Functional Dentist: New Research Linking Bleeding Gums & Cancer! Your Oral Microbiome Can Kill You!

Is there a link between our oral health and our fertility? Yes! This is some of the newest research that's coming out, and they found that over 90% of men who weren't able to conceive with their partners had an oral disease. But those who got treated, there was a 70% improvement in pregnancy!

Now researchers also found that if a woman has gum disease, it takes them 2 months longer to conceive. And I'm the only one who's talking about it. And who are you? I am the saliva Queen, Dr. Victoria Samson.

I am the trailblazing dentist whose data-driven research has uncovered the shocking link between our mouth and some of the world's most destructive conditions. More than 90% of diseases can be traced back to our microbiomes, and we now understand that having an imbalanced oral microbiome increases your risk of high blood pressure, heart disease, Alzheimer's, rheumatoid arthritis, and even men who have gum disease are 2.85 times more likely to have erectile dysfunction.

Really? Yeah, and then another study also showed there's oral bacteria that can make cancer more aggressive and harder to treat as well. But what is it that causes all of this? Poor oral hygiene, sugar, stress, but also some of us genetically will have mutations which can cause disease.

But there's ways to fix it. For example, I had a patient who had terrible arthritis and terrible gum disease. When I treated the gum disease, her rheumatoid arthritis got better to the point where she was actually able to walk again.

Wow! Yeah, so let's talk about what we can do about it. Is there any time when I shouldn't brush my teeth? Do I spit or rinse after I brush my teeth? Chewing gum, coffee, mouthwash—good or bad for me? Let's go through all of that.

So weirdly, this always has blown my mind a little bit: 53% of you that listen to the show regularly haven't yet subscribed to the show. So could I ask you for a favor before we start? If you like the show and you like what we do here and you want to support us, the free simple way that you can do just that is by hitting the subscribe button.

And my commitment to you is if you do that, then I'll do everything in my power—me and my team—to make sure that this show is better for you every single week. We'll listen to your feedback, we'll find the guests that you want me to speak to, and we'll continue to do what we do. Thank you so much!

Dr. Victoria Samson, what is the mission that you're on? Um, my mission is to show people that the mouth is the gateway to the rest of the body, and if they really want to achieve full body health, it starts with the mouth first.

I've never heard of the term oral microbiome really until I met you and went through all of your work and your research, and I think many people listening to this now also probably aren't familiar with that term, and also the importance of that term. So if you had to make a case to someone like me, who’s really unfamiliar with this subject, as to why it’s so important from a very top-line perspective, what would you say?

I think everyone knows that their gut has a microbiome. For the past 10 years, we've always talked about how you can change your diet, probiotics, prebiotics for the gut microbiome. But what a lot of people don't understand is that the oral microbiome is the second largest and most diverse microbiome after the gut. It's also a lot easier to change, and actually it's been shown to have a massive impact on general health.

So having an imbalanced oral microbiome increases your risk of oral diseases like gum disease and decay, but also can increase your risk of other systemic diseases like high blood pressure, heart disease, infertility, Alzheimer's, and it's something that is so easy to manage and balance.

How many people does this impact, and how many people is it relevant to?

So an understanding of my oral microbiome is going to help me in a number of ways as it relates to my overall health. But how many people does it really, really have an impact on? I think it depends on what you're trying to get out of the oral microbiome testing. I would argue that it benefits everyone. We all have teeth, we all have mouths, and everything that we do—every time we breathe, we eat, we drink, we kiss—we are impacting our oral microbiome every single time.

And then every time we swallow or we breathe, that bacteria that is put into our mouth will travel elsewhere to the rest of the body and cause problems. You said it’s the second biggest microbiome in the body. Yeah, how many bacteria are in my oral microbiome?

So you have approximately 700 different bacteria, which make up two billion bacteria overall. And what's also very weird about the oral microbiome compared to any of the other microbiomes is that you've got lots of different environments or niches within the same mouth.

So if you think about the bacteria that would like to live under the gums or at the back of your throat or on your teeth, they're all very different environments. Some are hot, cold, you know, wet. And so you've got lots and lots of different parties of bacteria within the same microbiome in the mouth.

Okay, and you mentioned a second ago that things like kissing, breathing, swallowing have an impact on my oral microbiome? Yes, in a significant way that I need to know about? Yes, so it's more about how often you're doing those certain habits.

So, you know, for example, with kissing, the research has shown that you need to kiss more than 11 times a day for you to be sharing the same bacteria or microbiome as your partner. But also, even the habits that we have, the air quality that we have—all of these factors dictate the environment that our mouths are living in and therefore what bacteria will live in our mouths.

And in the subject of oral diseases and things like tooth decay, how many people are impacted globally by oral diseases?

So the World Health Organization has come out, saying that 3.5 billion people have some sort of oral disease. They've also found that 10% of our world population are suffering from severe gum disease, which makes gum disease one of the most prevalent inflammatory conditions in the whole body.

This conversation around the oral microbiome, have you seen it developing over recent years? Have you seen it become more pertinent to people in society?

Massively. I think I've been doing this for years. It's been something that I've loved, and no one really knew what I was talking about most of the time. They all thought I was a bit of a dreamer—even dentists, patients—they all thought, "Okay, well, doesn't really matter, does it?" But in the last year or two, I've had people traveling from all around the world just to get their oral microbiome tested to understand more about what's going on in their body.

And I think we're seeing a shift in the generations in terms of this new generation wanting to understand their health a lot more.

So we're all sitting there wearing, you know, trackables, wearables. We're calculating how much sleep we have, how much we're eating, and now we're actually also wanting to understand our oral health. So that trust between a dentist and the patient is not necessary anymore. We want to actually understand what's going on in our mouths and actually, you know, be able to track things, see what bacteria we have, how much inflammation we have, our risk of diseases, and what we can do to change that.

Last question before I ask you a more personal question about yourself—what other diseases in my body or implications in my body are linked and can be traced back to the oral microbiome?

We now understand that more than 90% of diseases can be traced back to an imbalanced microbiome. If we zone in on just the oral microbiome, it’s got connections with infertility, heart disease, diabetes, Alzheimer’s, rheumatoid arthritis, and the list goes on—erectile dysfunction.

And what's also very interesting—going back to your question about, you know, is there been a new interest in this in the last few years—we’ve actually been able to show that there is a strong connection and causation between the oral microbiome and general diseases. Whereas prior to maybe 5 years ago, there was a lot of kind of—is this correlation? Is it just that there's the same risk factors with gum disease and with heart disease, for example, smoking? And now we're actually seeing that no! It's not just correlation; there is strong causation between the two.

And who are you?

I am Victoria Samson. I'm a dentist. I do a lot on the oral microbiome. People call me the saliva Queen; that's my name on the streets.

And what's your sort of professional experiences and education that have brought you here today? And how long have you been doing that? How many mouths and how much saliva have you seen? Give me sort of a big view on the wealth of experience you have on this subject.

So originally, I trained as a dentist, and that's six years of training. I would say I was a pretty traditional conventional dentist as I graduated. I’d done some training at the Carolin Institute during my university, and the Carolin Institute is the best dental school in the world—but they're very focused on the mouth-body connection, on testing saliva.

And what they thought was, you know, you go to your doctor and you have a blood test, why don't you go to your dentist and get a saliva test? So from even dental school, I had this in the back of my mind, but I still didn't have the training.

So I just became a dentist. I was working half NHS, half private, and then as time evolved, I then shifted to fully private. Then, when COVID happened, I started doing a lot of research, and all the dental practices were closed across the country, and I thought that was crazy because basically the government was saying dental practices—or dentistry—is not a necessity.

So I thought that was insane, and so I decided to do a lot of research and I wrote a paper which was connecting oral health with COVID complications. So what we found was that patients who had poor oral health or gum disease were at a much higher risk of COVID complications.

And then that evolved into me doing some studies with universities and hospitals, but the issue was that we couldn't go into hospitals and check people's teeth and gums because they had COVID. So instead, what we did was, we would collect their saliva and we would take it to the lab and we had this beautiful snapshot of what was going on in a patient's mouth at that moment in time just from their saliva.

So we did a lot of research and we found that COVID sufferers or patients who had gum disease were nine times more likely to have COVID complications. But also, what I took from that was that why aren't we using saliva, you know, more regularly? Why don't we use this in a more commercial aspect and for our patients?

So after that, I devoted a lot of time into developing oral microbiome testing. We had gut microbiome testing; you've got urinary microbiome testing. You've got every single microbiome has a test, but the oral microbiome didn't really have one. So I built one of the first oral microbiome tests in Europe, and that was a couple of years ago.

And then I came out and kind of left and created my own one about a couple of weeks ago.

That research you mentioned, specifically the research paper titled "Could There Be a Link Between Oral Hygiene and Severity of COVID Infections?" was the first research paper to link gum disease with worse COVID complications. And I was reading that it was the most cited research paper by one of the dentistry publications?

