Heal Your Oral Microbiome

In this episode of Functional Medicine Research, I interview my friend and colleague Cass Nelson-Dooley, M.S. in a discussion on how to heal your oral microbiome. Cass recently published the book “Heal Your Oral Microbiome” and we discussed many important topics about this often overlooked health issue. We discussed what conditions may be connected to a dysbiotic oral microbiome, how oral microbiome dysbiosis affects your health, health sweeteners, strategies to heal the oral microbiome, testing, dental products and more. If you’re struggling with healing your gut or have a health issue that won’t resolve, your oral microbiome may be the missing link.

Heal Your Oral Microbiome

Full Transcript on How to Heal Your Oral Microbiome

Dr. Hedberg: Well, welcome, everyone, to “Functional Medicine Research.” I’m Dr. Hedberg. And I’m very excited today to have my friend and colleague, Cass Nelson-Dooley, on the show. And Cass studied medicinal plants in the rainforests of Panama in 2003 as a Fulbright Scholar and then launched a career in science and natural medicine. She researched the pharmacology of medicinal plants at the University of Georgia and AptoTec, and then joined the innovators at MetaMetrics clinical laboratory and Genova. She enjoys teaching, presenting, writing, and researching how to address the underlying causes of disease, not just the symptoms.

She has over a decade of experience teaching doctors about integrative and functional laboratory results. In 2013, she started Health First Consulting, a medical communications company with a mission to improve human health using the written word. She created innovative videos and patient education handouts to improve practice efficiency and motivate patients. Miss Nelson-Dooley is the author of the book “Heal Your Oral Microbiome,” which we’ll be focusing on today. And has published case studies, book chapters, journal articles about natural medicine, nutrition, and laboratory testing. Her website is healthfirstconsulting.com. Cass, welcome to the show.

Cass: Thank you, Nick. So happy to be here.

Dr. Hedberg: Yes. It’s been a while. We were just kind of reminiscing about the days at MetaMetrics and I read your new book, “Heal Your Oral Microbiome.” So, I was excited to have you on about that because no one’s really talking about it. So, why don’t we talk about, kind of, the foundation of what we’re talking about here, which is periodontal disease? And so can you just talk a little bit about what that is?

Cass: Sure. Sure. So, yeah, it’s great talking with you after all these years and in the starting out, getting to know you in the functional lab industry. But, yeah. So, this book was a really fun book to write, especially from the jumping-off point of gut health, right, which is kind of a central tenet in functional medicine. And that’s some of the testing that we used to talk about years ago. So, so much of what we know about the gut really just perfectly translates to the mouth. And periodontal disease, you know, I kind of like to just simply say that it is a dysbiosis. It’s an oral dysbiosis that…and an aberrant or an over-reactive immune response to that dysbiosis.

So, one of the fascinating things, when I was writing this book, was realizing that so many of the things that plague our mouths are really just dysbiosis, you know, which we talk about all the time in regards to the gut. So, periodontal disease is an imbalance of oral bacteria that triggers an immune response that attacks and destroys bone and teeth. Cavities are a bacterial dysbiosis in the mouth. Root canal infections are bacterial imbalance in the pulp of the tooth. And then you can get cavities on the root of a tooth, which is, again, dysbiosis. So, it was pretty fun to realize, wow, all of these problems just go back to the oral microbiome and we just need to try to rein in that oral microbiome and make it healthier in order to prevent these diseases.

Dr. Hedberg: Yeah. And when you think of the microbiome, most people think of the gut, beginning with the stomach, but there’s a microbiome almost everywhere. Like you point out in your book, the sinuses, the mouth, you know, everywhere and…

Cass: The skin.

Dr. Hedberg: …the skin. Yeah. So many places. Anywhere there’s a cavity. So, it’s not just the gut. And, you know, really, people are not talking about the oral microbiome. They’ll look at, you know, stool analysis results and just think about the intestine or the stomach, or they talk to the patient, and they’re just thinking about their symptoms in relation to the gut. But the oral microbiome, I mean, it has just a significant impact on everything downstream going into the stomach, small intestine, and the colon. So, why do you think this isn’t a bigger issue? Why aren’t more people talking about it?

