Oral health and wellness can be so complicated. You try hard, yet it never seems to be enough. Let’s take the complex process of oral health and make it into much more manageable bite size nuggets.
I love cookbooks. Beautiful pictures of mouthwatering delicious goodness waiting for you at the end of a complicated recipe. Don’t you love when it all comes together and really does work? Recipes takes complicated instructions and breaks them down into an easy-to-follow step-by-step guide. The chefs include lists of products and amounts of each product. Everything is spelled out for you. (When I was in school studying to be a dental hygiene educator, we called this process a “task analysis”.) Cookbooks really mastered this process.
Here’s your step-by-step recipe and guide to oral health. We will start with the overview and then I will break it down further in future blog posts.
Missing Pieces of Oral Wellness
What does it take to have a truly healthy mouth? Stop the bleeding gums, the broken teeth and the cavities? You brush, floss and use all the products your dental office recommends but something is missing. You still have bloody, painful “cleanings” and new cavities. It can be very frustrating.
Let’s lay out a plan to help you unravel the secrets to oral health. The path to a healthy mouth shouldn’t be a mystery. It can be complicated, and it may not be easy, but it will be a journey that is well worth investing the time into your oral health and systemic wellbeing.
Here’s my big secret- during my early clinic days (and even more recent days, to be honest) I would be frustrated with my patients, and even more, with my knowledge and my skills. My patients would return again and again with those new cavities, and bloody gums. Were they listening to me and doing as I suggested? At best, about half were following all my fabulous suggestions, tips, and techniques. The other half? Weren’t they listening? Here’s the thing- they were. I could feel their frustration with both themselves and with me. I was failing them. I was only addressing one small part of the whole bigger picture of health.
The big reveal: Oral hygiene and plaque biofilm removal are only one (small) piece of the healing process. In hygiene school we were taught that if only the patient followed all our recommendations, they would automatically get healthy teeth and gums. Nothing could be farther from the truth. That is the big piece I was missing. I knew I needed more information, so I went looking for it and while I don’t know everything, I think I am finally heading in the right direction. Here’s what I found:
Oral health depends on great oral hygiene and SO. MUCH. MORE:
Breathing Nutrition/Fiber Proper Chewing Sleep Stress management Saliva Healthy Oral and Gut Flora Exercise Hydration Oral hygiene
#1. BREATHING
Something so simple plays a very important part in oral health. If you are not using your nose to breathe, then you are causing the plaque to become toxic and what we call dysbiotic in your mouth. Mouth breathing makes the mouth acidic. And when bacterial plaque biofilm gets acidic, the bad bugs take over.
Proper breathing is nasal breathing . Use your nose – 24/7/365.
Even when exercising. Yes, I know, I went to that aerobics class too where the instructor said, “in through the nose, out through the mouth.” Unfortunately, they don’t know what they don’t know.
Nasal breathing creates an environment where the air we inhale gets moisturized, warmed, filtered, and purified. Our nose makes nitric oxide and that kills the viruses (yes, that virus too), filters allergens, and keeps us healthy. Your mouth is an emergency hatch – just in case our nose doesn’t work. Your body wants to keep you alive. When we use our mouth exclusively to breathe, we send that unclean, cold, virus-ladened air straight to our lungs. We dry out our mouths, and drop the pH, making the plaque biofilm toxic. We need saliva for so many things. The health of our mouth depends on its production . (#6 will go into saliva’s qualities.)
When the mouth is dry, the bad bacteria, viruses and fungi start to grow. They love that dark, acidic, oxygen-less environment. There is no saliva to wash them off. The plaque biofilm, that soft film that covers teeth and feels like a fuzzy tooth sweater, becomes toxic to the entire mouth. It makes the mouth even more acidic and pathological. We then swallow these bugs, inhale them and get them floating within our blood stream . Those that breathe through their mouths have inflamed gums, bad breath and aggressive tooth decay. And! here’s the thing, even before masks, about 50% of the population was mouth breathing. Now, with masks, I suspect almost everyone is mouth breathing under there. So many folks also mouth breathe when they sleep.
Bottom line for oral health: CLOSE YOUR MOUTH. Breathe through your nose. If you can’t, then go see your GP doctor, an Ear, Nose, and Throat (ENT) doc, and/or an Allergist. FIX this or you will never be healthy.
#2. Nutrition/Fiber
The choices we make in the foods we eat will either feed disease or feed health. That is why this decision is so critical. Are we feeding the good bacteria in the gut flora or the bad ones?
