The surprising link between dementia and oral health | Prof. Alpdogan Kantarci

this is shocking if you neglect your oral health you increase your risk of heart disease your diabetes your dementia and your other diseases anywhere in your body when your gums are extensively bleeding you cannot just treat them by just brushing your teeth because it already shows that it's reached to a level that there's some generalized impact on your gums that's actually happening there good oral health is easy all you have to do is welcome to Zo and nutrition where World leading scientists explain how their research can improve your [Music] health I'm your host Jonathan wolf founder and CEO of Zoe today we hear about some amazing new science that links the state of our teeth and gums to the health of the rest of our bodies it now seems that not looking after our oral health can increase our risk of Alzheimer's heart disease and other serious conditions joining me today is Professor Al Kachi from the the foresight Institute as well as being one of the world's leading researchers into the impact of oral health Alp is a board-certified dentist and faculty member at the Harvard University School of Dental Medicine he studies the links between our oral health inflammation and chronic diseases Al joins me to explain how the latest research May transform how you think about what is going on in your mouth and to educate all of us on how to look after our teeth and gums to improve our overall health Al thank you for joining me today thank you Jonathan it's a pleasure to be here wonderful so I would like to start with uh something that we always do which is a quick fire round of questions for our listeners uh and I know that professors always find this really hard and the rules are quite simple you can say yes you can say no or if you have to you can give me a one sentence answer sure are you willing to give it a go sure all right let's start at the beginning if if I don't look after my teeth am I more likely to get Alzheimer's disease yes can sore gums increase my risk of heart disease or diabetes yes okay this is quite powerful stuff Can the bacteria that live in my mouth protect me from disease yes can taking a probiotic damage my teeth depends on what type of probiotic that you're taking of course okay but potentially it sounds like you don't have to say yes or no for this last one what's the most surprising thing that you've discovered about teeth and oral health that they exist I mean overall the teeth are part of the oral cavity and the oral cavity is a part of the entire body so the teeth are the only heart tissues living heart tissues that are extending beyond the entire body so if you think about it you don't have anything else that's erupting through your body as a heart tissue there's no bones around so the teeth are the most fascinating uh organs if you think about it because they are living structures but they heart tissues extending outside the body and that's the most fascinating part I love that you remind me of my wife now my wife's going be listening to this and saying what but she's a dermatologist and she thinks that by far the most interesting thing is skin and so what I love is that for everybody who specializes in what they do they're like everything else is sort of interesting but this is the most interesting thing and I think one of the joys of this podcast is getting people who are really experts in their area to help us to understand how how important it is now I have to say Al I think some of those answers are astonishing and I think that our listeners are just saying okay I would never have thought that's possible that this can be linked to alzheimer's and heart disease and things now you know I'm a little obsessed about cleaning my teeth um and I think that's partly because I hate this idea of having feelings or having my teeth taken out I haven't had any feelings and it's partly because I'm quite competitive and so when I go and see the hygienist and the hygienist says oh you haven't done this bit right you know I think I feel a bit like I'm being told off by the teachers I go away and I try and do it better but I think that probably like most people I've only thought about that as potentially that something might go wrong with my tooth and I might end up having to have it pulled out and replaced so I have never thought about it as being linked in any way to the rest of my health uh and I think that is the way that most people will have um will have thought so I'd love maybe just to start actually just with this idea of oral health at all because a lot of your papers talk about this and then how it links to disease could you just start by explaining very simple terms like what is oral health so the oral health covers for the dental health which is the tooth Health that's number one but it's beyond that because it also covers the gums that are surrounding the teeth so when you talked about what's fascinating about this as opposed to other organ systems the heart tissues are covered by soft tissues so it's an erupting system so that interface or that merger between the gums which are the soft tissues versus the heart tissues is actually the hard tissues is a teeth is a teeth and so they're actually connected with the bone as well so that's actually part of the very important interface in our bodies because if you think about it that's kind of the weakest link in the entire body because that's through which the bacteria can get into our systems it requires a very specialized system of defense mechanisms and that doesn't exist anywhere else so and so just make sure it's a weak link because the tooth is sticking up so sort of things can get in between the tooth and is connected to your bone okay immediately and that dot bone is connected with your entire jaws and so on so forth so that's number one number two the oral health also is important because that's how you chew things that's how you digest things in the first if you don't have teeth your entire digestion system goes through your stomach and your intestines and so on so forth which is not really the ideal place to do that so you have to grind your teeth so that's the reason why we say that the oral health overall is the most important part of the uh digestive system social part of your life and also fation your speaking is actually mediated by your teeth and there space between your teeth and then uh overall uh if you think think about the oral health then you're talking about gum health you're talking about the tooth Health you're also talking about the tongue which is a very important part of your speaking if you don't have a tongue you cannot speak if you're not really able to do that so entire cavity inside your mouth is considered an oral health and so someone's listening to this and they say well I've always thought about this as having clean teeth what is it that they might be missing that's beyond just the teeth being clean well teeth are only one part of the equation because I mean you have to not only clean the teeth or have the teeth becoming very shiny but you also have to clean