Cass: Well, I think it’s coming. I think we’re just at the front edge of it. I mean, the gut has been in the spotlight. The gut microbiome has really gotten a lot of attention over the last decade or two, at least, if not more. So, I really just think it’s a matter of time. I mean, this book, “Heal Your Oral Microbiome,” is the first one on the topic. So, I mean, people certainly know about the oral microbiome and talk about it. And I would argue that this is what dentists are working with on a daily basis is the oral microbiome. But no one had written a book about it before. And that was kind of neat that the publisher saw that opportunity, you know, that the time was right for this topic.

The oral microbiome is second in biodiversity only to the gut. So, I mean, it really is time to talk about it. It’s time to talk about the oral microbiome. And I think for anyone who has been interested in functional medicine or practicing functional medicine, it’s just kind of a natural next step. It just kind of needs to be folded in, like, instead of thinking of the gut as, you know, the stomach and downward, we need to think of it as starting at the mouth.

Dr. Hedberg: Right. Right. Many years ago, I was reading an interview with the gastroenterologist who wrote the book “The Second Brain.” I’m blanking on his name now, but they asked him what he thought of the idea of leaky gut and he said leaky gut is garbage. That’s just quackery. And now we have, you know, so many published papers on leaky gut. And so it’s a real thing now. And you talk about leaky mouth, which I thought, you know, is really interesting. So, can you expand on that?

Cass: Sure. And this is something that, you know, I have written about and mentioned and other dentists, I know Dr. Mary Ellen Chalmers had mentioned it, kind of, in passing years ago. This is just, kind of, an idea and I think it’s something that various of us have come to on our own because it’s just an extension of the leaky gut idea. But the lining of the mouth is very similar to the lining of the gut. And we know that, actually, it’s a little bit more porous, a little bit more porous than the gut lining. And we do know that just even in a healthy person when they chew or brush their teeth or get a dental cleaning, of course, anything like that, when they eat a meal, they develop some bacteremia from that, you know, kind of, action, that disruption in the oral microbiome. So, the bacteria from the mouth go through the oral lining and the mucosal lining and get right into the bloodstream, so, even in a healthy person. So, you know, it’s like, okay, we’ve got that barrier there.

So, what about someone with gingivitis? What about someone with cavities or a root canal infection that hasn’t been addressed or periodontal disease? What happens when they brush their teeth or eat or get a dental cleaning? That’s dysbiotic flora going right into their bloodstream. So, I think the concept of a leaky mouth, you know, when there is oral disease, I think this is a really big thing we need to consider. I mean, we know that oral bacteria flood into the bloodstream. We know that we can find oral bacteria in the joints or in the heart or in arteries or, you know, in various distant sites from the mouth. So, I mean, we really want to have a healthy microbiome in the mouth because that barrier is not…even in a healthy person, it’s not a watertight barrier. Things pass through it.

Dr. Hedberg: And, you know, cavities and gum disease and things like that is basically what you’re talking about in the book is dysbiosis in the mouth. So, if someone has one of those or it’s happening all the time, why don’t we get into what they can do to begin to shift their microbiome in the right direction?

Cass: Sure.

Dr. Hedberg: What would you say is the biggest way to begin that shift?

Cass: Yeah. So, I mean, for me, it’s diet every time, you know, kind of we are what we eat, right? And our microbiome is what we eat. And this is, again, such an easy jump to make from integrative and functional medicine because we already know how critical the diet is to the whole body health. So, it’s, you know, going into a healthy diet, meaning, you know, no sugar, no refined carbs, no packaged foods like breads and cookies and, you know, pasta and things like that and, really, working toward a whole foods, plant-based diet with plenty of fiber if a person can tolerate that if there isn’t a gut dysbiosis they’re managing. But, yeah. So, a healthy diet, I think, is one of the best ways to shift the oral microbiome and even things like, you know, in greens, you know, leafy greens and beets. I mean, it’s so interesting the foods that our oral microbiome really likes, you know, and thrives off of. So, lots of veggies and fiber. That’s really, you know, how the microbiome evolved with us, we would be on that type of a diet.

