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

welcome to the huberman Lab podcast

where we discuss science and

science-based tools for everyday

[Music]

life I'm Andrew huberman and I'm a

professor of neurobiology and

Opthalmology at Stanford school of

medicine today we are discussing oral

health now when most people hear oral

health they immediately think tooth

health and appearance and presumably

fresh breath or lack of bad breath as

well and while of course two and breath

freshness whiteness and health is a

critical component of oral health today

you will learn that oral health

including the oral microbiome the health

of your pallet your tonsils indeed the

entire oral cavity is an extremely

important component of General bodily

health so much so that today we are

going to add a seventh pillar to the

so-called six pillars of mental health

physical health and performance this is

not a trivial step to add a seventh

pillar to these six pillars if some of

you have been listeners of this podcast

for a while you may recall that the six

pillars of mental health physical health

and performance that is the six things

that everyone needs to invest specific

protocols into each day are in no

particular order by the way

sleep sunlight and light exposure

generally which by extension also

includes dark exposure

nutrition exercise which we could also

call movement both cardiovascular

exercise and resistance training stress

management and relationships and social

engagement including relationship to

self and today we are going to add oral

health and microbiome health and I

suppose we could generally call this

oral and gut health because as you know

if you think about it your mouth your

oral cavity and your gut are contiguous

with one another we are going to add

oral and gut health as the seventh

pillar of mental health physical health

and performance because as you will

learn today there are so many aspects of

oral health and daily protocols for oral

health that extend to cardiovascular

health to metabolic health and indeed to

brain health and to staving off diseases

in all of those bodily compartments I

cannot overemphasize enough how much

oral health influences your general

bodily health so today you will learn

about Oral B biology and health we won't

go tooo deep into the biology but we

will go deep enough into the biology

that you will learn some incredible

things such as your teeth have the

ability to literally fill back in

cavities that have formed provided those

cavities haven't gone too deep into the

teeth layers yet you will learn that

saliva While most people think of it as

just spit is an incredible substance

fluid that contains all sorts of

interesting and important things that

allow you to rebuild the strength of

your teeth and indeed to support the

health of your oral cavity and gut

microbiome and body generally so saliva

is super interesting and important and

today you're going to learn many many

protocols including zeroc cost protocols

protocols that will actually save you

money as well as some lowcost protocols

to both restore improve and maintain

oral health and in doing so maintain and

improve your overall bodily Health

before we begin I'd like to emphasize

that this podcast is separate from my

teaching and research roles at Stanford

it is however part of my desire and

effort to bring zero cost to Consumer

information about science and science

related tools to the general public in

keeping with that theme I'd like to

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pillows okay let's talk about oral