up the gums that are actually around your teeth which is very important you also have to clean your tongue for instance after you brush your teeth because tongue is also a big reservoir for a lot of the bacteria that can actually create a lot of problems for your oral health and your systemic health so you're not only cleaning up your teeth you're not only brushing up your teeth you're also doing a lot of flossing you're also doing a lot of mouth rinsing you're Al doing a lot of tongue cleaning just because of helping your body to maintain good I feel you already are adding extra toss to me every day but there's also one thing that we need to mention there saliva is a part of the entire oral cavity which is part of your oral health as well because saliva is the only fluid inside the body that's actually circulatory but it's also extending outside your body and saliva determines the strengths of your oral health if you don't have a good saliva flow you cannot be protective about this as well so so that's also part of the oral health oh that's what does a saliva do how is that I think we I tend to think about that as being quite similar to water what is it that is doing that's protecting it is a lot of water in it and then it is a lubricating fluid for sure but it also contains a lot of nutrients a lot of enzymes that are very important for your digestion if you don't have saliva if you have deficiencies in your saliva you cannot really digest a lot of the fluids because a lot of the foods in your mouth cannot be really processed through this and it's also very important because it's a part of your defense system if you have low levels of saliva you have will have rampant carries rampant decays in your teeth so it does protect your teeth from getting decayed it's also part of the entic activity I'm using a technical world on this one but it does help the wound healing so as opposed to skin for instance as opposed to different parts of your mouth or the different parts of your body oral wounds heal much faster thanks to the saliva so Sal health is I'd always thought somehow getting things cut in your mouth was difficult because it's like wet but you're actually saying it's the reverse that actually more painful but it's heals faster hi I have a small favor to ask we want this podcast to reach as many people as possible as we continue our mission to improve the health of millions seeing this show grow motivates the whole team at Zoe to keep keep up the hard work of creating new episodes each week the best way to get YouTube to show this podcast to someone new is if you click the Subscribe button right now so if you are enjoying this episode please hit subscribe and make sure to turn notifications on thank you and back to the show help us to understand how the oral health is linked to the health of the rest of our body because it feels like that's a bit you know it's your mouth I understand you have a problem but you just said to me oh it can be linked to things like Alzheimer's or heart disease how does this how how is this possible so this is a new relatively New Concept in the field of dentistry and in the field of medicine even newer because until pretty much late early 90s I would say people didn't really pay attention to much the difference between or the similarities between the oral cavity oral health versus the systemic Health when you go to the when you went to the medical school for instance you would never learn enough about the dental Fields although we learn more about the medical health or the systemic Health much more than the uh our medical colleagues but since then people have realized that there are a lot of connections between them and that was a time that people also realized that diabetes for instance was connected to heart disease or obesity was connected to other systemic diseases and we came up with the idea not we as a team alone but the dentists or the dental researchers came up with the idea that how come the dentists or are not part of this equation how come the oral health is not part of the equation and that's where the studies really started in 1990 and to this date we discovered a lot of links and there are about like 50 plus diseases systemic diseases that are connected with the oral health with good epidemiological data good Public Health Data good basic research data and good basically human data on this one which shows that this is not only one disease that is going to be connected and affected by the oral health or disparities in the oral health or disruptions with the oral health but it's really putting the oral health into map as part of the medical care and also the systemic health and in terms of the mechanisms this can go through couple of routes one of them is the your mouth is a reservoir for uh one of the richest uh microbial populations in the entire body so in addition to gut we also have about 700 plus species of microbial species that we've discovered uh that are actually living in your mouth at any time so your mouth is not sterile even if you're very uh picky about how you take care of your teeth as soon as your cleaning is done in a dental office your tooth surfaces are going to be covered by microbial community so you're never sterile and when you you were just talking about the microbes um in the mouth and we talk on this podcast quite a lot about the microbiome we generally talking about the gut microbiome right which is the you know the the largest number of bacteria we know but we have not really talked um at all about the oral microbiome so it's great to um talk about that today how do these bacteria in our mouth potentially have this impact on um you know these different diseases and you know maybe let's start with Alzheimer's it's something that um it's very close to my own heart um my gr people who listen to the podcast often will know that my My Grandmother Had Alzheimer's it came on you know very fast in her mid 60s you know it's a devastating disease it had a a huge impact on on our whole family and my father still basically sort of lives in Terror that this might happen um to him and I think many people listening this is one of those things that that people are particularly scared of right that um it sort of takes away those quality years we want and I think I have never considered it having any links with you know the state of my teeth and gums how how does that work and how did the bacteria play a role in that if we understand it at all sure I mean we always thought and then at the D school we learned that uh back in the day of course that the brain is the Last Frontier it cannot be contaminated with any bacteria it cannot be containing any like basically microbes and so on so forth that's not true so now we know that the uh and the is reason for that is that between the brain and then the rest of the body there's a even a another layer of interface which is called blood brain barrier so blood brain barrier acts very uh much like a limiting factor for anything that's coming in getting out of the brain which is really brain becoming much more protective but that's not the case anymore