Facilitated

35| Oral Hygiene 101: Your Mouth Is Not Vegas

• The Facility Denver • Episode 35

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We connect oral health to blood pressure, metabolism, and immune function by focusing on the oral microbiome and daily habits that protect nitric oxide production. Practical tools include hydroxyapatite toothpaste, flossing and water flossers, tongue scraping, xylitol, and targeted oral probiotics, plus knowing when to see a biological dentist.

• oral microbiome as a driver of systemic inflammation and cardiovascular health
• nitrate–nitrite–nitric oxide pathway and impacts of antiseptic mouthwash
• hydroxyapatite toothpaste benefits and ingredients to avoid
• brushing technique, flossing as non‑negotiable, role of water flossers
• tongue scraping for biofilm control, breath, and taste
• xylitol, Streptococcus salivarius, and Lactobacillus reuteri for targeted support
• saliva, pH timing around meals, and enamel protection
• red flags for professional care and value of biological dentistry

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SPEAKER_02:

Welcome to Facilitated, where we bring you real stories, strategies, and science from the world of functional medicine. I'm Dr. Mitchell Rasmussen, a functional medicine practitioner.

SPEAKER_00:

And I'm Kate Darty, a certified nutritionist. We are the owners of the facility, a functional medicine clinic here in Denver, Colorado.

SPEAKER_02:

We help people improve their biology and get out of their own way. In my view, our work is about getting to know the person with the condition much more than it's about understanding which condition the person has. As I always say, diagnose the biology, not the disease.

SPEAKER_00:

On this podcast, we break down complex health topics, share real patient cases, anonymized, of course, and explore cutting-edge wellness strategies so you can make informed decisions about your health. A quick heads up before we dive in, this podcast is for education and general information only. We're here to share insights, not to diagnose or treat. So if you're dealing with a health issue, chat with a qualified healthcare provider before making any changes.

SPEAKER_01:

All right, let's get into it.

SPEAKER_02:

That jingle never gets old.

SPEAKER_01:

We don't have to listen to it.

SPEAKER_02:

Yeah, I'm just but I'm I'm speaking it for the listener.

SPEAKER_01:

Putting yourself in the listener's shoes. Yeah. Your mouth is still blue. Is it?

SPEAKER_02:

Yeah. I took a little methylene blue this morning and I look like I fell into a blueberry patch. Yeah. Cool. Let's talk about oral health.

SPEAKER_01:

Yes. So we are not dentists. We actually don't have any desire. I don't have any desire to be a dentist.

SPEAKER_02:

No, they're like one of the most depressed professionals, I think.

SPEAKER_01:

Anyway, we would love we actually have plans to have a biological dentist or a functional dentist on to interview and get really technical. But this is a topic that we spend a lot of time talking with patients about, and we want to have a resource on it. So we certainly have habits, oral hygiene habits, and we can explain some of the connection of oral health to full body health. So we're gonna do a little bit, an intro, if you will, to this topic from our perspective as clinicians. And in the future, we'll get into the technicalities.

SPEAKER_02:

Yeah, this is a great example of where we know our limits on something and have great referral sources for more, but there's so much low-hanging fruit when it comes to things like oral health that we can actually get people quite a ways down the line until we need to bring in a specialist.

SPEAKER_01:

Exactly. Big first thing though, we can't separate the mouth from everything else in the body, and oral health has massive implications for overall health. So a couple different categories we can talk about within that, starting with oral microbiome. We have an oral microbiome, just like we have a gut microbiome or a vaginal microbiome or any microbiome on our body, oral microbiome matters too. So that is really just the balance of bacteria in your mouth, uh, good and bad, all make it up. And we know that it influences systemic inflammation, digestion, cardiovascular health. Just like we've kind of learned with the gut microbiome, different associations of different patterns of bacteria in the mouth, different associations of high or low amounts of bacteria correlated with different conditions or diseases. We know that gum disease itself is not just a mouth problem. There are links with periodontal disease and heart disease, pregnancy outcomes, insulin resistance, autoimmune activity, oxygen carrying capacity, blood pressure.

SPEAKER_02:

You want me to save that one though?

SPEAKER_01:

That's next on the list. We can go right to it. Nitric oxide and blood pressure, big one.

