166 - Oral health, best hygiene practices, & relationship between oral health and systemic disease
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- Опубліковано 16 тра 2024
- Dr. Patricia Corby is Associate Professor of Oral Medicine and Associate Dean of Translational Research at Penn Dental Medicine. Her work focuses on the value of integrating dental services into other healthcare and public health settings. In this episode, Pat provides an overview of dental anatomy, the importance of oral hygiene to overall health, and the association of poor oral health and systemic diseases like cancer and diabetes. She addresses tooth decay, oral hygiene in children, the utility of dental products, and ideal oral care regimens for different populations. She also discusses issues specific to immunocompromised patients and those with chronic illnesses as well as her own research with cancer patients undergoing radiation treatment.
We discuss:
00:00:00 - Intro
00:00:10 - Anatomy of teeth and the purpose of the dental pulp-a highly vascularized and innervated region of the tooth;
00:12:53 - Types of teeth and the different purpose they serve;
00:17:18 - Anatomy of the oral cavity, bacteria in the mouth, and what a healthy mouth looks like;
00:22:54 - Pat’s study demonstrating the importance of flossing;
00:32:45 - Detrimental effects of sugar and the importance of fluoride and oral hygiene;
00:42:27 - Oral health challenges for cancer patients and immunocompromised people;
00:53:05 - Pat’s current research on cancer patients undergoing radiation treatment and the oral health risks associated with human papilloma virus (HPV);
01:02:45 - Periodontal disease: caries and root canals;
01:18:15 - The relationship between poor oral health and systemic health diseases;
01:25:51 - Potential connection between oral hygiene and COVID-19;
01:31:04 - Dry mouth leading to oral infections and ways to prevent it;
01:37:05 - What determines the appearance of teeth, methods of teeth whitening, and whether you should remove mercury fillings;
01:43:00 - Importance of fluoride for preventing tooth decay, and dental care for children;
01:50:37 - Useful dental products: floss, electrics toothbrushes, and more;
01:59:44 - Ideal oral care regimens;
Show notes page: peterattiamd.com/patriciacorby/
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About:
The Peter Attia Drive is a weekly, ultra-deep-dive podcast focusing on maximizing health, longevity, critical thinking…and a few other things. With over 30 million episodes downloaded, it features topics including fasting, ketosis, Alzheimer’s disease, cancer, mental health, and much more.
Peter is a physician focusing on the applied science of longevity. His practice deals extensively with nutritional interventions, exercise physiology, sleep physiology, emotional and mental health, and pharmacology to increase lifespan (delay the onset of chronic disease), while simultaneously improving healthspan (quality of life).
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In this episode we discuss:
00:00:00 - Intro
00:00:10 - Anatomy of teeth and the purpose of the dental pulp-a highly vascularized and innervated region of the tooth
00:12:53 - Types of teeth and the different purpose they serve
00:17:18 - Anatomy of the oral cavity, bacteria in the mouth, and what a healthy mouth looks like
00:22:54 - Pat’s study demonstrating the importance of flossing
00:32:45 - Detrimental effects of sugar and the importance of fluoride and oral hygiene
00:42:27 - Oral health challenges for cancer patients and immunocompromised people
00:53:05 - Pat’s current research on cancer patients undergoing radiation treatment and the oral health risks associated with human papilloma virus (HPV)
01:02:45 - Periodontal disease: caries and root canals
01:18:15 - The relationship between poor oral health and systemic health diseases
01:25:51 - Potential connection between oral hygiene and COVID-19
01:31:04 - Dry mouth leading to oral infections and ways to prevent it
01:37:05 - What determines the appearance of teeth, methods of teeth whitening, and whether you should remove mercury fillings
01:43:00 - Importance of fluoride for preventing tooth decay, and dental care for children
01:50:37 - Useful dental products: floss, electrics toothbrushes, and more
01:59:44 - Ideal oral care regimens
I don't understand their position on root canals. They both acknowledge that root canal procedures can be and have been done improperly. And they both acknowledge that there can be occult infections as a result of such procedures (Attia himself admits to developing a tooth abscess after his procedure). Yet they both deny any association between root canal procedures and systemic disease and seem to scoff at those who think that there is an association. But in the very next section, they affirm the association between periodontal disease and systemic disease. These positions are not consistent.
This dentist also suggests that mercury fillings are safe. If they are so safe, then why do the latest recommendations state that pregnant women and children should not receive mercury fillings?
It is remarkable that many indigenous populations have never used fluoride, yet they have great teeth. The necessity of fluoride for healthy teeth is questionable. And it is unfortunate that the potential risks of fluoride were not addresed.
Since I went keto 11 years ago and carnivore 2.5, my dental health has been amazing in every way, going from crumbling teeth and bleeding gums to steel-strong and resilient.
I had a similar experience.
Saaaaaame!
Good to know, as I am about a year in. My health improvements have been stunning.
I listen to The Drive in the mornings with my significant other who just happened to be 40+ year dental surgeon. He was disappointed w the answers that this guest has to offer. For example, on the "need for nerve & blood vessels" in the fully formed tooth, there is a very special answer to that question. She is obviously very knowledgeable in her specific area of research and as an MD myself in Family Medicine, I really appreciate her input about oral health in cancer patients & I can certainly focus more in the mouths. My significant other couldn't bear the beginning part & was correcting the information along the way. I had to stop the podcast and come back a few days later & he agreed to finish the podcast w me. If Dr. Attia wants another expert, he can one of them or he can make recommendations on other knowledgeable speakers regarding this topic. Thanks.
What were his thoughts on that?
At 37 minutes in, Peter you posted a question about: how we cleaned our teeth 100 years ago. You should look into the work of Dr. Weston Price. People had a different diet then and just didn't get the decay and periodontal disease that we do today. It shouldn't be surprising that a century ago diseases like: coronary artery disease; Alzheimer's disease; macular degeneration; type II diabetes; etc ... were uncommon. I believe these all relate to the SAD.
Yeah, I think it's not a coincidence that if you're going to eat modern food, you're going to need modern oral hygiene.
We are eating much grains and sugar. We have been told to eat grains - told that they are good for us and that fat and cholesterol is bad.
Primal Teeth cleaning products are the best products for overall oral care. Developed on the precepts identified by Dr. Weston Price - Bentenine Clay and effective minerals rather than toxic flouride based tooth paste.
