Top 10 Dental Myths DEBUNKED (Root Canals, Fluoride, Whitening, Charcoal, etc)| Dr. Brittany Seymour

To avoid it not working. As I often say, it's the same as committing suicide to avoid death.

You really believe that can be a significant, you know, contributor.

Well, I mean, if we just remove simplified sugars from our diets, like just pure sucrose and like that kind of free uh glucose and fructose, corn syrup, and any of that stuff, 90% of decays will go away. 90%.

Denton has a yellow shade. First, she thought the whitening was successful when she got the stains as she continued this DIY method.

You know, 1,000% our oral health is connected to our systemic health. And you know, we know for sure, there's no question that, you know, problems in your mouth, disease, dental diseases lead to cardiovascular problems, rheumatological problems, endocrinological problems.

It's inside the body. It's all a part of the same system. And teeth are organs. I mean, we they are literally organs. We call them organs.

But the truth is it doesn't grow back. And so once we wear it away, it's really hard to come back from that.

It's a redundant term, right? All dentistry should be holistic. It's a redundant thing to say that. I say that's dentistry. Holistic dentistry is dentistry. A good point. Then everything short of that is tooth carpentry. And for oral health benefits to be covered for people, we we say put the mouth back in the body where it belongs. Natural doesn't always mean gentle. That's a really good point to keep in mind.

Looks like all systems are go. All right. Welcome to the Paul podcast uh where we talk about all things dentistry and non-dentistry from a generational perspective. I'm joined here in the studio with my co-host Dr. Par Shahiti and Dr. Roin Nas. Dr. Cotch is not joining us today. And uh we have again in our studio Parsa a second uh episode on a topic that's super important which is dental myths. In the last episode we talked about how they propagate and some of the mechanisms. And today what we want to do is after maybe doing a quick recap of what we talked about last time then do a quick top 10 right with our guest.

Absolutely. Absolutely. So last time as everybody knows we talked about dental misinformation, disinformation with Dr. Britney Seymour who's back with us. She's an amazing person to talk to about this. She's a dean of faculty affairs at Harvard School of Dental Medicine and the oral health policy and epidemiology department at Harvard School of Dental Medicine, the public health school and a national spokesperson for the consumer department of the American Dental Association. So, we're really lucky as always and we're super excited today. I'm not just exaggerating because we're going to be running down the top 10 dental myths out there and debunking each and every one of them. So, I'm ready if you guys are.

I'm ready. One by one, we're going to go 10 to one. We're going to leave our most exciting ones for the end. So, we'll keep everyone hanging for a little, but I think we're starting off pretty strong.

Yeah, we sure are. These are the important topics are all over the internet. Information, misinformation, disinformation, it's all over the place. So, let's let's try to see if we can debunk them. But before we start, why don't we talk again have the Seymour explain the eye care system by which you know we evaluate these. So, why don't you go ahead and ask Dr. Seymour about.

Let's do I mean, I'll tell our audience so much was said. We had a whole podcast on this. I don't think I can have you sum it up so briefly, but I will have you try. If you guys are interested in more of this, make sure to check out our last podcast because that's where we really dive into it. So, Dr. Seymour, I'd love to hear more about the eye care approach because we're really going to be putting it into action today and kind of demonstrating it for each of our 10 myths. So, do you want to just run us through a little bit what?

Can you just tell us first what is the eye care, why it's important, and then what does the acronym stand for?

Sure. So, quickly reflecting to last uh the last episode, we talked a lot about why uh people lean into certain pieces of information versus others, what we might consider misinformation versus true scientific information. So the IARE approach, it's an acronym that I and some of my colleagues um who've studied this topic came up with to help uh dentists, healthcare providers remember why information matters to patients and that it's often not about the information, but it's more about the messenger or where they got that information. Their social networks are often behind the scenes um putting this me this information out to people. And so that's what the I stands for, identity. It's a reminder that when we're talking to our patients, they they have an identity and the information that resonates with them is often tied to a part of their identity, a part of their social network, their social norms. The C in the IARE approach stands for connect. And really that's because in that moment we have an opportunity to build trust with our patients during those conversations and even around that specific topic. So finding ways to connect with them over their concerns, share that concern, really seek to understand where that concern is coming from. The A stands for anecdotes or stories. And this one um as as scientists and healthc care experts, we're guilty of a lot. We we like to talk data, but in that moment with our patients, they are not a data point or a statistic. They are a person. And so anecdotes really create that emotional resonance to help people connect with the messages that we are trying to convey in often very short amounts of time. And one um emotionally charged story, a success story um a positive story or even a story of something that didn't go well resonates and can go a lot further than a scientific study, a paper talking about all the data for for most people.

The R stands for request. So request more, ask ask follow-up questions. Try to understand more about why our patients are raising this concern. Where'd they find that piece of information before we go right to debunking? If they heard that from their mother, they might be more inclined to trust what their mother's telling us than what we are. So, understanding more about the source of the information and the source of their concerns by asking, requesting more from them will help us build that connection and then help us get to a more constructive discussion. And then finally we get to the E. That's the evidence. Okay, we can exhale. We can talk and should talk about the evidence. But there's a little bit of a foundation to build before we jump straight to the data, straight to the statistics. So the eye care, we don't necessarily need to go through it step by step. I C A R and then talk about the science, but I often will pause and employ one of those letters uh before jumping straight to the science when having conversations with patients.

That is that's so beautiful, isn't it? I mean, it's it's condensed down to something I mean, the way I look at it is basically a common sense approach that applies some emotional intelligence. Yeah. Before you jump into the kind of language you would be using with your colleagues because you're talking to people that are not trained and they're, you know, weak understand that language of science, but people are more interested about what's healthy and safe and so on for them and that's where they kind of go. So, that that I think is really important. You know, I must say I personally myself have can be accused of from time to time jumping into a thing and quickly as soon as somebody says something, I'll try to debunk it. But I should be more careful in the future to first do more active listening and kind of do a little bit more analysis and emotional intelligence. So Rain, why don't you.

So this is a very good framework for us to follow. That's beautiful. I agree.

For all of these myths that we want to try to debunk today and see what happens. So why don't you go ahead and start this countdown if you want.

Let's do it. We're gonna start off with number 10. Number 10 is, is bad breath always caused by poor oral hygiene? I think it's a really good question. I think it's a lot of our biggest fears, too. I'm walking into this podcast today. I'm like, don't get too close. I don't know if my dinner smells bad. But I mean, really, when we think about it, coming even from an identity standpoint, you know, we have to think about our patients. You know, is this person worried of being judged? Is this person coming um from a health care perspective? You know, are there other things going on that are manifesting, you know, in the mouth or really are they struggling to access, you know, simple day-to-day um dental hygiene um care and, you know, it is causing bad breath. I think there are a few different answers to this and while I haven't treated any patients yet, I am relying on you guys to put the A in my answers and give me a few anecdotes. Um, but what do you guys think? I think the word always here is very key. I don't think it's always caused. I do think it could contribute. Um, but I do think that there are other reasons why bad breath can happen.

Yeah, I think does poor oral hygiene always cause bad breath? And the answer is no. But most of the time it does. And I think it's about 80 to 90% of times we see uh of the time we see halattosis originating from the mouth. So that's you know the food we eat, the bacteria that's been accumulated working through that uh food as nutrition source to to break down the proteins from saliva, blood, and uh uh basically other sources inside of the mouth to create these, you know, sulfur compounds that create bad breath and they can come from the tongue, they can come from food trapped inside the mouth, they come from dental infections and um I think we say this happens in about 80% of the cases of bad breath. So we have about 20% left over and you might ask yourself, what is what else could be on this list of what's causing the bad breath? So about 10% of the time I think it comes from ENT related issues. So, you know, you might see nasal discharge, p uh not not pulp stones, tonsil stones, um and other uh, you know, basically post post-nasal drip. So, if you see if you find yourself uh with pressure in the sinuses, a lot of discharge, you know, coming off of a cold or a virus or the flu, you might suspect that could be the reason. You want to make sure that you're going through the the motions, you're practicing good oral hygiene, you're scraping your tongue, you're uh, you know, flossing. And if you notice your oral hygiene improving, well, there's a really good chance that that's going to be from your oral oral dentistician. But when you when you go through those motions and that's still not you know responding, you like to think about other possible sources of the of the halattosis. And another possibility could be GI related issues. So acid reflux, um, you know, uncontrolled blood sugar, um, uh, we have pylori infections. These are things that you might want to consult with your primary care physician and to be able to understand if that's still the source of the problem. So, if you find yourself practicing good oral hygiene and no improvement or you're waking up and that's still the case, no matter what you're doing, you may consider that it may be an extraoral cause of bad breath. And most importantly, we're we're trying to tackle the bacteria inside the mouth. So, people often think it's just the food, but our, you know, the bacteria in the mouth really thrive off of these low oxygen environments and that's when the bad breath really happens. So the number one thing we can recommend is practice good oral hygiene. And when that doesn't work, think outside of the box.