Yeah! So the British Dental Journal is one of the most cited and viewed articles, and what it also helped do was the World Health Organization and SAGE picked that up and they said, "Oh, wait a second; I think that oral health is really important for general health, and also we should reopen dental practices." So this also paved the way for dental practices reopening later on.

What's going on there? Can you explain that to me like I'm a 10-year-old?

So if I have a bad or an unhealthy oral microbiome, I'm nine times more likely to end up in ICU with COVID complications. What's the link?

So there are a few. The first one is inflammation. We know COVID releases a lot of inflammatory markers. So it's what we call the cytokine storm—essentially the storm of lots and lots of inflammatory markers. Gum disease separately is essentially inflammation of the gums.

What gum disease does is it releases lots of inflammatory markers from the mouth elsewhere to the rest of the body. So then when you add those together, and you have your cytokine storm from COVID, and you've got your inflammatory markers from gum disease—it's just adding petrol to the fire.

So you're just making that cytokine storm even worse. But then on the separate side, it's also bacteria. If you look at the autopsies and the research of COVID patients, most of them didn’t die from the virus itself. No one really died from COVID-19; they died from complications.

So the number one complication was actually a bacterial infection. So imagine your body— you’ve got COVID, you are really unwell, and your immune system is on absolute overdrive. This is the prime time for bacteria to come into your body and to cause what we call a bacterial super infection.

When you look at the autopsies of a lot of these patients, they had oral bacteria from their mouth traveling to their lungs and causing bacterial super infection, which would result in things like pneumonia, and that's actually the cause of death for most patients.

You don't really think that your oral microbiome can be fatal?

No, and even I think as a dentist we weren't really taught how important bacteria was or how important the mouth was for the rest of the body. The only one that we ever learned, and a lot of people would know this one, is that if you have heart surgery, you can actually have dental hygiene for about six months after the heart surgery.

And the reason for that is because you're at a very high risk of something called infective endocarditis. This is oral bacteria that travels down to a faulty heart valve and can actually cause death. So we know that, but we never really look at it for other diseases or other problems.

I want to take a step back before we go through the links between our oral microbiome and all of these diseases. But also, I really want to also talk about what we can do about it because I've got so many questions around it. I've got all of these products down below my chair, from mouthwashes to toothpaste, to all these kinds of things, which I want to talk about as well.

Just taking a step back to something that one of my guests previously was telling me about—I think it was James Nester—he was telling me that the mouth itself and the jaw, because of processed foods, is an abnormal shape.

And when I say abnormal, I mean in relation to how it was supposed to develop because we're eating so many processed foods which aren’t designed to be easy to chew. The mouth itself and the jaw have changed. Is there any truth in that?

Yeah, 100%! So there was a man called Weston Price, and he was a dentist. He basically suspected that. He was like, "This is strange; why is it that people who are in more industrialized and westernized areas have higher levels of decay and they have loads of crowding?" So they had basically lots of crowding of the teeth and smaller jaws.

So he basically traveled around the world, and he looked at lots of different tribes, villages, and countries, and he compared the teeth of, for example, twins. One twin would be in a very industrialized westernized area, and the other one would be not.

What he found was that in the twins who were in these non-industrialized areas, they were eating harder foods, they were having less sugar, and actually their jaws developed a lot better. So they didn't have crowding; they had perfect teeth, actually; and they had no decay compared to the children or the twins who were in more industrialized areas.

And it is because our food now has become so processed. A lot of children are not having hard foods, and so we don't develop the jaws and the muscles at an early age. The teeth haven't changed size; the teeth are exactly the same size as they were previously.

But what we're seeing is that those teeth don't have any space to grow anymore, and that's when we're getting crowding. And can you see that in any of those models?

So yeah, in this model, you can actually see at the very back. So a lot of people will have wisdom teeth, and one of the biggest issues at the moment is that a lot of people have impacted wisdom teeth.

This is basically—imagine your teeth are all upright; your wisdom tooth is coming out at a completely horizontal angle and it's pushing on the rest of the teeth. It's an absolute nightmare as a dentist to take out, and it's even more of a nightmare for a patient to have to endure.

But also, we're seeing that there are a lot more impacted wisdom teeth in the last 30-40 years than there were previously because the diets have changed. Because the diets have changed, a lot more children are needing orthodontic treatment now as well just because they have crowded teeth—teeth are overlapping, and so they need braces to straighten those teeth out.

If you think about cavemen, cavemen didn't have dentists. They didn't have braces. They didn't even use toothpaste, but they didn't die from gum disease, or decay, or crowded teeth. So it's been something in our industrialized or more kind of westernized diet that has changed.

My wisdom tooth is coming through on my left side at the moment, and I think actually also my right side at the same time, and I'm 32 years old now. So I'm like, why the hell am I growing teeth at 32 years old? I thought I was on my way out or something.

So I've got two questions just before we crack on. What the hell is a wisdom tooth? Why is it called a wisdom tooth, and why is it coming through at 32 years old?

So we have teeth erupting at different times of our lives. So usually, you have your baby teeth; they will erupt up to the age of about six or seven years old. Then you have your adult teeth coming through, and usually they will stop erupting around 12 years old.

Then you have nothing—you're chilling, you have nothing, nothing, nothing—until about maybe 18 or 19 years old, and that's where you start to get your wisdom teeth. The name behind wisdom teeth from what I understand is because it erupts when you're older—it's when you have more wisdom.

And you're more wise! I'm wise now, so this makes sense. And so some people will get it at 18, some people don’t have any wisdom teeth, and some people will have wisdom teeth that erupt perfectly and are all completely fine.

Others will have their wisdom tooth erupt at 32 years old and maybe be a little bit impacted or cause problems. So they’re also very strange teeth. They're very unpredictable. The way that they are— is there any evolutionary basis for why we need them? There must be some kind of evolutionary reason for them, right?

Not that I understand. What is also happening is that apparently—and this is some research—less people are having wisdom teeth because more children or adults are getting their wisdom teeth taken out.

And as evolution goes, eventually some people actually are not having wisdom teeth at all because their ancestors haven't had wisdom teeth. So why would they have wisdom teeth?

But overall, no, there's no real need for wisdom teeth. I never like to take them out unless needed because, I mean, more teeth the better! And you never know if you have to have something taken out, then we can use your wisdom tooth for something.

If I were to look at my ancestors from 500 years ago, you said they don't have dentists, they don't have toothpaste, and all those kinds of things. But you also said they don't have tooth decay. Yeah, does that not therefore mean that I shouldn't need a dentist and I shouldn't need toothpaste or mouthwash or floss?

If you had a caveman diet, then potentially you might not need toothpaste, floss, or even a toothbrush. And there's a lot of argument as to you know, there's a lot of people out there saying, "No, you don't need to use any toothpaste or floss or anything like that," and fine, go ahead—do that.

But only if you are going to be eating meat, raw meat sometimes, and you're only drinking water and you're not having anything in your diet that has any sugar or carbohydrates in it.

I mean, doesn’t that speak to what the perfect diet is supposed to be? Can't we tell what the perfect diet is supposed to be by looking at the mouth?

Yeah, so another issue is that with a lot of the food that we eat now, they have a lot more sugar in them, and that will impact the acidity of your saliva. Essentially, what decay is, is you have sugar or you have some sort of carbohydrates, and you've got this bacteria in your mouth, and they feed on that sugar.

As they feed on that sugar, they release acid. If that acid is left there, then it can cause demineralization of your teeth, and that demineralization will end up with decay.

Okay, so let's talk about the personal oral microbiome. Is my oral microbiome different from say, Jack's over there and from my girlfriend's?

Yes, massively different. I would say, um, so one of the issues that I used to have was I was doing lots of oral microbiome testing, and I would have, you know, let's say you and your girlfriend do an oral microbiome test.

And both of you, I would see your results and they would come out pretty much the same because we're only looking at certain bacteria—we can't look at all 700. So we would look at the top 20 bacteria that caused problems. So I would look at both of them, and then I would look inside your mouth.

And one of you, I don’t know who in this case had raging gum disease and terrible, terrible oral health, and the other person would be completely fine. So then I realized that actually, it's not just bacteria that causes disease or problems; it's how your body responds to that bacteria and the strains of bacteria that you have as well.

So for every bacteria, there’ll be multiple strains, and some of those strains can be really aggressive and really horrible for your mouth, and other strains are completely fine and are not going to cause you any problems.

So when I developed my test, what we did is we looked at strains. So we looked at the strains of certain bacteria, and we would be able to differentiate between patients who had the really bad strains and the really good strains.

But then also we looked at the ratio of good and bad bacteria in someone's mouth, so they're diverse, as well as their genetic mutations and also their inflammation. So when you put all of it together, it's like a puzzle piece. Then you can actually have a better insight into someone's oral health.

So I guess my answer is that everyone's oral microbiome is a little bit different, but it's also how your body responds to that microbiome and bacteria that really dictates whether or not you're going to have disease or problems.

So you could be someone who takes care of their teeth really, really well but still have a bad oral microbiome relationship with the rest of your body, effectively?

