The Functional Dentist: Stop Rinsing After Brushing! 6 Rules For Better Oral Health | Dr Victoria Sampson

0:00Over 50 % of our population have some sort of gum disease. It impacts 3.5 billion people globally. Gum disease and decay are mostly preventable. There are certain oral bacteria able to cross the blood-brain barrier, cause neuroinflammation. They've been found in 96 % of Alzheimer's sufferers. People listening to the episode right now might be thinking, Alberto, ask her for the solutions. What's the mouthwash? I want the brand of the toothpaste. What does a good daily practice look like? So... Wow, I've been doing it all wrong for 30 years. Most people have, by the way. Dr. Victoria Sampson is an award-winning functional dentist, researcher, and leading voice in preventative dentistry.

0:39Her research focuses on the oral microbiome and how it is linked to widespread health conditions from heart disease to diabetes. She is the founder of THS Labs, using saliva diagnostics to analyze oral bacteria and genetic risk markers, creating a personalized picture of oral health. Over the last probably five to ten years, we've talked the topic of the gut microbiome, but not so much about the oral microbiome. I don't think it gets enough attention. It's the second largest and most diverse microbiome after the gut. 60 % to maybe even 70 % of bad breath is actually to do with the gut, nothing to do with the mouth.

1:14It's in your control. You can change it, you can fix it. You've mentioned before that there are some mouthwashes or gels that are particularly designed to switch off that very bad bacteria. Can you name a few brands? So there's one. Victoria, for those discovering your work today for the first time, what is it that you are an expert in? I guess word on the street is I'm the saliva queen. What that really means is most of my work is connecting the mouth to the rest of the body and showing how diagnostically useful saliva can be. Can you talk to me about what you've studied, your credentials that make you a subject matter expert in the topic?

1:53um i think so i started my journey i mean i'm a dentist fully qualified and then when i was i think it was about 2019 covid happened um and all dental practices were shut down and i was like this is crazy and the nhs were like oh yeah dentists are not um what's it called like useful people and so we were like oh okay that's crazy and so i instead decided to write loads of research i was researching everything. So I was like, I really believe that poor oral health increases your risk of COVID complications. And before that, like dentistry and medicine have always been very, very separated. You know, medical colleagues, they study a little bit of dentistry, dentistry studies a little bit of medicine, but we don't really work together at all.

2:36So I basically wrote a paper which hypothesized that poor oral health increased your risk of COVID complications. And that was the first paper in the world to actually connect everything together. and it actually helped pave the way for dental practices to reopen and for people to see dentistry in a different way and not just see it as some sorts of cosmetic you know look pretty feel pretty but actually feel better like and be healthy so once that research was published I then started working with universities on actually proving this hypothesis and that's where I guess my eyes were opened to saliva testing, to the links between oral health and general health, and all the work that I do now.

3:19Fascinating. At least myself, I've almost always viewed my oral health as one-dimensional. So it was only related to what was happening within my mouth, as opposed to having or understanding the connection within the rest of our body components. I think over the last probably five to ten years, we've talked in several different podcasts, in several different books, the topic of the gut microbiome, but not so much about the oral microbiome. What is the oral microbiome? So the oral microbiome, I don't think it gets enough attention, is the second largest and most diverse microbiome after the gut.

3:58So a lot of people say that the oral and gut microbiome are actually very much connected and you cannot have a good gut microbiome if your oral microbiome is not healthy and vice versa. But essentially it's an ecosystem of around 700 bacteria, which make 2 billion bacteria overall, which are all situated within the mouth. And why should we be looking after this? Why should we get more education around that? So like you said, I think a lot of people have compartmentalized oral health and they just kind of think of their mouth as being totally separate from the rest of their body. Your oral microbiome and all of these, essentially these bugs within your mouth, they can release inflammation.

4:35So inflammatory markers, which can travel through to the rest of your body and impact general health. These bacteria can literally travel to other parts of your body and cause infections elsewhere. And so people, I don't think, even really even realize that their mouth has bacteria in it And that these bacteria, if they're not taken care of, they can do some really bad things, not only in the mouth, but also for the rest of the body. Talk to me about those bad things. So if we're just talking local, your classic ones are going to be increased risk of cavities, increased risk of gum disease, bad breath, bleeding gums, ulcers.

5:12Those are all kind of side effects of an imbalanced oral microbiome. But then if we look at the maybe more downstream effects, you can kind of separate into three different things. So the first is inflammation. So these bacteria, when you've got much higher levels of these bad bacteria, they can release inflammatory markers and they can travel through to the rest of the body. So imagine you have an inflammatory disease. You've got rheumatoid arthritis and then you've got these bacteria releasing inflammatory markers in your mouth and it's traveling through. it's just adding petrol to the fire it's just making your life worse basically making things a lot more difficult the second is that bacteria from the mouth can travel to other parts of your body so there are some really strong connections with things like infective endocarditis so this is literally a bacterial infection of your heart which can cause death but it happens in much smaller scales with a lot of other organs as well and again it's not necessarily that it's going to kill you, but it contributes to your body not being able to be as healthy as possible.

6:18And then the third one is basically like your blood vessels do not constrict and dilate properly. So what I mean by that is bacteria release inflammatory markers travel through to your blood vessels and your blood vessels cannot dilate and constrict properly. So you've got reduced blood flow traveling through to the rest of your body. And this is where we see connections with things like 20 % increased risk of high blood pressure, increased risk of cardiovascular disease, elevated levels of CRP. And these are real things. And I think the reason why I'm so passionate about it is because oral health is something that you can actually, it's in your control.

6:56You can change it. You can fix it. And I don't think people realize how much of an impact it has on general health. I certainly didn't. what are the daily things that negatively contribute to our oral health so that's a really good question i think there are some there are some things which are like bad for everyone okay so smoking um drinking too much alcohol poor oral health um so what i mean by that is like actual just not mechanically removing the bacteria and the plaque from your mouth so your teeth are the only non-shedding surfaces in the whole of your body. So what that means is that if you don't physically, mechanically brush your teeth, no one else's.

7:38And your skin, your nails, your hair, they're all shedding. So technically, if you were to never have a shower in your life, you would still kind of self-wash because your skin is shedding, but your enamel and your teeth do not. So that's why it's so important to be mechanically removing that biofilm and that plaque twice a day. And then otherwise, medical conditions can also really impact oral health. Diet is probably a huge, huge one that people don't really think about. And it's not just, you know, eat better. It's about the frequency of sugar. So let's say if, I don't know if you have a sweet tooth.

8:15I do. So I have a big sweet tooth. And for me, it's better for me to eat all my sweets in one go than to have little bits of sugar throughout the day. And the reason for that is because your saliva becomes very acidic every time you have sugar. And so constantly your saliva becomes acidic and that will increase your risk of problems as well. Fascinating. A very dumb question. What are teeth? I don't think I've ever been asked that. So they are actually vital organs. um most of us have between 28 to 32 of them um each tooth kind of has different numbers of roots and nerves um and people sometimes don't understand or think that your teeth have blood flow and nerve supply as well and that's why we get toothache that's why all of that is literally these teeth are living organisms um you've got three layers to each tooth so in the core of the tooth is your pulp, which holds your nerves.