100%. And as the dentist putting the R is to ask more questions. You know, asking your patient, do you get this when you're stressed? What medications are you taking? You know, when do you notice this? Only in the morning or does it last all day? And some of those questions can help, you know, guide that diagnosis. And really, we'll come to this a lot, I think, through the podcast, but our main takeaway for our patients a lot of the time is ask your dentist. Really, every mouth is different and while we can say yes, the majority is this 80% 90%, there is always the 10% and that is where our knowledge and education comes in and and we'll try not to spit out the evidence right away. We might ask you a few questions, yeah.

I guess, you know, asking simple questions as to like, who has told you your mouth smells? Usually something you found yourself? Was it a partner acknowledging it? And then sometimes I found something as simple as someone in a dietary way, somebody having a salad dressing that they don't know is so high doing garlic and they're just constantly having this bad smell with garlic and honey and then they don't know they keep brushing, it's just not going away. So I think a little bit of investigative work is important, but as you said, I mean, you know, you got to go with almost like a differential diagnosis, what most likely is the least likely and then cut down from the basic stuff that happens a lot like a diet and, you know, and then get down to something more deeper um in the body that that certainly can be causing these these chemicals. Do you have any uh examples, things you can remember?

I think this is well covered. I think um if the suggestions from from your dentist don't seem to be addressing the issue to expand to the broader healthcare team because we certainly know there can be um more widespread reasons for that, dehydration, medications.

Exactly.

I think that's one that I think we hadn't touched on is the medications and you just brought it up Dr. Seymour.

The uh medications that induce this dry mouth or xerostomia, right? I'm sure there are blood pressure medications, anxiety medications. I think almost every medication has a side effect of xerostomy or dry mouth, antihistamines, over-the-counter things that people can can identify to be the source of their dry mouth and obviously compensate for that effect. We don't recommend stopping your medications for bad breath. We recommend another approach which is, you know, hydrating your mouth and taking the right oral hygiene practices and and implementing them. Uh, but um, that comes in at number 10, folks. So, number nine.

Number nine. All right. This one is kind of perfect for our two endo specialists here and for the pulp podcast.

That's right.

You know, this is a pretty big question and I'm sure you've had patients walk in and maybe ask you this. Coming in at number nine is, do root canals actually work?

Yeah. So, you know, it's funny because root canals are such an abstract procedure to many people. It's very difficult to kind of understand what's going on and in fact there is also a vocabulary problem with it too because all of us our natural teeth have root canals. It's an anatomical space, you know, but but the problem is that it's been conflated and mixed now with the idea of having a root canal infection, which is an infection that's source is inside that anatomical space of the root canal where the pulp is, for example, right? So these things get conflated and mixed up so often. So people say, I had a root canal, I had a lot of pain. It's just like the root canal infection caused the pain. The root canal therapy is the procedure that people go to address a root canal infection and those, like any other medical procedure, have a certain success and failure rate. Right? You cannot expect anything in medicine that is so surgically intricate to have 100% success. Right? So it works some of the times and it doesn't work some of the times. What's good is with this procedure over the past century, it's evolved so much and there's so much technology and even not without technology, a better understanding of the mechanisms of infection and failure that our success rates have improved dramatically. And now with imaging and a whole bunch of different things um it it has really improved the success rate. But to go back to the eye care uh mechanism, I think the best way to say it, it's to first acknowledge that everybody wants to be healthy obviously. So patients are legitimately worried about a procedure that seems very abstract to them and has been kind of labeled because of this confusion on the branding and the label. Yeah. uh as something that is potentially not working and and and causes failure. Uh, currently uh, if you follow the standards of care in endodonics and are having a treatment done by someone who has experience and knows what they're doing, the success rates are in the high 90s. So nine out of 10 cases of these procedures will work. Does it mean that 100% 10 out of 10 work? No, it doesn't. But that all that means, like any other procedure, all you need is follow-up, which means you do the procedure nine out of 10 times, you could still have your tooth and then if you follow up and not just drop off the face of the earth and like come back many years later, but follow up with your um either endodonist or dentist doing the procedure to find out if it worked properly or not by having a six-month recall and follow-up, then there is no problem because you capture nine out of 10 cases.

that had the infection and save it. Yeah.

And then one out of 10 that it doesn't work, there's still some other things that you could do to try to save it. But if not, then you pull those teeth and that that's still healthy. So, it's not a problem. The idea of pulling teeth uh to avoid it not working, as I often say, is the it's the same as committing suicide to avoid death. So, so it's like you don't you don't you just got to take chances and see how things work, right? But as to give an anecdote myself, I had a root canal myself that uh 30 years ago actually, my root canal is probably older than most of you guys.

More than 30 years ago now. This was in 1990. So 36 years ago. Oh my god, time flies.

Wow.

So and it's still in my mouth, right? And so.

Find who did that. I know.

I know. And it was an upper classman in dental school.

Believe it or not. Yes. So what so what I think that if you follow the principles correctly and you know I myself do my share at home. It's not one of those things where you just kind of do a procedure and then it's all on the person doing it. It's kind of like the equivalent of saying, you know, my accountant does my taxes. Your accountant doesn't do your taxes. You're the one responsible to get everything going on. So for us, the equivalent of that is they do the procedure for you, but then it's your job to maintain that tooth, but proper oral hygiene and proper brushing and flossing and and a good diet so that you can sustain it, you know, and having avoiding any of these bad functional habits like chewing ice or, you know, eating gravel and that kind of stuff. So any of those. So root canals, to make a long story short, root canals work and their they work can be validated. It is a skill-based procedure. It's a good idea to see specialists that can that are well-versed in them or even um restorative dentists, general dentists who do a lot of these and have good reputation. But more importantly is to follow up so that you can make sure that what you had done works.

Has worked. So that's.

I think that I might push a little further on this one just to broaden it a little.

Do you feel like this question stems from patient anxiety? I know dental anxiety is very prevalent and do you find that, you know, patients are afraid of pain? And I might ask you, I feel like root canals tend to relieve people of pain, but is that a fear that you find coming into the clinic?

That's what I said. It's just that that's the correlation causation fallacy. Is people by the time they end up needing a root canal, they are have a big infection, they are in a lot of pain, they associate the procedure with the pain that they went through because of the infection, you know. So that's there's a big misunderstanding in this whole thing and it's primarily driven by just uh using the language incorrectly in many ways. Uh, nowadays with if you're having proper anesthesia and using those techniques, the procedure itself should be u painless, completely. It's just uh so but but you know, again, it goes back to the eye care. You have to validate people's fears and anxieties. They are right to to to fear that plus a procedure that is very uh complex and um um requires skill and so on. Uh, in many parts of the country where there's low access and low capability, it may not quite happen at the same quality that you guys learn in school and you guys learn in school that, you know, and that's that's a challenge. That's an access to care problem that Dr. Teamwork could probably speak to as a public health um advocate, but um, the skill and access to care is a challenge and in in many cases, you know, you have to kind of make sure that you have the right care available in which case if you don't, then I guess maybe um um you have to seek alternatives, but but I think that's the dynamic. What do you think about that?

I was really glad that was a a very I think important and thoughtful explanation. And I was glad that you raised um in the eye care approach the opportunity for an anecdote because if I had to guess as people are watching back and listening to that explanation, what's going to stand out the most is that you have a success story. You have a root canal treatment that has lasted more than 30 years. Uh, I would guess that's going to be what people remember from that explanation. We are not, we as meaning humans are not great at assessing risk because we're emotional and there's a conflict there um in assessment of a risk and in a rational uh response to something.

So anecdotes are really powerful tools when we are talking about a procedure and we're trying to convey risk. Uh, the way you talked about nine out of 10 times or the example that you used about your own treatment or um if you're hoping to convey, you know, if a patient follows up that reduces their risk. Telling that through a story of a patient who had a successful outcome and what that patient did to achieve that success with you as a teammate can be a really powerful way to convey that through storytelling.

Yeah. And I think one thing that you said that stuck out about root canals and I just want to make, you know, from my perspective, this crystal clear to the audience, they absolutely do work and that they are very effective and they are, you know, life-changing in a lot of ways because the idea, the thesis and the logic behind root canal therapy or endodonics as a whole is to preserve the natural dentition. And so you think about all the specialties of dentistry, this whole team approach is designed to retain the form, function, and and aesthetics of the teeth so that people can eat, they can communicate, and they can, you know, thrive. Um, and we know that the mouth is the gateway to the body. So I I think that the idea that um people have always come to the endodidonist in pain um I don't know. I feel like a lot of my experiences and I know for sure Dr. Dr. NS has been the patient come in in pain and leave happier than they were in the last 2, 3, 4 weeks because they felt no pain throughout the procedure and now they are on their track to feeling no pain hopefully forever. And so, you know, I I think one of the first things we were taught by Dr. Nasa was, you know, this should be an absolutely painless procedure from the second that they sit down to the moment that they leave. And hopefully with the right pain medication afterwards, they're not going to have anything close to what they had coming in. So I I feel that the public is is scared about that, but also I feel like there's some some unfortunate conversation about the materials we use, which are safe and effective and, you know, FDA cleared um and a lot and, you know, centuries of research have gone into these things. But then from the provider's perspective, which I know we're going to get into about the conversation of implants versus endo, I think everybody and any clinician would agree that if the chance, you know, arises to save your natural teeth, every ethical clinician will in fact advise you to attempt to save your your natural teeth. And I think that's a key takeaway of that question.