Yeah, and I see it every day. We have a lot of patients who suffer from terrible gum disease and they come to me, and they brush three times a day, they've never touched a cigarette, they have immaculate oral hygiene, they eat very well, but they have terrible gum disease.

For those patients, they might have genetic mutations that predispose them to gum disease and to inflammation. So even the smallest amount of bacteria, their body responds in a very aggressive and inflammatory destructive way, which can cause disease.

When I was speaking to, I think it was Tim Spectre, about the gut microbiome, he was telling me that the gut microbiome turns over, i.e., the bacteria dies every couple of days or weeks or something. How often does the oral microbiome turn over and why does that matter?

So what's interesting or different between the oral and gut microbiome is that the oral microbiome—if someone doesn't go in there and mechanically disrupt the bacteria and the plaque in your mouth—then that bacteria can stay forever.

So the gut, what happens is you've got something called peristalsis; you've got movement. So the bacteria moves; it changes, it regenerates. In the mouth, the teeth are the only non-shedding surfaces in the whole body.

So that non-shedding surface—imagine if you never had a shower in your life, you would still self-wash because the skin cells would shed. But if you never brushed your teeth, then your teeth are not shedding; they're going to stay like that.

So that bacteria will just keep on growing and growing and growing, and you'll get this really thick plaque. So that's why actually the oral microbiome, you need to mechanically remove that bacteria, and that's why brushing your teeth is super important or using the correct toothpaste, etc., or going and seeing your hygienist because you need to mechanically remove that bacteria quite regularly.

Okay, and the two ways I was reading in your work, it said that the two ways that oral health impacts overall health are by the spreading of bacteria, and the other central issue is it causes inflammation.

So on this point of spreading bacteria, I'm always concerned—this is a bit of a superstitious thing—but anytime that I'm sick, I'm always like, don't part of me—like, don't swallow! Because in my head, I think if I'm sick in my mouth or if I've got a sore throat or something, I'm like, if I swallow it, the rest of my body is going to get sick.

It's super, super superstitious, but is there any truth to any of this?

Um, so not from just being sick like a common cold. And it's actually really interesting—I had a patient yesterday, and bless him, he's very young—7 years old—and he had exactly that same mindset.

He just randomly woke up one day and he said, “This is kind of gross—why am I swallowing my saliva? There's all these bad bugs and gross things in my saliva, and I'm swallowing it every day.”

At 7! And so what he ended up doing was refusing to swallow his own saliva, and so he would basically just dribble, and he would just wipe his saliva off with his sleeve or he'd carry a towel with him and just wipe it.

So bless he had a big rash around his face. And it was a bit of a weird moment for me because I was like, “You're kind of right! I mean, it is a bit weird, especially as a child to sit there and think, 'Yeah, you've got 700 different bacteria, two billion bacteria overall, and then you're swallowing it and it can travel elsewhere to the rest of the body.'”

So yes, in short, yes, bacteria from your mouth—when you swallow it, it can travel elsewhere to the rest of your body. However, a lot of the bacteria dies. So the acid in the stomach can kill a lot of the bacteria, so it’s only the really, really bad bacteria that are able to survive and cause problems.

And that's why it's so important that you have a good oral microbiome and you balance it well.

And the other central way that it can cause negative impacts to your overall health is via inflammation. What is the link between inflammation and my oral microbiome?

So it's something that we call chronic inflammation. Imagine you've got this delicate balance of bacteria in your mouth, which is your microbiome. We all have bad bacteria in our mouths, but most of us, hopefully, have better levels or higher levels of the good bacteria.

There's always that balance, and what happens in an imbalanced oral microbiome is that shift changes. You get higher levels of bad bacteria and you don't have enough good bacteria.

These bad bacteria, firstly, yes, they can travel elsewhere to the rest of your body, as you discussed. The second is that they can release inflammatory markers.

So they basically release inflammation, and this inflammation can travel from your mouth to the rest of your body and contribute to inflammation elsewhere. So for example, if you had rheumatoid arthritis and then you had inflammation from your gums, that inflammation from your gums is making your arthritis in your wrists worse, so it's contributing to it.

Now, what's also interesting—and that's why it's called low-grade chronic inflammation—is often, you wouldn't even know that you have it. I have so many patients who say, “Oh, you know my gums bleed, but that's normal.”

If your eye, your bed, or your foot was bleeding every day, you would be worried, and you'd think, “Actually, there's inflammation here. There's a problem here.”

But so many people have bleeding gums, and they don't understand that bleeding gums is a sign—it's your gums screaming to you, saying that I have inflammation. And that inflammation can travel.

And then the third mechanism as well—so there's one more—is damage to your blood vessels. Again, the same bacteria in your mouth releases these enzymes, these toxic enzymes, and they can travel through the rest of your body through your blood vessels, and they can actually damage your blood vessels.

So these blood vessels are not able to dilate and constrict as well as they used to. On that point of arthritis, I read a stat which I believe is true; I think it actually came from some of your research that said people with rheumatoid arthritis are eight times more likely to develop gum disease than patients without rheumatoid arthritis.

Yes, which is shocking! There's a really strong bidirectional relationship between rheumatoid arthritis and gum disease. So that means that if you have really bad rheumatoid arthritis, you have pretty bad gum disease. And if you treat your rheumatoid arthritis, your gum disease will get better, and vice versa—if you treat the gum disease, your rheumatoid arthritis will get better.

And that was actually one of the first patients that really got me on my journey of the mouth-body connection. So like, yeah I was doing the saliva testing, I got it—I was like, "Okay, cool we are quantifying oral health, we're tracking things." But even me, I wasn't really fully sold on this whole mouth-body connection, how our mouth is connected to the rest of the body.

So I had a patient who was sent to me by her functional medicine practitioner. She had been seen by four or five different practitioners; she had terrible rheumatoid arthritis. She went to this final guy, and he was the first guy to ever ask her, "Have you ever had your teeth checked? What's happened?"

And she said, "Oh, I've had a few teeth taken out in the last year or two—about six teeth—but you know, it is what it is." And he was like, "I don't think that's normal."

So he sent her to me and he was like, “Can you do your saliva stuff that you do and see if there's anything up going on there?” We did do a saliva test, and we saw that she had super high levels of inflammation, collagen breakdown, and high levels of bad bacteria.

And what was the most important was that when I treated her gum disease—she had terrible gum disease, and that's why she was losing her teeth—when I treated the gum disease properly and aggressively, yes, her gums healed, but more importantly, her rheumatoid arthritis got better to the point where she was actually able to get off steroids and medication and be able to walk again.

Wow! Yeah, by treating her gum disease. And I think that sometimes as a dentist, we treat a lot of gum disease, and we treat a lot of things, and we don’t necessarily see the systemic consequences because the patient doesn't come back or it's such a small impact that you don’t necessarily see it.

But this was the one time where I was like, “Wow, like what we do is actually really insightful and really important.” And you mentioned alongside that inflammation also has an impact on cardiovascular functioning and health.

I believe it's the case that cardiovascular disease is the biggest killer in the world from what I understand. So I was wondering if you knew any of the stats that show the impact or the increased likelihood of me having a heart attack or a stroke or something based on my oral microbiome?

So the research has shown that if you have gum disease, you are at a 20% higher chance of high blood pressure, but also they are now saying that up to 30-40% of cardiac issues in hospitals can be traced back to an oral bacteria causing problems in the heart valve.

So the reason for this connection—so yes, inflammation—but also going back to that third mechanism I told you which was about the vaso constriction. So the blood vessels constricting and dilating.

So these toxic enzymes which are being released by the bacteria travel through the blood, and they basically stop the blood vessels from being able to widen and lots of blood to travel to the heart and also to constrict, and that is also one of the biggest connections with heart disease.

I found a stat which might well be from your work or someone else's. It's from the study called "The Association Between Periodontitis and Blood Pressure Highlighted in Systemically Healthy Individuals."

Not mine, but okay. And it found that people with gum disease were twice as likely to have a heart attack and three times as likely to have a stroke than those without inflammatory gum disease, which is absolutely staggering.

Yeah, and then another study also showed that when you treated someone's gum disease, their levels of CRP—which is an inflammatory marker that you can check in your blood—significantly reduced.

And for a lot of patients who suffer from heart conditions, they will get their CRP quite regularly checked through blood testing, and so this is a way of reducing their inflammation, just by having a simple hygiene.

I've even seen, particularly in America, there's a lot of cardiac surgeons and doctors related to heart health who are now actually working with dentists because they understand that if they work together, then they're going to have far better results for their patients.

And this is that swallowing thing we're talking about; this is because you're swallowing that bad bacteria?

Yeah, and your heart valves—imagine if it’s faulty, imagine you just had surgery. I always think of it like it’s sticky; it’s like Velcro, so it’s really prone to infection and problems.

It’s just like if you fell over and you had a scab and you were rolling around in mud all the time, you would get bacteria going into that scab and causing problems. This is the same thing with your heart valves.

Doesn’t the bacteria just travel on its own anyway? Because I feel like it's in my mouth, so I feel like—I don't know—these are living organisms; don't they just find their way down even if I don't swallow?