9:12And then the next layer is your dentine, which is like a sponge. And then the outer layer is your enamel. And your enamel is kind of like the kind of the waterproof rain jacket that covers the tooth. It stops you from having sensitivity. It protects your teeth. So anyone who's listening and they say, you know, their dentist may have said, oh, you've lost enamel or you need to take care of your enamel. The reason for is if you remove that enamel and you get rid of that, then you go into the sponge bit and that's super, super sensitive to cold, to temperature, to everything. So we want to keep our enamel for as long as possible.

9:48And the primary function of the teeth is to chew? A lot of different things. I mean, yes, mastication is probably the primary one, but then also even smaller things like your facial structure. If you didn't have teeth, I'm not sure if you've ever seen someone who's really, really old and they don't have teeth, them they go they very much hollow um their um proprioception as well so even your when you're eating it's not just the chewing but it's also the feeling the um the sensations which your teeth usually are are feeding back through to the rest of your body um why is that important because if you don't feel what you're eating you won't enjoy it i think interesting or perhaps it's signaling in our brain that we are being fed and at some point maybe satiated.

10:38Exactly. Yeah. Interesting. And what is saliva? Saliva is kind of a, well, I mean, I'm biased, but it's a golden elixir. It's got everything in it. We produce and swallow around about one and a half liters of saliva every single day. Wow. And it's a combination of, you've got enzymes, so the things that can break down complex carbohydrates, so they help you with eating. They've got sometimes sugars, proteins, hormones, genetics, bacteria. So literally everything can kind of be found within your saliva. And what to me is crazy is that we spend all our time doing blood tests and stool tests and urine tests, but we don't really often use saliva, even though it is the fluid that we produce the most of and is the easiest to produce.

11:30Interesting. And what are the things that the saliva test can tell us? So a saliva test, it depends on which test. I guess the better kind of answer is what can you find out from your saliva? So you can find out hormones. So actually some of the most already available saliva tests, which have been around for decades now, are for cortisol and for also testosterone, progesterone. And the reason for that is because it's so easy to test that people can test it throughout the day, five, six times a day and see how their cortisol levels go up and down. You can test your genetics. So that's where things like 23andMe or other tests have come out where you can basically find out where you're from and all those different fun things.

12:16And then you can also test like the buffering capacity and the acidity of your saliva. So your saliva is a very neutralizing fluid. so what that means is that anytime you put something in your mouth it's constantly trying to kind of limit the impact of that and it's trying to neutralize those acids and calm everything down a little bit so you can test that and then you can test all the bacteria and inflammatory markers which is where my company does a lot of work where we're looking at all the different bacteria how they interact with each other how they're actually acting and we combine that with your genetics and also inflammation as well.

12:55Fascinating. And what is the tongue? And what is its purpose? You know, it's one of the strongest muscles in the body. And the purpose of that as well, it helps with eating, with swallowing. There's a lot of work. My sister actually is, she's an orthodontist and we work together at our clinic and she does a lot of work on the tongue and the posture of the tongue, the mobility of the tongue. You don't realize until you have the problem how important your tongue can be. So a lot of kids, they have something called a tongue tie, which means that they have reduced mobility of their tongue essentially.

13:30And that will impact how they speak, how they swallow, how they eat, how they breathe, but increases their risk of sleep apnea, of mouth breathing. And these are all things that are really, really important for general health and impacts your ability to sleep. Why is mouth breathing important for overall health? Firstly, the thing is, is that it dries up your mouth completely. So if you're breathing with your mouth open constantly, going back to saliva and how it's kind of this neutralizing fluid, which helps to impact everything. If your mouth's dry, your saliva is just not there. So it can't do all the good that it's meant to do.

14:05It also means that it can't wash away debris or bacteria or food. So all that plaque and biofilm just sits on your teeth. And then the other thing is actually in terms of your general health. If you're breathing with your mouth open, it impacts how you sleep and essentially limits the amount of oxygen that travels through to your brain. So there's a lot of research now showing that if you're breathing with your mouth open during sleep, that can impact your quality of sleep. And actually in children, for example, their concentration, even in adults as well, we see it with chronic fatigue patients where they're just they're not sleeping properly because they're literally just not getting oxygen to their brains.

14:48You've mentioned tongue posture. What does that mean? So that is essentially like how, imagine your tongue is, it's a muscle, right? So it's kind of like our posture, right? So your tongue, yeah, actually you could probably get my posture as well. So your tongue, some people don't have as much muscle tone and motility to their tongue, which means that when they're eating, I don't want to say that they choke on their tongue, but they don't have the same amount of movement and freedom of movement as other people do. And it's literally like you can work with a myofunctional therapist to actually, it's like literally working out your tongue, like how to use your tongue properly.

15:27Some kids in particular, they're born and they don't really have anyone tell them how to use their tongue, right? No one goes and says like, okay, guys, let's do tongue exercises. So some children are not using their tongue properly. So they're not speaking correctly. That's where we see a lot of lisps, for example. So it is really important. What role do genes play in our oral health? So this is a bit controversial. I am very much on the edge of saying I think genetics is really important for oral health. It's not to say that you will get disease if you have specific genetic mutations. but I think for a long time, we kind of blamed patients.

16:11Like as a dentist, we would be like, you're not brushing well, you have gum disease. And I would see these patients where I just be like, this just doesn't add up. Like they do brush really well and they are taking care of themselves, but they've got raging gum disease. Or some patients who eat super well, they do everything amazingly, yet they're constantly getting cavities. And so a lot of the work that we're doing at THS Labs and also I would just say generally the research in the last 10 years has been looking at how genetic mutations can contribute to your oral health. So there are some genetic mutations which increase your risk of inflammatory markers being released.

16:49So that type of patient, let's say they have, there's a mutation called TNF. So it's for tumor necrosis factor, which is an inflammatory marker. So if you have that mutation, it's not to say again, you have gum disease, and this is more of a mutation just for general inflammation, not to do with the mouth. But if you have this mutation and you have even the smallest amount of bacteria or the smallest amount of physical stress within your body, you will release 300 times more of this inflammatory marker than someone else. And so that just means that you're creating this environment of inflammation and therefore increasing the risk of something like gum disease, which is an inflammatory disease.

17:27So I very much strongly believe that there's there's huge connections between certain mutations and particularly gum disease, but also cavities as well. And then from a cavity perspective, we see it sometimes with children and with adults too, where again, you're not, we're not saying you are going to get cavities, but there are some patients, unfortunately, I'm one of them who, even if I have the smallest amount of sugar, I have a sweet tooth, like quite literally genetically, I have a sweet tooth. So I'm someone when I'm stressed out and I'm having a really horrible day, some people will go and drink alcohol.

18:03Other people will go smoke. Other people, whatever. I'll go and buy a chocolate bar and I'll eat it because that to me gives me that kind of satisfaction. It calms me down. And then there's another genetic mutation, which means that actually your sugar cravings are much more heightened. So for me, I'm stressed out. I don't buy one chocolate bar. I'll buy two chocolate bars because my threshold is much higher than other people's. So those things, they increase your risk of something like cavities. And sometimes it is quite nice to tell a patient that because whilst we can't necessarily change our genetics, there's something quite, I guess, empowering.