100%.

Yeah. And I guess and and I I love the way you you put it is that using an example of a tangible person that has done it the right way, you know, by having the follow-ups and having the, you know, the healing experience and so on. It kind of it's a far more powerful way to communicate uh the mirroring of a model that would work.

In their mind.

That's right. It creates a chance for our patient to say, "Oh, I see myself in that story. I can do that, too." I think that just encapsulates the whole thing to me is like.

Putting it in phrasing in such a way that they can see themselves in that story because the alternative, which we talked about last time.

Is they seeing themselves in the story that is spread through gossip by people they trust at home.

Right.

And that's really the key point. That's really the crux of the issue. Terrific. So that was really good. So I think we we're getting somewhere.

We are getting somewhere. Absolutely. All right, we're going to take it down to number eight. And this is a pretty interesting question. Our question at number eight is, are ceramic implants safer than metal implants because they are non-metallic?

Yeah. Should I go with that one? Okay. So, so that's that's an interesting one because it's all over the internet as well. This issue and it's usually a um question that is put forth by you know the holistic dentists or the so-called biological dentists and now they some call themselves functional dentists uh ultimately besides the fact that I believe all dentistry should be just dentistry is holistic itself um and it's redundant to call it holistic dentistry because that's what dentistry is. Everything short of that is you know tooth carpentry. So um I think the the idea that um these uh ceramic implants are non-metallic and they would make a better alternative to implants. Again, the holistic dentist say, first of all, that again, root canals are toxic, they don't work, but don't get the metallic implants, come to us where we have ceramic implants. Now, the ceramic implants, if anyone understands chemistry, is what is makes it ceramic is actually zirconium um which is zirkon in the periodic element, which is a metal, right? It's a white metal. So it is this it's just under titanium in the periodic table. So you got titanium as a transition metal and then you have zirkon. So it's just a white metal. So it's essentially a bait and switch. It's kind of like, well, don't get that, come get this because I offer this and patients would not know necessarily that it's it's different. Now, I believe titanium implants are safe, right? So, I mean, if you're going to get an implant, get a proper titanium implant because it is actually stronger than the zirconium implants that are more fragile. But, you know, this is essentially the world we live in as we were talking about the the internet. The information uh travels as a form of marketing in the modern world. So people are marketing their, you know, their practice in which they kind of create a niche for this group of people that want to have non-metallic implants by selling them zirconium implants that are by core still a metal, but they're just white and so it's a bit bait and switch. So that that so that's the thing I've even seen online and some people doing, oh, look, the zirconium does not conduct electricity as much, so therefore it's not a metal, whereas zirkon is only 4% as you know, of a conductor of electricity than than copper, so it's much lower conductivity, but it still is a metal by definition. So you know, it's kind of like the old bending the spoon trick that people have been doing for years as a means of.

Right. And the metallic implants have a long track record of tried and true and proven to succeed. Excellent integration capacity.

Mine.

There you go.

There you go. Another.

Seymour. Have you had an implant before?

Can you tell which one?

No. You got a $200,000 smile there.

For sure.

So, yeah. I mean, you can tell us a little bit about that and your experience with the implant. I mean, I think it's our job. Some of us are endodontists. Um, but, you know, implants are a great alternative when your teeth come to the point of not being able to be restored or that's the right fit for you. Um, and like Dr. Nasa said, there's been a long track record of success with implants, especially with the right knowledge and know-how. Um, and obviously there are aesthetic concerns maybe between ceramic or zirconia, but what was your experience like having an implant? Was it metallic? How did it make you feel systemically, orally? All the above.

I've had a good experience. Mine was also a classmate uh in dental school and that was also um some decades ago. Um, so no, it's been a very positive experience and again, I think a lot of people, I mean, maybe these trained eyes know, but I don't know that everyone recognizes I have a dental implant and um I have had >> the the crown replaced um over the years because the aesthetic materials have improved as you were saying, but the core of the implant has remained strong and, you know, latest news is that it's going to go to the grave with me.

I love I love to hear that the longevity of the implant, but.

The longevity, right? Not that I'm going to the grave anytime.

I I mean, it might not be up to me, but if it is, I've got some years ahead.

120 years long and healthy. I I think to go uh back over this topic from the perspective of the eye care system um the eyeare model, the idea is that again, patients are right in being concerned over the fact that perhaps one type of an instrument or material or pharmaceutical or something that's being offered could be more harmful than another. Right. And again, they may not necessarily go based on the evidence as you said, but the reality of it is that um there are no studies that show there is any less harm in these so-called non-metallic implants that are zirconium, but there are plenty of studies that show that they are weaker.

By comparison, right? So uh as a result of that, I mean, the reality of it is that people have to understand that, you know, look, if you're going to have to get an implant, go with a stronger one and because the other one is also so metallic. We can't have a non-metallic implant at the present time that could be strong enough to withstand the forces of occlusion.

Absolutely.

Totally. So for our listeners, which honestly I kind of put myself with them right now. I still am learning. And I would say what I'm taking away from this is it's okay to take a few different opinions, not believe the first thing that I see. Recognize that some things are marketing. Typically, I would trust that my dentist has my best interests in mind and that it's okay to ask and it seems like with anything, treatment is personalized. So, at the end of the day, the other option might be what's right for me, but I might not be able to be the person that comes up with that right off the bat. And it might take a conversation and a bit more of a chat to get to the bottom of it for myself. So.

Yeah, absolutely.

I love it.

Yeah. Part of the challenge though is kind of separating the wheat from the chaff in terms of what is marketing for a practice as opposed to what is reality and uh that's where you know that that's where it comes this question of misinformation starts to become a question. Well, you know, if it's disinformation, obviously bad, but misinformation is bad enough too if it's going to effectively create bad outcomes for you, but that's I mean, that goes.

Right. The territory.

Maybe that's where our E comes in then. We really got to dig deeper for some evidence. We got to find the facts. I feel like if we're looking at pretty pictures and nice colors, it'll get us somewhere. We'll get interested, but then maybe we have to go to the numbers eventually.

That's true.

That's how we do it. And um, you know, we're talking about all these things and as a listener, I might ask myself a really important question. And that question is, you know, something that I'm going to ask you, Dr. Seymour, as we bring our countdown, Roy, if you will. It's okay. Number seven, as the national consumer spokesperson for the ADA on the consumer side.

Yes.

There's a million-dollar question, and that is, is there one product or habit that can fix all dental problems? Is there one?

Is there a magic bullet?

I think we all get that question a lot. Is there one product that can solve all my oral health needs, all my dental problems? No, there's not one. Um, actually, if any of you out there have been to the dental aisle lately, there's 1,000 or more products these days. And so, how do we even begin to advise and support our patients in determining what is that combination um or that one product that's going to work best for them?

Yeah. And so, thinking about again back to the eye care approach, when I get asked that question, there's a lot to unpack there. Um, and so that definitely is the R requesting more from the patient. Where is this question coming from? Sometimes um when when patients are thinking about that one magic product, it's not as much related to their dental needs or dental questions. They're just they're busy. They're stressed. um they're trying to do their best and they are living a full overwhelming day-to-day life and just need some guidance on what to do. It may not be a specific oral health concern. So, just running down the essential hygiene um routine and and supporting them and finding a moment in their day where they can feel confident investing um the minimal amount of time for maximal effort might become our job.

Totally. Um, but they may have a specific need. Um, and that's where you can start to ask more questions about what what types of products, what types of problems are you looking to solve.

So while there might not be one, you know, universal solution, what is, you know, obviously we have many thoughts, but we want to hear from you directly as you go down this list, what are the top things you're recommending? This is what you can do to bring your baseline oral health, you know, dramatically higher and make yourself healthier. What can they do?

There are two pieces of advice for for patients wondering about that um ideal product or that one great solution. The first is committing to a routine, a habit. So, good oral hygiene. Um, daily brushing, daily cleaning between your teeth, regular visits to your dentist, um, as well as um just overall healthy habits, eating well and taking care of ourselves. Um, all of those are not, this is not breakthrough information. It's not exciting. Um, and often not the answer people are ready for when they ask this question, but it's the tried and true that we've known for many, many decades, right? That these good habits support overall good health. The second piece is the dental aisle. It is important to find a dental routine and products that that you feel support your needs and that takes some experimentation. So there is so the American Dental Association has actually done a really nice service for consumers when purchasing products and shopping around for products and it's called the ADA seal of acceptance and it's a visual signal on dental products that have been independently and scientifically reviewed and when they receive that seal, it means they they say what they do on their packaging and they do what they say. And so essentially, you get what you get when you buy those products. And it's and so that seal, it's a security measure that people can feel confident that what they're buying is is advertised properly and has been proven to be safe and effective. And from there, then it's just experimenting with your individual pre personal preferences.