Yeah, even through your blood, and also through your gums as well! So you can swallow your bacteria, breathe it, or it can go through your blood.

At the start of this conversation, we were talking; you mentioned the sort of implications for your cardiovascular system. And one of the things you said was erectile dysfunction, and that was slightly alarming to me as a man who’s trying to stay away from erectile dysfunction.

What is the research that supports this idea that my oral microbiome can have an impact on my erectile functioning?

So men who have periodontal disease are 2.85 times more likely to suffer from erectile dysfunction. 2.85 times? Yeah, I'm pretty sure that's 280%, isn’t it?

Yeah, okay. So what is this periodontal disease? Gum disease.

Okay, so it's kind of—I would say it's a bit of a spectrum. So the early stages of periodontal disease or gum disease is just gum inflammation. So that's that patient who is brushing their teeth, spits in the basin, and sees blood.

So that's the—or, you know, the early inflammation. If they don't get that checked out and sorted, that will just continue and continue and continue to what we call gum disease. And that's where, yes, you've got inflammation, but actually you have really high levels of bad bacteria now, and this bacteria is essentially eating away the gums and also your bone.

And it’s now become irreversible. I'm just going to have a swig of this for your erectile function.

And then at the very end of the spectrum is people who are losing their teeth, having really terrible gum infections, and all of these kinds of mouth-body connections that we're talking about.

Okay, and can you just explain—as again, as if I'm 10—how that gum disease, that periodontitis, has an impact on my penis? I don't understand the link.

It makes all of my blood vessels—exactly! Yes! So it essentially stops your blood vessels from dilating, and so you've got reduced blood flow to your penis, and therefore it doesn't work.

Okay, so this is an emergency! This stuff is really important. That’s the one statistic that whenever I have a man in the chair and he’s like, “Oh, I don’t want to brush my teeth!” I’m like, “2.85 times more likely to have erectile dysfunction.” They usually will go straight to the bathroom to brush their teeth.

The other thing, though, but it’s true! But also the other thing that I read—research—which I found really, really shocking—is the link between my oral health, my oral microbiome, and cancer.

Yeah, I was reading specifically about female breast cancer, which I know affects a lot of women. What is the link there between breast cancer—cancer generally—and oral microbiome?

This is, I would say, some of the newest emerging research that's coming out. So with breast cancer, I didn't know this before this research came out, but your breast has its own microbiome.

So that tissue within the breast, different bacteria are able to grow. And what they found was that in women who had breast cancer, they had high levels of certain oral bacteria in their breast microbiome.

So the oral bacteria is called Fusobacterium nucleatum, and they compared the breast microbiomes of patients who didn't have breast cancer versus those who had breast cancer.

Sorry, what’s a breast microbiome? Just a collection of bacteria in your breast.

Okay, yeah. I didn’t even know there was a microbiome in your breast either, but apparently so. And so when they compared a healthy woman’s breasts to a woman who had breast cancer, the woman who had breast cancer had very high levels of this specific oral bacteria called Fusobacterium nucleatum in their breast.

There’s also been research on colorectal cancer. Apple News came out with something a couple of months ago, which was nice to see them kind of just spreading the word. But what they found was that in patients who had colorectal cancer, more than 50% of them had the exact same oral bacteria from the breast cancer study—Fusobacterium nucleatum in the colons.

And what they found was that oral bacteria made the cancer more aggressive and harder to treat as well. I was reading about a study in mice that linked that oral bacteria to tumor growth.

Are you familiar with that study? Yes! And it’s that specific oral bacteria—the Fusobacteria nucleatum—which has been shown to accelerate tumor growth within mice, but also for colorectal cancer and breast cancer.

And what’s your belief there? I know this research is fairly new, but do you think there is a causal relationship—a significant causal relationship—between the health of an oral microbiome and our probability of developing some form of cancer?

I wouldn't yet say causal. I think that for most cancers it is multifactorial, and there are a lot of things that can impact whether or not you get the cancer and how aggressive the cancer is.

I do think that oral health and some specific oral bacteria are risk factors and can definitely increase the aggression of those cancers or even the initiation of them. There’s also been research, and I think I'm waiting for the research to be published on what they're doing is they've created an antibiotic which only kills that oral bacteria that I was talking about—Fusobacterium nucleatum.

And they are going to be issuing that antibiotic to those patients who have the colorectal cancer which has the oral bacteria to see whether or not it slows down their progression or improves their prognosis.

So if I see those results and it shows it, then there’s for sure a strong causative link between the two. But for now, I would say that it’s multifactorial, and it’s definitely a risk factor.

That oral bacteria that you're describing, that you called Fusobacterium, yeah—what is it that causes that? Is it something that I’m eating? Is it a lifestyle choice I’m making?

Multiple things—poor oral hygiene, some of us genetically will have higher levels of it, it’s what we eat, it’s who we’re kissing, it’s what we’re breathing in.

Does my girlfriend have it? So we’ll have to see! But that’s the thing—that’s the beauty of being able to test these things now, is that you can actually see.

And also, what's strange is that green tea—you know something so simple—is extremely effective at killing Fusobacterium nucleatum. So it’s just knowing those types of things, being able to do the test, knowing the right treatment plans and recommendations based on that.

We know green tea is good for us, and now we can really understand why.

Okay, that’s interesting. You have actually tested Jack over there, right? And you said to me before we started recording that he’s got a ton of that Fuso bacteria?

Yes, he does! Yeah, it’s really getting out of control, that’s what you said—it’s really badly out of control!

Yeah, so I've given him a big vase of green tea as a gift. Green tea? Yes, green tea!

This guy’s going to edit that out! This is the problem! Green tea? Yeah, that’s good for my oral microbiome.

Yeah! Really good strains, but really good—it’s anti-inflammatory, it helps with what we call oxidative stress, so this is basically stress for the body, and it’s antibacterial. So it actually is very effective at killing Fusobacterium nucleatum.

What is your opinion of the impact that coffee has on my oral microbiome? I’m slightly biased because I love coffee.

Okay, um, but there is no negative impact of coffee on the oral microbiome directly. Coffee does dry your mouth out, and so you have reduced saliva, and that can actually cause problems for the oral microbiome.

So the saliva is super important in your mouth. It provides all of the food, the proteins, everything for the bacteria in your mouth. So it's kind of like this delivery service; your delivery route is traveling around providing all the food to the bacteria.

And that’s what keeps the good bacteria alive and happy. So when you have a dry mouth, let’s say you’re drinking lots of coffee, or you’re very nervous, or you are on antidepressants, for example—which are a big one—then you just don’t have as much saliva.

So those bacteria don’t have as much food, and those bacteria die, and then you get bad bacteria growing in replacement.

What about tea? We’re a nation of tea drinkers in the UK.

Similar! So it also does dry your mouth—not as bad as coffee—but otherwise, no problems. Other than staining.

What about if I put loads of sugar in it? ‘Cause a lot of people put a lot of sugar...

Okay, yeah. No! No—no! So sugar in your tea is even worse than you having a biscuit, for example, because the sugar dissolves in your hot tea, and the tea is hot when you drink it.

It can actually cause more problems. Another thing with sugar is I have a sweet tooth; I love sugar. But it's about how you eat your sugar.

So let’s say if you have your hot tea with five lumps of sugar in there, and you’re sipping it over an hour or two, that’s where you start to see a lot of problems. So actually you need to be having a sugar attack.

So just all the sugar in one go, that way your mouth has all the sugar in one go and is able to neutralize the saliva and get back to a good state as quickly as possible.

Every time you sip your tea with sugar, what happens is that the saliva has to go from acidic back to neutral, acidic back to neutral, acidic. And then it starts to just not work properly, and the saliva just stays acidic, and that’s where you start to see decay.

So you want to just down the tea! Or I don’t know. If you’re a peanut M&M guy, have all your M&M’s in one go! Don’t snack on M&M’s every 10 minutes!

What about other drinks? Like, I don’t know, Coca-Cola and these other sort of fizzy drinks that might have artificial sweetness in them, things like that.

They're not as bad as your natural sugars, but for example, something like your Coke, or Fanta, or whatever—it’s also very acidic and can actually cause erosion as well.

So this is essentially where the outer layer of your tooth—the enamel—is just worn away from having lots and lots of these fizzy drinks. Okay, so it’s not going to cause decay in the same way, but it might change the acidic balance which then decays my tooth, which makes me more susceptible to when I eat sugar having a problem?

Okay, got you. So going back to what we were talking about, the implications of an oral microbiome and the rest of my body—brain health is one thing that I was really curious about.

We’ve had lots of conversations on this show about Alzheimer’s and dementia and just general sort of optimal cognitive performance as I age; something I'm thinking a lot about. I want to have a sharp brain—it’s quite important because of what I do.

So is there a link between my oral microbiome and my cognitive and brain health?

Yes! So if we look at actually just the occurrence of Alzheimer’s and gum disease or oral health, a lot of research has shown that if you have gum disease for more than 10 years, you have a 70% increased chance of developing Alzheimer’s.