so we now know that the blood brain barrier is not static it can be very Dynamic and it does have opportunities for the blood containing uh or blood content to arrive to the brain as well so that's one of the major things because of that now it's not a surprise that bacteria from elsewhere in the body can travel to the brain that doesn't mean that they will live there or they will be contaminating your brain or they will infect your brain because I mean any bacteria can travel anywhere but if there's no real good uh opportunity for them to colonize there they won't stay there but what our research has shown that even if they're transient even if they get in and get out they have have the capacity to stimulate the brain cells so when you speak about the brain cells they're quite similar to the rest of the body but they're very specialized in the brain so one of the areas that they're very specialized that for instance we talked about micral cells these are very specific defense cells that can be found anywhere in your body but they are not called micral cells they are called macrofagos they're called Big cells that actually going to be responsible of engulfing the bacteria and eliminating the bacteria like you're talking about our immune system just in general protecting us from prot us from that the way that they will do that they will chew up their bacteria they will eliminate the bacteria or they will eliminate the viruses to that matter or fungi anything that can be noxious for the body can be eliminated through these immune system cells so their version in the brain are called micral cells and their micral cells can react to these passer by microorganisms and in a way that they can stimulate inflammation in the brain which is one of the major reasons why you will have neuroinflammation at the end of the day and the second one they can also cause disruption in the bacteria can cause disruption in the way that these immune cells react in the brain so one of the major functions of the brain cells in these micral cells will be to uh get rid of all of these PLU as we call amid PLU which is the reason why Alzheimer's disease really takes place and when there's a disruption in the way that the the these immune cells are going to be able to not able to uh basically divor these plaques that they will actually start getting accumulated and that's where we think that the link really exist not only with the oral bugs but also the gut microbes that they can actually stimulate they can make their way to the brain and they can stimulate the brain cells to completely disrupt their way of handling these Plex so to make sure i' I've got that you're saying that we used to think that it was impossible for bacteria to get into our brain because it was sort of this barrier but recently we've discovered they can get through um it's not only us I mean a lot of people have been showing that sci in general have figured this out that this is you know I would take all the credit for I would have loved to but that's not the case now figured out actually bacteria can get into our our brain and basically this is triggering uh a bunch of sort of I guess self-defense mechanisms in the brain to deal with that but these have unfortunate sort of side effects and those side effects are themselves reducing our ability to to um fight the sort of damage that leads to Alzheimer's or actively leading to it no both actually one of them is reducing our capacity to fight and the second one is activating the entire inflammation in the brain so both of them are actually controversially or paradoxically very much related because this doesn't mean that the bugs will cause Alzheimer's disease we're not stretching to that limit at least not yet I mean there's no evidence on this one but what this means is that the contribution generated by the bugs throughout this cycle can completely make the Alzheimer's or brain pathologies gets worse basically it's it's distract it's sort of like it's distracted by this it's fighting these bacteria instead of fighting um the the damage that's caused in Alzheimer's can I just come back to the link to oral health because um I think there's some link here that I haven't understood which is how do the bacteria get into our brain and how how does that link with the fact that maybe I'm not brushing my teeth as well as I should the answer really is coming from how the bacteria travel there so one of them is that it's very rare that when you brush your teeth even if your gums are bleeding let's say you're not a good like basically patient that's not really taking care of your mouth and so on so forth your gums are bleeding you brush your teeth teeth you introduce all of your oral bugs getting into your system meaning getting into my blood exactly into your blood that's very transient so the time that the bacteria can survive in the blood will be very very short and usually it gets very cleared very fast unless you have a another disease that's impairing your system to immune defense so another mechanism that can take place is the bacteria can travel into the system into your blood by the other C types which is something that we're working on which is like basically other cell types that are actually responsible of eliminating bacteria may not be perfectly functioning and that can travel from one location to another one hiding from the immune system from your defense system through this mechanism which is something in other paper that we just published uh this year along with our Alzheimer's paper at the same time which shows that this can be a the case this is a uh I'm sure your comp will love this because this is called the troan Horse uh concept and it's really thinking about the entire um Homer like describing how the troan horse they're sort of hitching a list actually on the things that are meant to destroy them but somehow they're hiding and help me to understand the link again with the w with with the mouth so how why does the bad oral health open this up is this again because you're saying my mouth is bleed help me to understand that bit so when your mouth is bleeding you have a disease right so you need to see a gum Specialist or a dentist immediately that's very important message maybe we should have given at the end but that's actually part of the story so when your gum is bleeding when your gums are extensively bleeding you cannot just treat them by just brushing your teeth because it already shows that it's reached to a level that there's some uh generalized impact on your gums that's actually happening there so but let's say your gums are bleeding when you brush your teeth and this introduces couple of things number one your bacteria in the mouth is going to get into your bloodstream and then go assem El this is one of the ways that the bacteria can travel from point A to point B including the oral cavity the second one is that in response to these uh bacteria in your mouth in in the case of gum bleeding there's going to be a lot of cells from our bodies that are coming to the defense system so these cells are responsible of eliminating the bacteria