Wow. Honestly, that's new to me. And I like that a lot, especially coming from, you know, the understanding that these are people who really are looking maybe for a quick shortcut. We all live busy lives and it sometimes it's not financially accessible to buy a million different products, nor do we have enough time to use all of them. So, it kind of does the work for you and you know what to look for, which I like that it does the work for you. That's a great way to put it.

Yeah.

It's good to have a little truth in advertising, I guess, in that sense. It does help with that. But that's what you just said is also very interesting is that people looking for shortcuts and it feels to me, I mean, I've done that in the past in any sport, right? Like, you know, you want to do a sport, you want to play tennis, you're like, well, which kind of racket I should get, right? Like if I get this racket, I'll play better, right? But the reality of it is that what makes you play better is those habits.

That is it's independent of the tool, right?

I bought a $100 uh table tennis racket when I played Dr. in the finals and I still lost.

So there are no shortcuts and he didn't even know that. But.

Because I had a $300 battle, that's why. That's the message.

It is definitely not the message.

But but you know, all of us are looking for that magic bullet, a short thing. But in, you know, it seems to me like in oral health, the same as a general health. It's just the the the boring, as you said, the boring kind of sticking to you know, you know, the general health is like eating healthy and exercising and, you know, staying away from any of these crazy habits that cause uh that that makes you lose. The same thing with with in oral health, right? Just eating healthy, low carb food and diet and.

I think you've talked a good amount. I mean, in other episodes, especially uh I remember we talked with Dr. for the ADA. You you've talked a a lot um about the impact of low sugar and I know there's not one solution, but you you really believe that that can be an significant, you know, contributor.

Well, I mean, if we just remove simplified sugars from our diets, like just pure sucrose and like that kind of free uh glucose and fructose, corn syrup, and any of that stuff.

90% of decays will go away.

90%.

Yeah. So this is the funny part of it to me is like dentistry is entirely preventive and yet um, you know, as a public health specialist, you know, you would probably know better than I, but so so that's true. I mean, these are the habits, it's the dietary habits, right? And then obviously the brushing and flossing and uh staying away from any, you know, parapunctional habits.

I was going to add one or two more things, which is not about a product, obviously, we know toothbrush, floss, in the diet, but I I'd say like small little things. Is I can, you know, anecdotally, I have a sweet tooth. And so I, you know, I try to eat right 90% of the time. That 10% of the time is sweet stuff. And so for me, it's not about not doing that. It's more about what can I do after the fact to prevent problems so I don't have to show up at Dr. Chair for a root canal. But the what I always say is, you know, my friends ask me is, you know, whenever you have something sticky or super starchy or, you know, a sugar basically um, what you can do is, you know, you don't want to necessarily brush your teeth within, I think the data shows about 30 minutes is when the when your tubules can can be um affected by the acid, right? Just rinsing your mouth with, you know, maybe lukewarm water can do a lot to just bring down the um the source of the the that the bacteria used to create the what we call through the caries activation process. So just a simple rinse with water can do a lot and then obviously for aesthetic purposes, it can be the same. You know, we talk about.

Teeth being like, you know, like a white t-shirt, you know, red wine, coffee, tea, a coke.

All those things. If you can just do a simple rinse, um, they can go a long way. I don't know if that's interesting to people, but some people who care about uh, you know, eating their cake, this this can help. Yeah. Yeah.

You know, that that does remind me. There is maybe there is one exciting tidbit that we can we can mention that one magic tip um if I had to pick one that's backed by the science and backed by policies around sugar now um worldwide is um.

Avoid or drastically reduce consumption of sugar-sweetened beverages. So, sodas, um, juices with added sugars. Um, for children, um, there are really great alternatives now that as a parent, I can say my daughter loves just as much where there's a fraction of the added sugars in an entire serving.

Um, it's it's remarkable the options out there and that is something that people can start doing right away and it will make a difference.

Yeah. I mean, it's the new dietary uh um kind of a pyramid that was just announced and in fact, we're going to have the parent come talk about that next uh week in the next session. So that that should be exciting to talk about. So they removed soda and sweetened beverages completely from the pyramid. That's really important.

Really important.

All right, let's move on. Let's go to the next one.

Let's do it. So we're almost halfway. We're coming in at number six, which is a pretty interesting question. It's does brushing harder clean your teeth better? And while it might feel like it does, I feel like I have to say the answer is not always yes. And if anything, you might be causing more damage and harming your teeth and your gums more than you think. And as you're doing that, it might actually lead to other things to stick to your teeth, wear them down, and then in fact, they become less clean, which is kind of counterintuitive when you think about it. But I have to I have to agree that I would think this too. Like I feel like when you're brushing it, it I kind of kind of put the two things together. If I work harder on something, I might have a better outcome. And I can understand that and it might feel cleaner, but I might actually be harming myself in the process. And so while I think there is a lot of good intention behind this one, um what we might end up doing is causing abrasion to our teeth. And we find that, you know, we're wearing down the teeth. We're wearing down the gums and they're therefore becoming more susceptible to the things that we are trying to avoid. And our teeth have our enamel is pretty strong, but the truth is it doesn't grow back. And so once we wear it away, it's really hard to.