Too bad most ppl can't afford dental care. For some ludicrous reason, in America, your vision, your hearing, and your teeth are not considered to be part of your "health" so insurance for those things is separate. This is a total racket. Please tell me a coherent answer as to why that is. I'll wait.
There isn't a coherent answer. It's a racket you're right
I agree with you that everything should be covered by our health insurance. The reality is that probably won't happen in my lifetime. Maybe in my 26 year old sons lifetime they will. Implants are never going to be affordable. They require surgery for placement. Sometimes more then one surgery. Most people including myself. Will have dentures. My advice is to get the best ones you can afford now. Then get better ones later. We can't even make it possible for everyone to see dentist. For regular cleanings. We need this discussion if we didn't have lack of care. Causing tooth loss. It definitely caused me lose mine. Along with tens of millions of other people. We have to fix that before we do anything else.
OKAY GUYS, please, why dont we come together like they did with tiktok from preventing them from getting rid of it? Well, this issue is a very common issue for a lot of us. Why dont we ( try) to fix it
Great! Very important issue, a forgotten public health problem. 👏👏👏
Thank you!
omg was this an eye-opener pod…thanks so much Peter and your Guest 🤗🙋🏻♂️
Dr Attia , I am a big fan of your work, you inspire me for keeping fit. Although you tried hard to put up good questions but she really didn't reply for a layman to understand. I request you to bring up this topic again but with another dentist. She must be good with her procedures but couldn't make her points clear at all for a common man to understand.
Love your work Dr Attia
Best wishes
Had to make the decision on a root canal vs extraction/implant this week.
Had a lot of doubts about the root canal, but went with it anyway so I could keep the tooth and support my palate/cheekbones.
Really appreciate this episode coming out now, because the rest of the alt health/keto/naturalist community thinks that root canals = death. Thanks Peter!
My dentist doesn't believe that I seldom floss and only brush at night before bed (Xylitol fluoride-free toothpaste). I had terrible oral health ten years ago, then I stopped eating sugars, grains, vegetable seed oils. Started keto/primal and taking fat-soluble vitamins, especially K2. Two of my brothers started on just D3/K2 and separately reported a year later that their dentist noticed a significant improvement in their oral health.
I agree 100%. The major influence in terms of teeth health has diet and general health of a person, or a child. I have seen this so many times. One can have the best dental care in the world, but without the crucial elements above, is not going to work very well. How many, so-called, primitive culture people had great teeth all their life? They even never brushed, or hey, flossed their teeth. Sure not in every case, as some people were living in appalling conditions. Sugar and added acids in drinks and in food have a major detrimental effect on the teeth and health, and even going through colds and infections, including drugs taken. It just doesn't make sense to me, making an antiseptic mouth is a solution. Our body is not an antiseptic lab. What about helpful bacteria?
Do they mention D3 and K2 in this video?
My gums don’t get inflamed anymore. Definitely diet makes all the difference!
Thank you both doctors ,very informative video 👍
There was not one comment about fat soluble vitamins to maintain bone and teeth health. You may be able to keep your teeth cavity free with obsessive clearing, fluoride and low sugar intake, but it would be much better for bones and teeth that there was a diet with high intake of fat soluble vitamins such as K2 and D. I and 64 and have had many filling and other dental work over the years, approximately a significant treatment every 2 years. I started a keto type diet with added vitamin K2 and sun exposure (vitamin D) 7 years ago and have not had a cavity since. I get my teeth checked by a dentist twice a year and she can't believe the change in my oral health. Even though 50% of my teeth have filling, bridges, crowns etc, I try an avoid all sources of fluoride and my teeth are the best they have ever been.
Cant have a podcast about everything, if peter didn’t mention it or asked, either he forgot (not very probable) or its not important
Nor any menu of Price discoveries.
@@daniel1RM it's absolutely important n shocking Peter didn't bring it up!!!
This is n=1. You did not provide any studies showing a direct link between the two. The fact that you changed you entire diet and life style doesn't necessarily mean that it is the fat soluble vitamins which are the cause of healthier and stronger teeth.
Thank you Peter.
Thanks Peter, I've been trying to find a good video in optimal oral health from a reputable source.
Peter I worked with a nurse who had a root canal and experienced dizziness and severe headache but never tooth pain for one year after the root canal. She was sent to Ottawa to a headache specialist. She was on numerous medications. Nothing helped. Off work for over a year until she was convinced by a MD to have the tooth removed. They found severe infection in her jaw below the tooth. All headaches and dizziness disappeared with the removal of the tooth. In Canada you still are having regular dentist still doing root canals. We need more specialist in small communities. People believe their dentist when they tell them they need a root canal. But no patient is aware that a specialist is needed. And that specialist is only available in very large cities.
AND you still have to make sure whoever does the root canal is top notch!
Love the camera angle, lighting, + editing on this one
Thank you Peter, very very useful podcast
I'm a dental hygienist and your dental hygiene routine is so important. I see firsthand the patients that work on their routines and the ones that don't. I know that going to the dentist is not possible for everyone but try! or do bettermouth its like $50. or simply brush twice a day and manage your diet! Do your research but your daily routine is the secret to good oral health!
'How did our species survive before brushing' I have wondered this sooo many times. I get the sense that Peter is searching for why our Ancestors could eat and be merry dentally but today something in our diet is destroying our teeth. I recall a documentary that showed that the shift to Agriculture is what did it.
It's sugar, plain and simple.
You don't have to look at our past, some tribes don't use toothpaste or tooth brush. Instead they chew roots or steams of some shrubs that act as a dental floss and most importantly they don't consume that much of refine sugar
Also now days we eat/snack more often, which is not good for oral health. After every meal/snack/coffee the environment in oral cavity changes to acidic one, and it takes between 30 to 60 minutes for PH to come back to alkaline. Low pH in mouth is making teeth more volunerble for bacteria and acid attack. When someone is on regular medication, that cause dry mouth (which is most meds) the time for pH to come back to normal range, providing safer environment is even longer. On top of that if someone is not brushing properly, esp do not floss, the bacteria build up on a tooth surface, creating sticky plaque (which overtime hardened - that's calculus-dead bacterias) bacteria will seep in between tooth surface and gum, pulling away gums from tooth and creating periodontal pocket full of information. It is very difficult to remove the bacteria from the pocket, so eventually the gums will shrink (body responses to oral periodontal inflammation) causing tooth mobility, tooth loss, decay and affecting general health-diabetes, cardiovascular diseases etc.