from our bodies which they will eventually eradicate eliminate all the bacteria and then bacteria will be taken care of if the bacteria load is a lot which is the reason why your gums are bleeding right now then the cells are not going to be sufficient to be able to do that so they will need more help for other cells and and so on so forth this reaches to a level that is going to be chronic you brush your teeth next day your gums don't bleed but few days later there's a a gum disease that's actually below your gum line that will cause even more advancement of your gum disease so this requires a very specialized immune system very specialized defense system below the gums that will be very much generating uh defense systems as you need so there's a very interesting twist there and this is something that makes the health to disease progression so that twist is that your defense system starts becoming primed which means they can become preactivated by the introduction of the first round of bacteria that can be stimulated that can be stimulating your defense system but when the response comes here again they will be even more active so they're getting sort of more it's like bring in you started in a knife fight and then you're a gun fight and then suddenly you're in a tank fight is that of my analogy not very good no it's a good analogy because it getss out of control after a while so your system your defense system starts turning against you at that level so this is the reason why oral microbiome is very important because in the rest of your body yes you can contair with diet for instance with the gut microbiome is heavily affected by your diet or other cell types but in the oral cavity it's all open to outside and then it's a very Dynamic level it's also have a very different levels of o oxygen compared to the rest of your body because it's a very oxygenated environment obviously your oral health is very oxygenated but when you get to the deeper parts of your gum Pockets then it becomes not oxygenated so we have at least three to four layers of oxygen content which determines what the types of bugs that you're going to be having in that level so it's much more complicated in the same a couple of millimeters Pockets you will have at least different species of going on with the different bucks so that creat creates a very different challenge for your immune system which can prime preactivate your immune system and that can turn this against you and then eventually can transfer some of the bugs to your different parts of your body I'd like to share something exciting back in March 2022 we started this podcast to uncover how the latest research can help us live longer and healthier lives we've spoken to Leading scientists around the world doing amazing research and across hundreds of hours of convers ations they've revealed key insights that can help you to improve your health if you don't have hundreds of hours to spare no need to worry at the request of many of you our team has created a guide that contains 10 of the most impactful discoveries from the podcast that you can apply to your life and you can get it for free simply go to zoe.com sfree guu or click the link in the show notes and do let me know what you think of it okay back to the show and so how much can this let's maybe start stick with dementia for now how much can um the state of our oral health affect that so um you know how if I if someone gets oral diseases how much does that increase the risk of dementia and on the other hand let's say that maybe someone we love is um either at risk or maybe already developing can we actually reduce the rate of progression if we make sure that there is no um sort of oral problems so the treatment studies are underway so we haven't done those ones yet and there are a lot of groups who are actually interested this one but in terms of the risk there are a lot of large cohorts that we've been publishing and other people have been publishing across the world and this is something that's not only limited to the United States or english- speaking uh countries but across the world now we know that the oral diseases or perodontal diseases specifically can increase the risk of Alzheimer's or neurodegenerative diseases were about like 1.5 to two fold dementia is about twofold increase and then Alzheimer's disease can be 1.5 that's enormous so just to make sure that I've understood that you're saying that you double the chance of getting dementia if you have oral disease um than if you if you don't exactly so that's number one the reverse is also it's huge right like often you know scientists get very excited about like 10% changes so that is a so I think you look at the and these are studies that been done on hundreds of thousands of people so basically you're looking at the cohorts on this one so they need to be verified they need to be validated in lots of other studies obviously but that's that's comfortably something that we can say reverse is also true having an Alzheimer's disease can also increase your chance of getting gum disease for about like almost 1.5 to two fold so it's a twood directional or bir directional link between those two which begs your view is that the the oral health it's not just that someone has dementia so their oral health is is worse you think that the bad oral health can also cause um this and I know you say you're doing intervention studies but we all know that takes a long time so we have to wait I think at this point we're we're interested in your best VI think for intervention studies are going to be extremely important because it will show that how much risk we can reduce and what populations are going to be resistant to this risk reduction I mean we yes these are all lovely studies that is showing that if you don't brush your teeth you may be getting higher chance of neurod degenerative diseases Alzheimer's disease and dementia but when we do the intervention studies is this going to help everybody to reduce the risk we don't know that yet so that's going to identify how much of this one is really coming from the oral sources and how much of this one is really coming to from the systemic impact of the oral diseases so that can actually affect their now we talked a lot about dementia but I I you know in the um in that initial question at the beginning you mentioned actually heart disease and other diseases so tell me about that how is um my um poor oral health potentially you know what else is it linked to Beyond demena so let's start with diabetes because diabetes has been I mean was the first disease that was connected to gum disease and that was back in 1990s that the Studies have shown that if you have diabetes regardless of the type of diabetes you will have a gums that are bleeding so that's important so oral health or the parodontal disease is one of the six major indicators or major symptoms of diabetes so that's one one of the major problems there and in Reverse what we have found and what the Studies have shown so far is that the gum disease can also make the diabetes get worse so there are Interventional studies