So that was a study done on over 20,000 people and they followed them for 20 years. And they saw, okay, if you had gum disease at baseline, whether or not you get Alzheimer’s at 10 years or 20 years—it was a 70% increased chance of it.

They’ve also done a lot of research where they’ve been looking at oral bacteria, and what they found was that there are certain oral bacteria—one called P. gingivalis, and that’s one of the worst oral bacteria, I would say, out of all of them—this P. gingivalis is able to travel from your mouth to your brain.

It’s quite close by anyway, and what’s unique about this bacteria is it's able to cross the barrier between your brain, the blood-brain barrier. And it releases these toxic enzymes.

So these enzymes are called gingipains, and imagine these like horrible firefighter things, and they can break down neurons; they can break down a lot of brain tissue. And so when they looked at the cerebral spinal fluid and the brain fluid or tissue of Alzheimer’s sufferers, they found that 97% of them had these toxic enzymes, these gingipains in their brains compared to zero for the patients who did not have Alzheimer’s.

So this is, you know, the first study shows yes there’s some sort of correlation, but there are a lot of other risk factors. The second one, which is looking at your gingipains, is showing that there’s definitely a strong causative factor between the two.

And then another study which was very interesting was looking at cognitive decline. So, okay, fine, you have Alzheimer’s—unfortunately—is it too late? Should you stop brushing your teeth, or what’s the point?

And so what they did was they had patients who had Alzheimer’s and they checked their cognitive function, and they also checked their oral health. Then, six months later, they reviewed them, and they found that the patients who had gum disease had a much more rapid cognitive decline than those patients who didn't have gum disease.

So again, it’s still important if you do get Alzheimer’s that you maintain your oral health—that you have someone help you brush your teeth because your cognitive decline will be faster.

How do they unpick that from other causal factors that might be going on? Like, bad food choices? Because in my head, I was thinking, "Well, if someone’s drinking sugary fizzy drinks every day, they’re more likely to have gum disease. But maybe also that the chemicals within that fizzy drink are impacting the chance of dementia?"

Maybe they’re also someone that has an unhealthy lifestyle? Maybe they’re more sedentary. If they’re eating bad things, maybe they’re more sedentary, and maybe it’s that that’s causing the rapid cognitive decline versus the gum disease itself? Is it possible to untangle all of this?

I mean, it is very difficult. I think that for those types of things, you are right—diet, lifestyle is super important, and we know that Alzheimer’s is again multifactorial.

I think it’s really about the quantity of patients that they check, so they need to be looking at a huge number of patients, and they did—to check whether or not there is a strong correlation between them.

Also, going back to the gingipains study—so the one about the bacteria—that shows it doesn’t—it’s not diet or lifestyle or nutrition. It is a specific oral bacteria that has traveled to the brain and released these enzymes which are then breaking down neurons.

So there’s definitely a strong causative effect that is fascinating! It’s really, really fascinating because dementia and Alzheimer’s still seem to be a bit of a mystery.

It is! And I work with a team for Alzheimer’s, and what they've done, similar to what you were saying is that they’ve kind of separated all of the causes of Alzheimer’s that we know, or the risk factors.

And thankfully, they’ve put oral health as one of them as well. And I think from all of the other risk factors, so you know—for example, if you have the genetic mutations, you got the ApoE4 or any of those mutations—that you can’t change that.

Unfortunately, some of us have mutations which mean that we are at a much higher risk of suff—of getting Alzheimer’s in the future. But something like that oral bacteria P. gingivalis and those gingipains, you can get rid of P. gingivalis really easily.

Again, if you tested it, you can even test for gingipains. And then you can get rid of the bacteria before it starts causing problems.

The test that you offered—does it test for gingipains?

It does! Yeah, so we’re the only ones on the market who do. Because that was something that I thought was super important. What’s the point in us telling you that you have a bacteria if we can’t tell you that that bacteria is being really bad in your mouth and causing a lot of problems?

And people think I’m joking, but you have actually tested several members of my team, including myself, so I am actually going to find out the results today?

Yeah! On the subject matter of the brain— is there a link between my mental health, depression, anxiety, and my oral microbiome?

So again, there’s been a lot of research. I think it’s difficult for something like mental health and gum disease— which, you know, is the chicken and the egg; which one came first?

Because one of the issues is if you have a decline in your mental health, you are less likely to take care of your oral health and therefore that can exacerbate issues. So there has been a lot of research to show that there’s a correlation between poor mental health and poor oral health.

But in my personal opinion, that positive connection is not there yet. There’s also been some research with things like schizophrenia, but again, the jury is still out in my opinion.

Are you able to tell the state of someone's mental health by looking at their oral microbiome in your view?

Um, you can know if something’s up! Like for example, I had a patient relatively recently—I’ve been treating her for five, six years now—and I know that she takes good care of her teeth; she takes good care of herself.

A few weeks ago she came in and she was not taking care of her gums or her teeth at all—everything was an absolute mess in there! So I did pull her aside and I was like, "What’s wrong? Something has happened here."

And I think it is quite a big sign for a lot of people. The first thing that they kind of let go of is their oral health.

Is that because of, you know, they start certain self-soothing behaviors because they’re stressed in other parts of their lives?

So if they’re having a bad time in their relationship or work and they're stressed, they might start eating sugar more or just not brushing, smoking, or drinking more.

Okay, or just not brushing. Like with this woman, she just wasn't brushing her teeth anymore.

Another thing that we can also see—I mean it's kind of a bit on a tangent—but also eating disorders as well. So things like bulimia or even sometimes anorexia, you can see in the mouth.

So there’s a lot of times where we’ll see young teenagers, and I’ll know that they are bulimic because they have certain issues in their mouth which they shouldn’t have. And again, it's a telltale sign!

Is that because the stomach acid is coming through their mouth?

Yeah! So they get a lot of erosion on their teeth, and then in some cases, you can also get these marks on the roof of your mouth. So if they're trying to force themselves to vomit, then you can see that.

And that’s something that, you know, you have to pull the patient aside or tell their mother and explain that to them as well.

And is there a relationship between stress and my oral health? So if I'm more stressed and my cortisol levels are higher, is that going to make everything in my mouth worse, yes?

Even outside of the lifestyle choices that I might make in such a state? Yes! Just that stress will increase your inflammatory markers, your inflammation.

It also will dry your mouth out, and all of those things will be linked. We do a lot of testing at my clinic, and so one of the tests that we look at is collagen breakdown.

So we have lots of different types of collagen all over our bodies, and our gums are made up of a certain collagen. So we look at an enzyme called MMP and this enzyme is responsible for breaking down that specific collagen.

So we test that enzyme all the time with our patients. It’s a really nice way of knowing whether or not someone’s about to have gum disease—how much collagen breakdown is happening from a biomolecular level.

So I had a woman—very healthy, always been fine—and then she had her collagen breakdown tested and her levels were through the roof. Her gums looked fine; she didn’t look like she had any problems, but I’ve never seen such a high level in my life.

And so, you know, I’m trying to think of what could be causing it, all of that, and she had lost her baby a couple of days before.

That type of intense stress on someone's body can have so many effects and impacts on the rest of your body, and that was one of them. When we retested her six months later, she was back to normal again.

But you can see even your mouth—stress can really impact you.

On this subject, I was thinking about—I mentioned James Nester earlier who was telling me about the research of how the mouth has changed shape because of the foods we’re eating and how that’s caused a bunch of downstream implications for us.

One of the other things he also mentioned was about mouth breathing and nose breathing.

Yes! And there’s a lot of people that have become incredibly interested in whether we should be breathing through our mouths or our noses.

And I was wondering if you had a perspective on that, and also the other thing that he mentioned to me was that there’s a link between mouth breathing and things like ADHD.

What is your point of view?

I completely agree with all of that. So actually, my sister, she is an orthodontist, so she works at our clinic and we run it together with our mother.

She is very, very hot on mouth breathing, and what she mainly does is she basically tries to stop children in particular from breathing with their mouths open.

What she has found is that most of her patients who come to her are mouth breathers; they often have some sort of ADHD, they have some sort of attention deficit.

They are bedwetters, they grind their teeth a lot of the time, and they have a whole cascade of other problems. She can treat it then, and it's relatively easy.

She would argue that it’s very difficult, but to me I think it's easy! I’m like—yeah there we go, you can do what you do!

Because the jaws of a child are very malleable; they haven't fully solidified, so you can still move things. You can get the teeth to meet, so if you get the teeth to meet correctly, then the child won't want to breathe with their mouth open.

The annoying thing is, is that a lot of adults are mouth breathers because their teeth do not meet correctly or their jaws are in the incorrect position.

At that point it is quite difficult to move the jaws into the correct position or to get the teeth to close in a way so that the lips are at rest, and you breathe with your nose instead of your mouth.

But again, I see those types of patients because they all come to me with a lot of other problems. So again, same thing—a lot of them have suffered from long COVID, a lot of them have inflammatory conditions, are always tired, a lot of them have chronic fatigue.

You know, there are a lot of connections now between mouth breathing and those types of issues as well.