Come back from that. And I think we'll touch on this in a few other topics when we come to fluoride and our maximum ways of protecting our teeth. But I think there's a reason that dentists do tell you it is best to brush for about 2 minutes. I think duration is important. I think technique is important. Kind of angling your brush 45 degrees, kind of getting along the gum line, choosing a soft to medium bristle, going around those fine movements, even using an electric toothbrush. Electric toothbrushes, they do the work for you. And I didn't even know that. I was I think I might have been over using my electric toothbrush. I was like brushing and it's vibrating. So, there a lot of ways to fall into this trap, knowingly and unknowingly, but I I have to lean towards brushing harder does not always clean better. And in fact, it might come down to the type of toothpaste you're using, whether or not includes fluoride, your genetic susceptibility, other reasons that fall into, you know, your susceptibility to having um carries or, you know, plaque and all of these things. But >> I think no. But tell me your thoughts. I mean, I'm coming in as a So, I'm sure I mean that's that's in the public health domain. Dr. Seymour could probably say it better, but I mean the question here is more about frequency rather than u strength or hardness cuz you know you don't want to be eroding your enamel as you just said and plaque itself is not that hard to remove if you do it frequently enough before it hardens into calculus and into tartar and that kind of stuff. So, I think more importantly, you want to do it more frequently. Uh cuz it's easy to remove with like soft bristle brushes. But, um and that's the mistake is if you actually use something too abrasive, it may be possible that in the short run it could remove the material a little bit better. But the harm it does to your tooth is kind of reaching that point of diminishing returns in whatever activity you do. So, I think that's probably the key thing is to to focus on soft bristles and more frequent brushing like at least daily. >> Yeah. you know, as opposed to, you know, trying to take it all out in one week at the end of the week, but using something like right before you see your dentist. >> Exactly. You know, the same thing on your cast iron skillet, right? It's the same thing you So, what do you think, Dr. Seymour? >> Yeah, I agree. So, so plaque is what builds up on our teeth after a meal. And it's a soft film. And so with just a reasonable amount of pressure in a soft to medium uh toothbrush choice, it it's relatively easily removable. Um but after about 18 to 24 hours, it can start to harden. And I think that's where people then see this buildup that's stuck in their teeth. They're brushing harder. But at that point, it's really more likely calculus or or that hard substance that really needs to be removed by a dental professional at that point. >> Right? I think they say it's like about after about 400 g or 4 newtons and I know nobody on earth can measure that with their tactile sensation, the efficiency of the toothbrushes lost because the the bristles will collapse and slay and then all of a sudden so you know the the the bristles aren't doing what you're asking them to do. So you know in one line the answer is obviously as you said Rowene you should not brush harder. In fact slow down calm down try to take it slower. I am a another anecdotal example I am a victim now with the implant of the root canal. I have recession. I have recession and it's jarring because I brush and floss religiously as you might imagine. >> And um you know every time I see one of my uh colleagues who's a perio specialist I won't name her name. She, you know, makes me aware that I have recession and and I know it's because I have an electric toothbrush. I'm overcompensating. I'm trying to, you know, overpower the the strength of my, you know, unbranded toothbrush. I won't say the brand. And we know that the the bristles, you know, aren't able to do their job. And so this sticky soft bofilm doesn't require a whole lot as you said. So, if you can just slow down, calm down and increase the number of times and the number of minutes per day, I mean, 2 minutes is for a reason. It's because that's how much time it takes to get through all of the the surface area of your mouth. >> Um, I think you should be okay. >> Yeah. And twice a day. Yeah. Twice a day. >> Twice a day. Two minutes. >> And if you're going to do it once a day, the most important time to do it before you go to bed, after you've had dinner, right? Because you know when your mouth is closed for that 8 hours time that you're sleeping that's a great incubator for bacteria to grow. >> So it's super important to um to brush and floss uh right before going to bed. What's from you guys? So what's the sequence? Should you brush first or you should do floss first? >> Oh, I get that question a lot. >> Wait, what? I don't I didn't know this was controversial. I brush first and then floss. Am I doing it wrong? >> Correct. That's what I do. >> Okay. Okay. >> Correct. >> I have another question then. >> You got 50/50. You got it right though. >> Do you brush first and then eat breakfast or do you eat breakfast and then brush first? >> You always brush first. We know that. We know that. Okay. I just wanted to >> What do you guys do? >> I get this question. >> Why you know I mean it's kind of like I was going to say it's like going to the bathroom before going to the shower. >> No how you do it. >> Brush late and then brush again. It's simple. Or you just don't eat breakfast. >> I go straight to the coffee. >> No, but after you eat, you got the food in there. >> Of course, if you're But I don't eat breakfast, so it doesn't matter. But >> you got to brush again. You got to be >> to the normal tone here so I can cut it properly. Okay. >> How But you see the thing is you may dental school has messed me up. I got to get up and I'm like, I have to brush my teeth cuz I've been overnight >> and then if I eat, you just have to, you know, go brush again. Well, the only problem just that, you know, after you eat, you have substrate for the food and plaque, right? So, that's a goal if you remove it then with brushing that you've done something. But if you brush before you eat, then you may have better breath at the breakfast table, but you're not >> a there's food you have to brush again. It's just, you know, are we are we recording right now? Is that a lot of >> There may be others who are I really grappling with these. >> I really get a lot. >> So, we could talk about the science. I agree. um before bed, removing the food source for the bacteria by brushing before bed is effective and then you have less worry when you wake up because you haven't introduced a new food source to the bacteria. If that helps ease your concerns about do you need to brush immediately when you wake up. >> I like that. >> The other thing is saliva is our natural our body's natural cavity fighter. It has anti- cavity properties and our salivary flow um is greatly reduced at night while we sleep. And so we really do want to give our bodies the best fighting chance when we go to sleep. So absolutely if you're going to choose one time, which that hurts to say because I really want to see everyone brushing a couple times a day, but I agree. If you're going to do it once um before bed is is the optimal time, >> right? Because you have imagine if you eat and you have all the food and then your mouth is closed. You have zero stone. I mean you have less salivary flow and you got a warm place that's like you know bacteria sitting right >> my take-home >> should you brush or should you floss first? In all my years as a dentist and a public health expert, I've never been able to tell the difference if a patient brushes or flosses first. But I can tell the difference if a patient does both or doesn't. Yeah, that's a great way of putting it for sure. I mean, >> you have to be more of a zealot to kind of argue over which comes first, but but I think the the the what what people have said is that, you know, brushing could potentially push more food between your teeth, which will then after if you've done floss will help remove it. Who knows? >> Can I just say one thing? It's making me laugh cuz I went for years flossing and then brushing and then I switched and I thought about this. I thought it was completely inefficient what I was doing. And I know you just said that, but I felt like I was flossing first, so I had extra work cuz, you know, when you brush, there's some level, it's like a, you know, sweeping before you mop. You're trying to get most of the stuff out, >> right? >> And so I would floss and I would spend, you know, 7 minutes flossing cuz I would keep finding food, you know. I'm sorry. But then I realized when I'm brushing, it would do like 90% of the work and I'm not going to not floss. So I would I would I would go in kind of as like a, you know, backup um to make sure I'm getting the interroximal areas and taking care of my teeth. So that's why I switched to the brushing and the flossing because it was an efficiency thing. >> See, it's just experimentally it was called selfobserved experimentation. All right, so Rowen, go with the next myth. >> All right, let's take it away. I love it. Let's take it down to our halfway mark. This is running along the lines of a few things we've talked about. We don't have to take it too long. So, number five is, do lemon juice, baking soda, or other DIY whitening tips actually help you whiten your teeth safely? Again, leaning towards the answer of no for a few reasons that we've already talked about. You know, we are running the risk here of damaging our teeth at the cost of marketing that got us efficiency that we're trying to take advantage of uh cost savings that might come with this. But at the end of the day, we might be doing irreversible damage to our teeth. And that is something that we can't get back even at the benefit of some of these other things that seem initially appealing and enticing. But have you guys seen anything like this in the clinic or do you have any stories or thoughts on the topic? >> So I mean you know hydroxy appetite is a crystal in our dentin and our calcified tissues that has a certain pH at which it mineralizes and it it breaks down right. So that's the demineralization that we talk about when we talk about um demineralized enamel which is like the precursor to getting a cavity right that's how actually how the bacteria attach to your teeth. They take the sugar, the sucrose, you know, so they break it down. They use the fructose to stick to your tooth and they take the the glucose to ferment and create lactic acid, which is what actually reduces the acidity of the mouth and that's what causes demineralization, right? So to me, the idea of then using an exogenous acid yourself like lemon juice makes little to no sense, right? Because your goal is generally to keep the oral cavity alkaline to the extent that is possible. So you can continue to have mineralization as opposed to demineralization. Right? >> So beyond a certain thing, you know, a pH usually around 5.5 or so, you end up having demineralization take place at really significant levels. So I don't see why you would want to have lemon. I mean, you know, again, in moderation and if it's diluted, lemon juice is diluted into a large bottle of water or glass of water, then the pH is not going to be all that that low. So, therefore, it's not a problem. But the idea of just, you know, consuming a lot of acid. That's why my son loves uh these uh um um Juicy Pops and like the CVS stuff that Oh my god, it's like orange. >> This is true. Sour. >> Sour patches. Oh my god. Sour patch. >> Sour patch watermelon. you're listening. >> I just salivated when you said the word >> your dental license right there. >> You can't, >> you know, we got to live our lives. But but you know, I I think we're going to say something about uh the um idea of the doyou yourself whitening. But before you do, Dr. Seymour, I think >> like a lot of people always talk about baking soda as a toothpaste, like how do they mix it into their toothpaste? >> Yeah. And I think the idea is there that it's supposed to be a natural um you know what do you call it um tooth whitening mechanism and and the reality is that true um teeth whitening true bleaching allows for penetration into the enamel with the dentinal tubules whereas something like baking soda is just abrasive and it just kind of the bicarbonate allows you to remove the stains superficially. So there's not really any true deep penetration of the of any bleaching material. So there isn't really long-term effect of whitening. So it might superficially help, but it's not giving you the results you're looking for with a zoom whitening glow glow science or whatever else that you're using. Would you agree with that? >> I agree. I want to go back to something roen that you said as well and and tied back to this idea of abras abrasion because >> I learned actually in dental school the hard way with one of my patients about the harms that can come from DIY whitening. Okay. And um she you know she had had some early success in removing stains using some of these at home abrasive products. >> Um which she thought was >> tied with >> I don't think it was tied. >> No, she was using lemons. Okay. Um and in a kind of a homemade lemon substrate. And initially it removed some surface staining that she had which she then thought, "Oh, it's actually the chemical whitening that I think patients really are thinking about when they're thinking, I want to whiten my teeth. They're looking for that shade change, not just the stain removal." So she what she ended up is repeating this process and actually got some enamel erosion. And now as we know some patients may know underneath our enamel is dentin which is the shade determinant for our teeth. Our dentin has a yellow shade. So she ended up um actually at first she thought the whitening was successful when she got the stains. As she continued this DIY method she got she removed her surface enamel so her dentin started showing