there which treated perodontal disease gum disease and we a able to reduce your diabetic disease so if you treat the gum disease in a patient with diabetes you can reduce your blood sugar levels hemoglobin A1c levels that can help our medical colleagues to treat the diabetes much so I just want to make sure I've got that because I've never heard that before and it's really amazing you're saying someone has diabetes which is you know incredibly serious disease with this enormous number of people um who who has it today who are living with it today and you're saying that for those people who also um have some sort of oral health problem if you treat that oral health problem actually suddenly their blood sugar control gets better um you know the the intensity if you like of the diabetes is actually reduced is that is that right exactly extraordinary it is but it's also proven because it's like that's also very that's reason why I started with diabetes because diabetes sets as the basis of all of our systemic disease what's going on so you treat two things number one you reduce the bacterial load by treating gum disease which talked about a lot so but the second one is that you're also reducing your inflammatory burden on your body by treating gum disease so your inflammatory burden is one of the reasons why your diabetes gets worse your blood sugar goes up your hemoglobin A1c levels go up and your response to diabetic treatments or diabetic drugs and so on so forth will will be completely impaired so and it's not trivial because if you and this is The Humbling moment that the dentist becomes a part of the medical team because we're not treating diabetes we treat our own diseases we treat our teeth we treat our gums we treat our oral cavity but we can help our medical colleagues treat their patients better if the patients are treated by us too you talked about diabetes what else has it been you know what else is it linked to so second one is cardiovascular diseases your heart and heart disease exactly so many of the oral bugs were able to be recovered from your PLU from your aortas so from the dead people as well obviously we cannot do this in humans in the alive people but when you sorry explain that for a minute so could could you just elaborate on where you found those oral bacteria if you think about the M most of the cardiovascular diseases or cardiac diseases are the results of your blood vessels mainly aorta becoming clogged and the aorta is aorta is the major vessel coming out from your heart and dist Distributing all the blood to rest so that's blocked you're definitely exactly and that's where you get the cardiac rest that's where you getting all of the heart diseases and so on so forth so think about this as a hose okay aort is like a hose and it comes all the way from your heart and goes into the rest of your body so that hose is now being blocked by the lipids by the fat layers internally that cannot really pass through okay that's where you're going to get a heart attack because if one of these blockage reaches to your heart and then it actually causes your heart not to function then you're going to heart attack it can also cause uh basically other parts of your body getting not enough ntion so and so forth so that's the image I have in my mind is sort of like the you know the pipe coming out of your sink and you know it can slowly get filled up if you're throwing all this stuff down the sink and not it get you know it shrinks and shrinks and eventually nothing can can get through that's sort of the analogy that I but it doesn't continue like that because if you're clogging anything on a pipe it's usually not that easy to moob mobilize that so if any of these lipids any of these like basically fat deposits inside of your aorta gets um mobilize from that location and reaches to another organ you can have a stroke mobilize means it breaks free and then it can get stuck somewhere so this is what we call as a thrombus this is what we call as a aop plx or like basically this is where one of these things breaks free and ends up in your brain or so it can go anywhere it can clog any part of your body it can basically cause you to get paralyzed and so on so forth so this is a process that can be completely aggravated it can be completely got worse by the gum disease through two mechanisms again from one of them is microbes microbes can actually stimulate these cells to become trombos trombos cells or it can also be becoming from the inflammatory cells that through the inflammation there well I think everybody's going to be listening to this and thinking I think I need to look after my teeth better than perhaps I thought 24 hours ago um so actually that's a brilliant point I think to transition from scaring us about all this maybe to talking about um practically what can our listeners do to avoid um you know uh getting uh you having a heart attack because the wrong bacteria ends up in the wrong place but actually looking after our um teeth and gums what what would you be advising so the good news about this is that we know how to treat the gum disease and so don't be afraid I mean just be going to the dentist or going to your gum special periodontist on a regular basis will prevent a lot of these problems and they will give you good advice and they will prevent any of these diseases from taking place I mean we're not I mean so far of course the uh picture was quite Bleak I mean I would say so as well because these are very scary moments in our careers and so yeah I've had more cherry podcasts you know but I wouldn't really create a silver lining on this one now the Silver Lining comes from the fact that we can treat gum disease we can treat so this is very treatable it's not one of the things where there's nothing you can do it's very treatable and it's very easily preventable so it's very very important so even if you don't have any bleeding gums even if you don't have any like basically shaky teeth and so on so forth just please go to a dentist please go to in healthcare then paradon TST so that will be actually preventing you from getting anything else it's never too late and the key advice for somebody thinking about this if you what are the key things you need to do to make sure you're looking off your mouth so um first of all we talked about all of these symptoms I'm not going to repeat about the bleeding and so on so forth but for instance if you don't have a good mouth smell your mouth smelling is already an early indication of your uh mouth can be habited by bad guys bad bugs also so that's very important it can come from your mouth it can come from your uh gastrointestinal tract so you need to identify the differences for this if it's not coming from your mouth you need to find out where it's coming from so that's very important so the smell is a bad thing we talked about mobility of the teeth carries Dental carries decay of your teeth are very important so don't miss those chances we didn't talk about one other major disease is is in the mouth which is the oral cancer that's in the rise that's really becoming a problem so one of the