The nutrients and micronutrients in our food – the protein, iron, vitamins, minerals, fats, carbohydrates, and more – are all essential for growth and maintenance of life. With the exception of Vitamin D, all our nutrients must be ingested as part of our well-balanced diet.
Vitamin D3 is antibacterial, anti-inflammatory and helps strengthen the immune system. It makes the gut lining stronger which helps assist in preventing gut permeability (leaky gut) . Exposure to UVB (ultraviolet radiation of relatively short wavelengths) increases gut microbial diversity. By increasing our Vitamin D levels we can heal, prevent and improve the body. Sunshine is so healing. Our vitamin D3 stores in the body should be tested so we can supplement appropriately.
In addition to vitamins and minerals we must also eat fiber daily. Fiber feeds the good microbiome in our gut. We need about 25 grams of fiber daily to maintain a healthy gut flora. Keeping our guts healthy is key because 70% to 80% of our immune system resides in the gut. (SO, if our gut ain’t happy, ain’t a body happy.)
The good gut flora is made up mostly of bacteria. They thrive when we feed them properly, If we do not, our body cannot absorb the nutrients from the foods we eat. Without the proper nutrients we then do not have the building blocks for healing.
Here’s the key: only about five percent of the population eats enough daily fiber. Fiber helps our gut make something called “short chain fatty acids” (SCFA). SCFAs are part of the body’s most powerful anti-inflammatory agents. Our body needs SCFA to put out the fires that inflammation creates. Gum disease is INFLAMMATION.
Time to eat fiber – 25 to 30 grams of fiber a day to be exact. Most adults get at most 12-18 grams a day. (Sad to say, I used to think fiber was only for “old people with constipation”. I was so wrong. When you know more, you do more and do better.) My favorite food is an avocado and that has 10 grams. Avocados change your life! Broccoli, beans, raspberries, blueberries apples, even nuts all have fiber so start thinking about ways to add fiber into your world and onto your plate for a healthier you! Fruits and veggies should take up about half of your plate.
Photo by Yaroslav Shuraev from Pexels
The Bottom Line: Help your body have the fuel it needs to make the building blocks it needs to fight inflammation and heal you. Feed it good food with phytonutrients , fiber , and antioxidants . Get outside to be in the full spectrum of healing sunshine. Remember, either we are feeding disease or fighting it. Time to be serious about eating for our health.
#3. Chewing
Another activity we take for granted. We think we are doing it properly, but, maybe not. Have you ever analyzed how long or short you chew your food? Do you chew each bite thoughtfully and thoroughly, until it is soupy? Or do you chew your food six times and gulp it down? Do you eat hard foods or prefer soft foods? Can you bite and chew or are your teeth misaligned? Crooked teeth make chewing and pulverizing food much harder to do properly. Do you take big bites and eat fast, or are you the last one at the table? Are you a picky eater? If you have gut issues, you may want to take a closer look at how you chew your foods. So many things to think about in learning to use your teeth correctly.
FYI- the magic number for proper chewing is 32. BUT it really depends on the food- steak and carrots may take 40-60 chews and mac ‘n cheese may only need 20.
Why do I care about proper chewing? If we cannot chew our food to a soupy consistency, we cannot get the maximum nutrients out of the food. If we only chew six bites and chunk food down, our digestive systems get confused. We don’t make enough saliva and dietary enzymes to mix into our food. Not chewing thoroughly can result in heartburn , acid reflux and constipation. Chunks of undigested food may cause abdominal pain, cramps, and more constipation. Is it any wonder then an antacid drug is the number three bestselling over the counter medication?
Airway, what airway?!?
And then, consider your tonsils. In addition to causing breathing problems, enlarged tonsils also make chewing and swallowing hard foods difficult for some people. Tonsils can become swollen and enlarged due to mouth breathing. Mouth breathing means you aren’t smelling (not breathing through your nose!). No sense of smell causes a loss of appetite, and food doesn’t taste as good. Folks that mouth breathe cannot eat and chew at the same time so eating becomes a chore. Kiddos especially get tired while eating and trying to breathe, and don’t eat properly, thus soft foods and processed foods appeal to them. So much easier and faster to eat soft foods.
BOTTOM LINE for Oral Health : Chew your food thoroughly. If you cannot, then discuss this with your dental team and/or your primary care provider. Find the cause- crooked teeth, enlarged tonsils, blocked sinuses, maybe even a tongue tie (can’t move food effectively through the mouth). AND THINK ABOUT CHEWING YOUR FOOD MORE THOROUGHLY.