SPEAKER_02:

Yeah, one of the first things we do for somebody who is hypertensive is to manage their oral microbiome. Yeah. And then I mean you had, and when you talk about like the different species, I mean, hundreds of species have been shown to be important for the oral microbiome. And you actually had a swab test done, right? Mm-hmm.

SPEAKER_00:

A salivary test.

SPEAKER_02:

It's insane. Just like the gut testing now, the dentists are running these like fascinating oral tests. And yeah, it really is the gateway into the rest of your body. You know, it's the start of your it's it's interesting because the mouth, the oral cavity is the start of multiple tubes in the body, you know, down to the lungs, through the back there, down to the GI tract. So it's it's so important when it when we think about how the lungs regulate blood pressure, it's such an unsung thing. It's like, oh yeah, it makes sense. It begins the gut. It's like, well, it also begins the airways. So that's where the correlation to the rest of the systems is so integral.

SPEAKER_01:

Do you want to talk about mouth bacteria and blood pressure, specifically thinking nitrates?

SPEAKER_02:

Yeah, absolutely. So nitrates come from nitric, nitrate-rich foods or things like beets and arugula, traditionally thought to be really good for blood pressure. I would say what most people get wrong is they don't let those things sit in their mouth long enough. You know, we know that nitrate-reducing bacteria are part of the system called the interostalivary system, which is a system that reduces nitrates to nitrites that then goes into this nitric oxide pathway. As humans, we don't really convert nitrate to nitrite on our own very efficiently. We literally outsource it to specific commensals within the oral microbiome. Essentially, think about it like this: you eat your greens, you eat your beets, your arugula, your celery, whatever it is that has nitrates in it, I guess wine.

SPEAKER_03:

Yeah.

SPEAKER_02:

Maybe, and it gets absorbed into the small intestine, it circulates, and it actually gets concentrated by the salivary glands. These nitrate-reducing oral bacteria take that nitrate and they convert it into nitrite, and then that's what you swallow. And then within the stomach and its acidity, this low oxygen, acidic environment, nitrites can be converted into nitric oxide. Nitric oxide is that vasodilator. It's important for endothelial health. I recorded a recent podcast talking about endothelial dysfunction being a precipitator of cardiovascular disease. Quite literally, that is how poor oral health contributes to that endothelial health, which leads to the cardiovascular diseases. We also know that nitric oxide is massively important for our mitochondria to function properly, for our immune system to get the right signaling, to make neurotransmitters. I mean, literally, this pathway of nitrates to nitrites to nitric oxide, the salivary pathway, produces like a quarter of our nitric oxide availability for our vascular uh support. It's especially important. We see this with aging, chronic inflammation, chronic diseases, where that endothelial NOS, that enos system, getting a little bit of a. I know, I'm sorry.

SPEAKER_01:

Okay, go for it.

SPEAKER_02:

But and you've heard me talk about this with patients. We got inos, we got NOS, we got enos. When people are chronically inflamed, what you want is a pulsatile release of nitric oxide so that your vessels don't just sit dilated all the time. You want them to be able to be flexible and have a rhythmic pulse uh pulsatile contraction along them. But what happens with this poor nitric oxide availability because of this oral route is you then take someone who's already inflamed for other reasons, so they're not making enos very well. This just slaps right on top of it, contributes to things like sleep apnea and insulin resistance. So I'm really passionate about this because a lot of the people that we work with do have poor enos control anyway, and then doing their poor oral habits makes it that much worse. So it's like a metabolic back door when you're already inflamed, as you if you can manage this nitrate-reducing process in the oral cavity, you at least have a shot to vasodilate.

SPEAKER_01:

Great side.

SPEAKER_02:

Yeah, huh? Enos, inos. We'll talk about inos sometime. I love it. But you don't like when I say future episodes because then I put us on the hook for them. Can you imagine everyone listening right now is like, oh, I'd love to know more about inos. Yeah. I I'd be that guy. There's a ton of nitrate-reducing bacteria within the microbiome. Yeah, a lot of these uh nesario species, umophilus species, previtella, um, essentially, all of these are using nitrate as a as an electron acceptor that helps reduce to nitrite as their main metabolite. And again, this thrives in a low oxygen, healthy mucosal environment, and they're highly sensitive to chlorhexidine.

SPEAKER_03:

Ooh.