through. So then she thought oh my teeth are stained again. got in a cycle and we actually had to do some restorations to repair the irreversible damage that she had done to her enamel, her two front teeth. >> Oh yeah. >> You know, when we do bonding, we use phosphoric acid, right? And you get that etched like white look to it, but but that's pitted. That's like essentially the demineralized enamel that is pitted. That's why it looks white. So you end up getting that white, but that's a temporary look until you cause enough damage where you get to the to the enamel. So, sodium per borate or any of these other bleaching agents that we use are not acidic. They're actually they just, you know, they essentially remove stains by um working on the double bonds on these stains. But, um but yeah, I mean there's just it's so important to understand some of the chemistry of this stuff that's going on because otherwise you end up causing yourself so much harm without knowing it. >> So, we talked about abrasion. Now, we're learning about erosion. Talking about pH, we're going down 5.5. You're demineralizing your carries. under four, you're leading into erosion here and we're really wearing down our teeth and we're not getting that back. So, I think the takeaway message here is see your dentist if you're trying to get whiter teeth. It's a cosmetic procedure and I think it's something to be taken pretty seriously because it could come at the cost of the health and longevity of of your teeth. And we said we're trying to save teeth here. We have our two-ended honest. We don't let them go easy. >> But don't use acids at home. I mean, unless you're having someone supervising and understand what they're doing, right? cuz you know >> talking about tooth protection. Let's lean into question number four. Big topic. Is fluoride harmful or unnecessary for our dental health? This is this is a big topic. Fluoride and water fluoridation. Um I think a lot of us get questions about the uses of fluoride. Bottom line, I'll say right off the bat, um, fluoride is is a natural element. It's found in all natural water sources and it's it's literally nature's cavity fighter. There's it's one of the the most successful public health interventions in the US. It's considered one of our top 10 achievements in public health in in the past century. um because it's a it's naturally found in our water sources and it has been demonstrated to um prevent cavities and to reduce um cavities by 25% or greater in some in some people and populations. >> Is it harmful? >> That's a big question. And if you look at the history of community water fluidation, um the the is it harmful question has come up, you know, every decade, but the question around what type of harm has varied over time. I'd say more recently there's questions around does it have an impact on IQ or neuro development. That's probably the most recent concern. I think historically there were concerns around does it cause cancer, does it cause thyroid problems and all of those have been very it's it's one of the most well studied public health interventions period not just in the US public health systems but period and um those have all been shown to not be concerns um so so the latest harm that seems to be um the more recent concern is around neurode development and I will say this is this is the time to call back the eye care approach. There's there's a lot it's it's rampant the misinformation and there are literally um info wars online about this topic and there's been documentaries made about this topic and books written about this topic um on all sides but also on the wars if you look up fluoride wars um it's a very contentious subject. It doesn't have to be. And that's all the more reason why when we are sitting with our patient face to face to really kind of turn down the heat on the topic and lean into the eye care approach and the topic of fluoride and specifically water fluoridation was actually the primary motivation for for why we developed the eyeare approach because it really did require um a different approach other than just debunking and talking about the science. Wow. >> So, um, Dr. Seymour, I mean, we we've talked about this topic a lot on the podcast and, you know, there's no question of how how much this dominates a news cycle and it's it's it's on everyone's mind. So, I think stepping back, maybe we can get into the science a little bit, maybe we can get into the philosophy of it. Some of the push back has been you know why do we need it to be in our you know common community water supply when we may get enough of it in sources of uh you know naturally from food or from um our toothpaste or other exogenous sources when there are even any signs or any possible correlations between neurocognitive issues and IQ related anecdotes. Why why would we put it as a blanket statement into our water supply? Well, how do you answer that question? How do you respond to those people? >> It already exists in our water supply, right? >> Um, as I'd mentioned, so fluidation is really the practice of adjusting it to optimal levels so that populations, people experience the benefits, the protective benefits without risk of any harm. So at the proper levels where um you know my daughter's born in Boston, grew up here in Boston drinking our tap water um and so she's I think a wonderful example of having experienced the benefits of community water fluidation um but without the risks. And so at optimal levels, um, the best available scientific evidence that we have and with my daughter as a case example is there's there's isn't a risk for these harms that you just described um, in the water. And I will also say that the number one reason, one of the top reasons for missed school days in the United States is for dental problems. Either because kids are um in pain or experiencing infections from dental problems or because they have to miss school to have their dental problems taken care of um by the dentist. So that's a leading reason for for kids being out of school. So, if we really want to be concerned about the health and wellbeing of our kids, let's keep them healthy. Let's keep them in school so that they're learning and and thriving in math like my daughter is. Um, I'm a proud mom. Uh, but I think she's an excellent example. And so, thinking about the eye care approach, I have a lot of parents that want to talk about this topic. And I always say a curious parent is a committed patient, right? They are committed to their health, to their kids' health. And that curiosity is our window to really connect and build that trust with them. And so, so I'm leaning into that identity of a parent that has seen a lot of scary things out there and is just trying to make the right decision for their family, for their child. I'm connecting as another parent and sharing real stories about my own daughter and that I would not advise my patients any differently than I'm advising my family. >> Yeah. And at the end of the day, this is one of the most effective ways that we can protect entire communities who otherwise may not have options like accessing the dentist or like affordable toothpaste in their communities. And so community water flidation, it's a public service that has been shown to reduce cavities and protect. >> Yeah, it's interesting. >> For you, it's an access to care thing. Is that how you see it, Dr. Net? Well, I mean, yeah, it is true. I mean, I feel like the Floyd argument revolves around the fact that we're trying to reach a segment of the population that does not have access to proper education about oral hygiene and and so on early on in life, right? So, the children cannot um get the proper toothpaste with the right amount of fluoride and have use it and so on. So, this is one way of achieving them. So it's a form of maybe some people would call a community pharmacy to have a target for a specific segment that has difficulty access to care or um be able to to achieve the optimal outcomes of health for their oral cavity and then the rest of us use it too. But to me I mean an anecdotal point the same thing we g you know I in Boston my my kids my family we all just drink tap water. So, uh, I have no problem with it cuz we know that the levels of the fluoride in that water is so low that it's really insignificant. And the funny thing to me is that, you know, we continuously keep forgetting that we all come from the jungle of the savannah drinking from like, you know, little ponds and like rivers and like open natural thing full of bacteria and things. And our lives have become so sterilized that we've kind of lost touch with the reality of what this body has been designed to do over millions of years of evolution. Right. >> Right. We think about like this one chemical is going to be our demise. And yet like our ancestors have lived through eating drinking out of mud and out of like everything that they could have found water in. So I I feel like some of our fears are just kind of modeling as we were talking about. us like people that have said something and we hear something and you know we have no source of appeasing our inner anxieties as as homo sapiens and we kind of grasp onto these little things that tend to have a short quick answer based on things that we hear right so to me it's an to me I mean drinking out of I mean know we're drinking out of these plastic bottles right now it's far less environmentally not us drinking from glass but like you know all the microplastics and the environmental, you know, u cost of having all of these things ship and move around to me is like a much bigger problem than maybe potentially getting a little bit of fluoride in the water cuz I know the body's going to be able to deal with it. So these studies sometimes, you know, create a little bit more confusion, but to me, if we just go back in time and look at the history of people drinking this and, you know, the lifespan keeps on going higher and higher despite all of this stuff. So I mean to me it's not a big deal and maybe it's a small price to pay to protect this segment of the community. But you know I at the same time I can also understand the argument for choice that people say that you know well what why can't we just provide more fluoridated bottled water to a group of people um and then everybody else should you know or have something that they can add to it or just you know pills or whatever. So I mean it's it's a it's a difficult argument. >> I I think your point Dr. Dr. Seymour is spoke to me because it's like you know the question is like what are the pros what are the cons and do the pros significantly outweigh outweigh the cons and then you know what let's say everybody had the choice to have it you know have fluoride in their water or get the right dosage of fluoride would you still as dental professionals recommend it and I think my answer your answer is yes we would so it you know whether you're getting it in your community water supply or not we would still recommend x percentage you know I think it's point what is it seven parts per million. Um and the reason is the science is the science is there right fluoride increases the uptake of calcium and phosphate >> and through that we get fluoro appetite and that creates pre you know prevents demineralization. So, I think when the science is clear, um, you you you can you can kind of advise accordingly. And I I do get that some people think, you know, would say it it I'd want to control what goes into my into my body and I and I can I can appreciate that. But I think when the science is so clear, ultimately the advice will be the same. So, let's help the communities that that don't have the access to get it through other ways. I think you know what you're saying is completely valid. >> Absolutely. I think the point of choice is worth pausing and sitting with for a moment though because that is really I think the tension in public health is public health is really looking at population level interventions and so there's this natural tension between individual choice and public policies to protect the population. Community water flidation is one example. Um seat belts is another example. >> Repelments you when these were introduced because motor vehicle accidents were the leading cause of death several decades ago and when policy requiring um driving safety laws such as seat belt laws were passed. There were protests about seat belts. There were protests about using car seats for kids. So this is a long-standing very natural, very normal, although no less frustrating tension for public health interventions. this tension between individual freedom of choice and our um freedom comes with a responsibility to protect one another. And this to me is an example where we have something that we know works and it's our responsibility to protect ourselves and our communities. >> Great point. >> Yeah, great point. >> I think that's beautiful. So I think it really comes down to the answer is >> yes, you should be using it. Can it be harmful? Potentially. Like anything, right? if we overuse it, overdo it, we could probably cause some harm. But if you're curious or worried if you're overusing it, it seems like it's not a terrible question to bring up to your dentist and just ask them. There are some numbers that we can look at. We can talk to we can we can learn a little bit more about lifestyle. What type of water are you drinking? What type of toothpaste are you using? And we can work through those questions, I think, with our patients in order to kind of both of us to make sure that we feel like, no, like you're at a good level and this is important and and we feel pretty confidently about that. I would say that's what it sounds like. Okay, cool. We're moving into our top three. This is pretty exciting. >> And this one takes us back to Dr. Cotch's story about walking into the toothpaste aisle and seeing an entire section of charcoal toothpaste. We don't have to sit with this one for too long because we've touched on a lot of similar topics, but is charcoal toothpaste safe and more effective for whitening? >> For whitening or blackening? So, go ahead. I mean, I think