some people say if your gum is bleed when you floss, you need to floss more. In fact, most dentists, I spoke to, said that. But they also emphasize that you need to floss correctly. You can't just pull the floss down onto the gum in between the tooth. You need to glide down the side of the tooth, get a little bit underneath the gum and use a circular motion and then lift up from between the two teeth. Which frankly is a lot easier if your teeth aren't very, very close together. Some of us have teeth that are very close together and we try and bring it up through the teeth. It's more of an effort.

1:09:45But they really all emphasize trying to not drop this rather sharp floss. Here, we could also be talking about the tooth pick base floss, whether there's a little arc with a little bit of floss across from it, the ones that you can buy. Some people actually use tooth picks or old fashioned method. Frankly, most dentists, I spoke to don't want people jabbing their mouth and gums with tooth picks. You can decide for yourself. But almost all of them, except for one, felt that flossing is a great idea for tooth health and that if your gums bleed when you floss correctly, as I just described what correct flossing is, that your best strategy is to floss at least twice a day between all of your teeth.

1:10:29And if you're not going to floss twice a day for whatever reason in protest or for lack of time at least once a day and when would that once a day be, it would be at night before going to sleep for the reasons we talked about earlier. And several dentists I spoke to you said that using a water pick is going to be better than using more typical floss or for or using those tooth pick base floss approaches because it's gentler on the teeth. I personally have not used a water pick, but I'm sort of intrigued by the the concept because it sounds like it's much harder to damage the gums and teeth by doing it and that it is at least as efficient as standard flossing.

1:11:03So for those of you that have the disposable income and the interest in using a water pick sounds like it could be a really good idea for the vast majority of us like me, just getting some traditional floss and using dental floss at least once a day at night and ideally also in the morning after brushing, that seems like the most direct and low -cost strategy. I should just mention that the pediatric dentists that I spoke to mentioned that flossing is really about removing food product from between the teeth and therefore children younger than six who typically have big spaces between their baby teeth and their adult teeth have not yet come in.

1:11:41In fact, that's what those spaces are about by the way, unless you're me and when you were a kid, your teeth were too close together and all your adult teeth came in behind those teeth. It was really miserable experience for me. Most kids, their baby teeth are spaced out a bit in order to allow the adult teeth to come in to erupt as it's called such a dramatic word. I love reading this literature, you know, when the molars erupt it's like, whoa, no, it's just come up through the gums. Those spaces are really there for the adult teeth to come up through the gums and so it was suggested that children who have those spaces between their teeth and the spaces are big don't need to floss between those teeth because it could cause some damage to the gums, rather they should just focus on their brushing.

1:12:24Now let's talk about some protocols that involve changing the chemistry of your mouth, not just immediately after meals or during brushing or flossing, but really around the clock. And one of the key protocols that I'd like to discuss is the use of an artificial sugar called xylitol. Xylitol is a very low calorie sweetener. Can place it among the other low calorie sweeteners like asperate, sucralose, stevia, etc. But what's unique about xylitol is that very much like standard sugar or any kind of carbohydrate sugar, the bacteria streptococcus amutans loves to eat xylitol. But when streptococcus amutans eats xylitol, it doesn't meaning it cannot produce the acid that normally would de -mineralize the teeth and create cavities.

1:13:16In addition to that, when streptococcus amutans eats xylitol, it kills streptococcus amutans. So what this means is that if xylitol is present in the oral cavity after a meal, say in the minutes and hours after a meal, then any streptutans that happens to be there is going to preferentially feed on the xylitol, not other sugars, and it won't be able to release acid and because xylitol can actually inhibit the growth, and that is the proliferation of more streptutans, we've got a tofer, we've got a situation where streptutans can't release acid to de -mineralize the teeth and potentially cause cavities, and the total amount of streptutans that can grow, that can proliferate in what are called colonies.

1:13:57Literally the bacteria colonizes on the teeth and that forming that biofilm, well then that can't happen. So xylitol is a very potent tool for improving oral health in this way. In addition, xylitol reduces inflammation of the gum tissue and other soft tissues of the mouth, and so xylitol is providing an array of positive benefits, especially when it's present to the mouth immediately after meals. And for that reason, there are a number of different dentists that have created xylitol products in the form of gums or in the form of mints, specifically to be used after meals. So by chewing a few of these xylitol mints or by chewing a xylitol -based gum immediately after a meal, you're taking substantial steps towards improving the chemical milieu of your mouth and inhibiting the proliferation of cavity forming streptococcus mutants.

1:14:45Now you can also find some literature on other proposed benefits of xylitol, such as improving overall microbiome, such as reducing inflammation in other tissues besides the gums and within the mouth. There is some evidence that it can support the gut microbiome because of course the oral microbiome and the gut microbiome are contiguous. They have different compartments. I mean, you might even be surprised to learn that within your mouth, there are different niches as they're called. For instance, there's different microbiota that live on the gums versus the hard palate versus the soft palate back in the throat and then as you descend into the gut, etc.