SPEAKER_02:

Yeah, they're highly sensitive to these antiseptic mouthwashes, so that's the whole point. Right.

SPEAKER_01:

That's always a question that we go through. Do you do you use antiseptic mouthwash? And we'll go further into that. I think excuse me, I think saliva is another little metabolic snapshot. Saliva's important. Uh even the basic question of do you have a dry mouth can tell us a lot. But saliva is important as a buffer. It's important because of the salivary enzymes that kind of start the digestive process, a little bit of immune health, and then just keeping the tissues healthy and hydrated.

SPEAKER_02:

Yeah, you know, your salivar, you know, we talk about this earlier with amylases, lipase, lingual lipases, and then salivary proteases. You know, obviously protease is much more concentrated coming from other glands, but this initial phase of salivary flow is quite literally what gets food to start to fall apart so that you can receive it. Um are we talking about blood pressure right now? If you have more to say, sorry, you you have a structure, and I just have a lot of little points I wanted to make. Okay, go ahead. Trying to stick on a schedule here. Um, one thing we know with blood pressure, like I said in the beginning, that's one of the first things we do is try to manage nitrate availability. Um, there's been human randomized clinical trials looking at this. That your systolic blood pressure after consuming nitrate, when oral bacteria are intact, can lower your blood pressure by like 10 millimeters of mercury. Which I think is insane, your systolic number by simply using this buffer system because this nitrite availability that leads to increased nitric oxide will cause relaxation of our vessels, which will lower the blood pressure. There's also things that are tested, they're called flow-mediated dilation. We see that that improves. We see that you actually get better exercise tolerance by simply having this process work better, and you have better perfusion into the small vessels within your brain and your kidneys, your sex organs, I mean, all over your body by simply managing this oral microbiome.

SPEAKER_01:

Yeah. I really wanted to talk about oral hygiene and steps that you can take at home and choices that you can make at home, and not to rush us past the biology too much, but can we get into that? Yeah. Okay, cool. This is kind of like what we tell our patients, I think, in terms of what choices to make, what daily habits to put in place as a protection for your oral health. Number one is toothpaste. And what do we look for in a toothpaste? So nano hydroxyapatite?

SPEAKER_02:

For now, open to seeing if that, yeah.

SPEAKER_01:

Do you know what that is?

SPEAKER_02:

Small. Probably has an OH group on it.

SPEAKER_01:

Uh hydroxyapatite, it's basically the same material that the enamel of your teeth are made of. So enamel is a 97% hydroxiapatite crystals. So when you use a hydroxyapatite toothpaste, it binds to those microscopic weak points that form in the enamel and it can actually fill them back in. So that's where we get remineralization. The alternative is fluoride, which has been traditionally used. Hydroxyapatite is somewhat newer, but fluoride traditionally used, it also strengthens enamel, but in a very different way. It swaps the crystals and just makes them more acid resistant. Dentists use it because it's been around forever and the research base is huge. Hydroxyapatite building, getting there. I don't really want to get into the issue of fluoride being bad, but we know modern life loads us up with fluoride already. So that's where do we really want to add an ingredient that could irritate the tissues, could cause more problems. I think hydroxyapatite is the way to go. Fair.

SPEAKER_02:

Yeah. Until until new data comes out.

SPEAKER_01:

Yeah. I mean it gives you the same protective benefit, but uses a material your body already recognizes and doesn't disrupt the oral microbiome in the same way. The other nice thing is that hydroxyapetite works even if your a little your tissue is a little stressed. The remineralization doesn't rely as heavily on saliva chemistry as fluoride does. So if you have a dry mouth, you are someone who mouth breathes, you have nighttime congestion, sleep apnea, or any kind of effect, any kind of stress is affecting the saliva. Yeah, exactly. Then hydroxyapatite is more forgiving.

SPEAKER_02:

And what's interesting, nowadays we use microcrystalline hydroxyapatite for bone density as well. MCHC is a much better form of calcium for bones, which I find interesting.

SPEAKER_01:

Good little tidbit. Yeah. You've got the tidbits today.

SPEAKER_02:

Yeah, that's what I that's what I came with. Um the other okay, go ahead. No, you okay.