@@saganworshipper6062Grains and sugar
Thank you Peter!
Thanks for sharing your story. I just had oral surgery and I am trying to improve my health. 😊
Fantastic. That was super informative and full of value as always. Thanks Peter! (was hoping one of you would mention Quip toothbrushes and whether they're at all worthy.)
"People talk about generational wealth. I don't have generational wealth but I have generational toothpicks." Lolol
Thank you so much .
Amazing. I had bariatric surgery. My teeth went downhill afterwards. Any studies on this?
We pretty much underestimate our teeth. There is such a thing as a mouth microbiome as well besides the gut. Eye-opener episode, Peter. Great knowledgable discussion.
Thank you.
36:45 THANK YOU FOR ASKING THIS QUESTION. true scientist
Peter, please share your opinion on Dr. Mew's hypothesis complex regarding "orthotropics". Maybe a newsletter or better yet, get him on the podcast. Bret Weinstein had him on Dark Horse, really interesting.
This video and conversation was very informative. I, too, had a botched root canal of a lower molar by a dentist, who tried to do it, but had to send me to an endodontist to complete the job because I was in such pain. I had no idea there was such a thing as a root canal specialist; but after I saw the 2nd guy that same day, later that evening I still had intense pain. I was referred to a 3rd dentist the next day (thanks 1-800-DENTIST :) after a night of pacing, and he discovered both previous docs had worked on the wrong tooth!!! He worked on the correct tooth, an UPPER molar that was referring nerve pain to the lower one. He saw it on x-ray. The lower molar later had to be extracted by an oral surgeon because it developed a crack. The O.S. was either a sadist or didn't care (think the Nazi torture guy in Marathon Man) because he has heavy handed, and I never went back. To this day I have a hole toward the rear of my mouth where at post and implant should be. I was surprised Dr. Attia did not ask about the effects of smoking; I know probably does not smoke but many people do.
Many incompetent dentists same as regular medical doctors. Also plenty of bad Veterinarians.
Surely the nerves serve to prevent us from biting things that are too hard that would then damage the teeth? I can imagine that in ancestral environments people would be munching some pretty tough stuff. You need to know the limits of the pressure they can take. Seems a pretty straightforward adaptive value.
I literally turned on the laptop just to write your exact same comment. I think this is like the silliest question Dr. Peter Attia asked since he was in kindergarten. Also, her answer, if I heard that right, that maybe the nerves serve as a signal for the immune system, is 10 times sillier. Loved the episode, but this thing... I'm glad I am not alone.
@@stoianmihail8480 😆 I'm pretty sure if you lost your teeth in ancestral times you'd be completely screwed. But who knows, I could be wrong. Glad I wasn't the only one who thought so! Great minds and all that! 😉
@@benjamenharris627 Yes! Great minds think alike because the truth is just one, while non truths are an infinity. Also, this episode kinda reminded me why we don't normally see dentists as real doctors :))
@@benjamenharris627 it is actually slightly more complicated. Nerves serve as a signal to stimuli, and react by creating reperative process - the decay starts on the enamel surface slowly progressing to inside - then thanks to nerves, blood supplies-cells in dentin create reperative layer of dentin called tertiary dentin that protects the pulp. So basically pulp (nerves chamber) provides nutrition to dentin and can provide a barrier to caries by slowing the progression od tooth decay and making teeth more resistant to trauma. But that is simplification. Without it (nerve and blood supply) teeth would be 'dead' and over time got brittle, more prone to cracks, would appear darker, and would have not last, when tooth is removed from the tooth socket the alveolar/mandibular bone is not stimulated causing its shrinkage and changing the facial appearance (its also difficult for dentures over time to stay in place). Nerves and blood supply also helps to get rid of toxins and bacteria throughout the dentinal tubules. During inflammation ( in periodontal disease and caused by carries) cells in pulp activate the immune system.
@@iwlew6423 THANK YOU!
Geeesh, as a common, non scientific laborer, I could figure this out for myself! But as an armchair anthropologist, I can see why Peter asked, so I don't think it was a stupid question. I was shocked that she seemed to be stopped in her tracks by the question, though! 😳 Anyway, my first thought is why would we evolve this way... Peter has obviously given this some thought through his many painful oral episodes. But no real answer from this interviewee.
He needs a Weston Price type dentist for this kind of interview.
How about rinsing with H2O2?
It's crazy that I follow this podcast for my interest in longevity. I fast weekly for 24-48 hours, I take NAD precursors, I follow a leucine-methionine restricted diet for MTORC-1 suppression, I take senolytics every 3 months and I even take potent experimental telomerase inducers for my anti-ageing. Yet, I neglected my oral hygiene because I didn't feel it was radically iumportant, and now I am paying a huge price for it. I lost a pre-molar on the upper left arcade which required restauration and root canal treatment. I lost *two* molars on my upper right arcade. The most backward one cracked and splitted in a war I couldn't restore. I had it removed because of the excruciating pain. The other one I had root canal. Just this week, the teeth cracked because the root canal failed and the root inflammed, and I went through the most horrid pain imaginable(worst than third degrees burns, and I can speak on this since I have experienced both). The pain is so horrid that even narcotics only reduce 40% of it. I had emergency surgery, the dead roots were removed, the canals were disinfected and sealed, and a temporary clay was put to save the little structure of the tooth left. The dentist said we need to wait a few weeks to see hows the tooth will react to see if it's possible to save the tooth or not. If not, I will be left with *NO* molar on my upper right arcade, as I also had my wisdom tooth removed when I was 23. I am 41, and I am going though hell on Earth because of my teeth. In the last 2 years, I had so many holes drilled in my teeth, so many restaurations and have gone through 100 X more pain in the last 2 years than in the previous 39 years of my life. While I do blame this on my neglect, I also blame it on medicine, which is SO pathetic that it cannot make brand new teeth grow even though we are more than 2 decades into the 21rst century. I do feel very angry at medicine for this failure. The only solutions they have now are the same from 40-50 years ago, root canal treatment or implants, both are which are very shitty. Don't neglect your teeth, folks. You got just one set for life, and if they perforate it's HELL ON EARTH!
Don't blame it on medicine, we only get 2 sets of teeth as human. Medical advances can't make you a 3rd set of teeth to grow unless... maybe... through embryonic technology 🤔?
@@patriciachung4458 No ST, genius. That was exactly my poiint. Why have you contributed with your post? Nothing.