But that’s not all. There’s a lot of other things to do to improve the oral microbiome. I mean, since writing the book, I’m a big fan of oral probiotics, especially…Hold on one sec. Oh, yeah. Excuse me. Oral probiotics are really great. There are oral prebiotics. So, you can feed the microbiome. Let’s see. There are…I mean, of course, dental hygiene, right? That goes without saying. So, flossing and brushing with healthy oral products. That’s something too we may wanna get into is so many of the grocery store products on the shelf are not great for the health of our mouths. So, kind of, looking more closely at what is in your dental health products to make sure that they aren’t actually harming your microbiome. And staying away from alcohol-containing mouthwashes or even staying away from mouthwashes totally in order to cultivate a healthy microbiome in the mouth.

Nutrients, right? So, nutrition is really important. And then, you know, if there’s dysbiosis, I usually say that people need to work with a practitioner, you know, to try to…If there’s gingivitis or, you know, cavities or some other type of chronic oral health issues, it’d be better to work with a practitioner to have that, you know, overseen because we don’t really wanna throw lots of antimicrobials into the oral microbiome without having an end in sight, you know, having a goal and a plan. And I think self-treatment is a little tricky when you’re using antimicrobials in the mouth, but that is on the menu, right? It’s a possibility. Some people may need antimicrobials, probiotics, things like that.

And then, you know, there are other treatments that can help too like treatments to lower inflammation in the mouth, things to heal the oral mucosa, and things to boost the immune system in the mouth. And for practitioners who do functional medicine, probably there are supplements coming to mind immediately, like, “Oh, yeah, glutamine. Oh, yeah, you know, aloe. Oh, yeah, you know, colostrum or immunoglobulins,” you know, things…because just like the gut, the mouth needs all of this type of help to heal and have a good balance.

Dr. Hedberg: Let’s talk about some specific products and brands, and feel free to mention those. I’ve used the PerioBiotic toothpaste from Designs for Health, which you mentioned in the book. Were there any other toothpastes that you like?

Cass: Yes, I do. And that one, I mentioned it in the book. They do have a paper showing that it suppressed streptococcus mutans, the bacterium that is implicated in cavities. So, that, I think, is a neat one. I also like RiseWell. They have a natural toothpaste line. It’s a company that has just a few products but they have an adult toothpaste, a children’s toothpaste, a floss, and a mouthwash. But especially the two toothpastes are neat. They contain hydroxyapatite, which shows the same ability to strengthen teeth as fluoride without the potentially neurotoxic effects of fluoride. So, that’s a really neat product. And hydroxyapatite, I think their floss has hydroxyapatite in it too. So, those are great toothpastes.

When referring people to healthy dental products, I also send them to askthedentist.com. Mark Burhenne has a tremendous following on web and social media related to dental health. And he’s basically a functional dentist. And he’s actually trying to build a functional dentist directory. And we need this. We really need this. I mean, we have biological dentistry but, you know, that kind of coming together of dentistry and medicine and whole-body medicine to have it be more of a cohesive look at health. So, he has a lot of neat products on his site. But I think in terms of toothpaste, those two I really like those. Floss, of course, you know the EasyGlide, Oral-B floss has toxins in it, unfortunately, including, I think it’s PFAS, poly-floral…I’m blanking on the chemical name, but these are, you know, known to be toxic by the EPA. And the famous one that we all know about it’s Teflon, to kind of think of it as like Teflon floss.

Dr. Hedberg: Oh, geez.

Cass: I know. That’s why it doesn’t stick. That’s why, you know, it glides easily between teeth. But that’s really not ideal. So, throw out your Oral-B Glide floss and have your patients do it too. And really, we need to be looking at silk floss, nylon floss. Waxed or unwaxed is okay. But, yeah. And then like I said, mouthwash is really a pretty big problem. We really have to watch out with mouthwash because, you know, if it’s chock full…Even if it’s essential oils. I mean, we need to be mindful about essential oils in the mouth because they can affect the microbiome. They can kill potentially even good bugs.

But, yeah. So, mouthwash…I mean, chlorhexidine mouthwash, you know, basically antibiotic mouthwash kills the microbiome, which I guess is its intended effect. But what some studies have shown is that that change in the microbiome harms our blood pressure regulation. So, the bugs that live in our mouths are pretty important in regulating our blood pressure. They help us make nitric-oxide properly. And when we eat things like beets and greens and stuff like that, that helps. And when you do mouthwash and you kill them, then blood pressure rises. So, I think, use mouthwash with caution.