we pause here and I don't know, honestly. >> You mentioned this earlier. You were saying that homeopathic, all of these things that are marketed as more gentle, you know, aren't really always as gentle and good as they seem. So, >> Right. Exactly. >> Yeah. I mean, that this is a very interesting point about charcoal, for example, is that, you know, the way I measure some of these homeopathic recipes and the way some people advertise out there to to use different things is the net potential negative effect. Right? Some things to me are they don't have any positive benefit. Proven, but they don't have a negative impact either. So, you know, somebody wants to try them on their own and, you know, it's just fine. But there are other things that could have potential negative impact. I think charcoal um you know, we're using it for whitening. It goes back to what we just talked about the use of acids such as lemon juice and things like that. Uh the acid will demineralize the dentin and in this case, charcoal will actually be too abrasive. We touched on the frequency and the force required to do proper brushing and we just we concluded that it's not a good idea to be brushing too hard because of the potential for abrasion of the enamel and pulling that away. And the same thing goes with charcoal. I mean, what's more abrasive than charcoal, right? It's fairly abrasive and therefore it may give the impression that it's making your teeth white, but it's making it white for temporarily the same way with acid until you erode all that enamel away. Now you have no protection on your teeth. >> So the key and that's one of the sciences of toothpaste design is how much abrasive material would you put in a toothpaste so that it's >> able to optimally remove the the the the plaque or stains without actually araiding enamel. >> Charcoal was not designed for you know for cleaning teeth and therefore it could have a very negative delterious effect on the overall um integrity of your enamel. So I I don't recommend that. But, you know, other things such as like people who like to do coconut oil pulling or any of these other things, you know, it may not have any negative positive effect, but I mean, you know, it doesn't really have a negative effect either. You want to be squishing oil in your in your mouth for a little while. You know, it's so that's to me that's the one thing that's a key thing. To what extent are you just being put on by some of these recipes and to what extent are you actually harming yourself? You know, that's a key thing. So I think charcoal is more on the side of the harm. >> Yeah. >> But um you know, so that's my opinion. Do you guys have a different opinion on charcoal? >> It's great for grilling by the way. >> Yeah. So some positive some some negative. I would I would completely echo your sentiments and um I know they've gotten a lot of steam on social media. I think you know again if we follow Dr. Seymour's eyeare approach we can you know kind of honestly evaluate each of these things. But if you're I I would assume most of the people most of the patients who use these are looking for, you know, uh some sort of aesthetic outcome. And I think that you're not going to achieve that with charcoal, point blank. So, um you know, you could use overthe-c counter whitening strips, you get teeth whitening from your dentist. Um you could practice better oral hygiene, but charcoal won't really give you the whitening effect you're looking for at that level, right? >> It's just about abrasion. Like you could use sandpaper, you could use sand, you could use all kinds of things to to to to clean surfaces. The question is, what are you removing along with the stains, right? >> Yes. And can you get it back? >> Yeah. >> Yeah. >> But doesn't grow back. That's >> natural doesn't always mean gentle. That's a really good point to keep in mind. >> Every time you think of a, you know, snake poison, you realize it's very natural, but you don't want to have it in you. >> That's a good point. >> And I feel like it's easy to fall into trends and we have to understand that. And I mean, we've all probably done it. And you're right, some things don't have a net negative effect and and we can move on from them and the new trend will come and it's fine. But there are some things to pause and sit with and make sure that we are, you know, not having something that long-term we're really going to regret. And it's very easy to fall into those quick success stories. I post a Tik Tok video. Hey, I just tried charcoal toothpaste. Immediately my teeth are so much whiter. Wonder why a whole layer is gone, you know, and I can't get that back. >> That's true. Do you guys remember that phase when we had fidget spinners? >> Oh my gosh. Yes. Yeah, >> I was going to say is that we still have them. Is that is that still going on? But it used to be a craze. That's true. >> So, I feel like that's a nice microcosm of humanity. So many of us really need something to keep us busy doing things. So, it's like you want to swish coconut oil, you want to do it. So, as long as it doesn't hurt, do it. Who cares? >> I got a great one at the Yankee Dental Conference. I'm not going to lie. I won't name the company, but I I I appreciate the company for making it. Actually, you know them very well. They're uh they make a great fidget spinner. >> Not a product. >> Take home message. >> Yes. It's not great. >> Go ahead. So take home message is >> take home message is Yeah. >> Use charcoal for your stakes. >> Wait, this we're going somewhere. >> Do that again. Do that again. Take home. >> Get a fidget spinner. >> Yes. So, so the take-h home message is to, you know, use charcoal on your barbecue and enjoy the smoky uh taste of a nice uh grilled steak, but do not use it on your teeth. >> You had me for a second. >> Absolutely. >> Yeah. All right, let's take it down to number two. This is a good one. Uh I think I think you guys have probably experienced uh this. So, can antibiotics alone fix a tooth infection without having to see a dentist? That's a very good one. >> I understand trying to avoid the dentist. I actually think it's a very common thing. And I think again, we all love a quick fix. We all love something that we can get and just make us better. Is that is that true? Can that happen? >> The answer is uh the answer is no. >> No. >> Antibiotics cannot solve a dental infection. And we talk about this a whole lot. Dr. Nasa, right? And endidonics. I so the answer is if you think about the logic of how you know antibiotics work they rely on blood supply and so you know you take a you take your tablet of amoxicyliners it travels through your bloodstream and it gets diffused locally in your capillaries and it you know you're imagining going right to your tooth structure but when you have a tooth infection often times that tooth is necross it's dead um meaning the the local blood supply is shot off and so there's no actually there's not an a you know an efficient or probabilistic way for that, you know, antibiotic to be delivered uh into the sight of the problem inside of the tooth because there's no blood supply. And so, you know, the source of the problem is coming from inside of the tooth, inside of the root canal system, and we must do antidodonics or root canal therapy to solve our problem. And you can imagine uh you know, the times where we would suggest antibiotics, you know, if you have a swelling, fever, you're developing these systemic signs and symptoms. The reason is because the antibiotic can travel close enough to target the bacteria in that area. Um, you know, so for example, if a tooth has an abscess, often times that means there's, you know, some protective barrier, some inflammatory cells in that area walling off the access to the to the antibiotic. And so we do we give the antibiotic so that it can lower the inflammation in that area and hopefully aid in some way towards your pain and discomfort. Um, but the root source, the problem won't be solved without root canal therapy. >> Yeah. Right. >> No, no, I agree. I think you you put it very nicely again to just kind of u define the question as to to dealing with dental infection right the the the key is to obviously have a proper diagnosis first and that's part of the problem of self diagnosing and taking medication is because I mean the question is what is the source of the infection right as as Barca just said if the source of the infection is an infected tooth and if it's coming from inside the tooth which is a root canal problem then you know the antibiotic won't get inside the tooth and that's temporary relief because it'll get the infection outside the tooth. But since the source is inside the tooth, it'll reconstitute a little bit later down the line, right? But there could be also the source could be a periodontal problem because you know the infection could come from different sources in which case the antibiotic again alone can help because again there's a source for that parodonal problem which is the bacteria on the surface of the tooth, right? So that needs to be kind of cleaned and removed as well. But you could have like kind of a temporary infection due to some kind of laceration in the gum or in the uh oral cavity issue in which case you know if there is systemic signs maybe an antibiotic would help. The problem here is that this should not be self diagnosed and it should be a professional who can see and kind of triage to see what is the source of the infection and then you know maybe if needed give the antibiotic along with the appropriate long-term solution for whether the tooth should be you know root canal should have parodonal treatment or it should be extracted and replaced with a non-metal no >> ceramic >> that's right >> I mean yeah and I get it. I mean, I can imagine from an eye care perspective, I mean, root canals can be expensive. Treatment can be scary. Um, what do you say to a patient who says, "Well, I had a friend who took an antibiotic and their pain went away. You know, why can't I do the same?" >> Yeah, it's the system one and system two thinking in our minds. You know, we always get short-term solutions versus long-term solutions, right? It's it's easy for us to think in terms of the um this is Daniel Conorman's actually Nobel Prize winners e psychologist who had won the Nobel Prize in economics who wrote this book thinking fast and slow and kind of essentially divides our way of thinking about the world in these two different mechanisms which is reflexive short-term thinking about the answer which is kind of well my friend took it and therefore X and Y as opposed to the nuance of what is really happening with this with the friend who took it and what were the mechanisms that led to the result which is kind of a far more detailed you know explanation. So I mean um you just have to as Dr. Seymour has said to kind of recognize that people will have that kind of system one system one thinking who are not trained in a complex kind of a healthcare situation and in fact I feel like most of the dental myths revolve around this type of system one system two >> I was just thinking that this seems like a huge theme thinking fast you know the quick fix of oh this DIY thing made my teeth white oh this this took away my pain but really at the end of the day did you wear down your tooth did you really treat the infection or are you just hiding the symptoms? You know, I think that's a >> we all want quick answers. I mean, look at the internet. Everyone wants to get rich quick. >> I was going to say this is not unique to dentistry. >> No, of course. Yeah. >> Yeah. >> And I and I think the other thing to your question is, you know, what can it just solve the problem? Maybe sometimes clinicians will recommend antibiotics when they can't address the problem, you know, fast enough or quickly enough or they can't be seen due to scheduling conflicts. So they want to manage the situation, manage the the bacteria outside of the source of the problem to to to lower the swelling and prevent exacerbation of the problem. And so if you think about a quick patch, you're going to deal with this problem, you know, in a week, two weeks, 3 months, a year come, it'll come back worse than it was before. And it will cost you more in terms of time, energy, money, resources, and happiness. And so I think a lot of times the right decision is always kind of what seems to feel like the harder decision. So you might want to do what you think is is harder now but better for you in the long run. >> I think you did a great job there by just kind of tokenizing and explaining it in their shoes, right? That's basically what you're talking about. Like this is what's going to happen to you >> if if you don't follow. I think that's a that's that was that's kind of an I care framework >> as opposed to my system one thinking and system two thinking that like nobody cares about. >> I saw myself in that explanation. We're all like, "Yeah." >> Okay, terrific. So, where are we at now? >> We're coming in at our number one most important question. Is oral health really connected to systemic health. >> That's the basis of the so-called holistic dentists, right? >> Yeah. >> Yeah. >> I mean, >> dive in. >> I guess they're not completely wrong. I would say that approaching dentistry, even from the beginning, I felt as though it was the portal to the rest of the body. I felt like this is a place where a lot of us start or a lot of us end. It is connected to everything else we have going on. And while there are studies that certain things are more linked, you know, we can talk about endoc endocarditis. We can talk about diabetes with periodonist periodontitis. Those are a really big link. Uh pregnancy, >> we have some things that really come into play. But I think at the end of the day, we were talking about medications and how that can affect your saliva production. and we were talking about what you're eating and what you're eating affects not only up here but everything down here and after you eat it comes sometimes right back up and these are things to really be cautious and and care for. I mean a lot of the times we might overlook how