health this absolutely critical aspect

of not just having fresh bright teeth

and no cavities and fresh breath or at

least lack of bad breath one would hope

but also total body Health as I

mentioned a little bit earlier oral

health is inextricably linked to all

aspects of brain and bodily Health both

in the short term and in the long term

and it is perhaps the most overlooked

aspect of mental health and physical

health so today I'd like to start off

with a quiz I'm going to ask you which

of the following three categories you

believe you best fall into okay the

first category is those of you out there

who brush and floss every day probably

twice a day and who make some effort to

try and keep your teeth clean who like

the feeling of your teeth being clean

and who pay a fair amount of attention

to whether or not your teeth are getting

whiter or not getting whiter maybe

whether or not your breath is fresh or

not fresh maybe okay these aren't

requirements for being in this category

but maybe you're somebody who also uses

a mouthwash or uses mints or gums in

order to try and keep your mouth

smelling and looking fresh and your

mouth clean okay so this first category

uh does not require that you do all of

those things but let's just make a basic

requirement of participation in this

category that you routinely brush at

least twice a day and that you floss at

least once a day okay if you fall into

that category you are in category one

and by the way if you're in category one

and you do those things and you do a

bunch of other things like tooth

whitening and maybe you go to the

dentist especially often more than the

recommended twice per year that still

puts you in category one okay second

category are those of you out there who

are let's say a bit more blasé about

your oral and tooth care those of you

that perhaps just brush your teeth in

the morning so that your breath is fresh

you clean out that kind of sticky

feeling in your mouth that's accumulated

overnight that sometimes brush and maybe

floss at night but you know a lot of

times you fall asleep without doing that

or you don't feel like doing it or

perhaps that don't really floss at all

okay that perhaps go to the dentist once

every 6 months maybe a little less maybe

once a year once every couple years so

while there's a bunch of different

things that could put you into Category

2 let's make a basic requirement for

belonging to Category 2 that you brush

your teeth once a day but not twice a

day on a regular basis or that you brush

twice a day but that you rarely floss

okay that would put you into what I'm

calling category to and then of course

there's the third category that maybe

some of you out there fall into and this

is the CATE ategory of people who are

extremely diligent not just about tooth

care but also about oral health

generally about maintaining the

microbiome of your mouth about making

sure that your gums are very healthy

about making sure that your soft pallet

and hard palet is very healthy about

making sure that yes your teeth are

clean that they're devoid of as much

bacterial buildup and other stuff in

there that can cause cavities but also

that you're paying careful attention to

your oral micro probiome and the overall

milu of your health in the mouth and the

fact that your mouth is linked to all

these different aspects of brain and

cardiac and metabolic Health okay if you

fall into that third category great but

let's be honest most people I would

argue 95 maybe even 98% of people or

more fall into either category one or

category two so as you're hearing this

you're probably thinking okay well if

I'm in category one I'm good right I go

to the dentist twice a year I brush in

floss use some mouthwash I even brighten

my teeth I you know I make sure that if

I had a sugary meal I'll rinse out my

mouth I try not to drink acidic Foods

things that we'll discuss today as to

whether or not they actually have

relevance for cavity formation or

not but guess what if you are in

category one as I described it or

category

two chances are you are doing things to

really deplete and disrupt your oral

health that's right even if you're

paying a lot of attention to tooth

Health chances are if you're like most

people out there simply because you

don't have the latest information on

what oral health really is and how to

best support it chances are you are

doing things that yes might be keeping

your teeth white and clean and you're

not getting cavities or you're not being

told you have cavities that need to be

filled when you go to the dentist twice

a year or more but that you are

disrupting your oral health in ways that

are depleting other aspects of your

brain and bodily health and I'm not here

to scare you I'm just here to tell you

that if you're in category one okay

you're clearly doing some things that

are beneficial for you but that there's

some additional things that you can do

and a few things to avoid doing that

very likely will improve your overall

bily health very quickly and the good

news is those things are also zero or

low cost or in some cases can save you

substantial cost now if you're in

category two chances are you are

depleting both your oral health and your

overall bodily Health but here's what's

interesting some of the folks in

Category 2 that are not doing as much

for the let's say hygiene and freshening

and whitening of their teeth actually

have a healthier overall oral microbiome

that's not always the case but often it

can be the case so what you're going to

discover today is whether you're in

category 1 or Category 2 there are some

wonderful and easily accessible

practices that are well backed by

science and by the way in preparation

for this episode I also consulted with

no fewer than five dentists including a

pediatric dentist I talked to a

periodontist I talked to people who fall

into the functional dentist category I

talk to people with a bunch of different

orientations who are all heavily

qualified to talk about and to make

recommendations about oral health and

tooth Health Etc and what I'm going to

deliver today is essentially the overlap

in the vend diagram of what they all

agreed on I'll highlight a few

differences that they each had and that

several of them they do fall into

different camps but I was positively

surprised how much overlap or consensus

there was in terms of best protocols for

tooth and oral health and by the way if

you're in that third category of the

person that's doing a lot for their

tooth health and appearance and breath

Etc but also oral health and microbiome

I'm sure that today you'll also learn

some new health practices and some

things that will allow you to expand on

your already terrific practices for oral

health so let's get into the material

about oral health focusing first on two

tooth anatomy and health and some a

little bit about mouth Anatomy I promise

to not go into this in too much depth

but we really need to have a firm basis

a foundation of understanding of what

the mouth cavity really consists of and

I'm not just going to throw a bunch of

names out there for sake of nomenclature

I don't need to Cloud your hippocampus

with that sort of information unless

it's functional information but it is

critical functional information for the