SPEAKER_01:

The other ingredient that we typically like to avoid in toothpaste is SLS, sodium laurel sulfate. That is really just a foaming agent. So it gives it like the bubbly, frothy, clean feeling. But it is an antiseptic agent. It is it's like dish soap. So it can kind of strip the mucosal barrier. Kind of like the same way that dish soap strips grease. It's an emulsifier. Yes. An unneeded emulsifier. So you will find that these SLS-free toothpaste are not giving you that foaminess, like with a crest.

SPEAKER_02:

It's so satisfying.

SPEAKER_01:

It is satisfying, but it's a detergent, it's disrupting things. It doesn't really help enamel, it doesn't help your gums, it doesn't support the oral microbiome. And people who have a really sensitive mouth, it can make things like canker sores much worse. And so especially if someone has history of canker sores, the very first thing to swap is like get an SLS-free toothpaste, even if it doesn't check all the other boxes, just removing that ingredient can help. Next avoidance.

SPEAKER_02:

If you want to talk about triclosan, I bet another antimicrobial ingredient. And it's persistent in the environment. It's in our water.

SPEAKER_01:

So it's been pulled from soaps, but it is still allowed in some oral products. Of course, the like I said, the trend is shifting away from it, but still something to pay attention to and avoid. It bulldozes the oral microbiome. As we talked about with nitrate producing bacteria, did I say it right? Yeah. Okay. I always get nitrate and nitrite confused. Essentially the same thing. Okay. As we talked about with that, we don't want a sterile system. We don't want to wipe out the good guys. Triclosin, that's exactly what it does. It comes in and napalm bulbs, everything.

SPEAKER_02:

Yeah, I mean, and and all of these oral antiseptic, they're essentially antibiotics for your NO pathway. Right. And we we see this um specifically with things like Listerine. Yes. Which, you know, chlorhexidine, mouthwashes, alcohol-based peroxides, this depletion of these nitrate-reducing bacteria can happen for up to a day. So you do this morning and night, you're constantly pushing that back. And we know that the nitrite production is severely blunted, and we're getting much less of you know, hours later, the postprandial surge from eating these foods of nitric oxide is much lower by simply hitting this once or twice a day. A lot of studies say 12 to 24 hours the effect happens, so you're never getting over the hump. And I would argue if you need those things, let's figure out what's going on in there. Is there biofilm? Is there oral dysbiosis? Is there candida overgrowth? You know what I mean? That's our initial goal is like, let's figure out what is in there that you keep trying to mask, yeah, mask up, essentially. Yeah. And that's where we even see that relationship within a couple days of using these mouthwashes or these triclosans, your blood pressure is measurably elevated. This isn't years, this is a day. You know, Nathan Bryan, world-famous nitric oxide researcher. I got to go see him in person like a year and a half, two years ago, and he said one of the fastest ways to chronic disease is use antiseptic mouthwash and get root canals. And his whole life is nitric oxide.

SPEAKER_01:

We see it with alcohol-based mouthwash listerine, but also the alcohol-free version, it's still an antiseptic. That's not what we're going for. I think better options would be something if you feel like you need a rinse ritual, I think something like oil pulling or more targeted rinses, whether that's xylitol, iodine rinses, essential oils, that gets more into patient-specific, maybe alongside saliva testing. That's where I really think having a dental professional make a recommendation on which type of rinse makes most sense for you based on your oral microbiome.

SPEAKER_02:

Do you want to talk at all about gum inflammation, gingivitis, any of that? Was that on your list? Sure. Well, I'm I'm just thinking about you know periodontal disease generally, gingivitis, high inflammation within the gums. What we see back to this oral microbiome is there's a reduction in these beneficial commensal species, and we actually get an overgrowth of these anaerobes, right? These porphermonas and fusobacteriums. Um essentially, this is gonna scavenge this inflammation by this dysbiosis, will scavenge these nitric oxide uh pathways, and you're gonna get a lot more ammonia conversion rather than nitrate into nitrites. You're gonna get, as you talked about, the relationship here, now that's gonna lead to poor salivary flow and just further goes down the line. Essentially, this oral inflammation blocks that that loop at multiple levels. So things are like feeding one another. Whatever led to the need for listerine, then is reinforced by the listerine, and people get stuck there, taking it for years, still dealing with halitosis or gum inflammation because they're not doing anything to restore function. At the end of the day, the body is wise and it will have multiple, right? There's no free lunge. And that's really what we're after with these basics is like you're stuck in this loop, this reinforcing doom loop. Let's find a way to like straighten the pathway out and make things work for you.