earliest detections can be made very easily if you go to a uh dentist or a periodontist on that matter so we can actually detect them ahead of time so so tell me about what to do regularly so how do you look after your mouth so couple of things I of course I do brush and floss on a regular basis and I how how often so you need to brush your teeth at least two to three times after what you do two or three depends on the day I mean like basically if you Skip One or so and so for but it depends on what type of a meal that you're eating because if your meals are very rich with carbohydrates then you have to make sure that you clean up your teeth much faster on this one make sure that you're not skipping the evening brushing that's very important because you cannot skip that because your saliva flow goes the lowest at night when you're sleeping so the lubricating function is not there anymore so don't skip the evening brushing brushing in the morning is also important and then in the midday if you can brush this flossing at least once a day preferably before you go to bed because you don't want any carbohydrates to get stuck between your uh teeth so that the bacteria cannot really uh breed on them so these are the two major things we also use a lot of the inter Dental brushes right now especially if you have uh Restorations if you have Crowns if you have Bridges if you have uh implant supported Bridges and so on so forth these are very important you these are the ones that look a little bit sort of like a toothpick but have a sort of like bit on the end rather than the sort of oldfashioned piece of floss so that's that's complimentary to flossing because this actually eliminates a lot of the larger pieces of food debris between your teeth oral rinses we also use a lot and then depends on I mean it can be a choice of yours but not all of them are created equal but usually they also suppress a lot of the bacteria to a certain degree so you're talking about mouthwash mouthwash so that's interesting so I was going to ask you about that what is your view on on mouthwash because I've heard you know I've heard different things as it feels like this might be wiping out the environment that you would have for your normal healthy microbiome and given I think what we've learned elsewhere you know i' I I I used to mouthwash uh uh quite a while ago and I stopped because it felt like it was actually unlikely to somehow be the right natural environment but it sounds like you're about to tell me something different so not major not too much different compared to what you may know but like don't everything is at moderation so don't get crazy about mouthwashes either I mean basically if you're going to do it do it once a day before you go to bed at night that's where your body is the most helpless and then that's where you really need to that so surpress this but if you add too much of mouthwash in your oral care regimen then you're also getting suppressing all the good guys as well which we don't want to do and is there good evidence if you mouthwash is that significantly better for your oral health than if you don't yes yes Ian of course that's a good additive but not all mouthwashes are actually really created equal some of them are really targeting larger spectrum of bacteria some of them are targeting for Less bacteria for instance chlorexidine in the US is uh by prescription because it's very powerful mouthwash and we don't really use that on a regular basis on anyone who's not really going through like any dental surgery type of things or anything that's really requiring a much more advanced things but interesting on balance you are in favor of it despite the way in which it might be wiping out the good bugs as well as the bads well at moderation it doesn't wipe out because the colonization really takes place much faster but you're really helping the good guys to suppress the it just sort of reduces the level doesn't really wipe everything we don't want to wipe that you feel on balance you're a you're a mouthwash everybody is different on that one because I mean you may create your own mix out of this so one of the things that is very important these are all the things that you can take care of in your oral cavity you asked me how I take care of my health so I take care of my General Health to be able to help my oral health eventually my oral health to help my General Health so I do exercise my diet is a very well balanced diets and then so those are things just like anything else helping your General Health also help your oral health and you mentioned something about probiotics right at the beginning that some probiotics might actually be bad for your oral health could you someone's listening to this and say oh I'd like to make sure my oral microbiome is better so can't I just you know I guess you wouldn't pop a pill you'd sort of like want to chew on it but what's the situation with probiotics and so probiotics are working beautifully elsewhere in the body because I mean if you take probiotics to get your gut health for instance that's actually working beautifully in the OR cavity we have a another problem though not all probiotics are created equal we're also talking about some of the targeted probiotics so the risk here is that if you use one bug to get rid of the other bug it does successfully do it but you have to be very cognizant about what that bug really does for instance certain species of probiotics are not really good for your um are good for your gum health but they're not good for your tooth health so if you have too much of those species you may actually cause decay in your teeth while trying to reduce the gum disease as a result what is your view about probiotics for the so we have to we still learning I would I wouldn't be promoting probiotics or prebiotics to that uh matter but there's a lot of good research going on with certain types of probiotics that do not cause Decay but can also colonize the bad guys out of there like like the populations that can also prevent the specifically you would mention or no I wouldn't I wouldn't mention too much about this but keep following that research because probiotic oral Rines are not uh that common compared to the probiotic tablets for instance that change the entire microbiome in your guts but there's a lot of research that's actually we're working on it a lot and then there are a lot of groups that are working on it so we'll be most probably promoting a lot of these names uh very soon but the probiotic research has a lot of Hope a lot of prospect but we have to be very careful about what you add into that probiotic mix Not to cause other diseases it sounds similar to what we've discovered in the gut microbiome where I think the first you know first flush of excitement seemed really simple and you could just pop this pill and actually the data you know interesting actually think is a lot more skeptical um about probotics in general um particularly for people who aren't in a um like a really sign significant disease State because it turns out that this is this very complicated ecosystem and um I guess in