Dr. Hedberg: Right. Right. And speaking of flossing, I had sent you this question earlier, and I’ve just heard a few biological dentists say that they don’t like flossing because it can create these micro-cuts in the gums where bacteria can grow in small pockets. But then I know other biological dentists who like flossing. So, what have you found as far as the best recommendation for that?

Cass: Yeah. And, you know, I have not heard a lot of talk against flossing. So, again, I kind of err on the side of my colleague and friend, Dr. Mark Burhenne, who…I mean, he does encourage flossing, for sure. And flossing before brushing preferably. But, you know, I have not heard him say that flossing isn’t a good idea. I mean, of course, we know that you can over-floss and you can injure gums, like, with a bad flossing technique or, you know, excessive flossing. So, that’s important to be aware of.

Dr. Hedberg: Okay. Yeah. Yeah. I think I’ve heard maybe two biological dentists say that they don’t like flossing, but, of course, that doesn’t mean that it’s true. And people are gonna have varying opinions.

Cass: Right. Now, are they using water picks instead? What is their…Do they have an alternative they prefer?

Dr. Hedberg: Yeah. Their alternative were the soft picks. And you mentioned the gum soft picks in your book.

Cass: Right.

Dr. Hedberg: So, yeah, what about those? And that brings me to my other question about the proper order of doing these things because I get this question a lot. And so you just mentioned you floss before you brush. And what about the soft picks? Would that be the same? You’d use a soft pick before you brush or after?

Cass: Yes. That’s what I would think. But I’ll be honest, you know, I’m not a dentist, so I can’t…

Dr. Hedberg: Sure.

Cass: …say expertly what the answer is on that, but I pretty much get the idea that you want to, you know, free up plaque, free up, you know, kind of disrupt the microbiome with things like floss or soft picks. You’re just disrupting the microbiome. You’re disrupting the biofilm. And then with brushing, you are kind of clearing it out and, you know, clearing out the debris and moving it out of the mouth totally so that it can’t, you know, basically, stick, you know, reattached to the teeth.

Dr. Hedberg: Right. Okay. And then what about xylitol gum? I know you mentioned xylitol in your book. And the practitioners know that xylitol has always been known as a pretty good antibacterial for some bacteria. Is this something that you think is a good idea to chew after meals?

Cass: Yeah, I think so. I mean, you know, xylitol is a perfectly good option. And xylitol gum, I mean, there’s nothing that I know about that would contraindicate that, I mean, unless there’s like a jaw issue, right, like a TMJ type issue or, you know, something like that. But otherwise…I mean, now there is this thing about xylitol. So, I have xylitol at home too for, you know, a little bit of a sweetener here or there because it does…It really effectively squashes streptococcus mutans. So, especially if cavities are a problem, it seems like a no-brainer to use xylitol.

But, you know, I think the integrative dentist or the functional dentists, you know, they really want us all to, you know, stop wanting sugar so much too. So, even with xylitol, it’s really minimalistic just in terms of getting our palates less hooked on sugar. So, xylitol is very sweet. I mean, it tastes to me just like sugar. And so, I mean, there is that if you’re dealing with xylitol that you don’t want to use xylitol as your crutch to stay hooked on sugar, the taste of sugar, because the ideal is to, kind of, move away from depending on sweeteners of all kinds.

Dr. Hedberg: You also mentioned stevia and monk fruit in the book as recommended sweeteners. And what about something like a local raw honey? Where does a good quality honey fit into that picture of sweeteners?

Cass: Yeah. I’m a little more uneasy about honey even though a local raw honey sounds totally wonderful and has a lot of other health benefits. But, yeah, I’m a little bit more careful with even things like honey. I mean, it still falls into the category of a sweetener and sugary. Now, I haven’t looked closely at studies on that and I wonder if it might be a little different. But I think, you know, minimalistic, if possible, but that if you’re going to have sweetener in your house, that sounds like a great one to have in moderation.

Dr. Hedberg: Yeah. Yeah. Moderation. Now, other ways to get these good bacteria into the mouth. You mentioned in the book some chewable probiotics. What chewable probiotic products do you like?

Cass: Yeah. So, that’s a good question. And there used to be one by Xymogen that is now not…My understanding is it was discontinued and a lot of people were bummed out about that.

Dr. Hedberg: Was it the ProbioMax?