Is there a link between the health of my oral microbiome and whether I breathe through my nose or mouth? Because James was explaining to me that the nose is affected like a filter system with certain temperatures, and it has some kind of mucus which helps to catch bacteria.

So if I'm breathing through my mouth, am I more likely to have an unhealthy oral microbiome?

100%! So exactly the same thing— you’ve got a filter in your nose, and so it will stop a lot of bad things from coming through, but the mouth—there is no filter. I mean, you breathe it in; it goes straight into your lungs.

So there's no way of stopping anything. A lot of people now are starting to mouth tape, and that's become kind of trendy and cool.

It’s not the easiest thing to do, so it seems a bit weird to tape your mouth at night time. But for anyone who’s worried that they breathe with their mouth open, mouth taping in my opinion is a really nice way of just testing it out and seeing whether or not you do breathe with your mouth open.

Because you’ll do some mouth taping and you can see whether or not you sleep better. So if you have a wearable, you can see, “Oh wow, my oxygen levels are so much better! I had such a deep sleep.”

And if that's the case, you might be more inclined to straighten your teeth or sort out the reason that you're breathing with your mouth open.

I took notes of a study which kind of is interconnected to the point we were making about mouth breathing. It said in a six-year study of 11,000 children, it was found that children who suffered from sleep-disordered breathing were 50% to 90% more likely to develop ADHD-like symptoms than were normal breathers who breathe through their nose correctly, which is absolutely staggering.

50-90% more likely to suffer from ADHD-like symptoms just because they breathe through their mouth at night, and have disordered breathing?

And it’s mainly to do with also oxygen being delivered to your brain, right? So there's not as much good oxygen, like real rich oxygen, filtered oxygen traveling to the brain.

And so that’s basically not allowing your brain to function as well. You mentioned kissing earlier on.

Yes! I’m still supposed to kiss my partner, right?

Yes! I hope you do many times! You said if I kiss her more than 11 times a day or something, then our oral microbiomes synchronize in some way?

Yeah, so there is some passage of bacteria from you to her and her to you. They have also shown that, for example, they did a study where one partner chewed lots and lots of probiotics—so like good bacteria—and then had a super long smooch with their partner, and actually was able to transfer nearly 60 or 70% of that good bacteria into their partner.

So it’s not necessarily long-lasting, I wouldn’t say that, you know, if you kiss someone once on a night out that you are going to terribly impact your microbiome. It's fine, you can go and kiss.

But it’s more for long-term partners if you're kissing regularly and for a long time, then yes, your microbiomes will start to be quite similar.

Another factor as well is that obviously your lifestyles are probably pretty similar; you’re probably using the same toothpaste, eating the same food.

So it’s difficult to fully put it on just kissing. But yeah—what about oral sex, and the implications that will have?

So if me and my partner are doing oral sex on each other, is that going to impact our oral microbiome?

Yes! So actually, there’s been a few case reports which have shown…there's one in particular, and I had a patient as well who had this. A woman who had a new partner, and she liked to perform oral sex on him, and then she came to me because she was complaining of very inflamed gums—and she was getting gingivitis.

And you know, it’s not something I really ask—I’m not going to be like, “How’s your sex life going these days?” So I didn’t ask it.

But she kept on coming back to me, “No, my gums are still inflamed! No, my gums are still inflamed!” And then she asked; she was like, “Is it maybe because I have a new partner?”

I was like okay—maybe you guys are kissing a lot. She was like, “No, no, no, no.” And then she explained to me.

And then I was like, “Okay, fine! Why don't you go and test and ask him whether or not he has any issues?” And it turned out that he was having recurrent urinary infections.

So actually they were transferring bacteria, and she was having inflammation in her gums because she was performing oral sex. So yeah, there is transfer!

Again, I wouldn’t be scared and say "Never do it!" I once made an ex-boyfriend do an oral microbiome test—just to check and to make sure everything was okay.

You made him do it?!? Yeah, I don’t—it's not a prerequisite anymore, but it was at the time! I was like, “H—let me see! Let me see!”

Of course it is! You must think that when you meet people, you must think, “God, I wonder what their oral microbiome is saying!” Like, in a romantic context, because you know the significance of it.

Yeah, I think it’s a—I spend a lot of time and energy making sure my oral microbiome is very nice and balanced, so I wouldn’t want anyone messing that up for me. So it’s important.

Are you in a relationship now?

Yes, I am!

Have you tested their oral microbiome?

I’ve been trying to, but he won’t let me!

You’ve asked him?

Of course I have! And what did he say?

“Mind your business!”

But I did give him an oral microbiome test, so hopefully he’ll just use it. I said, “You can even use a fake name; I don’t care! I’m not going to check it; I just want you to do the test for me—for you—for me!”

And what’s his rebuttal?

He was like, “What happens if you break up with me if I have a really imbalanced oral microbiome?”

And I was like, “I hope that our relationship is stronger than just your oral microbiome!”

But there’s ways to fix it! And that’s the beauty of the oral microbiome is that it's actually pretty easy to fix and to change.

If his results came back and he had a terrible oral microbiome—one of the worst you've ever seen. Yeah? Are you less likely to kiss him that day?

That day, yes!

Are you going, “Don’t do the test, my friend! No, no, don't do the test that day!”

Yes, and there's no upside to him doing this test. I completely understand.

And then I would go and creep into his bathroom and change all of his oral products, personalize everything for him!

And then you've done that already?

I already have! He tests everything out for me as well because I get a lot of products sent to me, so I’m always getting him to try things out for me as well.

Okay, so no, if they’ve got issues down there—

Yeah! Okay, and we don’t really know if they’ve got issues down there unless they admit it or do some kind of test!

Yeah!

Okay! What about fertility? Is there a link between our oral health and our fertility?

Yes! So if we look at men to start with, there was a study done, and they found, so they looked at a group of sub-fertile men—men who weren’t able to conceive with their partners—and they checked all of their mouths.

And they found that over 90% of these men had some sort of oral infection or dental disease of some sort going on. They split the group into two. Half the group had the treatment that was needed—so I don’t know if they had gum disease or decay—they got it fixed.

And the other half were left to their own devices. After eight months, there was a 70% improvement in their success for pregnancy. The men had their oral infection sorted, and they had a much better improvement in their sperm quality and motility as well!

And what did they do to those men in that group where they saw the significant improvement?

So for example, if the man had gum disease, they would treat it with hygiene, or if they had an infected tooth, maybe they would take it out or do a root canal, etc.—they would just have to treat that infection.

So I speak a lot about gum disease all the time, but actually, there are so many other oral diseases like decay, or tooth infections, or all those types of things that can also contribute inflammation and problems.

In that study, 6 months after that, their sperm had improved by 20%, and after 8 months, 50% of their wives were pregnant. Yes, that is staggering!

What about women though? Is there a similar sort of result as it relates to women's fertility?

Yes! So researchers also found that if a woman has gum disease, she is less likely to ovulate and also is going to have issues with conception.

So they found that women with gum disease, it takes them 2 months longer to conceive versus a woman who doesn’t have gum disease. But once the woman has conceived, the issue is still not over.

She still has to maintain her gums. So firstly, a lot of women will have pregnancy gingivitis. This is basically super inflamed, puffy gums because of all the hormones.

And so they should be going very regularly to see their hygienist. But also, what the researchers found is that women who are pregnant and have gum disease are at a much higher risk of pre-term birth.

So premature babies, low birth weight, and also pre-eclampsia as well. So they did a study in Malawi—it was on 10,000 women.

Malawi has the highest rate of pre-term birth in the world at just about—I think just under 20%. Pre-term birth is a big issue for governments, for hospitals; it’s really expensive. You need to keep the woman and the child in the hospital for a lot longer.

But also that child will have a whole myriad of problems afterwards as well. So weirdly, the sugar chewing gum company sponsored this study. They went to Malawi; they had these 10,000 women.

They split them up into two; 5,000 of those women were given sugar-free chewing gum, toothbrush, and some toothpaste, and the other half were left alone. And they found that there was a 20% improvement—sorry, 20% reduction in pre-term birth in the women who had the sugar-free chewing gum compared to the women who hadn’t had it.

So something so cheap and so easy like chewing gum was able to actually reduce the risk of pre-term birth for these women!

How and why?

So if you look into the research a little bit more, you’re going to get your chewing gum now, yes! So sugar-free chewing gum has been shown to stimulate your saliva, so it helps with what we were talking about earlier, saliva is super important.

It provides all the good food for your bacteria. But then also, if it’s sugar-free, let’s say it’s using xylitol, that’s naturally antibacterial, so it’s killing a lot of bacteria in the mouth.

What they found is that there are certain oral bacteria that can travel down to the placenta and can also cause problems there and essentially increase the chance of pre-term birth.

You sufficiently convinced me that saliva is an important thing, and I actually did one of your tests. Let me go grab the results.

Okay, every single time you eat you have an opportunity to improve your health. That’s why I love Zoe because it helps me to make the smartest food choices for my body.