rest of our discussion where we'll talk

about ways that you can really build up

the strength of your teeth even if

cavities have already started to form

and how to really get your saliva to be

the best healthiest saliva for your

overall mouth and for your gut and for

your brain your heart Etc okay so let's

talk just briefly I promise briefly

about the anatomy and a little bit of

the physiology of the this stuff okay

the teeth we're all familiar with what

teeth are and the tongue the tonsils in

the back of the mouth we have our soft

pallette hard pallet gums let's talk a

little bit about how all that fits

together centering around the thing that

most people think about when they think

about oral health and that's the teeth

it's just a good jumping off point for

us your teeth are layered structures

like pretty much every structure in your

body is a layered structure it's just

the way those structures form cells are

born at one location they migrate out

and form Stacks or layers those

different layers have different cell

types and your teeth are no exception so

while there are different kinds of teeth

in your

mouth teeth have an outer layer which is

the enamel the enamel believe it or not

is not white it is translucent light can

make it through but it's not transparent

it's not like a clear window it's

translucent light can make it through

but it's a bit opaque okay beneath the

enamel is a structure called Dentin

Dentin is important for today's

discussion because as it turns out

cavities form not surprisingly from the

outside of teeth Inward and Cavities as

the name suggests are holes that

bacteria burrow down through the enamal

and if you're unlucky make it down to

the Dentin our goal meaning your goal

goal is to engage in Daily protocols

that's right daily protocols that are

simple and fast and zero or very low

cost that allow you to avoid the

formation of those cavities yes but also

that can allow you to fill in those

cavities this is one of the most

important things to understand about

oral health that frankly I didn't know

until I started researching this episode

and talking to all these experts in the

field which is that you can repair

cavities that have started to form

that's right your mouth environment

based on its chemistry and some things

that are mechanical but mostly based on

its chemistry in particular how acidic

it is or how basic it is is always in a

state of what's called either

demineralization or

remineralization now those words are

hard to say and they're especially hard

to say fast so demineralization

remineralization it's a little bit of a

tongue twister today I'm going to use a

shorthand that's a convention in the

Dentistry field which is De Min or remin

to refer to demineralization or

remineralization remineralization is

good it is the process by which within

the enamel and to some extent in the

deeper Dentin layer of the tooth but

especially within the enamel there can

be the addition of new minerals that

form very robust

essentially chains of crystals okay if

you've ever looked at a crystal of any

kind under a microscope or you've seen a

picture of it they are incredibly well

organized they form a lattice of very

strong often although they're weaker

crystals too very strong bonds and

structure it's like the structure of a

really well-formed building okay

remineralization is the process of

putting minerals back into that crystal

structure and it's actually possible to

fill back in those cavities that

bacteria have started to form especially

when those cavities have burrowed down

into the enamel but have not yet made it

into the Dentin layer of the tooth or

teeth okay this is very important to

understand it's especially important to

understand the context of the fact that

typically not always but typically if

you have a cavity formed at one tooth

and let's say it's just halfway or 3/4

of the way through the enamel layer that

if you have cavities elsewhere in your

mouth chances are that they are at the

same depth or level not always but

chances are and that's great news if

those cavities have not yet made it into

the dtin layer why is it great news well

I don't know about you but I don't like

having my teeth drilled I don't like

having cavities drilled and filled I had

a very traumatic childhood with respect

to dentistry and oral health I'll talk

about it a little bit later in the

episode it's not that I had tons and

tons of cavities I actually had this

other issue where my adult teeth came in

behind my baby teeth I had have all my

baby teeth pulled I had to get a bunch

of injections of Novacane in my mouth I

didn't like getting injections into my

mouth so I opted to have any cavities I

had drilled without Novacane it's not

cuz I was a tough little kid although

that definitely toughened me up it was

because I hated having syringes in my

mouth I might have even bitten a dentist

or two or three I don't bite the dentist

anymore I thank the dentist by the way I

think dentists are wonderful regular

cleanings are wonderful we'll talk about

frequency of cleanings but here's the

point if you are somebody who enjoys

getting your teeth drilled well then I

don't know what to say but if like most

people out there with proper wiring of

your neurology well then you don't like

getting your teeth drilled and you can

avoid it in many cases by remineralizing

that enamel layer of your teeth now if

there's a demineralization down to the

deeper Dentin layers of the tooth then

most often you're going to need it to be

drilled drilled and filled as they say

or as some people say which is a bit

more cynical drill fill and build

because you get charged for that or your

insurance gets charged for that okay

back to some tooth anatomy and mouth

Anatomy we talked about the enamel layer

of the tooth on the outside I told you

that it either can demineralize demmin

or remineralize remin this is a key

Point your teeth are always in a state

of either demon or remen that's right

either demon or remen it's not both at

the same time it's one or the other and

it is largely dependent on the p that is

the acidity of your mouth which is

largely dependent on how much saliva

you're producing and the mineral content

of that saliva keep that in mind I think

it's a very important point now another

key point is that next to your teeth

right you have your gums the gingiva as

it's called now the gingiva provides a

really important role in keeping the

teeth stable we don't often think of it

like that but even though that stuff

seems gummy and soft it is soft tissue

it is very important for fixing the

teeth to the Bone it's not just about

the roots that extend down into the

Jawbone below the gums are very

important for keeping the teeth where

they are there's actually a little

ligament too between gums and the teeth

that resides a little bit deeper but the

gums form a critical barrier between the

oral cavity and the deeper layers of

what eventually is bone and into the

general blood flow or bloodstream of the

body now this is so important to

understand that the gums are a seal

around the tooth this is why when you go

to the dentist they're paying attention

with that little pick they're paying

attention to how high or hopefully low