#4. Sleep
Sleep is when we heal. No sleep, then poor health.
How well do you sleep ? Why would a dental hygienist care about how well you sleep? Because healthy sleep is all about the airway and the mouth is a big part of the airway. If we, the professionals, can monitor and lookout for possible signs of airway problems BEFORE they cause chronic illness and health complications, then you, our wonderful patients, stay so much healthier all over- and especially in your mouth.
Sleep is the time our bodies rejuvenate, heal and recharge. Without this restful sleep we do not heal. Sleep is when our body releases growth hormones- children need this to grow and adults need it to heal. Lack of this deep, healing sleep means a compromised airway and lack of proper oxygenation in your body. Lack of oxygen means brain cell damage (cell death), Chronic disease and systemic inflammation then results from a lack of oxygen. High blood pressure, heart attack, stroke, arterial disease, and diabetes all funnel back to airway and a lack of oxygen.
Seek help from sleep doctors, ENTs and/or allergists if you cannot breathe through your nose, if you are waking up more than once each night. We need this team, along with an airway dentist, an orofacial myofunctional therapist, chiropractor or body workers to help grow you and/or your child’s airway.
In my airway-centered office we do palatal expansion of children and adults to make room for the tongue on the roof of the mouth, so the tongue has a place to sit. If the jaw is too small, the tongue must find a place to go. During sleep, the tongue falls back into the throat. (Gravity pulls it there.) This closes off the throat and results in what is called “breathing disordered sleep”. You may know it as sleep apnea. When you stop breathing, your body wants to wake you up (and keep you alive) so it gives you a shot of adrenaline. Suddenly you’re wide awake. An apneic event is when we stop breathing for at least 10 seconds (some people stop breathing for 30 to 60 seconds!). AND!! Some do this upwards of 60 times an hour or more. With this sleep-wake cycle, you never reach that deep, restful, healing sleep. You are exhausted, and this paves the way for chronic illness and inflammation, never mind feeling fuzzy or unable to concentrate, and not having energy for the activities you love.
Sleep apnea makes the blood-brain barriers more permeable , allowing pathogens, and namely oral periodontal (gum disease), pathogens to travel across what should be an impermeable barrier. Those bad bugs create the same inflammation in the brain as they do in the mouth (bloody swollen tissues).
New research has just come out implicating an oral pathogen- Porphyromonas gingivalis- as a causal agent in Alzheimer’s dementia. P.g. is a bad bug in the mouth. Our brains make beta amyloid and tau proteins to try to heal and protect itself from these bugs. We must protect our brains by having great oral health and good sleep habits. Dementia is heavily linked to lifestyle so do your best to keep your brain healthy .
We will talk more about this bacterium and more in #7.
BOTTOM LINE for oral health: Poor sleepers are poor healers. Strive for seven to eight hours nightly. If you aren’t getting that much, then seek help from an airway dentist or other doctors to open the airway and help you to dreamland.
#5. Stress Management
Living in a perpetual state of stress is unhealthy and unsustainable. Stress prematurely ages us. Stress makes cortisol. It reduces the gut flora diversity. We need all the good gut bacteria for a healthy flora. Without this garden of good bugs, our immune system is affected. Seventy to 80% of our immune system is in our gut. And it goes without saying we need a healthy immune system.
Stress can thin the intestinal lining and create what is called gut permeability . When it is permeable, food particles, bacteria and other things can enter our blood stream. This creates an autoimmune reaction within the body, setting off a series of alarms within the body. And, no surprise, but inflammation and chronic disease can be the end results of this effect of stress. Gum disease and tooth decay are a symptom of this greater problem.
Photo by Alexander Daoud on Pexels.com
On the positive side- Hugging releases oxytocin. Hug all you want because oxytocin is a hormone that reduces stress and anxiety. They call it the love hormone . Can it get any better than that? I admit, I hug my patients. It helps both me and them to heal. Now that I know how awesome hugging is, I plan to do it even more! Other activities can also increase your oxytocin production, if you’re not a hugger. Find something that fits you!
Bottom line for oral health : Manage stress, take care of yourself with self-care and love. Exercise, meditate, breathe, sunshine, laughter, and fun activities are just as critical for your health as nutrition, sleep, and friendship. And hug your dental hygienist (if that’s okay with them).