Cass: Yes.

Dr. Hedberg: Okay.

Cass: Yeah. Did you…

Dr. Hedberg: It was discontinued.

Cass: Right. To my knowledge. Klaire Labs has Prodegin. They have a chewable probiotic. DaVinci Laboratories has a KidBiotic in ENT. So, another chewable probiotic. But those are really the ones that I know of from, kind of, the physician line brands. I don’t know of others. I mean, there’s many for sale on Amazon, but…And, of course, what you’re looking for is streptococcus salivarius. Let me see if I can get the strain name exactly. Yeah. So, streptococcus salivarius. And then there’s K12 and there’s M18. So, that’s what you want in a chewable. And studies have shown, you know, that those prevent gum disease, prevent bad breath. But interestingly too they affect ear health and throat health. So, this is a really neat oral microbe that…I mean, I’m hoping we’ll have more and more, you know, as time goes on that we’ll be able to, you know, better, you know, design products that are specific for the oral microbiome because right now we just, kind of, have the same old, same old. We have bifido. We have lactobacillus. These aren’t actually major players in the mouth, but streptococcus is, for sure.

Dr. Hedberg: You said strep salivarius, K12, and M18?

Cass: Right. Those are the strains.

Dr. Hedberg: And you also mentioned in the book a tea tree oil rinse solution. Do you know how that’s made or the ratio of tea tree to water or something like that?

Cass: Yeah. Let’s talk about that. So, I think that’s a great question because the clinician…I have some case studies in my book. I mean, being in functional medicine and, you know, doing, you know, education around in this topic, we know that case studies are some of the most helpful things to really figure out how to do this, how to get good results and recreate good results in multiple patients. But that case, they did not tell me what the dilution was. I think that was a little boy. That was at Grayson. There was a little boy with just awful cavities, you know, all throughout his mouth and the dentist wanted to do pulpectomy. Basically, root canals on all of his teeth, put him under general anesthesia.

And so the clinician who was an integrative and functional medicine doc, you know, treated him the way we would treat someone, you know, using nutrition homeopathy. She did use xylitol and actually had him eat more plums. So, those apparently suppress streptococcus mutans as well. And she worked on a few other areas. But he was not eating any sugar at all. And he was on a low allergen or no allergen diet because his parents had some allergies, so it was pretty shocking how bad his tooth decay was at such an early age, but…

So, I did, however, look into…And she did a tea tree oil rinse in his mouth to lower bacterial count. So, one thing to remember before people go out and try this is that this is an antimicrobial treatment. So, this is not a…This is a treatment that’s going to lower the…affect the oral microbiome. And so this is more appropriate for someone with an oral dysbiosis than this is not, kind of, just like normal oral health maintenance. So, in one study where they found a tea tree oil rinse worked better than chlorhexidine. It was basically an antibiotic mouthwash. They had patients take a total of nine drops per day of tea tree oil. So, basically, they would have…So, like, in this study, they had, the patient had, the person, subject in the study add three drops of tea tree oil to, like, less than half a glass of water after brushing their teeth, and they would have them swish with that three times a day. So, the total over the course of the day was nine drops, so basically, three drops in less than a half glass of water and swish with that.

Dr. Hedberg: Excellent.

Cass: Yeah.

Dr. Hedberg: And you also mentioned putting something in a Waterpik. Oh, yeah, frankincense oil. That was two drops into the Waterpik?

Cass: Right. Yeah. And I think that was just once a day.

Dr. Hedberg: Okay. And another oral rinse idea that you talk about is swishing some powdered glutamine with some aloe juice or water. That sounds like a great idea to heal the gums.

Cass: Right. Yeah. And this is really just an idea. I don’t know anybody who’s doing this, but it’s not such a far jump because this is what we do to the gut when the gut needs healing. And really, the architecture, the immune system, so many things in the mouth and the gut are almost identical. So, yeah. So, glutamine swish, potentially. I mean, the amazing thing about the mouth is it’s just right there where you can access it. I’ve even thought, like, what if you, you know, put it into like a dental tray or something and use it overnight? I’m trying to think what else. I mean, any type of…Even for people who might be doing, like, an anti-inflammatory medical food, you know, like UltraInflamX, maybe they could swish and then swallow to affect the oral health, oral microbiome, and the immune system in the mouth.