1:15:20And it does appear that xylitol has certain positive benefits for all of those different gut microbiome niches. But the literature on that is less well substantiated than, for instance, the literature showing that if xylitol is put in as a surrogate sugar substrate for strep mutants that it disables strep mutants and can prevent the formation of cavities. Now as far as I know, when consumed in mint form or gum form, I'm not aware of any specific side effects or bad effects of xylitol provided that it's not consumed in excess. But as with everything, dosage matters. So if you're somebody who wants to explore the use of xylitol gum or xylitol mints after a meal, I wouldn't suggest going from consuming zero xylitol mints to consuming 50 a day or something like that or even 10 a day.

1:16:05You might start off slowly and just consume one or two after a meal, maybe just your morning meal, maybe just your evening meal, something of that sort, rather than chewing xylitol gum all day long, etc. etc. I'll just mention one other positive benefit of xylitol gum, which is if you use xylitol gum after say your noon meal or your early day meal, it further increases the production of saliva, which as we talked about before is a great thing because one of the best ways to support oral health and tooth health is to have a long stretch of time in the middle of the day where you're producing a lot of healthy saliva in larger amounts because again, saliva is this incredible stuff that's supporting remineralization of the teeth.

1:16:44So lots and lots of reasons to think about, maybe consider using xylitol gum or xylitol mints. There are a number of different ones available out there. I have zero, again, zero financial relationship to any of those mint or gum companies. I'll provide a link in the show note captions to one source, the company and the products were developed by a dentist, Dr. Ellie Phillips, who is quite prominent in the public health education space around dental health. Some of her views are a little bit controversial like reviews on flossing. Other of her views, I find frankly quite ahead of their time in that she's been talking about a number of these things like promoting the health of the oral microbiome and the potential value of xylitol gums and mints, etc.

1:17:24for some period of time. I think most of the information that she puts out there is supported by other dentists and she still suggests regular dental visits. So nothing renegade out there or heretical. Again, there are other sources of xylitol gums and mints that you could consider. I'm simply putting a link to the one that I use because I happen to use them and like them. So I'd like to use the discussion about xylitol as a segue into a discussion about toothpaste because there is a lot of controversy out there about which toothpaste are better for us, maybe even bad for us and best for us. I think it's fair to say based on what we all now know about xylitol that if you can find a toothpaste that contains xylitol as a sweetener, that can only be a good thing.

1:18:08And indeed, there are a number of them out there. We'll talk about specific sources in a little bit. But let's just put xylitol on the short to not so short list of things that would be great to have in a toothpaste for all the reasons that you now understand. The real big question with toothpaste is always should I use a toothpaste that has fluoride or avoid toothpaste that have fluoride. And in order to answer that, we have to go back to our earlier discussion about fluoride. It really depends on whether or not you're somebody that thinks that fluoride is great because it creates the super physiologically strong bonds within our teeth.

1:18:40The crystal structures are that much stronger than when formed by hydroxyapatite or whether or not you're somebody who is wary of fluoride that you're concerned about potential brain health issues or thyroid issues. And you know, here I think people really do fall into either camp or the camp, frankly, of, I don't know, should I be worried? I don't know if I should be worried. I personally grew up using fluoride toothpaste. We had the kind of standard name brand fluoride toothpaste in our bathroom. I brush my teeth with those for years. Whether or not that negatively impacted my health or not, I don't know.

1:19:13Get my blood work done. My thyroid hormones are normal. My brain works at least, you know, reasonably well. But I do realize that some people are very concerned about fluoride and they just don't want to anywhere near their kids. They don't want it anywhere near themselves. So if you're somebody who's going to err on the side of caution with fluoride you are seeking a non fluoride containing toothpaste. There are such toothpaste out there. And most of those, if not all of them, contain, you guessed it, hydroxyapatite. They contain the minerals that naturally form the bonds that create that additional enamel that can potentially fill in cavities and by reminolarization of the enamel and some of the deeper layers of the tooth.

1:19:53So if one is seeking toothpaste and you want to avoid fluoride, you'd want to find something that ideally had hydroxyapatite and something that had xylitol. And they often also contain some sort of mild abrasive, okay, not a really scratchy abrasive substance, but a mild abrasive that can really allow for breaking up with a biofilm that we talked about earlier. Now I've provided links to a couple of sources for such toothpaste and also for these little toothpaste tablets that I've been using lately as well. Sometimes switch back and forth between the two. These are tablets that you chew up and then you brush your teeth immediately after with your wet toothbrush.

1:20:30Both of them work quite well. Again, I want to be clear that the companies that I've provided links to in the show note captions are companies for which I have absolutely zero financial relationship. I do know some of the people that started these companies. I actually discovered these companies because these people are dentists or periodontists or other people in the oral health field. But I also want to be very clear that there was no exchange of promotion of their products for information or otherwise. I simply tried and liked the products and I just so happen to have learned some things about oral health care from these people.