Holy moly, sounds like you went through the wringer!! Why didn’t you just brush your teeth? That might help.
@peterattia im a huge fan of your work! Im dentist in Brazil and im very happy to see this video. Specially for be a Brazilian Dentist. And first i would like to comment that i really remember the day of Ayrton Senna Accident. I remember even of my feelings that day. I remember that i went to his funeral and when his body arrived at Ibirapuera (An adress in São Paulo), thousands of people welcomed him by clapping and that was really sad but very moving. A very sad day and a big Lost for humanity because Ayrton was an example for many people of the wolrd. So, let me talk about my opinion of your excellent question: Why is it that the tooth is so much more complex that just have an enamel... What the function is of having something so highly innervated? To begin this answer, we must assume that the tooth is an organ of the human body. As an organ, it is composed of tissues from the embryonic layers of ectoderm, mesoderm and endoderm, as well as other organs. It is extremely common for these organs called teeth to be somewhat overlooked by world culture. But let's get down to business. Let's make a comparison with the skeleton for example. Many people know that it is bone and believe it to be something static. a bone. But we know that the functions of bone tissue are numerous and fundamental to healthspan. The absence of physical activity, for example, can worsen bone density and cause serious health problems. The mechanical load applied to the bone through pressure and traction from the muscles is very important and generates an entire bone metabolism of remodeling and maintenance of homeostasis. Bone is vascularized and innervated. It presents Haversian canals in the case of compact bones or confluence of cancellous bone. There is the bone marrow, anyway, the point is that although anatomically it appears to be an inert bone that serves to support and move, it has many more functions than that. Likewise, the teeth appear to be avascular and only used for chewing and creating more attractive smiles. But in fact, if you chew properly and have an attractive smile, these are just signs of general health.
Let's start with the fact that every newborn has mandibular micrognathia. The head is much larger than the face. Stimuli from breastfeeding, for example, correct sucking on the mother's breast, stimulates mandibular growth. The birth of teeth (and here it is very important to say that there is the right order for teeth to come in and for teeth to fall out. A change in this order can cause serious respiratory, postural, eating, digestive and even emotional problems), represents the first physiological survey of occlusion. and the entire dental structure (the tissues that make up the organ), serve as a membrane receptor (at the risk of oversimplifying as you yourself say), these organs serve as proprioceptive receptors for mechanical load that is transferred to both the alveolar bone and base that supports the teeth and the head of the mandible, stimulating endochondral growth). Furthermore, they begin to protect noble and fragile areas of the skull. The skull has pillars of force that coincide with the positioning of the canines, for example. Therefore, if you chew something that will harm, fracture, or damage any part of your skull, it usually hurts and the neuromuscular response is to divert the bite. Many times you don't even realize it and you do it all the time. The fact is that if you are a growing baby, your skeleton is being stimulated to do so. If you start chewing on one side only due to premature contact, for example, you will grow up with facial asymmetries. On the face we begin several fundamental functions for human life. It is on the face that breathing and digestion begin, for example. If the anatomy presents changes, obviously the functions are also altered and the aesthetics are the same. If you breathe wrong (or through your mouth or have a high respiratory rate and chest, the Bohrn effect happens... and then the organs cannot be oxygenated correctly. so we already know what this can cause... Including in the indexes and results of VO2...The surprising thing is that 85% of children present changes in the growth of their facial bones. Airways with compromised caliber, sleep and behavioral disorders, lack of focus, anxiety and its consequences, bruxism, headaches... it's the body screaming... please, I need to function properly. In adults it is no different. Patients increasingly suffer from sleep disorders and apnea. Using CPAP. Anxiety, burn out. And people usually look for a dentist because of aesthetics or toothache. Orthodontic braces? Because the tooth is crooked. Little do they know that this is a symptom of something much bigger. The fact is that no one is just a part. Yes, the face, the mouth, the teeth are part of our organs. The cells present in the tissues of the organ called teeth are responsible for maintaining homeostasis in the human body. It is so serious that the nerves and vessels are contained within the hardest structure of our body. The message called pain is extremely important to alert us when something is not right. I believe that replacement with a titanium implant partially restores (mainly in terms of maintaining dvo: vertical dimension of occlusion, providing correct chewing and aesthetics) the various functions of the organs called teeth. It's like replacing the head of a femur with a prototyped prosthesis, for example... It's sensational, but nothing like your own cells.
The type of industrialized diet, harmful habits, among other things, are etiological factors for changes in the growth of facial bones. Well, I could talk about this for hours. Thank you for caring about something that unfortunately seems to be a separate thing from human health for most people. What's more, with the current trend of "putting fillers in the chin", we end up masking the health problem. And focusing on aesthetics. I'm not against aesthetic procedures! On the contrary! But responsibly. Generally, if it has the correct shape and works well, the aesthetics come as a bonus!
The question I leave here is: with so many people presenting symptoms that are generally also related to problems arising from changes in facial shape and functions, wouldn't it be better to tell the world how to be proactive about this? Yes because this can be easily avoided. When I go to my children's school I can make a huge list of these children just by looking at them. What is the role of schools in this? What's the point of asking: speak properly, eat with your mouth closed, be more focused, stop snoring... if the person (whether child or adult) simply can't do it? Again, thank you very much for your inspiring work
Any benefit to baking soda rinse in terms of optimal pH for microbiome?
Instead of mouthwash?
I have not listened to the interview yet, so. But I have to state that I quit using any type of mouth "product" about 6 months ago. No toothpaste, mouthwash.. nothing but a soft toothbrush to clean my teeth and mouth. Usually several times a day as I sense my mouth needs to be cleaned. The results are beyond anything I ever expected. The mucus membranes of my mouth are the healthiest I can remember. My teeth are the natural color they are supposed to be, not horribly yellow, but not artificial glaring white either. I find stains do not stick as much as they once did when I was chemically scrubbing my teeth and torturing my gums with abrasive medium. This is something I tried and it is fantastic, of course try telling someone to try it for themselves and you get the practiced "eeeewwww face " as if its nasty or something.. o well, try it for two weeks.. gets better the longer your do it now.. back to the podcast.. well have to watch it all later.
Ps. Forgot to say I follow a low carb lifestyle so not so much problems with the sugar.