18:37And it's quite nice to be like, okay, like I'm trying my best here. But sometimes I'm up, I'm up against something which is not within my control, particularly the inflammation side of things. And with the patients who have gum disease, and it's, it's a really frustrating and sad thing when they do everything right, but they still have the disease. So having a sweet tooth is a genetic predisposition? Yeah, it can be. It can be. Otherwise it's habit because sugar is also an addiction. So if you've been born and raised on sugar, you literally will have a sweet tooth because of that. You mentioned cavities.

19:12In simple terms, what are cavities and how do they form? um so cavities form you've got your bacteria specific bacteria so um let's use the main one for now which is called streptococcus mutans so strep mutans is a bacteria which um lives in your mouth and then you have sugar and this sugar let's say you have a chocolate bar um the bacteria will feed on the sugar within that chocolate and what happens is that it will release acid and this acid will kind of sit and linger on your tooth. And then imagine your saliva, right? Your saliva is there to be like, okay, let me calm this down. Let me get rid of everything.

19:51Maybe your saliva is not doing so well. Maybe you keep having chocolate, right? And there's just too much acid being produced. So that level is kind of imbalanced now. So acid sitting on the tooth and it basically causes demineralization. So it essentially breaks down your enamel. And if it's not addressed then, then it just continues to break down it crosses through the enamel remember those three layers we have so it's crossed through the enamel now it's gone into your dentine dentine's a sponge so it's like a super highway so once it's crossed into the dentine it's very very fast to get to the nerve and once it gets to the nerve that's where you start feeling toothache or the tooth dies and that's where you know we have to do things like root canals and etc why do they get black So that is often the demineralization and the release of certain minerals during it.

20:43And how long, on average, does it take for the cavities to form? That's a really good question. Decay and caries is a very active process. So what I mean by that is that it's not like once it starts, that's it. It's going to end up with the tooth dying and you needing to take it out. Particularly when it's in that outer layer of the enamel, so in that hard outer layer. It's a very active process. So you might, let's say you're on holiday for a couple of months and you're not taking care of your oral health and you're having loads of sugar and not brushing your teeth. So maybe that carries or the decay is forming and it's kind of growing.

21:18And then you come back to London, you're like, okay, I'm going to change my diet. I'm going to change everything. And I'm going to use the best toothpaste in the world. Then actually you can often stop that decay in its tracks if it's in the ulcer layer of the enamel. And then let's say you're a weekend, you're like, nah, I can't be bothered to do this anymore. Then that decay starts again, and then it will cross into the dentine. So it's hard to give you like a number because some people will have early decay lesions for years, and they don't necessarily have to have fillings. Other people, I've seen them, and within six months, like huge cavity.

21:53And that's why we like to see our patients regularly to keep track of those types of things. Do you know what percentage of the Western population have this type of problems? Decay or gum disease? Both. So gum disease, over 50 % of our population have some sort of gum disease. It impacts 3.5 billion people globally. In terms of decay, it's hard to say and I don't know the full statistics. But what I do know is the World Health Organization has actually released a statement saying that, This is a really, really big problem because gum disease and decay are pretty much mostly entirely preventable.

22:34So what are we doing wrong and why is it that these two diseases are so prevalent within our communities? The other thing is that gum disease is the sixth most common inflammatory condition in the world. So it's just under diabetes and high blood pressure, etc. But again, it's entirely preventable. And the other problem is that gum disease is connected or linked to over 50 systemic conditions. So if you have gum disease, you're increasing your risk of heart disease, high blood pressure, cardiovascular disease, Alzheimer's, you know, and the list goes on. So it's really a global issue. It's a really, really big pandemic.

23:10If you were to put it in a scale, how much of our gum disease is contributed by our lifestyle and how much by our genes, if you put it into a percentage? I and this is purely my own opinion I would probably say it's 80 percent lifestyle 20 percent genetics honestly I feel like sometimes people ask me and they interview me and they want these like really complex solutions to improve oral health like it's really basic just brush twice a day use the right toothpaste see your dentist and hygienist like it can be very very simple but sometimes I think we over complicate things. And for that 20%, the genetics can have a profound impact and be a huge deal.

23:53But the prevalence of that is quite low. So the average person should be able to keep on top of their oral health. Sometimes when we brush our teeth, our gums bleed. What does that mean? So bleeding gums is not normal. And if you do have that, you should visit your dentist or your hygienist. Because I always compare this, if you woke up in the morning, and you yawned and you wiped your eyes and you got blood on your fingers, right? And you're like, you know, your eyes were starting to bleed. You would probably run to the doctor, right? You'd be like, this is not normal, right? But for some reason, when people brush their teeth and they spit in the basin and they see blood, they think that's absolutely okay.

24:32They have no problem with it. That is your first sign of inflammation. It's essentially, it's literally like release of blood is inflammation. So that is the first sign to be like, okay, I need to go and see someone and get this sorted out. And what could be the potential things that are happening within our mouth? So the most common one is gum disease. And gum disease is a bit of a spectrum. So if you look at it from the very early stages, that's like, okay, I haven't brushed my teeth very much. Or I'm not flossing or something. And you start getting bleeding gums. You're spitting in the basin.

25:05You see the blood. You walk away. You don't think about it, right? And then what starts to happen is that those bleeding gums will start to become more and more inflamed. and then we get something called pocketing. So now we're like further down onto the spectrum. And pocketing is, imagine your gum is like a turtleneck around the tooth, right? You want like a really nice tight turtleneck. You don't want anything to be able to go in around that gum. And what happens during this kind of stage of pocketing is that turtleneck becomes like an open blouse. Like anything can kind of come in and literally it becomes a pocket.

25:36And so if anyone's ever gone to the dentist and you hear us shouting out numbers and we're saying four or five, three, that's us literally measuring the depth of that pocket how deep can we go into that pocket and then this patient they're still not brushing they're still not going to the dentist they're not getting this treated then what starts to happen is that progresses into deeper pockets and bone loss and before we get to bone loss so before that with the pocketing that's entirely reversible so you can see your dentist and hygienist get the treatment that's needed and five years later, no one will even know you had gum disease ever in your life.

26:12But once you start losing bone, that is an irreversible procedure or irreversible kind of thing. And that will continue to progress. This person still isn't going to the dentist or the hygienist. And then you start to get tooth mobility, you get wobbly teeth, you get infections, all the way down to you've lost the tooth. All right. So if we have bleeding gum, we should definitely go to a dentist. 100%. Now, what should we do if we have bad breath? That's a different... So bad breath is very multifactorial. I have a lot of people come to me for bad breath. I think it's one of those... A lot of people don't come to you to be like, hey, I have bleeding gums.

26:54Unfortunately, I wish I had more of that. But also, sorry, going back to gum disease quickly, it's quite a silent disease. Like you don't really realize you have it until you've got a wobbly tooth all the way down at the end. So that's why the only, the first sign you get is bleeding gums. And that's when you need to come in to get that sorted. Otherwise, you won't really know what's going on until it's too late. What if the bleeding is intermittent? If it's intermittent? So sometimes in a few cases, it can be from like general health disorders. So I've seen it sometimes with patients who are going through menopause.

27:26I've seen it with pregnancy, quite like hormonal things where it can increase the blood flow to their gums and they can get it. Even if it's intermittent, I don't think there's any harm with you just getting it checked by your dentist. And then you'll know for sure what it is. If it's just one day and I don't know, you were a bit too aggressive with your TP brush, like fine. But if it's happening once or twice even, you should definitely go and see your dentist or hygienist. And then going back to bad breath. So it's, I would probably say 60%, maybe even 70 % of bad breath is actually to do with the gut.