1:21:03Separate in a way from anything about toothpaste or xylitol's etc. Okay, so it want to be very clear that I do believe these are quality sources. These are the toothpaste and two tablets that I happen to use. Gums and Mints that I happen to use. Large part is a consequence of researching this episode. But I pay full price for them. I'm certainly not suggesting that anyone else has to use them. They just represent one option if you're looking for non -flouride containing toothpaste and some other things to promote oral health. And I'm sure there are other sources out there. And if you'd like to refer the various viewers and listeners of this podcast to those sources because you feel very strongly about those other sources.

1:21:41Just put those in the comment section on YouTube. Okay, let's talk about mouthwash where mouthwash is plural. At the beginning of today's episode, I said, let's determine what category of oral health you are in. Are you somebody who pays a lot of attention to oral health? You brush and floss at least twice a day. You're using mouth washes, tooth whiteners perhaps as well. Or are you in category two or three? Well, here's the deal. Most all, most all, not all, but most all mouthwashes, especially those containing alcohol are terrible for oral health. Simply put, they deplete certain components of the mucosa lining of the mouth and they disrupt the healthy components of the oral microbiome.

1:22:29So for those of you that rely on such mouthwashes, I would really encourage you to learn more about them. You're about to do that now. You're already doing that now. And to really consider whether they're not they are helping or harming your oral health. Now, I'm not suggesting that you create a scenario where your breath is causing other people to dissolve into a puddle of tears or back away from you quickly. That's not what you want. That's not what I want. That's not what anyone wants. But I think it's important to realize that these alcohol -based mouthwashes are not good for us. In addition, there are antiseptic mouthwashes, some of which contain alcohol, some of which don't.

1:23:04Which sometimes are prescribed for very serious bacterial overgrowth and infections of the oral cavity. If your dentist or physician or periodontist prescribes those, I certainly am not going to try and get in the way of that prescription. That's between you and your health care professional. But you would be wise to ask them whether or not these chlorahectidine type mouthwashes, etc. are potentially bad for other components of oral health or microbiota in the gut generally. Because in some cases, they have been shown to be not good for us. At the same time, we don't want over proliferation of really bad bacteria in the mouth, so we don't want infections to run wild either.

1:23:43Most people, however, are using mouthwashes to freshen their breath and to kill off additional bacteria in the mouth that they might believe they couldn't get with brushing or flossing. If you are somebody who really wants to use a mouthwash for that reason, I encourage you to try and find a mouthwash that is not alcohol based and that is not a strong antiseptic or that if it is an antiseptic, that it's not alcohol based. In such mouthwashes exist out there. They're a little bit hard to find. I'll provide a link to at least a couple of them in the show note captions. Here, I have to say I have not tried those mouthwashes yet.

1:24:19They do come from sources in which they were developed by licensed dental health care professionals. But this is always the case when somebody is selling something, it's worthwhile to do diligence. Now, as we talk about toothpaste and mints and gums and mouthwashes, I think it's worth taking a step back and also asking the question, are there any zero or very, very low cost or even cost -saving alternatives to any of this? And the great answer is yes. There are actually a number of things that you can do with basically over the counter stuff from the grocery store that all the dentists I spoke to said, yeah, that's a pretty good option.

1:24:55It's not the best option available, perhaps, but it's a pretty good option. And in many cases, it's better than the typical commercially available toothpaste or mouthwash. For instance, I would imagine based on everything I now know about the structure of teeth that using something like baking soda to brush the teeth would, indeed, scrape off the biofilm. Perhaps even whiten the teeth a little bit, although as we talked about earlier, not really whitening the teeth, you're actually just changing the reflectiveness and some of the composition of that enamel, which is translucent, so that you can see the underlying components better.

1:25:29Well, I talked to several dentists and they told me that baking soda actually is fairly low on the abrasiveness rating scale. They have a specific rating scale for this that we don't have to go into, but it's actually considered quite safe for the enamel of the teeth, especially if you're brushing with a soft tooth brush and you're not really grinding the stuff against your teeth at maximum intensity or even near maximum intensity. So it turns out that baking soda and water is actually a pretty good toothpaste if you're not going to go buy a toothpaste. So that's good news. Now, you may have heard that you can make a sort of mouthwash or mouth rinse with baking soda, water, and a little bit of hydrogen peroxide.

1:26:06I want to emphasize a little bit, but I'm also going to emphasize, I don't think this is a good idea at all. Why isn't not a good idea at all? Well, first of all, when we were kids, we used to take baking soda and hydrogen peroxide and put them together to simulate volcanoes. So that tells you right there the kind of chemical reaction that you're going to get. But in addition to that, it's pretty clear that hydrogen peroxide, unless there's a specific medical recommendation to do so, is not something you want to introduce to the oral cavity. Now, this is something that I'm very familiar with because when I was a postdoc, so this is in the 2005 to 2010 stretch, I started to get some pretty bad canker sores.