the tenting is the the the little

recesses or pockets of gums along the

the

here in my mouth yes I'll try not to do

that during today's episode point to my

teeth so much so that I'm then you know

you can't understand what I'm saying

that the gums are providing a seal

between the oral cavity and essentially

the bone and the general bloodstream now

this is so critical because let's just

take a step back and think about the

oral cavity and what a remarkable place

it is think about it this is a gaping

hole in our body okay we have some other

gaping holes in our body but those tend

to be sphincter based holes yes I

realize there probably some Chuckles as

soon as you say sphincter like yes the

anal sphincter okay we're anatomists

we're biologists we can talk about that

stay shut stuff is generally not going

up there and if it is not very often

okay your nasal passages yeah those are

holes but you know there's a lot of

stuff there there's mucus to catch stuff

there's a CRI form plate there's a bone

there's a bunch of things that act as

barriers between the nasal cavities and

the Brain which sits right behind it the

olfactory bulb and yes we have eyes and

then you know we have the outside of the

eyes and there's a you know a

susceptibility there but we have our

blink reflex there's a also an ocular

microbiome there's a bunch of things

there but think about the just this

gaping hole in the front of our face

that we use to eat and speak and breathe

okay it's a huge hole and as a

consequence it's filled with bacteria

from our outside environment all day

long all day long sometimes at night

although we're going to talk later about

the critical critical need to be a nasal

breather at night and not a mouth

breather not just for sake of staving

off sleep apnea but also because turns

out the dryness of the mouth is one of

the ways that you really can throw off

your oral health in major ways in fact

it's one of the leading causes of tooth

decay in people like methamp addicts or

if you see people that are mouth

breathers their oral health and their

teeth generally but certainly their oral

health is severely depleted so you've

got this big hole in your front of your

face and you're talking and eating and

moving about during the day even if

you're a nasal breather when you're not

talking or eating and all this bacteria

is getting in and it's a really moist

environment and it's really warm so the

combination of bacteria moist and warm

means that this thing is like a petri

dish for growing stuff that could

potentially be really bad for us but but

it has this incredible feature which is

that if the pH is right then the bad

stuff is killed off doesn't make it into

our system doesn't disrupt our oral

health or our bodily Health it also has

a critical feature which is that the

bacteria that are good for us

proliferate and supports the sealing

process of the gums against the teeth

and tooth health and tongue health and

pallet Health Etc okay so the oral

cavity is Amazing by virtue of how

vulnerable it is but also how robust it

is and the way it stays robust is by

keeping the saliva healthy now there are

other ways too but that's one of the

main ones and it's a huge portal into

the rest of the body and if the oral

cavity isn't amazing to you already

based on what you've heard thus far

think about this if you get a cut on

your arm or your hand or your shin

unless you're one of these remarkable

people that always heals up without a

scar as long as you're about 25 years or

older typically you'll form a little bit

scar there'll be something noticeable

there the oral cavity also can take cuts

and burns and things like that

unfortunately those things occur but

with rare exception heals up with nearly

zero scarring sometimes there's a scar

but nearly zero scarring which is

remarkable why well it's basically an

open wound with a bunch of bacteria in

it and it's warm and it's moist so

clearly there's something special going

on in this thing that we call the oral

cavity indeed there is and it's anchored

in the fact that if we treat it right

you can encourage

remineralization how do you do that by

keeping the saliva healthy how do you do

that by supporting the proper bacteria

within the mouth and making sure that

you're eliminating the bacteria that you

don't want or at least limiting those

bacteria and today we're going to talk

about how to do that and by virtue of

doing all the things that support tooth

Health you're also going to support gum

health okay those gums are critical

because they form that barrier that if

it gets too big if those Pockets those

recesses get too big and you're not

taking care of the bacteria in your

mouth when you're not getting rid of the

bad bacteria those bacteria worm their

way down into the deeper recesses near

the roots of the tooth sometimes into

the tooth we'll talk about that and can

get down into the bone and then can

cause serious serious issues this is

so-called perodontal disease and

perodontal disease is associated with

all sorts of really bad stuff including

Alzheimer's okay this is not just some

Wellness culture woo science leap to

alzheimer's there's literally evidence

that the specific bacterias that cause

recession of the gums can cross the

blood brain barrier if they make it into

the general circulation and potentially

cause Plax and Tangles some of the

Hallmark features of neural degeneration

in Alzheimer's okay probably not the

only cause of Alzheimers but potentially

one of the major causes this is a new

Theory but it's one that a lot of people

are starting to pay attention to and

it's also very clear that bacteria make

it down into these deeper recesses near

the roots and into the bone that you can

end up with issues related to cardiac

health and certainly metabolic Health

okay so again the goal today is not to

scare you it's not to spend too much

time um on all the terrible things that

can happen but rather to emphasize the

positive which is that if you do the

right things at the right times

especially if you do them on a regular

basis that you can really improve the

health of your total oral cavity and

your teeth and your breath and all the

other stuff that people care about for

Aesthetics and interpersonal

interactions will flourish as well I'd

like to take a brief moment and thank

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huberman 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 as I mentioned before cavities

are literally holes they're

fenestrations as the uh nerds call them

nerds like me call them little

fenestrations little holes down into the

enamel that if they make it down to the

Dentin layer of 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 cavities 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 demineralizes

the tooth in this very focal area that

we call a cavity okay now if that isn't

surprising enough get this the bacteria

that causes cavities by eating sugar and

releasing this acid while there are

several of them the major one is called

streptococus mutans or what I'll call

strep mutans for short strep mutans 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 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 typically 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