SPEAKER_01:

Sure. Unfortunately, you are gonna be stuck in a doom loop of brushing and flossing. Yeah, it's just tongue scraping, it's the unsexy backbone. It there's no way around it. I think I'm not gonna say everyone needs an electric toothbrush, but I will say electric toothbrushes remove the technique variable. So they do the motion for you at a speed that your wrist can never replicate. They have timers, they have pressure sensors. So instead of scrubbing harder, which will damage enamel and gum tissue, there is a pressure component to how you can brush. The brush handles the movement and you just guide it.

SPEAKER_02:

See, my problem is I use wooden plastic-free toothbrushes, the bristles, so I haven't found a good powered one that has that yet.

SPEAKER_01:

Wrist is getting a work out every day.

SPEAKER_02:

Yep.

SPEAKER_01:

Well, the research pretty consistently shows that electric toothbrushes reduce plaque and lower gum inflammation better than manual brushes. Mostly because they're harder to mess up. Well, yeah. And the timer, the pr the pressure and the speed of muscles.

SPEAKER_02:

How do they do pressure sensing? So it'll like beep at you if you're pushing too hard or like stop moving.

SPEAKER_01:

Mine's color sensored, but really, yeah.

SPEAKER_02:

I did not know that. That's actually interesting because I do sometimes think more is better. Yeah, we're getting in there. And then my toothbrush looks like a rat's nest, and I'm like, no, that's normal. That's how my dad's was when I was a kid. Yeah.

SPEAKER_01:

Well, uh, we talked we briefly talked about this earlier today, but you know what disclosing tablets are?

SPEAKER_02:

No.

SPEAKER_01:

So those are the colored Oh.

SPEAKER_02:

When you're a kid. I don't know what they are, I didn't know what they were called. Yeah.

SPEAKER_01:

So when you're a kid, you go to the dentist and they give you those little tablets to show the plaque on your teeth, it colors it like purple or red or something. Try it. Check your manual toothbrush technique. Let's see how good of a job you're doing.

SPEAKER_02:

That's funny because I didn't know you were going to talk about that. And I was just we were talking about this episode today, and I said, Oh, in fifth grade, we had a dentist come in, and this kid in our class you know, put it in his mouth, and he came back and he said, I don't know what's going on. My teeth are all just purple. And we were I thought that was so funny. Like, like, well, yeah, you have plaque all over your teeth, poor guy.

SPEAKER_01:

Well, the goal is clean teeth, healthy gums, not perfection or gadgets. So a main win is just consistency, whether manual or automatic, but the electric just makes that consistency nearly automatic.

SPEAKER_02:

And I don't like flossing, so I like a water pick.

SPEAKER_01:

Okay, but we need to talk about this.

SPEAKER_02:

Okay.

SPEAKER_01:

Flossing, I think, is a non-negotiable for metabolic and gum health. Brushing only cleans 60% of the tooth surface, and the other 40% is that tight space between your teeth. Yeah.

SPEAKER_02:

Oh.

SPEAKER_01:

Yeah.

SPEAKER_02:

What about water pick?

SPEAKER_01:

Well, uh, so what happens is plaque can sit between your teeth, it turns into tartar. That tartar is what triggers inflammation in the gums. Anaerobic bacteria, which are those stinkier inflammatory ones, I'll call them stinkier, cause bad breath. They thrive in those tight unoxygenation, unoxygenated spaces between your teeth, and floss disrupts the environment. So it breaks up that biofilm before it matures into something that can irritate the gum, erode the enamel. We say ready, we say this.

SPEAKER_02:

Yeah, what do we say? Tell 'em. Tell us all.

SPEAKER_01:

Brushing is for the teeth you can see. Flossing is for the teeth you actually keep.

SPEAKER_02:

Okay.