Dr. Hedberg: Right. And what about specific nutrients? You write…you talk about some nutrients that people can take to support their oral microbiome.

Cass: Right. Yeah. There’s a lot of great nutrients for the mouth. So, not only do we have tissue in the mouth, you know, mucosal cells and the oral lining, but we have teeth, bone. So, B vitamins, of course, are critical. Folate. Minerals are a big focus. So, calcium, copper, magnesium. Usually, phosphorus isn’t something people need to supplement because there’s a lot of it in the diet. Potassium, zinc. So, minerals are really huge. Of course, vitamin D, critical for bone development, calcium homeostasis, vitamin A, vitamin C, vitamin E, vitamin K. So, essentially, you know, you wanna be getting adequate B vitamins, a multivitamin-mineral, and antioxidant vitamins.

And keep in mind…I mean, we know this, Nick. But keep in mind that just eating a healthy diet and taking your multi is not always enough. So, even eating a healthy organic diet doesn’t always cover the bases because each person has little, kind of, idiosyncratic nutrient deficiencies that might be, you know, a genetic difficulty or a little problem getting the proper amount or just a higher metabolic need. So, sometimes testing is helpful to figure out if someone has an additional nutrient issue that needs to be addressed.

Dr. Hedberg: Let’s expand on some of the mechanisms here. So, someone has a dysbiosis in the mouth. And, of course, when they eat, they’ll be swallowing large numbers of bacteria that aren’t going to be good for the gut. And then, of course, when they brush and do things like that the same thing happens. So, what’s really happening there as they swallow all these microbes and they get into the gut? Are we seeing gut issues that aren’t resolving because of that, because of the constant load coming into the gut from the mouth?

Cass: Yes.

Dr. Hedberg: Can you expand on that?

Cass: Yeah, I would…I mean, that’s great, Nick, that you picked that up from the book and I’m glad you bring that up because I think in functional medicine, you know, again, where we kind of are laser-focused on the gut, you know, in a gut dysbiosis that won’t resolve, definitely check the mouth. Definitely check the mouth because they are swallowing whatever bugs are growing in the mouth, they are swallowing them all day long, every day. So, I mean, certainly…And I mean, H. pylori, I talk about that all the time because, you know, I do some consulting for Diagnostic Solutions Laboratory who does stool testing. And so we see H. pylori in stool tests. And I talk about that a lot because H. pylori…I mean, that one, there’s literature showing that, you know, stomach ulcers, stomach infection with H. pylori is more successfully eradicated if the person is getting regular dental hygiene treatments.

And people who have H. pylori, have ulcers, the ones that are treated, all of them were treated with triple therapy. The ones that get their regular oral health cleanings, their H. pylori goes away. And the ones who don’t get their regular dental cleanings, they have an 80% recurrence rate of H. pylori. And that’s because H. pylori lives in dental plaque. So, that bug is a good example that we can point to the literature, like, yes, literally, the bugs from the mouth can go straight into the gut and create trouble. And I think that’s…I mean, like you said, the dysbiotic bugs and the immune, you know, cytokines are going potentially into the bloodstream.

But if we’re dealing with, like, a chronic dysbiosis, I would check the mouth. And I have heard of cases where, you know, there’s this dysbiosis and they’re doing everything and the diet is perfect and then when they finally go to the periodontist and get something checked out, sometimes they don’t even know what’s going on. Right? Sometimes they have an abscess that they don’t even know about. They can’t feel it. And then once that gets addressed, the gut microbiome normalizes.

Dr. Hedberg: Yeah. This is really important for practitioners to know about when they are seeing cases and the gut issues are just not resolving. And it’s interesting, you know, you brought up H. pylori because we see that a lot. And I’ve read studies on H. pylori being identified inside of arterial plaque in the coronary arteries. And so, you know, not just in the mouth, but in the gut and then into the bloodstream. And so can you talk a little bit about the connection with oral health and cardiovascular disease?