the same way we Now understand you know you can't just change one thing in the rainforest and expect everything else to to follow follow through and also on top of this you add even a probiotics you're changing the entire defense systems of our body as well so you have to be very careful about like what type of a prescription that you're going to be starting with probiotics because you're also changing the way that our immune system is also defending itself so I think we all going to have this in our Arsenal in addition to Mechanical like methods of eliminating bacteria suppressing the bacteria and so on so forth but we also going to have other drugs or other medications that can also train our immune system better so probiotics is only dealing with the bacterial part of this we also have a lot of uh anti-inflammatories that are actually in the pipeline that can increase your capacity to defend defend your body so couple of these molecules are called lipoxins and resolvents that we've been working on this for the last 25 years what they do is that they do not have any antibacterial properties but they do have uh the capacity to boost your immune system bring the good immune guys into the system and then so that they can actually reduce this there was a one paper that got published from our group last year and it was very high-profile paper that got published and the first ever oral rinse mouthwash that contains the lipoxins which show that without even killing the bacteria these don't have any antibacterial properties when you increase your defense capacity you can have much less bleeding in your gums you can have much less uh perodontal disease gum disease in your body as well so that's something that's also in the lookout that we're going to be adding to Your Arsenal so if you have this conversation let's say 5 years later most probably will have much more medications that can help our medical uh mechanical uh types of amazing healing as well and what about food I feel like when I go to the dentist you know the thing they focus on I think about when I take my children to the dentist as well is like lots of sugar is bad for you you know sugary drinks are particularly bad but is I think most people listening to this will be like that's also really not good for you in general in terms of what's supporting your gut health but thinking about food um as regards oral health is there is there anything more than just saying that you shouldn't be sucking sugary sweets all day I mean you you're not supposed to do that obviously but I was pretty confident you were going to tell me that exactly but uh disappointing would' be fun to say oh we've changed our mind on that and you know you can suck sweets as much as you want but I thought you weren't I me the sugar were of course introduced to human diet after The Agrarian Revolution I mean basically we didn't have that until then so we don't need sugar so sugar of course is not something that we need to add into our diets many of our food items already include enough sugar for us to nourish on them but on top of this uh we don't have any major particular um food types that can help oral health that is not helping the systemic health so whatever is good for your systemic health is also good for your oral health so that's the message that I want to give us that doesn't mean that we're not going to discover any of these specific foods for instance there's a lot of uh phyto Botanical treatments that you learn from the uh nature that can help for a lot of the um food items that can we can consume for gum health and so on so forth and does the food that we eat has we know has this huge impact on the microwaves that are living inside our gut but obviously that's what's feeding them there there for a long time do we know whether the diet we eat changes the oral microbiome we have yes yes but it doesn't really change because the food items are stick sticking in your oral cavity for too long because I mean the amount of time that you spend with any food item in your mouth is a couple a couple of minutes I it's not like hours and something like so we don't really create the digestion uh end point there so that doesn't mean that the food items are going to directly change your or cavity except for carbohydrate rich foods like sugar and so on so forth but that doesn't also mean that we cannot use this as a delivery system because if you're going to have a specific food that's going to be helpful for your mouth you will we can create lenes we can create mouthwashes we can create a lot of these type of nutritional things or pastels and like tablets and so and so forth that can expose the oral cavity with these nutrients for longer got it but the normal environment not think about treatment it the main message is make sure that you're not eating or drinking things with lots of sugar in because that does really affect the bacteria whereas everything else in general it's not spending long enough in your mouth to really matter so the food is not directly shaping the the health of your microb if I was worrying about diabetes and heart disease and the way you're talking about then there's not other than saying you know don't drink apple juice um the diet isn't directly going to shape that well I think you can drink apple juice Ian you should drink apple juice it's a good thing a lot of ways and so so for as long as you're not about apple juice but that's okay keep going up so but but for instance with that same token don't drink anything that's acidic because it's going to change the entire equilibrium between the bacteria and then the surface of your mouth I mean if you're having like a soda or if you're having too much acidic drinks and so on so for am I not sparkling water that's a debate am I allowed sparkling water or you think maybe that's bad the jury is still out there because I mean the the jury is out there because of two reasons one of them is that is the acidic food plus the sugar making the impact or is it just the acidic food that's causing this but acid also have its own levels for instance if you're um having a lot of citrus like in your mouth that can also weaken your teeth for enamel surfaces same thing can exist from like a lot of the like basically uh sparkling water and so on so forth but it's also not happening in every single human it also requires a lot of like lot of doses of these um drinks but you may also be predisposed to having very thin enamels so if you're in that category you don't want to drink any of these carbonated beverages because that can weaken your uh tooth surfaces much faster so it sounds like you're not forbidding me my sparkling water but you're also saying it's possible it's personalized is what you're saying it is it is possible but it's not like most probably applicable to you per se is there anything that you really want else you really wanted to cover in terms of people thinking about actionable advice before we so one of the things that we want to make sure that as dentist we're very proud to be able to uh communicate our research with our listeners so and I'm a very proud dentist