SPEAKER_01:

So if you want to avoid root canals and we say that all the time. Yeah, we do. Water pick, it's a great addition. Basically, they use pressurized water to flush out debris, disrupt the plaque. Really great for under the gum line. Uh thinking like on the front sides of your teeth and maybe on the back sides of your teeth, whereas the floss is going in between your teeth, but great for in between the gum line. Great for reducing gingival inflammation, reaching the pockets that the string can't get into. They can reduce bleeding and gum inflammation about as well as traditional floss, especially for people who have braces, dental appliances where it's hard to get in there. Exactly. Yep. Or those deep periodontal pockets, those deep spaces that aren't necessarily between the gums but more on the front side of the teeth. But not a replacement. Because water flossers really fall short because they don't remove the sticky plaque that's tightly attached between the teeth. They loosen it, they weaken it, they rinse a lot of it out, but they don't scrape it the same way.

SPEAKER_02:

So I I do it before I brush, and then I hit six apparently only 60%. But really, I always feel so satisfied with a water pick. Kind of grosses you out the food that comes out.

SPEAKER_01:

I think it's great. I think there's a place for both. I think it's water pick is a daily flosser. I think string flossing still matters a few times a week. A few times a week, not necessarily every day. If you floss well with a string, great, keep doing it. If you hate flossing and completely avoid it, a water pick is a massive improvement over nothing. But the dream team is both. String for those tight contacts and then water pick for under the gum.

SPEAKER_02:

Well, and as we always say, What do we say? We always say things like brushing is for the teeth you see, flossing is for the teeth you keep. Right?

unknown:

Yeah.

SPEAKER_01:

What do you think about tongue cleaning?

SPEAKER_02:

I think we I mean, prime example of a recent patient had horrible, horrible gut issues was eating just meat, essentially, and rice. I said, stick your tongue out. Saw crazy white coating on his tongue, looked like essentially looked like oral thrush, and ran a gut test, found all sorts of issues in there. A lot of things were thrown at him, but one of the things was tongue scraping and then uh natural antimicrobial oil pulling. Like I think it was some coconut or sesame oil with a little bit of on guard or like a clove and oregano time, I believe. Yeah, yeah. Uh mouth rinse with it. And when we I had him stick his tongue out last month, and it was 70% better, and also he's feeling he's normal. All right, he's not running to the toilet seven times a day, and he can eat cookies again and things, so yeah, I think just don't be too aggressive with it.

SPEAKER_01:

Well, so the tongue it's kind of like a sponge, you have all the little bumps on the surface, they can trap bacteria, food particles, sulfur-producing compounds, and other cells, and it's kind of the same logic as skincare. If you never exfoliate, the buildup is gonna create its own little ecosystem there. So tongue cleaning really is helpful for bad breath. There are randomized studies showing that tongue scraping reduces volatile sulfur compounds, so those sulfur-producing compounds, more effectively than brushing alone. Brushing the tongue helps, but scraping works better because it physically removes the coating rather than just moving it around. Because again, we're thinking about a porous surface. Think about like brushing a sponge. Scraping works a lot, a lot better.

SPEAKER_02:

And I'm what's interesting about tongue scraping is if you're not too aggressive with it, you'll actually preserve preserve the healthy bacteria. Which is, you know, pretty fascinating to me.

SPEAKER_01:

Yeah, they've done microbiological analysis, basically saliva samples, uh showing that it reduces the odor producing and inflammatory bacteria specifically on the tongue. It actually improves taste perception too.

SPEAKER_02:

Because you unclog the receptors?

SPEAKER_01:

I mean, kinda. Restores acuity of taste.

SPEAKER_02:

And knowing that we have these bitter taste receptors in the back of our tongue, we frequently have people, it's interesting, multiple mechanisms here. You chew arugula to reduce nitrates, but you also do it to thin your bile. So I'm even wondering now, I'm thinking in real time, I'm wondering if maybe scraping the back of the tongue might help. This is a thought experiment, but might free up better bile receptor or bitter taste receptor function. Because you can better to increase bile flow. Oh, we're gonna add that to the toolbox for our gallbladder patients.

SPEAKER_01:

Great. Let's do it. The tongue scraping, obviously, when we visually inspect someone's tongue and it's it has that white coating like you were talking about. If you look at it and it's like it's not quite the right color, or there looks like there's like a coating on it. Yeah, that's a person who needs more frequent tongue scraping. But it's also helpful for anyone who has goes to the dentist and they say you have a lot of plaque or you have a lot of gum inflammation, and it kind of makes sense, right? It's a it harbors a lot of bacteria, so just scraping it, you have a lower plaque score, less inflammation because it's reducing that reservoir that's reseeding your mouth all day.