streptococus mutans because almost all

adults carry it not all but it's

communicable like a STI or like a flu or

like a it's communicated between

individuals we are not born with it now

that's a whole area of U 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 mutans most people in the world

have strep mutans or will get strep

mutans and it lives in the mouth okay it

just resides there strep mutans is there

and it's hungry what's it hungry for

sugar when there's 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 does that mean that you should

never consume a lemon or and by the way

yes I'm guilty of everyone a 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 mutans love sugar no turns

out strep mutans like sugars in the form

of complex carbohydrate sugars too so if

you eat pasta or rice or oatmeal and

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 I'm an omnivore as most

people are well then strep mutans 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 mutans to consume sugar and

release acid maybe maybe however most

people won't do that and strep mutans is

a very clever maybe even diabolical

bacteria and if you are on a zero

carbohydrate zero sugar diet there's

some evidence that strep mutans will

figure out ways to feed on other

components of food in order to create

this acid to then create cavities in

your teeth so the key thing to

understand here is that cavities form

form not from foods not from sugars per

se but from strep mutans 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 never

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 and floss and when you should

brush and 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 the amount of time in

which your mouth is net acidic or net

alkaline the amount of time that you are

in a

demineralization 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 mut mutans can feed on

and produce acid the key is to try and

reduce the amount of strep mutans 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 for 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 these 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 and lates there's

a whole bunch of interesting you know

angled forces stuff that the Architects

will understand and the the construction

workers will understand at a very

intuitive and and 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 re remineralization bonds

form is through the addition of specific

minerals at specific angles and the

naturally occurring mineral mineral

that's responsible for the majority of

these Bonds in the enamel and teeth is

called hydroxy appetite what a great

name if you're talking about oral health

right because we use the mouth 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

hydroxy appetite bonds and they are very

strong but they're not indestructible

acid can actually break those bonds okay

that's the mineralization process now

fluoride is a substance that is not a

vitamin it's not a mineral it 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 in

Mass in the United States and Europe

that the addition of fluoride to the

drinking water and to many toothpastes

or tooth powders would be useful because

it creates these super physiologically

strong bonds within the minerals of the

teeth and indeed it does it does

fluoride gets between those Lego pieces

and makes them extra extra strong and

this is why fluoride is added to the

drinking water but and this is very

important to emphasize but nowadays

there's a really polarized debate about

fluoride because some people out there

believe that fluoride can disrupt

thyroid Health might be disruptive for

brain health certainly if 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 really two camps now

that have formed and 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 I want to

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 and as a consequence their

children's teeth or oral health or both

is depleted and they are suing for

damages okay so there this is a really

polarized camp now I did a full episode

of The hubman Lab podcast 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 time stamp in that episode I link to

that time stamp 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 if

you're concerned about fluoride then I

suppose you'd probably want to avoid

toothpastes 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 mineral 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 but 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 so 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's

just kind of stands to reason but people

don't really talk about this right when

you talk about x amount of fluoride by

concentration in a given liter of water

or gallon of water you also have to ask

well how much tap water are you drinking

every day okay you have to ask that

question right it's not simply the

concentration it's how much you're Ines

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 government's

figured out hey well if we want to

reduce tooth decay what's the simplest

lowcost method to do that well it's to

put fluoride in the drinking water and

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 you're 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 T and on and on but 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 or 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 all Health I'd like to take a

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inside

tracker.com huberman so in a moment we

are going to get into what to do the

to-dos 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 todos I think

it's very important to discuss the do

Nots that every dentist and periodontist

I spoke to agreed

on the 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 cut off

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

that'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 a you know you've

got a like scratch in the back of your

throat you're getting sick you know you

should drink and 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 uh that are making

you sick Etc so alcohol is bad I'm not

saying you shouldn't drink at all if

you're a non-alcohol 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 the not good for us list for

sake of oral health are stimulants now

of course things like methamphetamine

which are you know severely dilus

addictive drugs for all sorts of reasons

they kill dopaminergic and other brain

neurons they are highly addictive um and

on and on but also stimulants like

adderal viance etc those stimulants

basically any drug that increases

epinephrine and norepinephrine so called

adrenaline and noradrenaline are 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 well there are really two

reasons there's a chemical reason and

there's a mechanical

reason the chemical reason is that

stimulants change the pH of your saliva

making the mouth more acidic which makes

strep mutans and other bacteria more

capable of creating cavities down into

the teeth they take your mouth and your

teeth from that remineralization state

or 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

demineralization mode so there's a

chemical reason why stimulants disrupt

the oral health milu and cause

disruption in tooth health and

degradation demon of the enamel of the

teeth and deeper layers of the teeth and

this is profoundly evident in meth

but the other reason and this was a

reason that was shared with me by a

physician an 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 stimulant 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