28:04Nothing to do with the mouth. Even though we are the ones who get all the patients. And so the things that can cause bad breath within the mouth are infections, gum disease. there's a very very specific smell that um you can get from gum disease and unfortunately i'm very well trained to it so i literally sometimes like i'm at a restaurant i'm like what does it smell like i don't know how to even explain it it's um it it tastes it tastes it smells like um like breakdown of tissue i don't know how to it's not a little bit a tiny bit um so a lot of people mistake gum disease with bad breath but they just need to treat their gum disease.

28:46And then there's also certain bacteria, which are called volatile sulfur compounds. So the most kind of important one is one called Fusobacterium nucleatum. And this is a bacteria which literally releases volatile sulfur compounds. And sulfur gives you that kind of eggy, not so nice smell. And so that can contribute to bad breath. And then actually also tongue as well. So people who maybe have like a really hairy tongue, or there's lots and lots of stuff on their tongue and they're not brushing or even their teeth either that can also obviously contribute to poor or to bad breath but then the other 60 70 percent so I work with a functional medicine practitioner within my clinic and I often you know I'll do an oral micro balm test on the patient and if I don't see anything which could be oral contributed I will refer to the functional medicine practitioner and the biggest kind of causes of bad breath from that side are things like SIBO.

29:39So that's upper intestinal infection, but also things like H. pylori, even just gut issues. Acid reflux is a huge one that people don't necessarily realize. And so actually she often is better suited at treating bad breath than I am.

30:01i've read some studies that draw a connection in between our oral health and alzheimer's are you familiar with any of this yes yeah um so there's a lot of research which is definitely coming out in the last like 10 to 20 years and basically um the the mechanism behind this link is there are certain oral bacteria so namely one called porphyrmonis gingivalis and this is like probably like the big bad, the worst bacteria in the mouth. Okay. So we call it like the keystone pathogen. It's really, really important. Even at small amounts, it can really cause a lot of destruction. So this bacteria can release virulence factors.

30:41So these are toxic enzymes. And these toxic enzymes have been shown to be able to cross the blood brain barrier and to actually travel into the cerebral spinal fluid and cause neuroinflammation. And they've been found in 96 % of Alzheimer's sufferers. So these toxic enzymes are called gingipanes. And yeah, 96 % of Alzheimer's sufferers have these gingipanes in their cerebral spinal fluid compared to patients who do not have Alzheimer's, they do not have gingipanes. So there is a huge link there. There's also now research, kind of it's more retrospective work looking at hundreds of thousands of people to track and monitor them whilst they have gum disease.

31:21So essentially, if you have gum disease for more than 20 years, does that increase your risk of Alzheimer's? And they followed these people. And they found in one specific study that having gum disease for over 20 years increases your risk of Alzheimer's by 70%. And then I always get some people, some naysayers who are like, well, surely if you have Alzheimer's, you won't be brushing your teeth well enough. And therefore, or, you know, it's like chicken and egg, like which one causes which. So there are some earlier studies which are just coming out now, which have shown patients who have Alzheimer's split them into two groups.

32:00One group has, you know, gum disease and the other one doesn't have gum disease. And the patients who have gum disease and Alzheimer's have a faster cognitive decline than the patients who do not have gum disease but do have Alzheimer's. So you can see that even if you have a patient who has Alzheimer's, it's not too late. You should still be maintaining their oral health because it can contribute to their, well, improve their cognitive decline. How does that terrible bacteria end up in our mouths? So it is actually only found in your mouth. And what happens is it kind of can be switched on, turned on essentially.

32:38So we all probably have this bacteria in our mouths. and this is where a lot of my work has um i've been doing a lot of work on this bacteria because uh this bacteria i was doing testing maybe five six years ago i was looking at this and i was oh my god everyone's got porphamonas gingivalis like we're all gonna die like why are we all why do all of us not have gum disease why do all of us not have problems um and so that's when i started to kind of dive deeper and look at how is this bacteria acting in certain patients so me and you can both have porphyrmonis gingivalis in our mouths, but I could have a terrible strain of this bacteria that's releasing lots of toxic enzymes like these gingipanes, which have been turned on.

33:18And things that can turn this bacteria on are poor oral health, stress, anything, essentially. And you could have the same bacteria, which is not turned on. It's doing absolutely nothing. So for you, you shouldn't be freaking out and thinking, oh my God, I'm going to have problems. But for me, maybe I should be kind of thinking like, okay, how do I, maybe I need to improve my oral health a little bit more. How can I actually look at switching off this bacteria? And there's now a lot of treatments that are coming out and different gels and mouthwashes, which literally are focused at switching off this bacteria and stopping it from releasing these enzymes.

33:56And I think one thing that some people sometimes have a misconception of is that something like gum disease or even decay, it's not a contagious disease, right? If you were to kiss someone and you had that bacteria, you're not going to pass on that bacteria. You can, but it might not survive in the same way in that person as it does in you. And that's what's really, really important. And that's why we're not, you know, gum disease is not some contagious disease that we pass through kissing, because it's so important how the host responds to that bacteria. I'm pretty sure that people listening to the episode right now might be thinking, Alberto, ask her for the solutions.

34:32What's the mouthwash? I want the brand of the toothpaste. Before we get into those, and we will get to all of those, I have a few more questions when it comes to the problem. So what is the relationship in between stress and activating that bacteria and our overall oral health? So it's to do more with kind of your host immune response. So anytime you're, I don't know, stressed, and that could be physical or mental stress, that impacts how your body is able to respond to anything. And so those bacteria, for example, let's go back to the research I did with COVID, right? So what we found was that patients who had gum disease, they had all these problems in their mouths, but they never really had systemic issues, they were chilling, having these problems.

35:15Then they get COVID. COVID puts their body under physical stress, probably mental as well at that point. So they're under a lot of stress, And all of a sudden their body is like, their immune system doesn't know what to do. It's like, should I be fighting this or should I be fighting that? And so you become immunocompromised. And then what happens is that your body focuses so much on, let's say, killing that virus, that all of those other bacteria, which normally were kind of okay and not doing too much, all of a sudden are able to do whatever they want. They can release their toxic enzymes, they can cause inflammation, they can travel.

35:50And so actually the biggest cause of death of COVID sufferers was not the virus itself, but actually bacterial super infections. And these were bacteria that were always present in their mouths or their bodies, but all of a sudden were allowed the terrain or the environment to essentially cause destruction and cause problems. So most patients were dying from pneumonia and that pneumonia was from bacteria which was traveling to their lungs, which normally wouldn't have been able to survive. But because they're immunocompromised and their body's trying to fight something else, it's kind of it's crept up on them.

36:25So the same can be kind of applied to stress. You know, the number of patients I've seen where everything's fine, you know, all great. All of a sudden I don't see them for a year and, you know, something really bad has happened in their life. They've lost someone there. They've lost their job. They've lost, you know, whatever it is. And all of a sudden, their oral health goes from being great to having pretty horrendous gum disease and having these problems. And again, part of it is maybe poor oral health and hygiene, because if you're super stressed out or you're depressed, you might not feel like brushing your teeth as frequently or you might want to eat more bad foods.