#6. Saliva
Saliva
Saliva gets its own category because without saliva, our mouth fails. Saliva is made up of water, mucus, antibacterial substances, and digestive enzymes. Mixing saliva with our food breaks it down, this is the start of the digestive tract. We have three main salivary glands- the parotid gland- in our cheeks, the submandibular glands – on the floor of our mouth, and the sublingual glands – under the tongue.
Saliva is critical to our health and well-being. It nourishes our teeth, bathes our gums, coats and protects our tissues, and is the beginning of our digestive system. Life without saliva is not nearly as pleasant. Low salivary flow causes the mouth to be on fire. We have a name for it- “burning tongue” or “ burning mouth syndrome. ” Teeth crumble and decay without this source of moisture. Dry mouth hurts on so many levels.
If you take two or more prescription medications , chances are you have a reduced quality and quantity of salivary flow. You may not even notice it, but your teeth and gums do. Mouth breathing also reduces saliva flow. Stress also shuts off salivary flow
Saliva remineralizes our teeth, desensitizes our teeth, and cleans off the bacterial biofilm on our teeth. It keeps our gums moist, which keeps the gums healthy. When we chew hard foods, we pump our parotid glands. This floods our food and begins to break it down, to properly to start the digestive process.
BOTTOM LINE for Oral Health: Our mouths, teeth , and body require saliva. Work with your dental professionals, your primary care doctor and your medical team to reduce your prescription medications, if possible. Your dental hygienist can help you find the best saliva substitute for you as well any other as other tools, tricks and techniques to stimulate your saliva flow. A myofunctional therapist will help ensure you are nasal breathing, chewing properly, and swallowing correctly. Every drop of saliva counts.
#7. Healthy Oral and Gut Microbiome
The Oral Microbiome is alive and very active with bacteria. Spirochete is eating a WBC
(The new name for plaque is biofilm )
I am lumping the gut microbiome in with the mouth microbiome because they all work together. Our oral health is determined by our level of good gut bacteria. We need a good garden of healthy bacteria, fungi, and viruses both in the mouth and in the gut. These good bugs keep us healthy. They fight for us. Rather than wipe out all the bacteria, we need to rethink our protocols and instead feed the good bacteria, so they crowd out the bad bugs and repopulate with good bugs.
In my biological dental hygiene practice, I use a phase contrast microscope to look at and monitor the pathogens. In a healthy mouth the scope is nice and quiet, with little activity, but when gum disease is present the microbiome is completely different. I can see spirochetes, rods of all shapes and sizes, red and white blood cells, yeasts, and parasites. I look at quantity, variety, and motility. The more disease, the fasters and crazier the slide looks. The above slide is mostly spirochetes and white blood cells. The bacteria eat the blood cells, as well as other dead bacteria so there is plenty of food for them under the gumline.
As I mentioned above, P.g. is a bad bug. He is the “Keystone pathogen”, the kingpin of them all. He organizes and directs everybody else under the gumline. I cannot distinguish P.g. on my slides but I know P.g.’s best friend is the spirochete so if I see spirochetes on the slide then I suspect that his buddy P.g. is close behind. As I mentioned, there is new research that directly connects these bacteria to Alzheimer’s dementia. If that doesn’t inspire you to have excellent oral hygiene, then let me add this: 50% of heart attacks may be directly related to these same bugs . Just by adding regular flossing to your daily routine can add upwards of six to eight years onto your life expectancy. P.g. and other oral pathogens are also connected to type two diabetes .
The best way to know exactly what is lurking underneath the gumline is to do salivary testing. Salivary testing is easy to do and should be standard in every dental office. Ignorance is not bliss. In addition to the oral bacteria, we also need to be aware of the virus population within the biofilm. Viruses play a role here too. Viruses such as Cytomegalovirus, Herpes Simplex, and Epstein Barr virus as well as a host of others has also been found to infect the brains of Alzheimer’s dementia patients. These pathogens infect not only seniors but children and young adults, causing cognitive impairment. The mouth microbiome influences the entire body’s systemic health.
Yet, it is critical we do not wipe everything out. How many of us use antibacterial soaps, hand sanitizers and mouthwashes? Antibiotics can wipe out up to one third of our gut microbiome and can take upwards of a year to repopulate. We need the good bacteria and microbiome to keep us health. Being too clean is not any better. Instead, feed the good microbes with probiotics, prebiotics and nutritious food to lay the foundation for a healthy body.
And more reasons: Mouthwashes kill important good bacteria on the back of the tongue that make nitric oxide (mentioned above in Breathing). We need nitric oxide for opening blood vessels and healing our bodies. Instead of killing everything, good and bad, we should concentrate on feeding the good guys, with nutritious food that feeds then (think fermented foods, fiber foods, probiotics, and hydration).