Interesting 🤔
Hi, there is a significant amount of science behind what you are saying. I am currently a 1st year dental student and we discussed a lot about the degradation of oral health and it is almost entirely based on diet and lifestyle. Looking at skeletons before society had farming (more importantly high starch content flour + sugar) deceased adults show no carious lesions (other problems mostly from wear do exist). Unfortunately, restorations (aka fillings) are not a permanent solution as a bad diet + lifestyle still causes leaking of the restorative margins i.e. there is a tiny gap between a filling and tooth structure at the edges that will accumulate bacteria (specifically Streptococcus mutans...the main species causing caries). If you want to fix your oral health ... you must fix your diet. Excessive brushing causes abrasion to enamel and unnecessary wear. Toothbrush bristles are larger than the crevices that bacteria will infiltrate. Also, brushing too often and and too hard will cause nearly irreversible damage to your gums. Long story short, I now brush 1 time a day paired with a low carbohydrate one meal a day diet. I floss 3 times a week. Periodontitis is a bit different, more complicated and involves more bacterial species than carious lesions.
I'll also add that if anyone has a dentist recommend a gold crown for a posterior tooth he/she is not trying to fool you. Currently gold crowns have the smallest marginal gaps ~10 microns and are soft enough to not wear down the opposing teeth. It is a great choice if you are okay with the aesthetics.
@@jaredn.3484 thanks for the info. I'll watch how many times I brush. When I brush I try to do it lightly and not irate my gums... as far as proof that what I'm doing is good.. try it yourself😉
@@jaredn.3484 I wish I had the same knowledge as a D1. Can I ask what school you attend?
Bravo 👏
Very frequently chewing Trident gum saved my teeth. Early in my adult life the dentists started noticing gum pockets. I was eventually diagnosed with gingivitis and later, peridontal disease, ultimately with bone loss. I always very diligently brushed and flossed, usually brushing very thoroughly after eating or drinking anything other than water. I took prescription fluoride rinses and other mouthwashes, and used electric brushes. The dentists would deep-clean my gums, and I was seeing the hygienist three or four times a year. The deep cleanses would set the disease back a bit, but it would always come back.
Then I started chewing Trident, almost continually each day, and the disease immediately stopped. My ligaments healed, and the pockets shrank. I still have deeper pockets than ideal, allegedly because of bone loss, but the pockets are much shallower than before, and they're stable. I also stopped getting any new tooth decay. I write this five years after having started chewing gum. The benefit has persisted, even though I now only brush once daily.
Based on my experience, I recommend that anyone concerned about their oral health consider chewing sugarless gum, and preferably chewing it quite a lot. I think it's key to chew it a lot. Just try not to bite your tongue.
Why did I have the problem in the first place: it may be linked to my need to usually breathe through my mouth when I sleep. It may also be linked to allergies. Something made me vulnerable, and the standard of care could only slow the disease, but not stop it.
Is the idea behind chewing gum for tooth health to increase saliva production in your mouth?
@@ThePearguru98 The primary idea is that it worked tremendously for me--for whatever reason. Seemingly, the benefit is partly from saliva and partly because artificial sweeteners, especially xylitol, seem to be antibacterial, especially against harmful oral bacteria that attack the teeth, bones, and gums. I understand that gum chewing was not found in studies to be very beneficial, and I guess this is because the subjects in the studies did not chew gum enough. In my experience, it takes a lot of gum chewing to fully stop the disease. However, it's very easy to chew a lot.
Thank you for the podcast- just a question- Can the root canal crack and cause hidden problems? I too have a root canal on a wisdom tooth ( with crown) and have often felt there is something wrong with it but simple x rays of teeth do not show everything.
Yes, it can crack. Happened to me! I ended up losing the bone supporting the tooth due to infection, lost the & ended up w an implant after bone grafting. 😢
@@patriciachung4458 It happened to me as well, and it was the WRONG TOOTH, so I had to have a second root canal - done correctly by a different dentist. I posted about it above.
Yes, it can happen and, as a matter of fact, it’s quite common.
Diagrams would’ve been so helpful describing gum pockets . Do another and pull in the research of Dr Weston Price which although we’ve learned a lot since then, the info about organ meats and critical fats and hormone D etc is critical for dental integrity .
Very interesting. About half way through and hoping that the subject of how fluoride is absorbed will be addressed. For example, does fluoride in toothpaste absorb in the mouth or through the teeth? And fluoride in drinking water...it is absorbed in the gut, and how does it get incorporated into the enamel? Thanks for addressing dental health!
F- displaces OH- in hydroxyapatite.
Thank you! I’m a changed brush, floss, brush rinser !
LOL at Peter’s toothpick supply 😆
I started oil pulling with coconut oil and the next time I went to my dentist, the first thing he said was how healthy my gums looked, and asked me what I was doing 😁
Also, raw minced garlic tucked into the cheek will completely wipe out an infection in a matter of hours!!
Dr peters Q's is the value here, thanks Dr. Her sound is also a bit poor, sometimes disappearing,and in combination with her light accent, I couldn't make out several words, no matter re-listening. Please have guests with good loudspeakers and good articulation and pronunciation, especialkly with odontological terms and difficult words. Thank you very much. His sound is excellent, and this also affects the listning experiance.
Make sure to have plenty iodine in diet to balance against all that fluoride and frequently replace toothbrush not just clean it. I soak mine in Hydrogen peroxide then rinse warm water then store in enclosed travel case.
How about nose- vs. mouth-breathing?
Good question. Mouth-breathing leads to an increase of carious lesions, absolutely. Salivary flow is incredibly important for maintaining tooth health as saliva contains buffers (phosphates) that neutralize the enamel de-mineralization caused by bacterial production of acid. Re-mineralization only exists with healthy saliva contact of tooth structure. If you have this problem definitely see your dentist about increasing your visits, adjusting your diet, and increasing the amount of fluoride. Anti-depressant drugs also cause xerostomia (dry mouth) that leads to the same conditions. Good luck with your health!
Actually, scientific evidence supports that even infected dentin can be removed, leaving just microns distance between that and the pulp. Dentin is able to regenerate itself .The procedure should be performed with rubber dam isolation, and dentin should be sealed after removing the infected one. The dentist is only able to do that through high magnification loupes or microscope, though. I do have more than 100 cases like that, with almost 100% survival of the pulp.
Can you provide the article names please?