Cass: Sure. It’s fascinating. It’s totally fascinating. And we don’t really know…There’s a couple of hypotheses of how it’s happening. But I think it’s pretty well established, like, there’s not much doubt that, you know, the oral microbiome is critical for systemic health or cardiovascular health. One study says that there’s level A evidence supporting that periodontal disease is independently associated with arterial disease. I mean, they pretty much just say, like, it’s a cause. It is a cause. Periodontal disease is a cause of arterial disease. And I mean, the evidence just kind of stacks up. I mean, everyone’s heard of, you know, if you stop flossing, then your risk of cardiovascular events goes up. If you stop doing your oral hygiene, your CRP levels go up. The minute you start flossing and brushing again, your risk of a heart attack goes down immediately, like, in real-time. You don’t even have…Like, immediately, you don’t have…it doesn’t account…you don’t have to, kind of, pay back for all that time you didn’t floss and brush. It just immediately has an effect. So, it’s pretty incredible.

And then we talked about bacteremia. Right? So, that, I think, that’s pretty much accepted that that’s a way that pathogens get into the bloodstream. And then, of course, if you have periodontal disease where you have a lot of inflamed tissue, you have a lot of microbes, a lot of dysbiosis, and then every time, you know, multiple times a day that the microbes and the inflammation is, kind of, getting flooded into the bloodstream, okay, that’s gonna cause inflammation in the system, kind of a low-grade systemic inflammation.

Now, there’s also hypotheses that, well, it’s just the pathogens, you know, directly damaging the walls of the blood vessels, kind of like nicks, you know, and cuts. So, it could be that it’s the pathogens themselves just doing direct damage. I mean, there are certain high-risk oral bacteria that are implicated in atherosclerosis. So, yeah. And then, like I mentioned earlier, there’s also an effect on blood pressure, right? So, there’s, I think, maybe multiple mechanisms whereby the, you know, unhealthy oral microbiome results in heart disease.

Dr. Hedberg: You mentioned C-reactive protein, which I run on pretty much every patient, which is a marker of inflammation in the body. And I just had the wheels turning, you know, thinking about this, some patients who once I get them well and they’re feeling fantastic and their C-reactive protein level is still slightly elevated and there’s just nothing really pointing to that elevation, this has me thinking that even though they’re feeling good, maybe they have some ongoing microbiome issues in the mouth. Can you talk a little bit more about CRP and what that means?

Cass: Sure. I mean, 100% I think you’re exactly right. And really, if we see a high CRP, I mean, to me, one of the first things you should think about is like, you know, an oral infection. It’s way up there in the list of potential causes. And the patient may be asymptomatic. And then, you know, Dr. Mark Burhenne, the dentist I was speaking about earlier, you know, he talks a lot about poorly done root canals. So, I mean, I think we have to, kind of, know that a lot of people are walking around with bad root canals and that those…Here we are in the second-most diverse microbial location in the whole body and it can definitely develop dysbiosis if it wasn’t properly filled and treated. And then, I mean, I don’t know how well they really stand over decades, you know.

But, yeah, you’re exactly right, when you’ve gotten everything tuned up in that patient, and their diet is cleaned up, and their gut is great, and they’re feeling much better and, you know, you’ve got everything tuned up, and yet CRP is still high or high-normal, that could be an oral infection or an oral dysbiosis. I mean, it is very important to look at the mouths of these patients, you know, and talk with them about if they’re going to their…if they’re getting regular cleanings and what their dentists are saying and…I mean, I know in our field, people are really aware of amalgams and things like that. But yeah, that’s an important piece.

And then there’s also a letter, I put it in my book, and it’s also available online so that the practitioner and the dentist can collaborate on a patient, you know, especially like if you’ve got that high CRP, that stubborn high CRP, you know, you could send your patient with the letter to their dentist and get some information about what’s happening with their oral health in case that’s the cause, in case that’s the root cause.

Dr. Hedberg: There’s also connections with the oral microbiome and autoimmune diseases, things like rheumatoid arthritis. Can you talk more about that?

Cass: Sure. Rheumatoid arthritis is a really interesting one, right, because much like heart disease, we have seen some of these oral pathogens in the synovial fluid of joints in rheumatoid patients. So, I mean, it’s pretty mind-blowing, really. And then there’s, in the literature…And I mean, it’s not quite as strong as it is with heart disease, you know, the association, but…I mean, Hippocrates talks about curing joint pain by pulling a tooth 2,000 years ago. Yeah. So, this isn’t like a really novel idea, but the research does support it as well. I mean, when patients with RA, when their periodontal disease is treated, the severity of their RA improves. Citrullinated proteins, the auto-antibodies are found in patients with periodontal disease and RA. And then most people with RA have an increased incidence of periodontal disease.