37:00But also the other side is that you do become immunocompromised in your body. You know, our bodies are really, really sensitive to stress. I want to talk about hormones. How do hormones and hormonal changes in particular affect our oral health, especially in moments like menopause or pregnancy? So for women's health in particular, hormones are, I mean, they drive the mouth crazy. So the first time we see it is probably puberty, a little bit, a bit of gum inflammation, but that's okay. Boys have that too. And then what happens is pregnancy is the next time. and what often happens for women during pregnancies, they will get bleeding gums.

37:41They get a lot of gum inflammation. Sometimes they even have these little growths that appear within their mouths. So they're called pregnancy epluses. And so literally it's just the hormones just going crazy and it's just high levels of estrogen and progesterone and it's just causing that inflammation. It doesn't mean that they actually have gum disease, but I would say if you are pregnant, it's really important that you do have hygiene every three months because even though you do not have gum disease and that inflammation is being caused, it's being driven hormonally, it still has the same symptoms, like the same side effects.

38:14So you're still got that inflammation in your mouth and it's much harder for you to keep your teeth clean. You know, if you've got inflammation, you don't really want to sit there and scrub your teeth. So have hygiene every three months is my recommendation. And then the next time we see it is kind of peri or pre, more peri and just menopause where we see women who, again, often will have gum inflammation. They get gum recession quite often. We also see sometimes they lose a lot of their enamel, so their teeth become a lot more sensitive. And it's hard for us to really understand what is happening apart from there's just a lot of inflammation going on.

38:54Does this also happen during a woman's period? I would say at a smaller scale. I definitely have seen a lot of women who during their period will hate having a hygiene. So I know some people who specifically, you know, book their hygiene session for a day when they're not menstruating, basically. Interesting. We've discussed some of the most common and known oral diseases, but I'd like to discuss probably the worst one, if not one of the worst ones, which is oral cancer. how does it evolve and and where does it occur what are the symptoms um so the main symptoms are you've got a um a lesion which is painless um and doesn't go away so if after two to three weeks you still have a lesion usually it's kind of like a non-healing ulcer um and it's not going away you need to be seeing your your dentist immediately and often you'll be referred for a two-week wait for a biopsy to essentially check it in terms of what increases your risk of oral cancer and oral cancer is really it's a really brutal cancer and the reason for that is because it takes a while for it to show up and then once it shows up it really it it can really kind of cause a lot of problems.

40:19And often if you are able to remove the affected area, it has a huge impact on that person's quality of life. So I've seen patients who've had their whole tongues removed. I've had patients where, you know, large amounts of parts of their mouth have to be removed or excised because of that oral cancer. And usually it's squamous cell carcinoma. And squamous cell carcinoma is a very, very aggressive type of cancer. So it moves very, very fast. Things that increase your risk would be smoking. Particularly if there's a chewing beetle nut or pond is a very, very, it increases your risk significantly.

41:00But also even smoking and also drinking alcohol. And often the two combined together are really what impacts it. And it's not just, you know, you're on a night out and you had a cigarette and some alcohol. I'm talking like very, very regular use of that. What is the relationship in between alcohol and oral health? So alcohol literally, you know, have you, you know, you know, when you like, I don't know, you have an alcohol rub and you put it on your skin, right? It kind of like, it makes the pores of your skin really sensitive, like opens everything up. So it does literally exactly the same thing in your mouth.

41:34And your gums are a very, very soft tissue, mucosa. And so it literally just aggravates the mucosa. And essentially a lot of things like oral cancer, what causes these cancers is essentially aggravation. It's something aggravating the mucosa or the soft tissues constantly. So you've got your alcohol, it's making the mucosa a lot more susceptible. Then you've got the smoking as well. And they kind of just add on top of each other. Is there a less harmful alcohol? I have not looked at the research to see which alcohol my suspicion would be something like wine might be better but I have no idea so the reason one of the reasons why I was asking you the alcohol question is because you trended on tiktok about um sort of like endorsing drinking pure tequila do you still stand by that I do I actually I remember once I was at a bar and someone um sent over a bottle of tequila and they were like it's the tequila dentist and I was like oh my god But like, this is so bad.

42:39But I do still believe that having pure alcohol like tequila, which is much kind of cleaner than other alcohols, is better. If you're going to choose from the worst, then at least do the best from that one is my argument. Noted.

42:58Let's talk about solutions. What does a good daily practice look like? um so wake up in the morning um brush your teeth some people brush before or after breakfast doesn't really make much of a difference um i personally brush my teeth before so i'll brush my teeth in the morning um two minutes you spit you don't rinse out with water um wow i've been doing it all wrong for 30 years most people have by the way so you brush your teeth two minutes and then you literally just spit the residue and walk away. No rinsing with water. Really? Yeah. What? I can't believe that. So I just keep it on me? Just keep it, yeah.

43:43So it's kind of like imagine you put sunscreen all over your skin for two minutes and then right before you go into the sun, you have a shower. You do that every day? Yeah, twice a day. But most people have... You didn't clean your mouth with water after brushing your teeth. I just really want to make sure that we're talking about the same thing. Fascinating. No, no rinsing because you want to keep all the goodness of your toothpaste on your teeth for as long as possible. You can swallow a little bit to an extent afterwards. Yeah, you spit, like spit, but then the tiny, yeah, you might swallow a little bit.

44:13What about mouthwash? I'm not the biggest fan of mouthwash. I mean, there's a time and place for it and that should be guided by your dentist or hygienist if they feel like you need it. But for the average person who has no problems, they shouldn't be using mouthwash every day. It actually kind of wipes out the microbiome. It can kill all the good and the bad bacteria unnecessarily. And there's actually now research showing that if you're using mouthwash continuously, it can increase your blood pressure. And the link behind that is you've got these good bacteria, we call them commensals in your mouth.

44:46And these commensals basically will convert your nitrate. So these are things like your beetroot, your dark leafy greens into nitrite. and the nitrite will then be converted into nitric oxide. And that's basically what allows your blood vessels to constrict and dilate. So what you do with mouthwash is you're nuking and killing all of those good bacteria that are working really, really hard to help you with your blood pressure and your vasodilation. And therefore, it can increase your blood pressure. Jeez, my oral hygiene protocol was so wrong. Like I was using mouthwash once a day, every day. No, I mean, unless you can use it like a cologne, I don't know, you've got an event, you're like, okay, I need to freshen up a little bit, but it shouldn't be part of your daily routine.

45:32We also shouldn't use cologne every day? No, you can use cologne. You're changing my whole life right now. You've mentioned before that there are some mouthwashes or gels that are particularly designed to switch off that very bad bacteria. Can you name a few brands? So there's one and I have no, I'm not sponsored or anything by them, but it's called Curaprox, Perio Plus Zero. And it's a really, really cool mouthwash. So what it does is it basically kills, sorry, not kills, it switches off Porphyromonus gingivalis from releasing these virulence factors. And it does all of this without using your really, really horrible, aggressive antimicrobial mouthwashes.