demineralization mode so if you do take

stimulants by prescription I would hope

not methamphetamine or elicit drugs but

if you take prescription stimulants and

by the way things like Wellbutrin

modafanil they do qualify as stimulants

even though modaal is a little bit of a

special case any drug that increases

norepinephrine epinephrine 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 po 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 and 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 breathe 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's Sports where you need to Exhale

through the mouth specifically certain

martial arts for instance so not saying

don't ever breathe through your mouth

but as much as possible try and keep the

oral cavity moist and closed okay 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 people like well

what about cannabis well I didn't

episode about cannabis cannabis does

have certain medical uses that are very

interesting and um 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 then

people ask what about vaping vaping is

not as bad as smoking right that's what

they say where 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 Okay so we've got

alcohol stimulant smoking SL vaping and

by extension dipping tobacco frankly not

good for oral health or tooth Health in

fact they can be proc cancerous to the

gum tissue it's 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 um you know do as

you will um if you're somebody who never

eats those things great but then

understand that any carbohydrate any

starch provides a sugar that strep

mutans 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 they run

even in 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 we'll talk about

mouthwash es later just to give you a

little window into where we're headed

with that most

mouthwashes terrible terrible for your

oral health especially alcohol-based or

antiseptic based mouthwashes 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 trying to you

know swish some water maybe spit it out

maybe swallow it that's up to you are

you a spit or swallow not my business

don't want to don't tell me don't put it

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 grapefruit I just 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 atic

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 in

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 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 it'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 milu of the mouth is acidic

because of this whole demon remen thing

strep mutans and the acid created by

strep mutans 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 demineralization

the formation of cavities remember it's

like a seesaw it's either demon or reman

but not both so anytime you're

demineralizing 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 it 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 milu of the

mouth as moist and as basic or alkaline

rather less acidic as possible so 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 y

bate 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

Segways into a really important point

that came about when researching this

episode that if I had to highlight bold

face 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 okay 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 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

now 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

11:00 a.m. every morning sometimes

earlier sometimes have a little

breakfast at 9:00 if I particularly

hungry but typically I eat my first meal

around 11:00 a.m. or noon and then I eat

my last bite of food by about 8:00 p.m.

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 than simple

caloric restriction I 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 this is ongoing I think it's the

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 or even

just gaps between meals not constantly

snacking or sipping on acidic beverages

throughout the day as an opportunity to

create that healthy milu during which

the teeth can remineralize and the

overall oral health can improve

now 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 heard me say that

in the context of viewing morning

sunlight and other protocols that I you

know suggest on the huberman loud

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 mutans

and other bacteria to feed on and create

a 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-prong protocol on the one hand I'm

saying you might consider trying to

introduce maybe an hour or two hour 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 PL water

would be great avoiding carbonated lemon

water would be great but if you like

those things and indeed I love those

things I love carbonated lemon water I

love things like yamat indeed the yate I

like is cobw zero sugar but has some

lemon and ginger in it okay 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 and indeed I tend to

drink my caffeine early in the day and

not so much throughout the day maybe a

little bit of mate in the afternoon

sometimes okay so that's one aspect of

maintaining or encouraging the correct

pH of saliva to remineralize your teeth

right 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 and that's

the critical time to make sure that

there is as little opportunity is

possible for strep mutans 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 health care 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 nighttime it's at

nighttime 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 mouth you know

morning breath that kind of thing but

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 or 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 ew 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 and 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 and floss and clean the mouth and

get the millu 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

and 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

mutans 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 could do for overall oral

health care we'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 so 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

you're 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 suggest in we do

when it comes to brushing and flossing

and fortunately 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 the 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 Cor 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 the teeth in the back it

just feels good I feel like I'm doing

something good I get into the backs of

the teeth the fronts of the teeth I know

I actually enjoy brushing my teeth

especially lately don't ask me why but 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 and

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 you're not providing a

lot of pressure is going to be the best

way to break up that bofilm layer each

and every time and promote the best

tooth and overall oral health so I

suppose um manufacturers who are making

medium and hard toothbrushes maybe give

us some w rationale for that um you know

because the dental professionals that I

spoke to and again I spoke to a fair

number of them all said the same thing

soft toothbrush Notch 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 the

teeth and gums and 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 perodontal 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 um you know sort

of nicked their uh gum with a while

while flossing or with a toothpick can

tell you bleeds very readily and that's

not a good thing right you 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 gun just yet I said jump the

gun not jump the gum by the way if you

are brushing your gums make sure you're

using a soft toothbrush if you're using

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 reverse to tooth anatomy

in any kind of detailed way now but of

course within the tooth you have again

enamel you have the Dentin you've got

What's called the the pulp or the center

there's a lot of nerves inating the

center of the tooth there's a bunch of

other tissues and 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

the idea that's of 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

reemphasize 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 toothbrushing and