1:26:45I don't know about you, but canker sores feel awful to me. I hate them. When you eat, they hurt. When you swallow, they hurt. When you do anything, they pretty much hurt. And someone gave me the recommendation to use a little bit of baking soda dissolved in some water and a little bit of hydrogen peroxide to use that as a oral rinse and of course, then to spit it out. And I did that. And actually, what happened to me is I got almost quarter size ulcers on the roof of my mouth and on the sides of my mouth. It took those little canker sores, which were annoying and kind of painful and turn them into full -blown ulcers.

1:27:18I know this because when I stopped using it, those healed up almost immediately. And then when I spoke to some dentists and periodontists, they said, oh yeah, hydrogen peroxide is just far too abrasive for the mouth cavity. And the reason I raised this is because I don't think I'm alone in that if you kind of venture into some of the, let's call it alternative recommendation space for oral health. You may hear that things like hydrogen peroxide can be useful for gargling with or swishing with if you are starting to get a little bit of a throat tickle, maybe an infection. It turns out it's a really bad idea.

1:27:52Now, if there are physicians or oral health experts out there that strongly believe in the use of hydrogen peroxide rinses or gargling with it to promote oral health for any reason, let me know in the show note captions. I don't want to now consider kind of old school recommendation of creating one's own mouthwash with a little bit of baking soda, some hydrogen peroxide in water does not seem like a good idea. Not just based on my experience, but every one of the dental professionals that I spoke to. That said, it does seem that creating a high salt solution. Okay, so taking some salt, putting into water, dissolving it and then finding the point at which it won't quite dissolve because the concentration of sodium is just high enough and using that as of course not something to swallow, but rather as a dental rinse, so putting your mouth and swishing it around and then spitting it out and it's going to taste very salty and then taking a swig of water, you know, just plain water and then swishing it around and then spitting it out.

1:28:48That actually provides a really nice milieu for the production of healthy mouth bacteria. It's near zero cost. Suppose you need a little bit of salt little water in a glass to put it in, but it's basically zero cost. And if you think about it, that high saline or high salinity solution is a lot like the sort of brines and the liquid that comes from these low sugar probiotic foods that earlier I was suggesting in other episodes I've suggested could be really healthy for swallowing for the gut microbiota. But again, I want to be very clear. Do not do not swallow high salt concentration fluid. We're talking about a swish and then a spitting it out as a way to improve the overall milieu of the mouth to get their pH right to promote the proliferation of healthy microbiota components.

1:29:41Okay, so we've talked about some commercially available gums and mince containing xylitol. We've talked about some commercially available toothpaste, indeed some toothpaste that almost fall into the very boutique category because they have all these things that are known by dentists and parodontists would be great for oral health. But those can run some cost, right? And so I do think it's important that we also talked about the use of just baking soda with a soft toothbrush and some water and gently brushing the teeth as a great way to disrupt the biofilm and clean your teeth. And a high salt solution as a swish and spit followed by, you know, swish and spit with clear water, clean water, no salt in it as a essentially very low cost or zero cost mouthwash far and away different from the heavily scented alcohol based antiseptic mouthwash that are commercially available and that we know are basically not good for our oral microbiome.

1:30:37In addition, I'd like to point out that those alcohol based mouthwash that many people in the world use are also known to reduce the amount of nitro oxide that's produced in the oral cavity and that's very important for the production of nitric oxide elsewhere in the body. Why is that important? Well, nitric oxide promotes vasodilation, not just within the blood vessels that line and feed the oral cavity, but also the throat, also in the nose, also in the brain, also in the heart. So what we're talking about here is a substance that is indeed increased when we, for instance, nasal breath, we know that dramatically increases nitric oxide.

1:31:16We're talking about a substance that when the oral microbiome is preserved in its healthy state tends to increase in production and we're talking about a substance that's really good for small capillary vein and arterial health because it allows for the passage of blood, both for the delivery of oxygen and other nutrients to tissues, but also the removal of waste products from tissues. So we don't want to do anything that reduces nitric oxide unless there's some specific medical condition that leads us to want to do that. So for most people, increasing nitric oxide or keeping nitric oxide levels stable is the state that we want to seek and these alcohol based mouthwash are known to deplete the production of nitric oxide.

1:31:58So there's yet another reason to avoid the use of these alcohol based, more typical over the counter mouthwash. By the way, this is not a scare tactic against mouthwash. I'm sure that if you use mouthwash, you're still producing some nitric oxide, but I think nowadays many, hopefully all of you are interested in doing whatever you can to improve your mental health, physical health, and performance. And if there are things that you are doing that are inhibiting those in any way that you potentially want to at least think about those, maybe remove them from your protocols, especially if there's a cost to them that you can remove.

1:32:31In other words, you can save on costs. So again, lots of reasons to move away from the alcohol based standard antiseptic mouthwash is aside from the improvement in your breath that by the way can be better achieved by supporting the oral microbiome other ways that we've discussed, there's really no clear advantage as to why one would use one and there apparently are a number of disadvantages. Now earlier, we talked briefly about canker sores. They are really uncomfortable. There are a lot of theories as to why canker sores form and there are a lot of products and theories as to how to get rid of canker sores.