I'm very very proud of what I do and that doesn't mean that we know everything but we can treat a lot of things that are really going to help the systemic health of our patients of our people and our major goal is to prevent the diseases so if you come to us at a very early part of the game and a regular basis then we can prevent all of these problems that can be coming for later if you cannot prevent or treat any of them so then we actually also have restorative capacities that can be a bit expensive like implants and so on so forth Dental diseases are the cheapest when you can prevent them I was going to say I think one thing that is really interesting because obviously normally we're talking to um to doctors and one of the things we talk about a lot is that sadly almost all of the health budget is spent on treatment so there is very very very little that is done on prevention i' never thought about this before but actually it's really interesting as you think about dentists like we go to the dentist every six months hopefully um when you don't think there's anything wrong with you and so you're constantly seeing this this prevention and it's a completely different model than the doctor where generally you go to the doctor and if you're not really sick with you know if you haven't actually really got symptoms they're like you're fine you know come back um in 5 years and there is something very appealing I think it fits very much with with zoee and what a lot of our listeners are interested in which is this idea of of of catching stuff really early before it really becomes a disease so there's there's something interesting I guess about this model um you know for the rest of medicine and then we also differ from the rest of the medicine because we don't really need any extensive imagings or anything else for that we just open people's mouth and then we can check and dentists are trained to be able to do that so that's very important for us because if you go to a dentist even if you don't have any problems we can detect not only the dental diseases but also your systemic diseases before they are happening so if you prevent Dental diseases you can also prevent a lot of the complications of the systemic diseases to that matter as well so that's the I love that idea as well what you're saying is that because actually your your teeth and your mouth is visible you know we've been able to see what's going on for you know I guess hundreds of years or and and certainly over the last 100 year that's very different from a lot of other things that are going on where we couldn't see what was going on inside your your blood and I think that is exciting because I think a lot about um a zoi is about this idea that you can start to measure all of these things that you couldn't measure before and that if you have enough data you can start to spot things that are going wrong and so in some senses you know new technology ought to allow us to do the same thing with our health overall that we've been able to do with with teeth for so long because it's visible and I think that's a beautiful way to um to to wrap up I would like to do a quick summary if that's all right as we always do on the on the podcast and please let me know if we got uh if I get any of this wrong because it's the first time um that we have done anything to do with um teeth and oral health but I have a feeling it may not be the be the for the last time so I think we started by just saying like what is oral health and it turns out that it's not just whether or not your teeth are clean but actually it's about your whole math and we ended up talking a lot about the gums and whether or not your gums are bleeding is one of the signs that this in a bad place and it's going to start to have impact um elsewhere we talked about the fact that there is a whole oral microbiome with hundreds of different species of bacteria which is completely distinct from your gut microbiome because it's where there's all this air and so it's a different sorts of bacteria that will will live there apparently we know that bad oral health can increase by 50 or 100% your risk of Alzheimer's and Dementia we know that if you treat oral health with someone who is living with diabetes it can actually improve their blood sugar control I think the number one message you said in terms of practically is if you have any of the signs that things are going wrong with your teeth go and see a dentist that was clearly the uh the most important one and certainly if you're seeing any mouth bleeding and then in terms of what else you could do brush as a dentist you were at the extreme of doing this properly so three times a day and with flossing every day we talked a bit about mouthwash you do mouthwash but there sounds like there's some um interesting um debate but not to do it all the time Once A Day probiotic rinses you wouldn't recommend right now but there's a lot of research that's coming so we should um watch that space and in terms of um in terms of food releases avoiding sugar this is a thing that really um affects what's going on um and I'm probably still allowed my sparkling water but a acidity is also potentially something to watch out for and the moderation in moderation brilliant did I that was okay that was perfect thank you Jonathan thank you so much for coming in I think it's absolutely fascinating and I think um you know a lot of what we talk about is this idea that there are things that you can do in your life that can affect what's going on so you're not simply just sort of a victim of your genes there's nothing you can do to affect all of these diseases and I think you know this research is is another fascinating um uh explanation of actually how much we probably can do things through our our lifestyle to to affect that and it's it's very exciting it sounds as though we may discover a lot of things that we can just treat that could really reduce sort of major risks and it's an exciting time for all of us as well I hope I can convince you to come back in the future when you have more research sure love to it's a pleasure thank you so much my pleasure byebye thank you Al for joining me on Zoe science and nutrition today our conversation has highlighted the importance of looking after our teeth and gums for our long-term Health another way you can support your body is with the best foods for you and with that in mind and to help ensure many more healthy years to come you may want to try Zoe's personalized nutrition program you can learn more and get 10% off by going to zoe.com podcast as always I'm your host Jonathan wolf Zoe science and nutrition is produced by yella huin Martin Richard willin and Tilly fford see you next time oh

Channel: ZOE

Views: 133,843

Keywords: zoe, zoe podcast, gut health, ultra processed foods, tim spector, jessie inchauspe, gut health diet, ultra processed foods documentary, ultra processed food, oral health, teeth, gums, disease, dental hygienist, gut microbiome, jonathan wolf, alp, alpdogan kantarci, teeth cleaning

Id: lSpxhALRYmI

Length: 56min 36sec (3396 seconds)

Published: Thu Oct 12 2023