46:13So it's a little bit more sparing to the microbiome and it uses citrox, which is actually originates from grapefruit. And we should only be using this product if it's recommended by our dentist. Yeah, yeah. Or at least if you're not going to be using your recommendations from your dentist for a short amount of time. So like one week, two weeks maximum, you know, nothing. There shouldn't be anything that you're using mouthwash wise, particularly long term. do you have a particular recommendation around toothpaste i think so i think toothpaste is like skincare so i think it's kind of should be it should be it should fit the person it should fit the person and what they need so if you're high risk for cavities there are certain toothpaste which would be good for you if you're high risk for gum disease um other ones some people have very sensitive mouths so there are some toothpaste which are free of some of the nasties and the irritants um so i think it's a little bit um hard i will approach the question because i get asked this every single time fluoride versus non-fluoride toothpaste um and i think again it's very much up to you and um your risk of disease so in my opinion um you know fluoride toothpaste has been around for decades now like we have hundreds and hundreds of papers and research to support that when you put fluoride in your toothpaste, it reduces your risk of cavities.

47:41And the way that it does that is your enamel is made out of something called hydroxyapatite. So imagine hydroxyapatite is like a brick wall, lots and lots of different bricks within this wall, right? And the fluoride from your toothpaste is applied onto this area. And what happens is it basically strengthens that wall. So the fluoride literally enters into the brick wall and causes what we call flora appetite. So it's much, much more resistant to acid and to cavities. And so this has been around for a long time. And then we have some people who are slightly hesitant about using fluoride. And the reason for that is because there is some research coming out that when you have fluoride in very, very high concentrations, this fluoride can be neurotoxic and cause systemic issues.

48:27Now, it's worth noting that this research is on very, very high concentrations of fluoride like i'm talking eating a lot of tooth like you're like really just eating toothpaste and so in i kind of feel like anything in such high quantities is usually not very safe but some patients still are quite resistant to fluoride which is absolutely fine so then the kind of non-fluoride alternative has come out which is called hydroxyapatite so it's biomimetic which means that they've literally looked at what are the building blocks of enamel and they've tried to essentially recreate that. And the idea behind that is, well, if you're losing your enamel or whatnot, why don't we just replace that quite literally like for like?

49:08So hydroxyapatite, you've got micro and nano hydroxyapatite, which are different particle sizes and both work in different types of ways. When we look at the research and we compare your non-fluoride toothpaste to your fluoride toothpaste, there are some papers which say that they are pretty much the same. There are other papers which say fluoride is stronger. So it kind of depends on your camp and on what you do. If you want my personal opinion, I feel like fluoride toothpastes are still stronger and more remineralizing than some of the hydroxyapatite toothpaste on the market. And the reason for that is because the non-fluoride market is completely unregulated.

49:47So there is no FDA approval. There's no regulation for these hydroxyapatite toothpaste. So if we're talking about like the biomimetic and imagine back to your brick wall, the particles have to be the perfect size for it to replace those missing blocks. But no one is regulating that. And there are some absolutely brilliant hydroxyapatite toothpaste on the market. I work with a couple of those companies and I love them. But there are a lot of other really, really bad hydroxyapatite toothpaste, which do absolutely nothing. And if that particle size does not work, then it's basically expensive cream, like it's not doing anything to your teeth.

50:25So if you have high risk for cavities, I still would go for a fluoride toothpaste. If you have a high sugar diet or you're unable to brush your teeth correctly, I would still go for fluoride. And if you're someone who's low risk, you don't have problems, you don't have cavities, you eat really, really well, you could probably opt for a non-fluoride toothpaste and just be careful. Can you name me your three most recommended or favorite brands? For both? Yeah. It's a one and one. One and one. So that's hard. Two and two. Two and two. So I would say for the non-fluoride toothpaste, I really like Boca.

51:03They're based from the US. And then I also really like Super Teeth as well. So Boca and Super Teeth are probably my favorite non-fluoride toothpaste. and then fluoride um there's a new one that's just come out called s3 which is awesome um i really really like that it's got fluoride and hydroxyapatite in it so it's kind of like a double whammy um and then just for like a maybe more standard classic one is your sensodyne pronamel um which you know they say nine out of ten dentists recommend uh it actually is a good toothpaste and it's um free of a lot of the irritants and nasties so that's your like kind of cheaper option which one do you use Oh gosh, you should not, you do not want to come into my bathroom.

51:47I've got literally every toothpaste. Like I open, I have like maybe, I literally just wake up and I'm like, hmm, I feel like using this toothpaste today. So I'd use fluoride and non-fluoride. So in the mornings I use a fluoride toothpaste. And in the evenings I use a non-fluoride toothpaste. If you were to choose one from your cabinet, which one would you choose? Oh, that's very hard to say. At the moment, I'm really liking S3, which is my new favorite one at the moment. What about toothbrushes? Yeah. Which one would you recommend? Should we go electric or non-electric? If we go electric, which one should we use?

52:24So I personally prefer an electric toothbrush. The research has shown that when you use an electric toothbrush, your mechanical debridement and plaque removal is much more effective than a non-electric toothbrush. My two favorite ones are Oral-B. You've got your IO78910. I prefer IO6 and above. It's an awesome toothbrush. It's, you know, it's oscillating. So it's kind of going around, times you, pressure sensor, amazing toothbrush. And then the other electric toothbrush I like is Suri. So Suri is another electric toothbrush. It's great for travel. So I really, I use both toothbrushes. So I've got my Suri for when I'm traveling.

53:07It charges with your iPhone-like cable. It's got a really sleek case. It cleans your toothbrush head from within the case. Super, super nice and easy. And it's very pretty as well, which is quite nice. And then the Oral-B for other days as well. What about the SoniCare? SoniCare is good. It uses a different technique. So your Oral-B is oscillating. So it's literally just going around. And your SoniCare, your Philips, it uses sonic vibration. So it's literally just going like this. So you need to have better technique when you're brushing your teeth with a Philips Sonicare than with an Oral-B. Oral-B, you could literally just go around there.

53:46You just have to kind of angle the toothbrush and you'll be fine. Philips, you still have to work quite hard, in my opinion. You need to make sure that you're using rotational movements. You've got the right pressure. So if you're going to go and invest all that money into a good toothbrush, I'm like, well, you might as well just get half your job done with an Oral-B. let's talk about the I've got you a toothbrush here I mean it's not electric but I want you to show me how to use it right so imagine that this is electrical so I'd like to see the movement right okay and then for anybody for everybody listening look into your phones or your computers now gosh I hate opening toothbrush there must be a right way of brushing your teeth and a wrong way There is.

54:34There is. It's called the modified bass technique or bass technique. Okay. So what that is, am I literally just doing this on me? Yes, yes, yes, yes. Okay. So toothbrush, we're going to do it to the top. So you don't want to go 90 degrees. You want to go slightly at a slight angulation. So 30 degrees towards your gum level. So like this. Okay. And then what a lot of people do is they go like this, right? Right. We don't want that. You want to go up and then you want to do rotational movements like that.

55:05I'm glad I didn't wear lipstick. So you do rotational movements all the way. I'm quite a methodical person. So I like to do all the top outsides and then all the bottom outsides. Then I'll do all the biting surfaces. Then I'll do all the insides. When we do the bottom teeth, again, not 90 degrees, you're going to go slightly towards the gum margin and you're going to do a rotational like that. And you're moving at the same time like that. Yeah. So you're using, you're doing the same movement across the three surfaces, right? Yeah. One, two, three. Exactly. And how long should that take us ideally?