1:33:04Well, indeed, there are some ways that we can prevent the formation of canker sores and accelerate their healing. And that actually has to do with promoting the health of the gut microbiome. So there's a clear link between gut microbiome and oral microbiome in a way that can either promote or reduce the formation of canker sores and can actually help heal canker sores. And to my knowledge, the best way to support a quote unquote healthy gut microbiome is to consume at least one to four servings of low sugar fermented foods per day. I mentioned what some of those are a little bit earlier. I also did an entire episode about gut microbiome.

1:33:42We've hosted expert guests on the microbiome, including Justin Sondenberg from Stanford School of Medicine. And for sake of time, I can just briefly list off the things that are known to promote a healthy gut microbiome. And that would indirectly support the healing and prevention of canker sores. And those are consuming one to four servings of low sugar fermented foods per day, for instance, consuming enough prebiotic fiber. So consuming enough fiber in the diet through fruits and vegetables or perhaps supplementing prebiotic or probiotic fiber. And in some cases, if somebody is really despiotic or if you've been taking antibiotics, actually taking a pill form or capsule form probiotic.

1:34:22But it's not something that I recommend people take consistently and I certainly don't. I think by ingesting those low sugar fermented foods on a regular basis, by trying to make sure that you're getting enough sleep each night, this is key. Probably should have mentioned this earlier in the episode. But you know, one of the folks who I have great respect for in the public health discussion around dental health is Dr. Mark Berhine. He goes by ask the dentist on Instagram. He's actually a retired dentist. But he's been deeply involved in the kind of evaluation of the consumer product space as it relates to dental and oral health care for a number of years.

1:34:58And Mark Berhine in addition to discussing all the various topics that we've talked about today, such as Zyletal and fluoride, yes, or fluoride, no, etc, etc. has also been a big proponent of people paying attention to that first pillar of mental health physical health and performance, which is sleep. And pointing out that when people get fewer, then they're necessary allotment of sleep each night. So typically most people need six to eight hours, some people need more, some people need a little less. But getting at least six to eight hours of quality sleep per night, which supports the health of the gut microbiome and oral microbiome.

1:35:33And thereby indirectly supports the health of the entire brain and body. So Dr. Berhine and others have talked about this, but I really appreciate that he's championed the importance of sleep among other things, but certainly sleep as a way to support the oral microbiome. So we've talked quite a bit about teeth and gums a little bit about mucosal lining and throat. One thing that we haven't talked very much about is the tongue. The tongue. Your tongue is obviously a very important component of your mouth. And as I mentioned earlier, different niches, different locations within the mouth have different microbiota living on them, both good and quote unquote, bad, meaning ones that we'd like to promote the proliferation of because they reduce bad breath and promote oral health and all that good stuff.

1:36:22And quote unquote, bad bacteria because they make our breath smell bad and because they deteriorate the various tissues of the mouth. I looked pretty extensively into this issue of tongue scraping. And it's an interesting one. And every licensed dental healthcare professional I spoke to in preparing for this episode agreed that yes, it can be a good idea to scrape the tongue. And each one of them cited the fact that a number of unhealthy bacteria can build up on the tongue across the course of the day and throughout the night, much in the same way that biofilm can build up on teeth, although through a different process, different bacteria, and that scraping the tongue or brushing the tongue can be advantageous for removing that bacteria.

1:37:03What was interesting is that several of them pointed out that lightly brushing the tongue may in fact be better than scraping the tongue because they argue that especially when people use those steel tongue scrapers that few people know how to use them with sufficient force to remove the bacteria, but not so much force that they don't damage the tongue tissue. And the tongue is a very fragile soft tissue. So the recommendation that they relayed to me was to suggest once or twice a day brushing of the tongue, but here's an important point. They all suggested that you use a separate toothbrush to brush your tongue then you would to brush your teeth.

1:37:46Okay, so things weren't complicated enough already. It's right about using a separate toothbrush. Why? Well, they gave two reasons. One is they want to prevent crossover of the bacteria between those two different tissues, especially if one is brushing the tongue too vigorously. You don't want to introduce bacteria from your tooth brushing onto your tongue. Of course, you can rinse it in between, but the ideal situation is to use a separate toothbrush for the purpose of brushing the tongue. Now that opened up a whole exploration and discussion about tooth brush care. We do a whole episode all about tooth brush care, but we won't.

1:38:17Suffice to say that when you brush bacteria off your teeth or tongue, and presumably the toothbrush gets moist if by no other means, certainly by means of your saliva being on it, then you rinse it off. And then even if you were to dry it off with a clean, some sort of clean towel or something like that and you set it out, a lot of bacteria are going to perlifrate on that toothbrush. So this opened up a whole discussion about, you know, should you cover your toothbrush or let it dry out in the air? Should you use UV irradiation to sterilize your toothbrush? And frankly, it took us me down the rabbit hole of tooth brush care so far that one point I just screened like an uncle, like enough.