I’m a huge Dr. Attia fan, and most of his podcasts are super informative. However, from time to time, the guest transpires to be a failure, and this is perhaps the worst example. I’m very interested in oral health and have been reading about it for decades, so I was super excited to hear this. Unfortunately, this guest is a bust. She does not engage with a lot of the questions, giving responses that don’t actually address the question, she simply talks about whatever she wants on a very basic level (all 101 stuff) - but does NOT answer the actual question about 60% of the time. And sorry to say, she does not seem very knowledgeable - at least in the areas that Peter asked her about. This is a super important subject - so I think Peter owes us another crack at this subject with a better guest who actually knows the subject on a deeper level and actually engages with the questions. Sorry, Peter, you usually hit it out of the park, but this time, it was a giant FAIL. Hey, it happens. I think you need another crack at this. As I see from the comments, I’m not the only one who noticed this guest is underwhelming. Of course I’m happy for those who still got value from this, but for those of us who were looking for Peter’s customary DEEP DIVE, I am hoping for a do-over. Thank you Peter for all the fantastic work you do (even if nobody bats 1000!), and the youtube format brings a lot more compared to the aural only podcast. Thank you again!
Yes, as a dental student, I agree that this episode was very disappointing. Unfortunately this guest just didn't seem to understand the topics Peter wanted to address very well. Either bring this guest back on and talk about what she is actually knowledgeable in or bring on a new guest please! I'd love a deep dive into this topic!
@@adammccourt1629 Are you salty that she wasn't a WAPFer, who didn't promise you that you can reverse cavities with butter and cod liver oil?
@@adammccourt1629 Indeed. When he was searching for information about why we experience dental diseases and our ancestors did not (to anywhere near the same extent - the fossil record and animal evidence is clear on this), she put it down to sugar. That is correct, to an extent. Sugar will feed harmful bacteria efficiently. But any start can be metabolised by these bacteria, and a serving of potato chips (for example) that is not cleaned from the mouth will give them all they need to start growing, albeit at a slower rate than a serve of glucose.
I also think she missed the opportunity to explain why fluoride is important; it remineralizes the mouth and takes the place of the microscopic damage to the teeth from insults and decay. That alone would have answered much of the question, rather than creating the idea that fluoride is magical (which both pro and anti-fluoride folk seem to believe).
I can hardly even finish this interview....😕
Her studies may be interesting but do not get to root cause (😉 no pun intended). Kudos to Peter for recognizing this gracefully, and going on to important facts that she did have to offer.
I went to whole food low carb diet over 2 years ago and was SHOCKED at the difference with my teeth. I immediately noticed how much less build up was on my teeth. Flossing became a whole different experience. I mean I hardly needed to floss, really. My teeth just stayed clean! My receding gums are filling back in. Unfortunately, I have cracked teeth full of mercury fillings.
I have resisted root canals and crowns to date. Had one rear molar removed and still thinking about implant. But I may just leave well enough alone.
As a lifelong refined carb eater (including sugar based formula from a bottle), with years of low to zero fat in order to keep my weight in check per SAD diet recommendations, I never knew any different til new keto diet in my 60's. My teeth have suffered.
I have not consumed a lot of fluoride as we have mostly had well water since it became routine to add fluoride to community water. And recently, I switched to a clove based natural toothpaste and mouthwash. Though I often use nothing, or baking soda.
101 stuff was what i was looking for. She did fine. You and Adam are being obnoxious.
It’s because asthmatics are often inhaling corticosteroids. Corticosteroids are immunosuppressive which leads to thrush. So they are induced an immunocompromised environment in the oral mucosa
It can also because people with clogged airways end up breathing through the mouth, causing a drier oral cavity.
What’s the name of the toothpicks
Root planing? Laser deep cleaning?
It works for me. It helps decrease pockets.
It is hard to understand how a supposed expert can look like the most simple questions related to their field of expertise have never occurred to them.
What part of this are you referring to? I ask because without a reference point your comment comes off as a quip that serves to diminish everyone’s work involved here…decades of studies published by Dr. Corby and Peter’s time organizing and putting together over 2 hrs worth of discussion on teeth anatomy.
I think there is a lot to know about just the teeth alone, and I found this conversation informative and at the same time unpretentious and accessible for non-dentists and -microbiologists like myself! Thanks Peter for covering the subject of teeth and it’s connection to the rest of the body!
what's the innervate count on this episode
😆 haha
Valuable information presented.
Hard to understand why they are so dismissive of oral health and cancer connection, almost mocking of the research. Yet much time is spent speculating connections of oral health and other illnesses.
Why? Was the research done by people who are not part of your esteemed cohort?
Seems tribal.
Hi Dr. Attia, first of all, your understanding of the human condition is amazing, but my question is this...what's on your arm, namely, your tricep or triceps? Is it a biomonitor? Or something else? P.s Big fan of your insight into the topic of aging. Bye for now, Alex :)
It's a CGM ( Continuous Glucose Monitor), I recall him saying he's been using it for a few years to track his glucose.
He actually addresses his continuous glucose monitor at length in the video here: ua-cam.com/video/ZapXw377t5s/v-deo.html. I'm thinking about getting one because it's better than a finger prick and does not need blood. Thanks to Dr. A and others, I started working to reverse type 2 diabetes, and my HbA1c is finally down to the "pre diabetes" range. I'm using a time-restricted diet with occasional two-day fasting in order to an insulin sensitivity reset.
Of all the Drive shows I've listened to, this one is by far the least informative. Dr. Corby is simply not equipped to keep up with Peter's line's of inquiry. It starts right from the beginning when she completely misses the most important reasons for and consequences of the heightened innervation of mammalian teeth. It only gets worse from there. I honestly think Peter knows more about dental health than this lady.
Could the rise of HPV cancer be associated with the rise of metabolic disease?
Can you just clean your toothbrush with toothpaste and then avoid the taste of hand soap?
According to the discussion, the rise of HPV disease is related to the increased transmission of HPV thru sex. It makes sense to me that oral sex is more common now than in the past, so why the need to correlate it with anything else?
So I have Wondered if poor oral health being linked to other diseases has more to do with eating a sugary diet than any other factor.
No. The link of poor oral health and systemic diseases is the inflammation because of the bacteria that enter the bloodstream.
@@VICTORMGomez-fx7du Well, a sugary diet also leads to inflammation.