And really, I mean, if you look at the two conditions, it’s a little bit like a mirror image. I mean, there is an immuno-inflammatory response happening in the mouth and in the joints causing, you know, joint and bone destruction, tissue and bone destruction. So, it’s not really shocking to see those two conditions, kind of, track each other a little bit.
The citrullinated peptides are really interesting. So, two oral pathogens are common in RA, Porphyromonas gingivalis and Fusobacterium nucleatum. And P. gingivalis produces these citrullinated peptides that seem to trigger autoimmune inflammation. And actually, antibodies to this peptide is found in something like 70% of people with RA. Yeah.

So, I mean, if you’re struggling with an autoimmune condition, just like we would say about the gut, you know, I mean, start with the gut. If you really want the gut healthy in someone who’s struggling with autoimmunity because that’s where the immune system lives too, you also would want them to have a healthy mouth and oral microbiome since, you know, that’s the first place where the whole outside world is coming into the body is right there in the mouth and the immune system is there too. And those oral pathogens can make a protein that the body wants to attack.

Dr. Hedberg: Fascinating. Yeah, that all makes sense. And we’ve covered quite a lot of ground today. Is there anything else that you wanted to…Any other information you wanted to get out to the listeners today?

Cass: Well, you know, I do wanna mention testing. We have all these great stool tests when we’re looking at gut health, but there are tests for the oral microbiome. They’re not, kind of, to the level that we are…I’m hoping that they get better and more sophisticated and tell us more. But I do want people to know about the tests that are out there, especially if someone’s struggling with oral health problems and they need answers. So, there’s a company called OralDNA Labs. You have to have a license to order tests from this company. OralDNA Labs. They do a PCR test mostly of pathogens. So, they’re pretty focused on pathogens. There’s a company in Canada called OraVital, so O-R-A-V-I-T-A-L. And then there’s a U.K. company that’s Invivo that sells an oral test, Oral EcologiX with an X, EcologiX with an X at the end. And I like their panel too because it includes some commensals as well. This isn’t just on pathogens.

But, yeah, I think the testing, the supplements, you know, finding a practitioner who understands, you know, how to heal the mouth and how to heal the microbiome even if mostly they work on the gut, I mean, I think that’s really what people need. Ask the Dentist, also, they sometimes do a 28-day oral microbiome reset. So, it’s kind of a one-month program, which is pretty neat for patients who are really trying to get their oral dysbiosis under control.

Dr. Hedberg: Oh, excellent.

Cass: Yeah.

Dr. Hedberg: And that’s askthedentist.com.

Cass: Right.

Dr. Hedberg: Great. So your book is “Heal Your Oral Microbiome.” And where’s that available? I know it’s on your website, also Amazon.

Cass: Yes. That’s right. That’s right. I can do a signed copy if you order it from my website. We’re, kind of, getting my store off the ground on my website. Amazon is a great place to order it. Yeah. And then I’m on social media as Health First Consulting or Cass Nelson-Dooley, you know, Facebook and Twitter and Instagram and LinkedIn. And I have a newsletter if you’d like to learn more and stay up to date on these topics.

Dr. Hedberg: And your website is healthfirstconsulting.com.

Cass: That’s right.

Dr. Hedberg: Great. Well, I highly recommend your book. It was a great read. The great thing about the book is that it’s going to be very, very useful for just a layperson who’s interested in this topic. And then it’s also a great book for practitioners. So, it covers the whole spectrum of readers. And there’s some great, you know, dietary and supplement recommendations there and a lot of expanded information on what we talked about today.

Cass: Thank you, Nick. Thank you so much. I’m so honored you read it and liked it.

Dr. Hedberg: Oh, yeah. Definitely wouldn’t miss it when I saw that you had written a book.

Cass: Thanks.

Dr. Hedberg: Well, this has been great. So, everyone can go to drhedberg.com and you can just search for “oral microbiome.” And it’ll be a full transcript of our conversation. And I’ll have links to the book and Cass’s work. And you’ll see all the information on the products that we talked about as well. So, take care, everyone. Thanks for tuning in. This is Dr. Hedberg, and I will talk to you soon.

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