1:39:00I think one has to decide how much bacteria they are willing to tolerate living on their toothbrush in between tooth brushes. Anywhere from zero where you use a new toothbrush or toothbrush head every single time you brush that seems unreasonable or economically unreasonable for most people versus replacing it once a week versus once every two weeks. Really, there's no specific recommendation I can make. All I can say is be aware that bacteria are growing on the toothbrush head, try and avoid contact between the toothbrush head and any unsanitary surfaces, try and rinse and dry off the toothbrush head.

1:39:34All these things are recommendations that were related to me and that just make good common sense. Now prior to this episode, I put the call out on social media for questions about oral health. And one of the questions that came back from many hundreds of people was what about fillings? What about metal fillings? What about sealants? Are they safe? Well, most dentists will tell you that sealants are safe. They are now made from compounds that are generally not thought to cause any major issues. To be honest, I did not do a deep dive into the chemical composition of different sealants because it turns out that different dental practices use different sealants.

1:40:10I'm sure that if I looked hard enough, I could find some really bad stuff in sealants. I'm sure I could also find some reassurance that at the concentrations and conditions that they're introduced to teeth that they are a better alternative to having deep cavities into the teeth. And that actually gives me an opportunity to raise something that I perhaps said earlier, but I want to reemphasize, which is I've been talking about how you can re -mineralize the teeth and how that's critical if you want to maintain and build up your tooth and oral health. But it's very clear that if the cavities get down into the dentine layers of the tooth, that in most cases, there is no remaining opportunity to re -mineralize the teeth using the sorts of practices we're talking about today.

1:40:54And that indeed, it's very likely that those cavities need to be drilled and filled. Now, that's not always the case. And this is one reason why I highly recommend that if you've listened to this episode, and if you're here at this point in the episode, then you've listened to the episode, that you talk to your dentist, ask them if they say you have a cavity. How do you think that would be? I think that's the best way to re -mineralize the teeth if I do the following things. And if they tell you, look, you have a cavity or cavities. And they're simply too deep into the tooth that you can't re -mineralize your teeth and fill those in.

1:41:28Well, then you should trust them. They're the dental professional. If you don't, then you should find a different dentist. However, they may be surprised, and who knows, pleasantly surprised for you to say, hey, you know, I heard that you can actually re -mineralize teeth. And if I've got a cavity, but it's still not through the enamel layer, you know, if I'm really diligent and, you know, use some zyletal and maybe some hydroxyapatite and avoid certain things and do certain things discussed in this episode that I could re -mineralize and fill in those cavities. That said, there, of course, will be situations where you need to get those cavities drilled and filled, especially if they make it into the deep, deep layers of the tooth.

1:42:03And you do not want those cavities to persist and for bacteria to proliferate in those deeper layers of the teeth and down into the bone. That is, oh, so bad. For reasons we talked about earlier, not just for your mouth and your teeth, but for your general health and brain health included. So for that reason, and also because, you know, the history of dentistry was such that, you know, in the early part of the last century, if you had a toothache and a cavity, what did they do? They pulled the teeth. They extracted the teeth. Then at some point, this business of filling teeth became industry standard so people would get metal fillings.

1:42:39Now the types of metal fillings that people had and have depend on when they got those fillings. They were, believe it or not, lead fillings. This is not good. You don't want lead in your body for all sorts of reasons. It is terrible for brain health. That's why it's now illegal to contain in paints and many household goods. You don't want lead fillings, but some people had lead fillings or silver fillings or a combination of lead, silver, and other things. And many metal fillings that were given and sometimes are still given, depending on where you live in the world and country and the kind of healthcare and costs that you have available to you, contain mercury.

1:43:16Now I asked several dentists about this and said, well, if somebody has a metal filling that likely has mercury in it, do they need to have that metal filling removed? And all of the dentists I spoke to said, it depends, but generally the practice is to leave those fillings in and try not to disrupt them. Now they also provided an important recommendation, which is if you have metal fillings that contain mercury or that you think might contain mercury, to avoid disrupting those fillings to the use of things like a mastic gum. We haven't talked too much about mastic gum. I've used mastic gum before.

1:43:51Not for long periods of time. It's a very thick gum, you know, the original use of mastic gum and the kind of origins of mastic gum are like a tree sap that kind of substance that you chew on, so it's a strength in your jaw, etc. I don't use it any longer. I use it for a short while. It doesn't taste like much of anything. Some people believe there are certain anti -inflammatory and other health benefits of mastic gum. I haven't really explored mastic gum in enough depth or detail to comment on any of that, but a number of dentists said, well, if you have metal fillings chewing on things like mastic gum or, you know, hard candies where you're really chewing on that hard candy, which by the way, you're supposed to suck the hard candy, the jelly rancher, not supposed to chew on them, but that some people will do that.

1:44:32They're just naturally chew on those. Can actually disrupt and liberate some of that mercury, and that would be bad. Keep in mind also that when mercury is contained in a metal filling, it's not really bioactive in that mode, but if it's liberated, then it can get into the bloodstream and potentially cause other issues. This is a somewhat controversial topic so much so that in certain countries, and I believe in the EU, somebody checked me on this, but I believe that in the not -too -distant future metal fillings will no longer be used in the European Union, perhaps elsewhere in the world. They're sometimes still used in the United States.