SPEAKER_02:

And it's biofilm, right? We we talk so much about biofilms. Uh biofilms are associated with like three-quarters of all chronic bacterial infections, and the mouth is no different in that sense. I also would just want to say, again, being that we're not dentists, if you have pretty aggressive leukoplakia, please go to the dentist because it can be a preceding element of oral cancer. Right? So don't mess with that, don't just scrape and scrape and scrape. If nothing's changing, you really need to go see an expert for that.

SPEAKER_01:

Thank you.

SPEAKER_02:

Yeah, that was my disclaimer to take care and not for my ass, but to just take care of your health and make sure that you're not just thinking, oh, it's candida. It could be a preceding element to something much more uh serious to be taken.

SPEAKER_01:

There are a few things you can do for oral microbiome support beyond the hygiene. So this is using things like xylitol. It is a sweetener, but it has a really interesting mechanism in the mouth. It starves bad bacteria that trigger the cavities, help reduce plaque. You can find it in gum, you can find it in mint form, you can find it. A lot of toothpaste actually use it as the sweetening agent, essentially. It's really great after meals when you don't have access to brushing your teeth right after a meal. Using a xylitol-based gum or mint can actually help that balance. The other thing is getting more specific into probiotic lozenges or probiotic. We use a lot of liposomal probiotic uh rinses for oral health. There are a couple strains that really matter. Streptococcus is one of them, which helps with recurrent strep. It helps with tonsil stones, helps with halitosis, yeah, helps with gum inflammation. So just like when we're looking at someone's microbiome, or when we are assessing someone's GI complaints, there's going to be a different probiotic strain depending on what's going on. Same thing in the oral cavity. Depending on what's going on, there might be a different strain. So Streptococcus salivarius is the specific one for that. More research and more studied is Lactobacillus ruteri. They were actually renamed recently. Did you know that? I had no idea, but they were. And I can't even say it anymore. I don't know why they've changed it, but now it's Lemo Salactobacillus.

SPEAKER_02:

You killed it. Definitely not bacillus, it's bacillus. Are you are you we even with the gut, we always talk about strain and species specific. Are you looking mostly just strain specific for these?

SPEAKER_01:

Yeah.

SPEAKER_02:

Yeah, so it's more general. Interesting.

SPEAKER_01:

Yep. You can uh these are species, by the way. You can get strain specific. So it'd be lactobacillus routeri DSM 17938.

SPEAKER_02:

That's what I was looking for. So it is more okay.

unknown:

Yeah.

SPEAKER_01:

Or Streptococcus salivarius K12 or Streptococcus salivarius M18. Pulled those right out of my brain.

SPEAKER_02:

Wow. Not that iPad.

SPEAKER_01:

So though that's the strain, that DSM 17938, that's the strain. The lactobacillus routeri is the species.

SPEAKER_02:

I'm sure that there's gotta be so much more coming down the path for this stuff. It's so interesting. This is all developing in real time.

SPEAKER_01:

What I thought was fascinating about the rooterai species, the lactobacillus ruteri strains, they produce something called routerin, which directly inhibits candida. So that is something where we see that oral thrush, we see that even maybe like post-antibiotic, that might be one to lean into.

SPEAKER_02:

That's a nugget for everybody. That's awesome.

SPEAKER_01:

Yeah. I learned about that because my dentist, actually, which I'll tell you about them, but my dentist gave me a probiotic, an oral probiotic after my cleaning. And it was the lactobacillus ruteri. Because just like when you take an antibiotic, you might want to repopulate. After you do a dental, like a deep cleaning, a dental cleaning, you want to support the oral microbiome. So they handed me one as I was walking out the door. Like, here's the time to do this.

SPEAKER_02:

It's like your post-colonoscopy probiotics. Exactly. Got a fresh start.

SPEAKER_01:

So kind of getting into the weeds on those. Again, this is something where I really want to have the dentist on and like get deep into probiotics because I love it. But Streptococcus salivarius, great for upper airway, tonsils, breath, strep throat recurrence, L. ruteri, better for gums, plaque, periodontal health, candida. Fair.

SPEAKER_02:

Sweet.

SPEAKER_01:

Okay. What do you know about pH?

SPEAKER_02:

Um, I know like three things.

SPEAKER_01:

Eating makes your mouth pretty acidic, right?