55:42Two minutes. Two minutes. One thing as well people never do correctly is the insides of their teeth. Most people just go like that. No, you want to go like that. So elbow up and you want to really reach the gum margin on the inside of your bottom teeth. Yeah. Should we brush our tongue? I like it, but not with a toothbrush. You want like a tongue scraper. Okay. If you brush with your toothbrush and you just go at it, it actually can cause these little filly forms, which is like the little buds on your tongue. Sometimes they get a bit hairy. They can overgrow, and you can literally get something called a hairy tongue.

56:19And the worst one is a black hairy tongue, which you do not want. And that's literally just you're aggravating the taste buds and the filly form too much. So I would use a tongue scraper. I wouldn't use it every day, so I use it like three times a week. Gentle scrape, one or two, and then done. And it should be copper, ideally. How many times a day should we brush our teeth for those two minutes? Twice. Twice. I like to keep things simple. Some people brush three, four times a day. No, twice a day, that's all you need. So the first one is before or after breakfast, and the second one is after dinner?

56:50Yes, it should be the last thing you do before you go to bed. And you don't rinse your mouth? No. But you rinse your toothbrush, right? Yes. Okay. Just double-checking everything now. Now I just, yeah, you rinse your toothbrush.

57:08Do wellness protocols like supplements or exercise or a good night's sleep affect our oral health? It's a very interesting area, which is growing a lot. And I feel like wellness and longevity all of a sudden are like, oh my God, oral health, which is amazing for us dentists. in terms of like sleep quality I don't think there's any research there for sports performance there is quite a lot of research now showing that if you have good oral health it'll improve your sports performance we're now starting to work with athletes with our oral microbiome test so we're having like like professional athletes come to us and ask for oral microbiome testing to see how their oral health is impacting the rest of their body and some of the biggest athletes that you've seen, they often have had quite a lot of problems because they have very sugary drinks, trauma, like, I don't know, boxers, et cetera, but like, especially long distance runners, footballers, they're having Lucozade and they're sipping on that throughout the whole day.

58:08Their mouths are often really, really not very great. And there's actually some early research showing that if you have poor oral health and particularly something like gum disease, it will actually slow down your rate of recovery. So if you hurt yourself and you injure yourself as an athlete, you will recover slower if you have poor oral health. So that's where a lot of now kind of managers and athletes are like, oh my God, if I can improve my recovery rate, then that will make me a better athlete and I can bounce much quicker. So there's a lot of work going into there as well. We're taking care of our gut microbiome through taking probiotics and prebiotics.

58:49Should we mirror that with our oral microbiome? It depends. For some people, yes. I know that's a very Switzerland answer, but it really depends. Because a lot of probiotics on the market, we don't actually digest and they don't actually survive. So one of the problems we're seeing with our oral microbiome tests is people who are like, I use this oral probiotic and I've been using it for six months. And I'm like, doesn't look like it because you don't have high levels of those good bacteria. So it's important that you're choosing the right one. But also I feel like we're kind of in this new culture where people think that they can just like fix problems by just throwing probiotics into their mouth or into their gut.

59:33And actually there's now a lot of problems that people are getting from having too many probiotics. So I would say prebiotics, go for it, do as much as you want, particularly from a food perspective, enjoy. Probiotics, be a little bit careful. And if you are going to do it, I would normally do it for like three months and then stop. Just to make a distinction in very simple terms, so our audience stays with us. Prebiotics are feeding our bacteria and probiotics are adding bacteria, right? You are the founder of the THS Labs. And you've pioneered an oral test, which I did, a saliva test. Yes. Talk to me about the saliva test, and then I'm very happy for you to share your findings of my test.

1:00:16Okay. So, yeah, we built THS Labs about a year and a half, two years ago now. And basically, it was off the back of me working with other saliva tests on the market. And what I was finding, what I was struggling with was that you would do two tests on two patients, and they would come back with identical results. but they would have very very different mouths and different problems and I was like this makes no sense like why you know and so that's when I kind of went back to the drawing board and I was like okay so actually it's not just the bacteria that causes diseases otherwise like I said gum disease would be a contagious disease but it's more to do with that complex interaction between bacteria how your body is responding to that bacteria how those bacteria are acting with each other and the interactions and how those specific bacteria are just performing and acting combined with your age, your medical history, your dental history.

1:01:12So I basically collected hundreds of saliva samples from my patients within my clinic. And we basically mapped out what would be a new test. And I built an algorithm which combines all of those different factors I just said to actually give you a prediction of what's going on inside that person's mouth. And so that's how Oralis-1 was developed. And we've been on the market for about a year and a half. And we look at 500 bacteria. We then zoom into the top 20 that we know are associated with things like gum disease and cavities. And then we zoom even further to see how certain bacteria are acting and interacting with each other.

1:01:50And then we combine that with about 10 genetic mutations and then also age and medical history. And then we give you a personalized report, which goes from, you know, what toothpaste or mouthwash you should be using to even your diet, nutrition, lifestyle, supplementation, and how often you should be seeing your dentist. Yeah. And that's it. Do you want to go through my report? Sure. It was hot off the press. It came through this morning. So you have very good levels of good bacteria, which is quite rare and difficult to achieve. So that was very good. You had high levels of a couple of bad bacteria, which were associated with some gum inflammation.

1:02:28And then you had, speaking of that Porphyromonas gingivalis that we were talking about you did have porphyromone gingivalis and it wasn't behaving so nicely so it's releasing a couple of those enzymes that we don't like the toxic enzymes um now it's important to note that that does not mean that you have gum disease at all it just means that these bacteria are starting to do bad things and we need to stop them before they cause any destruction um you also interestingly had a genetic mutation which um so it's called il1a and it means that you are more predisposed to plaque and bacteria accumulating around your gums so you're someone who maybe you need to brush quite frequently to stop plaque and build up in your mouth twice a day twice a day or i don't know you forget your toothbrush and you're like like you might be someone you feel that film collect really really quickly you might need um hygiene more regularly you get that build up and again not to say that you are going to get gum disease but it just means that you have a slight disadvantage, I guess, from a plaque control perspective.

1:03:30But apart from that, you didn't have any of the kind of nasty, dangerous genetic mutations. And then we gave you a couple of recommendations in terms of diet, nutrition. I remember there was some supplementation for reducing inflammation generally. And we said to reduce your hygiene recall. So for you to go every three to four months for hygiene, just to keep everything at bay. And then the mouthwash I was telling you about earlier to kind of switch off that bacteria from doing bad things. And also propolis as well. So propolis spray, which is raw bee pollen. And it's been shown to be able to reduce the virulence of Porphyromonas gingivalis as well.

1:04:08And all of these recommendations are in the report? Yeah. I think everybody should get this test done. I think so too. How much is it? It's on the kind of higher end. So it's£299. But you get a full personalized report. each report is also a clinician releases each report. So you get like a written part from a clinician. And then you can also actually book in for a 15 minute complimentary call afterwards to go through your results with one of the clinicians. We have people following us from all over the world. Is this test only available in the UK or if someone from Australia wants to get it? Australia, no, but we are available in the US and 12 countries across Europe as well.

1:04:50Great. Let's stay away from my oral status and talk about oral aesthetics, which is becoming more and more mainstream these days. For those who don't know what veneers are, what are they and what are your thoughts on them? So I always say, I always kind of compare veneers to, for all the ladies out there, like nails, right? So you can either get nail polish, which is kind of the equivalent of composite bonding. So it's where we're adding something onto the nails. It's removable. It doesn't damage the underlying tooth. The downside is that it can chip quite easily and it does need quite regular maintenance.