1:45:04There's a lot that's changing in this landscape around fluoride, around metal fillings, etc. So it's very dynamic landscape right now. I think suffice to say that if you have metal fillings currently, try not to disrupt them in a way that could liberate that mercury. However, if you have them and you're really concerned about them, talk to your dentists, ask what the various options are, see whether or not they could be replaced with something safer and if the process for replacing them is really worth the trouble. Again, to just go back to the larger point of whether or not you should get cavities filled, whether or not you need that root canal, that was a very common question.

1:45:35A lot of people said, do we really need root canals? Do we really need to drill cavities? My observation, based on now having talked to a number of different practitioners in this space, really pay a lot of attention to the peer -reviewed research, the old school practices, the new practices, and where everything is headed, is that there are indeed instances where people need root canals. There are many cavities that are just too deep into the teeth that re -mineralization of the teeth through the sorts of protocols that we're talking about today is not going to cut it that they really need to be drilled and filled.

1:46:06Of course, we hope those dentists are doing that as little as is required to maintain dental health. I also would hope that dentists are talking to their patients about ways that they can improve their oral health. Indeed, there are a lot of cases reported online where people will go in, get x -rays, and an exam, they'll talk about all these cavities that they have, and then they go home, and they do a bunch of practices, and they are able to re -mineralize their teeth and to essentially reverse those cavities. And I certainly don't doubt those stories, but it's simply not always the case that we can re -mineralize our teeth and fill back in our cavities.

1:46:39If those cavity recesses are too deep into the teeth, they need to be drilled and filled. Now, that raises a final set of questions and points, which is, do we really need to go to the dentist twice a year, every six months? That's the general recommendation. And this is a tricky one to ask dentists because, of course, dentists are highly incentivized to see their patients. And I'm not somebody that believes that everything is an attempt to make money, but look, when money is involved, things can get complicated. Now, what was really great is that the feedback I got from dentists was very balanced.

1:47:10I mean, I must say that the community of dentists seems like a really wonderful community. I don't know how they treat each other, but they were very kind, very generous with information with me. And at the end of this episode, just before wrapping, I'll refer you to a couple online oral health and dentist educators that I think are providing some really useful content on a consistent basis. And I'll provide links to those in the show note captions. But here's what the consensus was. This business of going to the dentist twice a year makes sense. It makes sense from the perspective of, quote unquote, routine cleanings.

1:47:45But everyone acknowledged that those routine cleanings, while they can remove tartar that's built up, that would be very, very difficult for people to reverse or eliminate at home. And while they can identify cavities and tell you how far cavity has developed into the tooth, etc. Every one of those dentists agreed that those routine cleanings are not actually going to help remineralize your teeth, except to the extent that they remove existing bacteria, plaque, and tartar. And so all of them said that they wish for and that they really strive in their own practices to promote more oral health daily protocols of the sort that we've talked about today, which I think is just great.

1:48:22I think obviously I believe in medical professionals providing routine care. I also believe in each and all of us doing things for our health, not just oral health, but sleep health, mental health, physical health, etc. to try and not just maintain, but really bolster our brain and body against disease and also to bolster our vitality to feel really great energetic, focused, sleeping better, etc. So it was refreshing to hear that they feel that way as well. And in addition to that, all the dentists I spoke to said that, you know, setting aside situations of like reconstructive surgery for the mouth or peridontal surgery, which often is needed if that those recesses into the gums and gingivitis and worse have started to really develop and proliferate.

1:49:08All of them emphasized that the twice a year dental visit is not just about getting the cleaning. It's really the checkup to evaluate how those daily practices are emerging. So it's sort of like going to the doctor for a checkup on your BMI, on your blood pressure, but also things like blood tests, things that typically we don't do at home unless we're accessing those through particular sources. But all of them emphasize that going to the dentist twice a year is not just about those cleanings. It's also about establishing what the baseline level of health is in one's mouth and teeth and having that on record and in a very detailed way so that one can check back routinely twice a year and discover whether or not in fact they could get away with perhaps one cleaning a year because you're so diligent about your brushing, flossing, zyla, it's all not being a mouth breather and on and on.

1:49:59Or perhaps if you're not being very good about those protocols or, and this is important, if you have some of the genetic variants that create an over proliferation of certain bacteria that predispose you to gingivitis or that predispose you to excessive buildup of tartar, this is the reality that some people have genetic variations that create a susceptibility to certain things, both bacteria and other conditions in the mouth that make it such that those people perhaps need to go to the dentist not just twice a year, but perhaps four times a year or six times a year. Indeed, there are some individuals for whom either because of lack of diligence to protocol and or genetic issues actually need to go to the dentist every single month for major cleanings, but fortunately if we are diligent about these daily protocols, nighttime protocols, and we really are paying attention to the components that can create healthy saliva and remineralize the teeth and that can fill in any cavities that begin to form and we're diving off the production of mu -tans and we're scraping away that biofilm on a regular basis that we are going to prevent the need for so many routine cleanings and even if we are still getting those two -year routine cleanings, you know, for those out there that are fortunate enough to have that covered by insurance, we're going to forward it.