SPEAKER_02:

Especially the way we eat.

SPEAKER_01:

Yeah. Mm-hmm. It takes about 30 to 60 minutes to come back to neutral. If you brush immediately after, it can be not so good for your enamel. Did you know that?

SPEAKER_02:

Well, I've always thought if you have anything bubbly or carbonated, don't brush right after.

SPEAKER_01:

Yeah, acidic foods specifically. But even with I mean, like you said, the way we eat, a lot of our meals are pretty acidic.

SPEAKER_02:

Sugar. Yeah, high protein, protein's everything, kind of acidic.

SPEAKER_01:

So rinsing can be better or brushing your teeth before breakfast. Yeah. It's a wild take. If you have good, consistent oral hygiene, you shouldn't have bad breath. You shouldn't be brushing your teeth to control your breath. I will say maybe sardines are an exception. Yeah, you may.

SPEAKER_02:

What I like nowadays, we eat sardines of the same day, so we just commit to it. Yeah.

SPEAKER_01:

We covered a lot about what you can do at home, brushing, flossing, tongue scraping, microbiome support, things that make the mouth a friendlier place to be. Like you said, there is a line between what good habits can fix and what needs an actual dental professional. This is where we again we zoom out. We're not dentists. Let's talk about more of those signs where it's time to get in the chair and get a look. I think bleeding gums is a pretty big red flag. A tiny bit every once in a while, okay, but consistent bleeding is your gums saying they're inflamed. We ask that to our patients all the time. I think chronic halitosis, chronic bad breath, another reason you can't always address with just your home tools, you might need a little bit deeper. And then pain or sensitivity that lingers. The big one is metal fillings, root canals, chronic gum issues. I think all of those are worth getting a biological dentist's take on, not just a traditional dentist. Even snoring or jaw issues or congestion, any reason that you're mouth breathing at night, have a dentist who understands the airway and the oral microbiome is so much more helpful.

SPEAKER_02:

Yeah, I mean, and we know that people that mouth breathe have higher blood pressure, they have more incidence of erectile dysfunction. It's that microvascular circulation I was talking about earlier. It's, you know, you have these nitric oxide secreting cells in the back of your airway up in your head, and you need to pull that stuff down into those capillary beds of your lungs to diffuse through your bloodstream. And so open mouth breathing has multiple issues. It really changes the oral microbiome so that you don't reduce nitrates very well, but it also doesn't give you that advantage of those tissues that are desiring to make NO for you, and that both of those will lead to elevated blood pressure.

SPEAKER_01:

So if you are local here in Colorado, I've had an amazing experience with Dr. Pop at Colorado Biodental. I really want to get him or someone from his team on the podcast to go way deeper into dental procedures like root canals, which could be an entire episode on root canals. Their new patient exam is amazing. Like Mitchell said, it includes saliva testing. It includes 3D images of the sinuses and the jaw. They use ozone therapy during the cleaning to re to prevent the recirculation of bacteria. They just go above and beyond. It is incredible. Another patient described their process as like functional medicine for your mouth. And it's it truly that's what I felt like. It was awesome. So if you're looking for someone, can't recommend them enough. Colorado Biodental. Can't wait to have a conversation with them. So the summary rapid fire practical tips. Switch out to hydroxyapetite toothpaste. Pour out your mouthwash, swap it for oil pulling or something similar if you want some sort of rinse. Add a tongue scraper. Get a disclosing tablet and see where your how your brushing habits are holding up. Electric toothbrush with consistency, water pick, and flossing. Keep nasal breathing.

SPEAKER_02:

That's a good summary. There's a lot of solid takeaways there. You don't have like a pun or anything.

SPEAKER_01:

The mouth is the front porch of metabolic and immune health.

SPEAKER_02:

I was w I knew it. I didn't know you had something, but I knew you had something.

SPEAKER_01:

But what was the alternative? The alternative is even better, I think. Hold please. Your mouth is not vegas. What happens there doesn't stay there.

SPEAKER_02:

Put on all you have here.

SPEAKER_00:

For more about what we do at the facility, check out our website, www.thefacilitydenver.com. You can also follow us on Instagram at the facility Denver for extra tips, behind the scenes fun, and updates on new episodes. Thanks for listening. Now go facilitate your own health, and we'll see you next time.