As you guys probably know, Zoe is a sponsor of my podcast. I'm also an investor in the company which is important to say. I invested in the company because Zoe combines my health data with their world-class science.

Using these two things, Zoe guides me to better health every single time I make a food choice and eat, which means I have more energy, better sleep, better mood, and I'm less hungry.

And the best part about Zoe is that it's backed by their recent clinical trial, something called the METRICS study, which is the gold standard of scientific research.

I started Zoe just over a year ago now, and I've been able to track my progress week after week so I can learn how to be even smarter the week after.

And if you haven't joined Zoe yet, I'm going to give you 10% off when you join Zoe today. Just use the code "steven1" at checkout, so many of you have asked me for a bloody code for Zoe.

And here, opportunity—steven1 at checkout! There may not be another one. And here are the results!

Okay, I've not actually seen them yet, so this is exciting! I’ll give them to you so you can explain them to me. Is that okay?

So this is the test that I did, right? Yes, you did! Yeah, and the test I did contains this little kit that basically—in the middle of the office one day someone came up to me and said, “Steve, can you spit in this?” And I said, “Sure, why not?” And then they took my spit away.

Yes! Um, and it turns out it was a request from you! Yes, exactly! I wanted your saliva!

Yeah, which is just to check to make sure if I could do this interview. So this is the test that I did. I spat in this little thing, sent it off back to you—how long does it take to do this test?

It would probably take you about 2 minutes to do spit yourself, and then you get the results three to four weeks later.

What did did you find out from doing my test?

Well, okay, let’s go through your results! So, we found that you have quite a diverse microbiome. So that means that you have a nice ratio of good bacteria versus bad bacteria.

And this has been compared to healthy and disease subjects. So you are really right on the top of the bell curve, so very good with that, so happy!

Then we predict your diversity is better?

Arguably, yes! Yeah, okay.

Then we have is—we've created this algorithm that predicts your risk of certain issues or diseases in the mouth. So those are things like bad breath, gum disease, decay, and general inflammation.

So your risk of bad breath was low; you didn’t have a high risk for that. Gum disease was medium, so slight—maybe there’s a bit of inflammation going on there. Your risk for decay was also medium, and your risk for general inflammation—so this is inflammation throughout the rest of your body—was quite low.

And then if we zoom in, we then look at your good bacteria. So we're also quite unique because we thought that it was unfair that a lot of tests don't look at the good stuff.

So we look at all of the bacteria which has been shown to be the most beneficial in the microbiome. So for you, you had pretty much high to very high levels of good bacteria, which is great—no problems with that!

And then we look at bad bacteria. So we actually look at about 500 different bacteria, but then we zoom into the top 20 bad ones which are really associated with things like gum disease, decay, bad breath.

So for you, out of all the bacteria that we looked at, you only had quite high levels of one bacteria which is bad for you.

And so this bacteria is very strongly associated with basically a lot of buildup of plaque in your mouth. So having not looked in your mouth, I have no idea about your dental health or anything like that, I would assume that basically you’re a bit overdue on a hygiene—maybe?

Maybe there’s a lot of plaque buildup going on from that result? But the rest of the bad bacteria—so all of these ones we’re talking about, the erectile dysfunction one, your erectile dysfunction one’s fine; your P. gingivalis is fine; you know, F. nucleatum, those ones were actually very good.

Then also, on top of that—going back to the Alzheimer’s—we look at those virulence factors associated with P. gingivalis, and you had none of those spirulin factors, which is also really good!

Okay? Then we look at your genetic mutations. So we’ve identified about 10 different genetic mutations which increase your risk of decay and gum disease.

So for the decay, out of the five genetic mutations we looked at, four out of five of them you had. So that means that you and maybe you have stopped it, but you are at a higher chance of having a sweet tooth, of having more acidic saliva.

On top of that, it might be that if you're stressed out or you're really unhappy, some people will run to the casino, others will run to the bottle, and for you, you might actually be someone who goes and has a chocolate bar and actually enjoys sugar.

No comment.

On top of that, let’s say you’ve had your sugar because you are stressed out or whatever, you also have been shown to have a genetic mutation which means that your taste perception is lower.

So you need two bars of chocolate, not just one, to make you feel...

That's the end of this podcast! That's the end of this episode! I'll close your document.

How dare you!

No, I mean it all squares with reality, so please do keep going!

So that’s your decay situation.

In terms of gum disease, again we look at certain mutations. There are some mutations that can triple your risk of gum disease. They can increase the amount of inflammation that you release from your mouth.

So imagine there are some people who—even the smallest amounts of bacteria—they might have great hygiene; they have a few small bad bacteria in their mouth, and they have mutations which means that they respond in a very hyperinflammatory and very aggressive way, and they will be at a very high chance of

I like to keep it simple. You don't need to— we don't need to make things super complicated. You don't have to spend that much money. Having the right toothpaste, right toothbrush, and the right floss is honestly as much as is the most necessary thing that you need.

Okay, so in terms of brushing though, you give some sort of practical advice around when we should brush. MH, what is that? And is there any time where I shouldn't brush my teeth?

Uh, you should never brush straight after anything acidic or sugary. What you end up doing is grinding the sugar or the acid into your teeth. So, actually, you should wait 30 minutes until you brush your teeth.

That's interesting because when I eat something sugary, I feel like I need to brush my teeth to get rid of it.

Yeah, no, no. So you want to wait 30 minutes. Instead, you can chew some sugar-free gum or there are lots of pastels that we use. So, like I use chewable mints, and you can chew one of those and it will actually neutralize your saliva really quickly so that you don't have that acid causing the demineralization.

And do I spit or do I rinse after I've brushed my teeth?

Spit. So you should never rinse your mouth out with water after you brush your teeth. So brush, brush, brush, spit into the basin, and that's it. The reason being, again, going back to my sunscreen analogy. Imagine you spend two minutes putting all this lovely sunscreen all over your skin to then just go and have a shower right before you go into the sun. So with the toothpaste, you spend two minutes putting all of that on your teeth, and then if you rinse it, then you're actually removing all of that goodness from your teeth and gums. It’s kind of like you haven't done anything.

Toothbrushes—yes, which toothbrush should I use, this one or an electric one?

Um, I generally prefer an electric toothbrush.

Why?

Um, usually they kind of do the work for you. So it just means that patients have better oral health because most people don't know how to brush their teeth properly. Actually, we're never really taught or trained or we get taught by our parents. Our parents don't really know; they've been taught by their parents. So a lot of people don't actually know how to brush their teeth. Number one. Number two, we often don't brush for as long as we think that we are. So we're meant to brush for two minutes; the average is 20 to 30 seconds. We think that we're brushing for two minutes, but we're not.

So with an electric toothbrush, it times you and then also has a pressure sensor. The electric toothbrush often will have a pressure sensor which will show you whether or not you're brushing too hard or you're brushing at the right pressure, and that will reduce your chance of recession.

Can you show me on one of those tooth models in front of you the area of the mouth and teeth that people most often overlook?

Yes. Can I have your teeth? So I would say the area that people usually struggle with the most is the insides of their very back bottom teeth. So, inside, where next to my tongue, basically.

Yeah, just near your tongue. Basically, what a lot of people will do is they'll kind of go on the inside and they brush their teeth like this, okay? Whereas, actually, you want to get your elbow up, and you want to brush a lot more like at a 90° angle when you're getting there. It looks like you're brushing the gums a little bit.

A little bit, yes. You actually do want to brush the gums a little bit. And then when we're on the outsides of the teeth, we want to kind of brush at a 30° angle—so rotational movements at a 30° angle. So not straight like a 90°, but kind of towards the gum margin. By doing circular movements, we're essentially kind of massaging the gums and getting rid of the bacteria from under the gum and then flicking it out.

Okay, yeah, so just like that. And then I always tell everyone it's really important to kind of have a method behind your tooth brushing. So don't go like brush and then go there and then up there, you know, because you'll never brush properly. Um, so always start, let's say, on the left-hand side, go do all the outsides, and then do all the B surfaces, and then do all the insides, and then do the same on the top teeth as well.

And that model there—you've got another model in front of you, which is like a see-through model. What does that show us?

Um, so this is to show you what an implant looks like. A lot of people don't know what implants look like and how it looks like if it was within your jaw. Also, what all the roots look like. And then also, if you look on the other side, you can see this tooth which has the black within it.

Yeah, and it's got like a red bubble at the root of it. So this is a tooth that's had a root canal done to it and has an infection at the roots of that tooth. So that’s an abscess, and a lot of people don't actually know what that looks like. Um, they only feel tooth pain, but this is what a tooth is actually in their jaw.

When our teeth get—teeths? Is that the right word? Is that a plural? When our tooths...what’s the plural of teeth?

It's teeth.

Is teeth? Yeah, yeah. When our teeth get stained, yes, what we often do is we'll take some sort of whitening toothpaste, or we'll go to a dentist or a hygienist or something and ask them to whiten our teeth. Now, I've always been a bit scared of that because there must be a cost to this whitening industry. Should we be whitening our teeth? Is there any healthy way to whiten our teeth?