41:10 I think evolutionary questions are very important, here is another example. How did our ancestors thousands of years ago get enough fluoride in youth without refined administrations (toothpaste/mouthwash)? Some dietary source? Is it like saltlicks for wild animals or did they discover plants/foods with high concentrations of fluoride and chewed it? Maybe mother's milk cancentrates fluoride? To have good teeth (like any other complex system / Anna Karenina principle) you need to satisfy every health aspect not to lose the functionality (leading to lower fitness or even premature death), meaning they have to have overcome this. But how?
Edit: Btw, the same goes for animals. How do other mammals get fluoride?
@Nandha K Samy Ok, but if that was the only natural source, we would expect non-modern human and animal populations to not have been able to live in geographical areas with low-fluoride levels in water for extended periods let alone for life. I don't know if that pattern exists, but seems unreasonable.
See my above reply. Fluoride is only important due to modern day diets.
@@linusyootasteisking It's because now days we need fluoride to help enamel get bit harder. At the moment most people have very easy access to food, so you can eat whenever you want. We tend to eat more often and snack in between meals. After every meal, snack, coffee the environment in the mouth changes to acidic one causing demineralization of enamel making teeth vulnerable to bacteria attack and decay, whereas fluoride helps to restore the surface to fluorohydroxyapetite which is more resistant to acidic environment. This is actually very interesting subject. In some regions of Asia the traditional tea is full of fluoride causing fluorosis in locals. In some regions with natural, mountain water supply the same thing happens.
@@jaredn.3484 Hmm, I think I have found what you referred to. Basically, you are saying that the important difference is that today our mouth pH AUC (area under the curve / integral) is significantly lower (our ancestors probably ate acidic food so acidic instances still existed, although extremes were probably not as extreme) meaning that there was not much need for a pH buffer in the saliva. Today, with lower pH UAC, we need more buffer to keep enamel from demineralizing, and the buffer complex includes fluoride. So net effect is that we have a greater need for fluoride than our ancestors. Is this what you meant?
This seems plausible and better yet, this can be tested. If we know the stochiometric relationship between fluoride and the buffer complex, we can predict how much fluoride is needed to buffer for any given low pH UAC to be protective against demineralization. If we see that the predicted amount is not sufficient, then there are more factors. If sufficient, this hypothesis just needs to confirm the mechanism.
@@linusyootasteisking Yes, our fluoride need is greater than ancestors (I don't actually know how much need they had for fluoride). Not sure what you mean by acidic food...(except for citrus plants). The acid is produced by microbial fermentation of food...more specifically fermentation of glucose (obviously a much higher concentration in glucose in modern diets), but the food itself, like bread, probably doesn't have a low pH. Next time you go to the produce section of the grocery store, ask yourself what foods here existed like this 100,000 years ago...my guess is almost none of them as we selectively bred fruits and vegetables to taste sweeter...aka high starch = more glucose, more sweet = more fructose and glucose. Now, due to our diet being higher easily fermented carbohydrates we need fluoride substitution of hydroxyl ions, to change the pKa of demineralization. Here is a great little video explaining this process in detail:
ua-cam.com/video/jzqBKHRJLWE/v-deo.html
On a side note, if you have heard of "silage" it is an agricultural method of storing feed long term. The processes depends on the acidic environment produced by microbial fermentation to kill off most microbes...than the environment kills the fermenting bacteria. Very interesting process.
I lost all confidence in the dentist when she claimed that root canals don't cause any problems. After having a tooth re-treated with a root canal, I have had an infection in my jaw bone that has been there for three years. My Endodontist just keeps saying "maybe your immune system will kill the infection". I asked him if the bacteria could migrate to other parts of the body but he denies it.
The dentist in the video and the medical profession in general deny a possibility simply because no massive double blind studies have proven it. Well, have there been any massive studies demonstrating that bacteria cannot migrate and colonize in another part of the body? I don't think so.
The dental profession does not deny the possibility. It's actually well taught in good US programs and vital for preventing greater systemic problems! Is it in fact an infection? Lesion does not necessarily mean infection...(at least not a current infection)
I wish evolution would have evolved humans to grow a third set of teeth to come in around the age of 50. Seems like that would help out a lot of ppl for when they get older.
True. But evolution has not yet "seen" humans that age, which is quite a new thing. So there was no reason to have new teeth at age 50, because there was no life then. Maybe in a million years ;p
@@bernardojunqueira2392 Plenty of hunter gatherers lived past 50 if they lived past childhood. The issue is more likely that at 50 you've already reproduced. Evolution isn't very concerned with your teeth any more.
I wonder how important flossing is in a diet that’s 100% free of sugar and grain?
A "sugar" free and "grain" free diet is technically not a high-blood glucose free and phytic acid free diet. In other words, simply eating a lot of carbohydrates in a sugar (added sucrose) free diet is not going to give you decay free teeth. Other foods besides grains such as legumes have phytic acid in them e.g. Dr. Rhonda Patrick complained about having cavities in a Joe Rogan podcast even though she eats a table-sugar free diet. The sucrose in her fruit and vegetable smoothie is the same chemical found in table sugar (your microbiome does not know the difference).
The Weston A Price Foundation has an article on phytic acid in bread and how the phytic acid in wheat flour and legumes bind to the minerals in the teeth and lead to demineralization: www.westonaprice.org/health-topics/vegetarianism-and-plant-foods/living-with-phytic-acid/
I don't see how flossing your teeth would affect the loss of minerals in your teeth to the phytic acid in your stomach. Flossing seems to only be useful for removing food particles between your teeth, but that depends on the texture of your food and not its chemical composition.
I think sugar changes your mouth's microbiome, but someone else can confirm that with a citation if they read this. Overall, I don't think flossing is that important unless you have visibly wide spaces between your teeth. I've been told by dentists I should not floss my teeth simply because there is no visible space between my teeth.
@@ketoscience sorry, what I meant was, “wound eating a keto or carnivore diet do less damage to your teeth and perhaps require less or even no flossing (less getting meat out of your teeth”. In my mind if you cut out sugar and grain you’re left with Keto or carnivore but if forgot about veggies and fruit since I never eat them :).
They started to touch on diets effect on the health of your teeth but unfortunately that did not go very far.
Are you talking no fruit and no veggies? Like carnivore? That is an interesting question. Although I'd still want to floss with meat stuck in between my teeth.