flossing the main goal of brushing is to

break up the biofilm layer that provides

a substrate for strep mutans and other

bacteria to layer on thicker layers of

bacteria so-called plaque that will

eventually turn to Tarter okay if we

really want to gross ourselves out and

really motivate brushing and flossing

maybe we should describe that what

happens with strep mutans is it forms

these strand-like bacteria so these are

like little Celia so they're attached to

the tooth is the bofilm layer so like

little strands of strings but if enough

of it accumulates and it gets thicker

and kind of Mossy it's kind of like you

know thicker it looks kind of sponge

form and that's the plaque and then if

enough of it forms and there's enough

acidity in the mouth then it forms

tartter which is the hard caked on stuff

that requires scraping off by the

dentist you know and some people get a

lot of tartar some people have less

Tarter buildup depending on how diligent

they are at removing the bofilm with

brushing now you can remove biofilm and

plaque with brushing but once it starts

to form tarar that is once it's layered

on sometimes it has a yellowish tint to

it then you really start to run into

trouble because brushing and flossing

will not remove that tarar 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 bofilm if you've ever been to the

dentist you may recall they'll do this

tooth polishing you know they'll do that

thing the kind of gritty stuff on your

teeth and you wonder um you know is this

to make my teeth whiter and indeed it

can create a bit more shine or Sheen to

uh 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 your your teeth

too right if they're good dentist they

do 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 bofilm to

stick and form and certainly for the

more dense plaque and Tarter layers to

build up on top of it so they're making

your teeth smooth so that the 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 is it

always about cleaning or filling Etc but

in the

meantime brushing and brushing often

enough such that you don't get any

buildup of bofilm for very long periods

of time a eliminating or reducing the

amount of plaque and tartter that builds

up is going to be your best strategy for

improving tooth Health now what about

flossing there's a little bit of debate

about flossing in the Dentistry field

some people say if your gums 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

right some of us have teeth that are

very close together and when you try and

bring it up through the teeth it's more

of an effort okay but they really all

emphasize trying to not drop this you

know rather sharp floss and the you know

here we could also be talking about the

tooth pick based floss where there's a

little Arc with a with a a little bit of

floss across from it the ones that you

can buy some people actually use

toothpicks they're old fashion method um

frankly most dentists I spoke to don't

want people jabbing their mouth and gums

with toothpicks 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 you

best strategy is to floss at least twice

a day between all of your teeth and 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 said that

using a water pick is going to be better

than using more typical floss or for or

using those toothpick based 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

um much harder to damage the gums and

teeth by doing it and that it is at

least as efficient as standard flossing

so 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 uh floss and using dental

floss um at least once a day at night

and ideally also in the morning after

brushing that seems like the most direct

and lowcost strategy I should just

mention that the pediatric dentist 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

in 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

and 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 molers

erupt it's like whoa no it 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 now 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

I can place it among the other low

calorie sweeteners like aspartame

sucrose Stevia Etc but what's unique

about xylitol is that very much like

standard sugar or any kind of

carbohydrate

sugar the bacteria streptococus mutans

loves to eat Xylitol but when

streptococus mutans eats Xylitol it

doesn't meaning it cannot produce the

acid that normally would demineralize

the teeth and create cavities in

addition to that when streptococus

mutans eats Xylitol it kills

streptococus mutans so what this means

is that if xylol is present in the oral

cavity after a meal say in the minutes

and hours after a meal then any strep

mutans 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 strep mutans

we've got a twofer we've got a situation

where strep mutans can't release acid to

demineralize the teeth and potentially

cause cavities and the total amount of

strep mutans that can grow that can

proliferate in what are called colonies

literally the bacteria colonizes on the

teeth in that forming that bofilm 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 milu of your

mouth and inhibiting the proliferation

of cavity forming streptococus mutants

now you can also find some literature on

other proposed benefits of Xylitol such

as you know improving overall

microbiome uh 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 pallet versus the

soft pallet back in the throat and then

as you descend into the gut Etc and 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 mutans that it disables strep

mutans 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

xylol gum or xylol mins after a meal I

wouldn't suggest going from consuming

zero Xylitol mins to consuming 50 a day

or something like that or even 10 a day

you 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

large amounts because again saliva is

this incredible stuff that's supporting

remineralization of the teeth so lots

and lots of reasons to think about maybe

consider using xotl gum or xotl mins

there are a number of different ones

available out there I have zero again

zero Z 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 her views 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 etc

for 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 visit so

um you know nothing Renegade out there

or heretical uh again there are other

sources of xotl 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 tooth space 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

xylol that if you can find a toothpaste

that contains Xylitol as a sweetener

that can only be a good thing and 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 um 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

toothpastes 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

these super physiologically strong bonds

within our teeth the crystal structures

are that much stronger than when formed

by hydroxy appetite 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

fluide toothpaste we had the kind of

standard name brand fluoride toothpaste

um in our bathroom I brushed my teeth

with those for years whether or not that

negatively impacted my health or not I

don't know uh get my blood work done my

thyroid hormones are normal um 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 it anywhere near their