1:51:18Well then, all the better because, as I mentioned at the beginning of today's episode, oral health is not just about having clean straight white teeth and fresh breath, it's not just about that. All of those things are great to have, but oral health is about all of that and it's also about reducing cardiovascular disease. It's about reducing irritable bowel syndrome. Yes, I know that we haven't done an episode about this yet, but I get so many requests to do episodes about irritable bowel syndrome and other colitis type, you know, bowel and gut issues that people have and it's so clear that oral health and promoting oral health has been linked to promoting positive gut health as well, maybe even reducing and possibly eliminating some of the symptoms of irritable bowel disease.

1:52:02Because again, the mouth and the gut are contiguous with one another. They're related and a lot of the bacteria that can cause things like gut issues are making their way into the body not directly through the gut, but through the oral cavity because of the richness of blood flow to that region. So again, today we've talked about a lot of different protocols ranging from cost saving to zero cost to low cost to let's just be frank, higher cost products and protocols such as water picks, etc. The point of today's discussion was essentially threefold. First of all, to really tamp down in our minds the importance of oral health, not just tooth health, but oral health on the whole because of its relationship to brain and body health on the whole.

1:52:46So much so that I'm placing it right up there next to the other six pillars of sleep nutrition, movements, stress modulation relationships and light as the seventh pillar of critical to attend to on a daily basis in order to promote our mental health, physical health and performance. The second point is that there are many things that we are probably doing currently that we could do differently either by doing the more or perhaps less or eliminating them all together, things like considering whether or not these antiseptic alcohol -based mouth washes are good for your not. They're not. They're bad for you in my opinion, but you can decide for you how often you brush when you brush, whether or not you decide to use zyletal, etc.

1:53:29As ways to improve your oral health and of course in doing so, the strength of your teeth, the brightness of your teeth, the freshness of your breath, etc. But through some means that I think for most people they weren't aware of. I certainly wasn't aware that we could remineralize our teeth at any moment by changing the acidity, the chemical milieu of our mouth and that they're very straightforward, cost savings, euro -cost and low -cost ways to do that. Then the third point is that today's discussion by no means was exhaustive. You may be exhausted, but it was by no mean exhaustive. Meaning we simply don't have time to go down the rabbit hole of all these other promoted health practices such as, for instance, oil pulling.

1:54:11A lot of people out there believe that if you take olive oil and swish around your mouth and spit it out, that that's good for your mouth. And licensed dental health care professionals said, yeah, I think there's some benefit to that. There's the whole story about vitamin D and whether or not we're getting enough vitamin D can indeed impact our tooth health. So make sure your vitamin D levels are sufficient. I'm sure you're getting some sunlight. Again, this ties into some of the other six pillars. Am I suggesting that everyone do oil pulling? No. I don't think the peer -reviewed evidence on oil pulling is sufficient to suggest that people do that.

1:54:45But as a practice, considering that it's essentially near zero cost, you know, taking a little bit of olive oil and swishing around your mouth and spitting it out, a couple cents maybe. You know, if that's something that you feel benefits you, great. If you are aware of some terrific peer -reviewed research on that and you want to put a link to that in the comments on YouTube, great. Please send them my way. I'd love to review them. But my point is that there are a lot of different practices that have been promoted, including oil pulling and a bunch of other things that start to get pretty far into the esoteric, which doesn't necessarily mean that they don't have merit.

1:55:16But today, I've really tried to focus on the major ones, the ones that relate to what most everybody could and should be doing, like brushing and flossing, rinsing, getting the oral microbiome healthy, reducing the amount of strep mutants and the opportunity of strep mutants to create that acid that's going to deplete the enamel of your teeth and lead to tooth decay, trying to limit the amount of recessing of the gums and peridontal disease. And for all the reasons that we talked about before, keeping a healthy mouth, including healthy teeth, healthy tongue, healthy gums, healthy palate, and all the rest is also important, not just for your mouth, not just for speaking and smiling and looking the way you want to look, but also for your heart, also for your gut, also for your, believe it or not, your skin didn't have time to go into this, but it directly relates to skin health and for your brain health.

1:56:13So I strongly suggest that all of us take a look at what we are currently doing for our tooth and oral health and consider what modifications are best for us. If you're learning from Endor and enjoying this podcast, please subscribe to our YouTube channel. That's a terrific zero -cost way to support us. In addition, please subscribe to the podcast on both Spotify and Apple. And on both Spotify and Apple, you can leave us up to a five -star review. Please check out the sponsors mentioned at the beginning and throughout today's episode. That's the best way to support this podcast. If you have questions or comments about the podcast or topics or guests that you'd like to suggest for the Hubertman Lab podcast, please put those in the comment section on YouTube.

1:56:52I do read all the comments.

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