@@dylanfgarrison Doesn't matter what you eat you have to floss, as food particles mix with saliva and stick to your teeth creating biofilm (sticky coating-ideal environment for bacteria). If you only brush your teeth, you only remove the biofilm from 3 surfaces, and the bacteria from in between your teeth will builds up eventually pulling the gums away from the tooth surface and seep in creating a periodontal pocket, which leads to more problems. Actually the plaque forms on the teeth moments after we stop brushing teeth. It's slightly more complicated process, but very easy to understand. It's a shame she did not explain the basics
Love how first couple comments are regarding carnivore.. lol
Wow
So that's what dentist's do!
why is it stupid to not go to the Dentist? THANK YOU FOR YOUR PODCAST! I KNOW THIS IS VERY IMPORTANT I HOPE I CAN GET MY FRIEND TO WATCH LATER. Now some people don't even know what a Dentist is, and for Generations that go back thousands of yrs. if not Tens of thousands of years+. Now what if people don't trust Dentist and know that they don't get any learning or teaching so they don't learn anything so better health is not coming maybe Dr. will say floes more and their mouth wash is good for cuts & cleaning but not good to put in your mouth for two minutes it's like when you drink hard liqueur your don't wrench your mouth because it's strong tasting ,not good mouthwash taste like that nasty.I can hear your show now very good also remember not everybody history has cave living but i do knot what you mean there are people with phobias and they are hard to get rid of even with help. Thank again ,i will watch this again and take notes, i just love all these pod case its great.
During the time i Wash my teets i stand in one feet for my équilibre
@3:13 I'm also brazilian and I also want to be Attia's friend ;-p
and this all starts when you are in the mothers womb and if she gets enough protein and fat to form the jaw and eye socket correctly.
Fluoride 🤔 is a double edged sword, thats being kind
@J Rose According to Heather Hiyeng and Bret Weinstein the form of flouride in the water supply is toxic and not helpful for dental health
Ugh fluoride - Will just stop there the tooth is alive every layer in a very accessible and interesting electrical environment with a flow of ions through it - begin looking at the BCEC of the nasal oral cavity which is a “closed” biological electric circuit and branch out from there to the rest of the body - Attia teeth must be due to lifestyle of the maternal line see Westin A Price author of “Nutrition and physical degeneration”
Wasn't very impressed by this guest. She didn't directly answer many questions and didn't give the 'why?' to some of her explanations. A lot of the advice she gave is pretty generic advice that can be googled
Ayrton Senna, 05/01/1994, the day we all wept!!
I apologize but did not know who he was and had to look it up.
I'm not going to waste my time with this,
I'm dying because I didn't take care of my teeth
I think that this dental "specialist" is not much more than a voice for the dental establishment. Not much new to learn from her. But what left me totally baffled, from Attia as well, is that she has no knowledge of what "oil pulling" is. WHAT? This is willful ignorance! Her life dedicated to dental care and she has never seen, or has had any interest in this ancient practice? "Ancient" does not mean ineffective. I know of two persons who are living testimonials of the benefits of oil pulling. I personally have benefited from it for the last 10 years, having reduced my yearly visit to the dentist for a cavity to... NOTHING. Not a single cavity in 10 years. And interestingly, we learned about oil pulling from... the assistant to my decades long dentist.
Maybe more genetics?
Especially, in determining saliva composition and the laying of enamel and dentin in formation!
It wouldn't surprise me if in the distant past the harder fare humans would eat would abraid the biofilm If they would constantly chew on nuts or roots it would never really accumulate whilst awake. Also, I'm sure we knew the Romans and Egyptians cleaned their teeth.
Interesting! But does she truly believe that humans has clenaed their teeth for all eternity? Probably has to do alot with what food one consume also how many times a day. It is quite established that or oral cavitys are smaller due to softer food -> less chewing --> smaller jaws. Caveman didn’t have coorked teeth! She answered a lot of questions vaguely, didn’t say when she clearly didn’t knew. Not up to par with Peter!
Dr. Corby is not prepared to give concise answers in the limited podcast time.
Is there ANY real research on Tonsil Stones? Dentists just tell people it’s food, bacteria mixing and getting caught in tonsils with craters.
This is so suspect as the body trying to tell me something ELSE is wrong. I go to the Dentist every 6 months, parents took me entire childhood , always had great dental care and follow all brushing , flossing guidelines.
What is it under microscope? What does it grow when universally cultured?
Like most symptoms of the body , it usually indicates something else.
Thank you 😊
If you have a very specific concern for a condition of that sort...I would recommend seeing a board certified Oral and Maxillofacial Pathologist. They are very well trained and will be able to answer your concerns.
@@jaredn.3484 I was hoping a Dentist who is involved in Research would know of some Research. I work with OMFS and they don’t know. How would one find a OMFS Pathologist?
@@moontrack4625 That's a good question. Oral pathologists are few, but any major dental school will have one. Pathologists will also work with the surgeons analyzing biopsies etc. Since, you are looking for research I would suggest doing a search for an Oral and Maxillofacial Pathology Residency Program and contacting a doctor from that program. Good luck though! ...they are immensely busy.
I'm also referring to U.S. programs I can't speak on behalf of outside of this country.
I have been battling with tonsil stones all my life, alongside severe canker sores and bad breath. My diet consisted mainly of highly processed food and sugar. I ate pretty much fast food and a lot of pasta, rice and flour-based products like bread.
Once I educated myself on nutrition and cut out the processed food, especially wheat, I never had any of the issues I mentioned and it's been almost two years now.
I highly suggest you experiment with the food you eat and definitely journal every ingredient you consume in order to investigate the issue.
Definitely try eliminating wheat from your diet and see what happens.
Nice woman, but didn't learn much. This appeared to be a ADA infomercial. She never heard of oil pulling? Don't waste your time on this one unless you want the conventional dental info and no alternative options/views.
Disappointed by this guest. Really found her info/answers to be basic & shocked by her utter disregard regarding the safety of old mercury amalgam fillings left in the mouth. As someone who has an autoimmune disease, I’ve heard many doctors/dentists feel mercury is indeed a risk & she didn’t even discuss the pros and cons or evidence. Just totally dismissive of removing the mercury. I did listen to the entire podcast (thinking it would get better) but really found this podcast sub-par and boring (in contrast to Peter’s usual deep-dive interviews).
Mouthwashes -waste of time and money?
better to brush than swish
Yes! Low carbohydrate diet, reduce frequency of meals, and good oral hygiene. The only time you will need a product is if you have periodontitis or some other uncommon condition.
She doesn’t even know senna!!😆
She knew, but did not remember the date. I did not know of him - horrible I know.