BOTTOM LINE for Oral Health: Feed and water our good microbiome to encourage their take over and keep us healthy. They are our biggest allies and our microscopic protectors. Weed out the bad guys by feeding the good guys. (Hint: they love fiber, probiotics and prebiotics). Work with a functional nutritionist to help you make good food choices to grow a good microbiome both in the mouth and in the gut.
#8. Exercise
Exercise is an important part of a healthy lifestyle. Less than a third of the population exercises on a regular basis. It helps reduce inflammation. It gets all our body parts moving. It controls our blood sugar and reduces our risk for diabetes. People who exercise had a 54% lower likelihood of developing periodontitis.
Stretch and move daily to stimulate our immune systems. It helps our brains to stay healthy and boosts its neuroplasticity which helps keep our brains young.
Bottom line for oral health: Move it or lose it. Try Yoga – love the stretch and strength of it. Beginners or pros, it is something everyone can do. Or get outside and just walk for 30 minutes daily. Fresh air and sunshine are so great for the body and the mind. Oral health needs exercise.
#9. Hydration.
Water
Yes, water. Something so healing, so simple to implement, and totally overlooked by all health professionals. All our cells need water, yet many of us, and especially seniors, are dehydrated . Drink one to two glasses before and with meals. Eat fruit and vegetables that release water more slowly. Learn more about water and how to incorporate it into your lifestyle.
Your cells and the mitochondria within the cells need water to function properly. Our health depends on the health of our cells. Reduce your chances of a chronic disease by getting fluid into the cells. Simple yet so important. Learn more about fluid and its impact on health. Read the book Quench by Dana Cohen MD and Gina Bria.
Teeth need water too. They have a dentinal fluid system similar to a tree’s water system. This fluid is what nourishes our teeth.
Bottom line for oral health: Eat (foods with water), drink, and be merry and healthier!
#10. Oral Hygiene
Last but not least, oral hygiene and a shameless plug for my fellow dental hygienists. Your fabulous, incredible dental hygienist is truly your oral health and prevention specialist. They love to help guide you to tools, tricks, and techniques that will help you reduce the inflammation in your body, your mouth, and your brain. They want to help you heal your mouth and be truly healthy. They are your oral health coaches and biggest cheerleaders when you succeed.
Oral hygiene is all about reducing the bad bugs and growing the good ones. My goal: find the best tools that work in your hands, fit your lifestyle, and do the job well. Whether you use an electric brush, manual one, or even a miswak stick, the goal is to reduce and remove as much of the plaque microbiome as you can. Clean in-between with floss (if you like to floss), oral water irrigation, tiny interproximal brushes or other toothpick-like tools. Then raise the pH, because the bad bugs like an acidic environment. Clean your tongue twice daily – there is a lot of bad bacteria on the tongue. Need some suggestions for the right tools for you? Check out my recommendations , send me a message, or ask your wonderful dental hygienist!
Bottom Line for oral health : Oral hygiene is only a small part of the solution, but I encourage all my patients to give it their 100% attention. Work with your dental hy-genius so they can help you find the best tools, and products to fit your needs. And, HINT- HINT: schedule your oral health recare appointments for every three to four months so you stay healthy between. Yes, I know insurance doesn’t cover this but really, this is the best way to keep the bad bugs in check and stay healthy.)
The Bottom-Bottom Line for Oral and Systemic Wellness:
Infected Gums
Gum disease and tooth decay are but a sign, a symptom of a much bigger issue. They are the alarm trumpeting a storm brewing deep within the body. We must pay attention to it to ensure we live a long, healthy, and disease-free life. (BLEEDING GUMS mean INFLAMMATION)
Chronic disease and inflammation are the biggest disease creating issues we face. Leaky gums mean leaky gut and leaky brains. Inflammation creates these leaks.
Recipe for Systemic and Oral Health Success
Putting it all together – oral health is a big part of true health. We cannot just brush and floss and think we have done our part. We need to address airway, hydration, exercise, nutrition, and oral health, and make them all part of a healthy lifestyle. It takes all the ingredients mixed together to create the complete and beautiful end product which is a healthy YOU!
Please join me in being a healthy, happy, (senior) citizen, and live our best healthiest, long and pain-free life. Now that I know better, I do better. Be healthy, it is the true wealth.
Warmly,
Barbara
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