Yes. Um, so you've got two different types of staining: one which is extrinsic. So that's basically your coffee, your tea, your smoking—super easy to get rid of. You just have to go to your hygienist and get a hygiene done, and they'll get rid of the stains pretty quickly.

Um, or you can try a whitening toothpaste. Be very careful with a lot of those whitening toothpastes because they can be quite abrasive and damage the enamel, actually. So it’s kind of like exfoliating your teeth, but your teeth don't grow back. If you keep on exfoliating and getting rid of that surface layer of enamel over a long amount of time, that can be quite an issue and quite problematic. You get sensitive teeth.

Yeah, sensitive teeth, and then the underlying tooth will start to shine through, and that’s quite yellow. So you actually start ending up doing the opposite of what you wanted to do.

Um, then whitening—so you should do that professionally. Um, don't go and buy some over-the-counter online thing because a lot of the time either they don't have the right percentages, or they can actually damage the teeth and the gums really badly. So you want to get that done professionally. Um, if you get it done by a good brand—and even within the professional world, there are some whitening products out there which are really bad for the teeth, and others which are actually really good for the teeth.

So we use one in particular; it's called Enlighten. And the whitening for one day is the equivalent of having a Coca-Cola. Um, so thinking about it—I mean, I'm sure everyone has had one Coca-Cola in their life. Having a Coca-Cola every day for let's say five or six days is okay in the grand scheme of things. It’s not going to massively damage your teeth at all.

Okay, so there are safe ways to do that.

Okay, good. And is there any way to remove plaque yourself without having to go to a dental hygienist?

Um, so you can try a water flosser. I've just bought one of those, but it doesn't feel powerful enough 'cause when I go to the hygienist, I don't know what they're using, but it like it’s so strong that it blasts my mouth. My mouth feels so different after.

Yeah, and I wanted to know if I could buy one of those for my home, but I think it’s a little bit dangerous.

Um, well, the reason I think that the water flossers are not that high intensity is because people can damage their teeth if they don't use it correctly. So, kind of know. There are some supplements that you can take to reduce the amount of plaque that builds up, and that actually does work quite effectively.

I mean, what are you...there were two more—there's a couple more things there that you have in your pile that we haven’t talked about?

These are probiotics. Okay, so going back to our microbiome—probiotics are basically good bacteria. So, um, not everyone needs them, but a probiotic essentially will put good bacteria into the microbiome, and if it's got the right environment to live in, then it will continue to grow there.

Basically, if you're eating the right things.

Exactly. If you're eating the right things, you've got prebiotics, you know, all of those types of things, then this will be really effective.

So these are two different options: this is a mouthwash. Um, and again, on the microbiome test that we've created, OralEs One, we look at all the levels of good bacteria, and then we'll recommend a probiotic based on what good bacteria you are missing.

So a lot of us are actually genetically born without certain good bacteria in our microbiomes, and so this is really lovely to supplement them. So this is a mouthwash, but it's in a powder form. So you take a teaspoon, you mix it with some water, and that activates the probiotic. Then you rinse it around, and you swallow it. So it's a kind of a two-in-one for your gut.

This is a pill, so it's a tablet you chew it, um, and then you can swallow it. So this is again, this is super easy too. Um, and I love these as well. Very easy to use.

Victoria, what's the most important thing that we haven't talked about today that we should have talked about today?

Uh, the only thing that I think you haven't mentioned that your viewers might benefit from is the use of straws. Straws are very, very important to use for sugar and also for acid. So drinking through a straw actually helps you bypass all of your teeth. So if you're having something acidic or really sugary or even something staining, then it bypasses the teeth and it goes straight to the back of your throat so you can swallow it.

Um, so this helps reduce your chance of decay, tooth wear, and also staining as well. But specifically if it's bad for you because I'm sure there's some things that are good for the oral microbiome that you do want to be in the mouth.

Yes, yeah, yeah. So if you're taking your probiotics or whatever, then of course those are great.

Um, like for example, um, you know, I'm human—I like a nice Coca-Cola once in a while, and I'll drink it through a straw. Um, or if I have alcohol, I'll also drink that through a straw, as long as it's not wine.

But about smoking and vaping—

Um, so yeah, smoking and vaping—neither of them are good for the oral microbiome. Um, it goes back to dry mouth, so smoking will dry your mouth out and then you don't have the saliva, and the saliva can't do what it wants to. It stops vascularization, so it stops blood flow to your mouth.

And so a lot of smokers actually will not have bleeding gums. That doesn't mean that they don't have gum disease, but because they are smoking so much, the blood vessels are already really tight and constricted from the nicotine. Um, so they don’t ever get bleeding gums even though they have gum disease.

Um, and then the third thing is that actually we know that smoking is very strongly associated—one of the biggest risk factors for gum disease.

If someone’s now curious about their oral microbiome and the work that you're doing, what is the sort of easiest entry point to learn more, to get themselves checked, or to, I don’t know, to resolve some of the issues that are causal or consequence of having an unhealthy microbiome? Where do they start? How do they find you?

We have a clinic in central London called The Health Society. Um, we opened about a year and a half ago now, and our aim was to put the mouth back into the body, to explain to patients exactly what's going on in their mouth. And we can do that through microbiome testing, other saliva tests. Um, we look at your blood glucose levels, your vitamin D levels. We've got packages. We have an infrared sauna. We have a nutritionist.

And the idea is that we're working all together because one of the issues I was seeing was that patients, they want to understand what's going on in their mouth and they want to optimize it, but they don't understand a lot of what dentistry is all about.

We used to live in a world where the dentist would say, "Okay, you need two fillings and you've got gum disease and you're not brushing your teeth," and that was the end of it. And you would just listen to them and you’d get your work done.

But now we are trying to essentially decode dentistry and explain it in a way that patients can understand. So I would say—I’m biased—but come over, come to the clinic. We can explain everything. Um, or you can do an oral microbiome test, and you can actually understand yourself what bacteria, what genetic mutations you have, what inflammation you have, what products you should start using, and then based on that decide on what dentist you want to go to for any treatment if needed.

What if I'm in Australia, or Canada, or New Zealand, or America? What can I do?

Um, so we’re actually rolling out the oral microbiome test to all of those countries. Um, so you can actually buy it at the moment through that. You just have to email us. But otherwise, they—you know, I'm not the only one. There are other people who are doing this type of dentistry and are thinking in this type of way.

So you would have to do a little bit of research, but, um, I guess maybe follow me on Instagram and I can give some top tips. I'll link your website and your social channels below, and if anyone wants to send you an email, you might get a couple of emails—warning you now.

Um, so you got to be careful what you wish for, but I'll put all those details below.

Um, we have a closing cue on this podcast where the last guest leaves a question for the next guest, not knowing who they're leaving it for.

Okay.

And the question that's been left for you is: What is the most important relationship in your life, and why?

Um, this is going to cause you problems, I know. Um, I would say my mother. I think that is the most important relationship for me. I think she has been one of my biggest mentors. She's been my biggest cheerleader, my supporter. Um, she's hard on us, but that has led to me being the person that I am.

Um, and I think that if I don't have a good relationship with her, then I can't have a good relationship with other people. She’s taught me respect; she’s taught me how to handle myself around people.

Um, so yeah, I guess uh big up to my mom. Is she Iranian?

She is, yeah.

She's Iranian, yeah. And your father?

He is French-American.

French-American. And if we sit here in 10 years' time, what are you hoping the world looks like as it relates to the oral microbiome—people's understanding of it, the regulations, what are you hoping for? If you could wave a wand.

I am hoping that, um, the mouth is back into the body in the sense that dentistry and medicine are fully integrated within each other. So you can go to your dentist and you can get a saliva test, and that could flag up issues with your heart or diabetes, and you will go and see your diabetologist. Um, and we link everything together.

Uh, also my other dream is that people start testing their saliva and they understand that blood is not the only way that we can understand things that are going on within our body.

Dr. Victoria Samson, thank you so much. I find this so unbelievably fascinating in part because I've never heard about any of this stuff before. And I do this job—you know, I've done it quite a few times now, so I've spoken to a lot of health experts that talk about the brain or, I know, infertility or the gut microbiome, but never one that looks at the body and our overall picture of health through the front door or the lens of our oral microbiome.

And so it's really, really inspired me. And I think sometimes on this podcast I just love having these conversations because sometimes you just need a little bit more information about the importance of something to make even a small change in your life.

And as it relates to our microbiomes, our oral health, our brain health, and all of these things—even a small change can have a big downstream impact when we're talking about areas of our health where things compound over time and can either compound for us or against us.

And so thank you so much for doing the work that you do in shining a light on this. Your work has been really seminal in sort of driving the conversation, but also turning the lights on to the state and importance of our oral health.

And I'm sure that if we sit here in 10 years' time, you would have impacted many, many, many millions of people, um, and their overall picture of health through the lens of their oral microbiome because of the work you're doing and the message you're putting out there.

And that is quite something, so congratulations. Well done, and thank you.

Thank you so much.

Thanks!

[Music] [Music]