1:05:33And then the second option is veneers. Or in my nail analogy, it's like a false nail, right? So it's something literally like a shell that's added onto the nail. It does sometimes damage the underlying tooth structure. And sometimes we need to shave a little bit of tooth away to allow for space for the veneer. But it's porcelain. It lasts a lot longer. You've got much better control over the aesthetics. You can literally change anyone's smile through doing that. Yeah. Would you recommend people to do that? I think that there's a time and place for it. I think that currently our society is doing, there's too many veneers.

1:06:13Like I think that instead of just trying to fix, let's say you're unhappy with your smile and you're like, okay, well I could do veneers and it would take me a month and it's super fast to do it. I would rather take the less lazy option of straightening the teeth, whitening the teeth, maybe doing a bit of composite bonding because it's your real teeth. And especially younger patients are coming to me and they want full veneers. And I'm like, but like you also, people have to remember that when you do veneers, there's, there's a life kind of, there's a life expectancy of everything that we do within dentistry.

1:06:48Nothing lasts forever. So if you're 20 years old and you're getting veneers and the average kind of life expectancy of your veneers is 15 to 20 years, you're going to be replacing those veneers three to four times in your life. And every time you remove those veneers and you replace them, your teeth go under a lot of pressure and you increase the risk of your teeth dying, needing root canals. On the flip side, I have some patients where they're in their 60s and it's the right thing to do. They can't go and straighten their teeth and whiten. Sometimes if you've lost all your enamel or whatnot, then it can be the right thing to do, but it's very much case specific.

1:07:26I'm always fascinated by dentists that put veneers on patients or clients, but they don't have veneers themselves. Would you ever get veneers um no i i mean again if i think maybe i'm quite lucky that i you know my mother made sure i had orthodontic treatment uh my sister's an orthodontist i have so like i have very good access to to dentistry um but like i whitened my teeth i would do composite bonding if i wasn't happy if i was maybe on the more unfortunate side of like i had the shapes of my teeth were incorrect or there was something which I could not change then yeah of course I would do veneers but I think it's not it shouldn't just be like a one size fits all let's just all get veneers because it's easy.

1:08:14And how often should we get our teeth whitened? That depends on the whitening system and how you've whitened your teeth so we usually have two different options you've got in-chair whitening where you come to the clinic you get your teeth whitened takes about an hour results are immediate, but they only last about three to four months. In my opinion, I don't think they have a very good, they don't last very long. So I don't love it. It's better. It's only good if like you came to me and said, Hey, I'm going to a wedding tomorrow. And I'm like, okay, fine. The other option is at home whitening.

1:08:43So we make you whitening trays. We give you whitening gel and every night you'll put the whitening gel inside your trays and night by night, your teeth will incrementally get whiter. That if you've got like, you're using a good product and you've got a good dentist, that can often last a good couple of years. And then you've got the whitening trays and you can like, I probably top up once a year before my birthday, I do a little top up, but I did all the whitening like four or five years ago. Let's talk about the Invisalign treatment. What is it? So Invisalign is clear aligner therapy. So basically what it does is it straightens your teeth.

1:09:20So week by week or every two weeks, patients will pop in these clear aligners and every week their teeth will be moving into the correct position would you recommend for people to do it absolutely i think it's um it's really it's a really nice alternative to your fixed braces so for a long time if someone particularly let's say when they're over the age of 14 years old they want to straighten their teeth they didn't really have an option other than train tracks which some people do not feel like having when they're in their 30s or in their 40s. So clear aligners have allowed people to straighten their teeth and still be quite discreet about it.

1:09:58So if you've got a big meeting or you're getting married or something, you can pop your aligners out. No one will even know that you've got Invisalign. And I think the benefits that Invisalign has, or clear aligner therapy, has offered to our society is incredible. It allows people to straighten their teeth, feel better, look better, etc. The next question is for parents. Okay. what would you advise them to look after their children's oral health what like recommendations would i give them yeah um so i would say start young bring your child in from the age of two and it's not like we're going to be doing a full checkup on them but they need to be acclimatized to the dental practice bring them with you for your checkup or something and also we can be fun and cute and give them stickers you know so um one of the biggest problems i see is when parents bring their children at the age of seven and the children are terrified of the dentist and then they've got cavities and then I have to like it's really really hard to treat them at that stage so start early the second thing would be um again I mean brushing twice a day even if your child is just starting to um to have teeth um and just make sure that you're brushing those some people have this kind of misconception that like milk teeth like don't count and they're just kind of like oh it's just a baby tooth it doesn't make a difference we'll just wait for the adult teeth and that's absolutely wrong these baby teeth will pave the way for your adult teeth so if you've got baby teeth and you've got cavities and all of them and we have to take them out early they impact the development of the adult teeth and impact the development of your jaw structure and your bite as well so it's really important to keep those baby teeth as healthy as possible So apart from that, I would say if you have just given birth, it's worth actually checking like if you're breastfeeding, can your child breastfeed correctly?

1:11:53Are they able to latch? And that might actually show or have an indication on their tongue and if they have a tongue tie or a lip tie. So it's important even from a very, very early age to start screening for those types of things as well. how often annually should children visit a dentist i would say so we always um will categorize it depending on the risk so for like a high risk patient be it a child or an adult would say like every four to six months sometimes um if it's lower risk every year for children i like every six months because things just happen so quickly in children and i think it's also from an from an acclimatization perspective it's good to just constantly seed them and remind them that like we're nice, we don't always hurt, we're not really mean people.

1:12:39Because there's that stigma, right? People don't want to go to the dentist because they already think that it's going to be hurtful. Yeah, they all hate us, unfortunately. We're combating that with this episode. I hope so. I'm not sure how many children are going to listen to this podcast. My last question to you is a question that we call the signature question of Thriving Minds because it's the only question that we ask or I ask to every single guest that sits on that chair, regardless of what they do for a living. Victoria, if you had to compress all your knowledge into one essential piece of advice that we all must implement in our daily lives, what would it be?

1:13:24I'm going to zoom out a little bit and not, I think I've given enough recommendations for oral health, but I would say stay curious. and I think as people grow older, we lose our curiosity and we kind of, you know, for me, for example, I was a dentist and I was a very normal, average, traditional dentist. And because of my curiosity and because I never settled for like someone else giving me an answer, that's allowed, you know, open so many doors in terms of my research, in terms of opening my business, in terms of fundraising, all of those types of things. And the one thing is like, you should always keep that inner child alive and that curiosity constantly alive.

1:14:03And also I think like with people too, every person has a story to tell no matter who they are. And if you have that curiosity, you will connect with people in a very, very different way. Beautiful. I believe that curiosity feeds intelligence. 100%. They're very much interconnected. Thank you so much. I've learned so many things And you've completely transformed something that I do on a daily basis and that I've been doing for 30 years. I used to think of my oral hygiene one dimensional, right? So it's keeping your teeth clean, don't have bad breath, off you go. But you've given me an array of several different other things to consider, especially how it relates to our general health, which is something that I had no idea.

1:14:54And I find that fascinating. And most importantly, how little changes can make a very big impact. So thank you so much. My pleasure. Thanks for having me.