Much we can really change our overall health through taking care of just our mouth and vice versa, taking care of our overall health to also simultaneously take care of our mouth. So I think they are way more linked than we might think. I think even as you know, trained professionals, we have to learn about the rest of the body before we can really specialize in what's going on up here. I like to think of dentistry as we've already specialized in medicine, um, and just taken a few extra years to really focus on this because there is so much going on in here. We've talked about all kinds of species of bacteria and and all kinds of different terminology that comes with just this small environment where there are so many things growing.

But maybe you guys have, well, should say because I mean, that's been really the essence of our school, right? I mean, it's part of the mission and the vision of the school. So why don't you talk about this overall vision that our deans have had, probably from the very beginning of the school, from the conception of our of our school and our program. We were the first dental school to be formally affiliated with a university and and with a medical school. Um, we've always really recognized dentistry as a part of medicine, just what you were saying. Um, in public health, when we're really advocating for access to care and and for oral health benefits to be covered for people, we we say put the mouth back in the body where it belongs. We're not, we don't just carry our mouth out here separately. Um, it's all very much interrelated. And yes, our mission is, um, to to improve oral health through the integration of of medicine and dentistry because they really can't be separated for the good of either one of them. They're they're so synergistic.

Yeah, absolutely. And this is precisely why I always have this beef with people who identify as holistic dentists because to me, it's a redundant term, right? All dentistry should be holistic. It's a red thing to say that I say that's dentistry. Holistic dentistry is dentistry. Then everything short of that is tooth carpentry. It's basically people who think of the mouth as things that you're going to drill and fill and do this kinds of stuff with. But the reality of it is that as as Dr. Sever just said, I mean, the mouth is not something that's out there separate. It's the, you know, it's the entry to the thing, but it's it's inside the body. It's all a part of the same system. And teeth are organs. I mean, we they are literally organs. We call them organs and made up of the same kind of tissue. So to me, the problem again, it goes back to what was talking about the differences in language usage and terminology.

It's just that maybe at some point in our past, dentistry decided that for whatever reason, it would be better to be kind of a separate thing from medicine. So, you know, so that it could have more autonomy and freedom to do what it wants to do. Uh, but in reality, it it is essentially a specialty of medicine. It's just that it focus on the oral cavity as opposed to the other people focus on different parts of the body. Right. Um, and the sooner we realize that the better off we are. And to be honest, I think our profession is also a little bit, some of the professionals might be a little bit to blame in the sense that they have not really treated the field in the same way.

And what Dr. Um Seymour was saying also, the history of our school was that, you know, the the first affiliation as this idea of medical medical dental uh connection, um, was because dentistry had was trying it was coming originally from a profession that was associated more with like the barbers were also doing some of the dental work, right? So, um, but it has evolved since then, become part of the science. It's very different. It's not just a mechanical things that we do. It is an understanding of the biological basis of what we do, which is essentially the same thing as everywhere else. So, you know, we as dentists are a little bit to blame too, and that's why I can understand some patients have a problem with some dentists that kind of treat the mouth as a, um, you know, as a bunch of teeth as opposed to it's a famous saying by one of the endodonist Dr. uh Grossman who says, you know, we should treat the mouth as a as a whole with a W, not just as a whole, which is H O L E. I like that. So that's, you know, it's true. I mean, we I feel I feel that the only reason that it's, you know, not treated that way as a part of the as an integrated part of the body is because of the insurance system.

And and if I had to point to one thing, that would be it. And I think, you know, 1,000%, our oral health is connected to our systemic health. And, you know, we know for sure, there's no question that, you know, problems in your mouth, disease, dental diseases lead to cardiovascular problems, rheumatological problems, endocrinological problems, uh, you know, um, you deal with a whole slew of things and I, it would be too long to name all the associations, but, you know, it's an absolute fallacy to disconnect them. And, um, I think that probably the best dentists I know or specialists I know in our industry are the ones who think about things holistically, even though they probably all should and they don't look at things in a silo. I think it's really important and so this is a number one for a reason. This question is number one for a reason. I think the people, if we can advise patients who are listening or clinicians who are listening, is to take this point seriously because, um, the the people who will be the healthiest, I think look at this as a as as a joint system. They can treat their mouth as a gateway to their body and the clinicians who will probably do the best and probably do do the best are the ones that really think about things as a whole and systematically to quote, um, Dr. Gman.

So, absolutely. So, to our patients, don't forget to mention your medical conditions. Don't forget to mention your fears. Don't forget to mention what you're eating, what you're drinking. As much as it's tied to the rest of the body, it's tied to your dental experience and vice versa. When you go to the doctor, you know, it, I agree with insurance. We are not guaranteeing that everyone is seeing a doctor and a dentist every single year. Twice a year dentist, once or twice a year doctor. So when you're seeing your care team, recognize that we all care about all of your things and your health as a whole. And so when you sit in a chair, feel comfortable to ask your questions, feel comfortable to share your experience. And it's our job to be receptive, to integrate the eye care approach, to think of anecdotes, and to really connect with our patients on an an intellectual and emotional level and all the things in between.

Yeah. Terrific. So, I think this going to wraps it up. It was a very good series. Yeah. And it was enlightening. Do you have any final words for the audience? I say the audience of dentists and the audience of patients. I'd say for patients, there's always going to be a trend of the week and, um, that's that's often all it is, is a trend. I think things that are grounded in science that have been longstanding are less exciting and don't get the views and the clicks, but they get you to health and where we all want you to be. So, um, for the dentists, for the healthcare providers, remembering this eye care approach and if anything, if you remember one thing about it, um, don't go straight to the evidence. Practice other ways of building that connection, opening that conversation first, and then when you've got that opening, it often isn't even necessary anymore to share your favorite study or that statistic you're dying to talk about because your patient, you've already you've already helped them understand, um, through that that powerful story or creating a way for them to see themselves in the conversation. So, um, even if you don't remember the eye care approach, try something first before going to the data and the statistics. Yeah, that's terrific. And I guess for me, for the patients, one other thing I would say is that the internet is full of misinformation and disinformation. Most truth is nuanced and it's not bundled into one quick solution. The getting to the right answers often times requires expertise and and and and dealing with people that have studied these things a little bit more detail. So, it's just find someone that is that you trust and that you feel like when you're in their care that they are taking good care of you and u that might be the best thing that we can ask for.

In the meantime, we're here to keep debunking. Totally. That's right. Drop some comments on some future myths you'd like us to debunk. Terrific. All right. We'll see you in the next video. With every word. A show like no other you've ever heard. Health and hearts we tune into where stories unfold.