kids they don't want it anywhere near

themselves so if you're somebody who's

going to air on the side of caution with

fluoride and you are seeking a non

floride containing toothpaste there are

such toothpaste out there and most of

those if not all of them contain you

guest it hydroxy appetite they contain

the minerals that naturally form the

bonds that create that additional enamel

that can potentially fill in cavities

and by remineralization of the enamel

and some of the deeper layers of the

tooth so if one is seeking toothpaste

and you want to avoid fluoride you'd

want to find something that ideally had

hydroxy appetite and something that had

Xylitol and they often also contain some

sort of mild abrasive okay not a not a

really scratchy abrasive substance um

but a mild abrasive that can really

allow for breaking up of the bofilm 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 um 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 uh brush your teeth immediately

after you with your wet toothbrush both

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 uh but I

also want to be very clear that there

was no exchange of promo of their

products for information or otherwise I

simply tried and like the products and I

just so happen to have learned some

things about Oral healthc Care from

these people separate and away from

anything about toothpaste or Xylitol Etc

okay so want to be very clear that I do

believe these are quality sources these

are the toothpaste and tooth tablets

that I happen to use gums and mints that

I happen to use large part as 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-

fluoride 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 just put those in the comment

section on YouTube okay let's talk about

mouthwash or mouthwashes 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 mouthwashes 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 mucosal lining of the

mouth and they disrupt the healthy

components of the oral microbiome so 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 or

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 they're antiseptic mouthwashes

some of which contain alcohol some of

which don't which 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 healthc care

professional but you would be wise to

ask them whether or not these

chlorohexidine 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

overproliferation of really bad bacteria

in the mouth so we don't want infections

to run wild either most 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 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 okay and 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 they do come

from sources in which they were

developed by licensed mental healthare

professionals but this is always the

case when somebody's 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

lowc 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

basic over-the-counter stuff from the

grocery store that all the dentists I

spoke to said yeah that's a pretty good

option it'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 bofilm

perhaps even whiten the teeth a little

bit although as we talked about earlier

you're not really whitening the teeth

you're actually just changing the um

reflectiveness uh and some of the

composition of that enamel which is

translucent so that you can see the

underlying components better well 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 toothbrush

and you're not like 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 mouth wash or mouth rinse with baking

soda water and a little bit of hydrogen

peroxide I 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 is it 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 um 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 postto so this is in the 2005 to

2010 stretch I started to get some

pretty bad caners saurus I don't know

about you but krur feel awful to me I

hate them when you eat they hurt when

you swallow they hurt when 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 siiz ulcers on the

roof of my mouth and on the sides of my

mouth it took those little canr saurs

which were annoying and kind of painful

and turn them into full-blown ulcers I

know this because when I stopped using

it those healed up almost immediately

and then when I spoke to some dentists

and peridontist they said oh yeah 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 um let's call

it alternative recommendation space for

oral health um 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 now 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 go

against any of those recommendations but

this now considered kind of old school

recommendation of creating one's own

mouthwash with a little bit of baking

soda some hydrogen peroxide and 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 in 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 that actually

provides a really nice milu for the

produ production of healthy mouth

bacteria it's near zero cost suppose you

need a little bit of salt low water and

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 brins and the

liquid that comes from these low sugar

Probiotic foods that earlier I was

suggesting and 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 milu of

the mouth to get the pH right to promote

the proliferation of healthy microbiota

components Okay so we've talked about

some commercially available gums and

mints containing Xylitol we've talked

about some commercially available

toothpastes indeed some toothpaste that

you know almost fall into the very

Boutique category because they have all

these things that are known by dentists

and uh peridontist to 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 bofilm and

clean your teeth and a high salt

solution as a Swish and spit followed by

you know uh Swish and spit with clear

water clean water no salt in it as a

Essen

very low cost or zeroc cost mouthwash

Far and Away different from the heavily

scented alcohol-based antiseptic mouth

washes that are commercially available

and that we know are basically not good

for our oral microbiome in addition I'd

like to point out that those

alcohol-based mouthwashes that many

people in the world use are also known

to reduce the amount of nitric 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 breathe we know

that dramatically increases nitric oxide

we'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 mouthwashes are known to

deplete the production of nitric oxide

so there's yet another reason to avoid

the use of these alcohol-based more

typical over-the-counter

mouthwashes by the way this is not a

scare tactic against mouthwashes I'm

sure that if you use mouthwashes 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'd

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 in other

words you can save on costs so again

lots of reasons to move away from the

alcohol-based standard antiseptic

mouthwashes 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 anes now earlier we talked

briefly about canker sours they are

really uncomfortable there are a lot of

theories as to why canker form and

they're a lot of products and theories

as to how to get rid of canker sorus

well indeed there are some ways that we

can prevent the formation of canker

sorus 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 we've

hosted expert guests on the microbiome

including Justin sonenberg 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 sorce 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 dis biotic

or if you've been taking antibiotics

actually taking a pill form or capsule

form probiotic but 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