Functional Dentist: New Research Linking Dental Hygiene To Many Other Diseases - The Diary of a CEO with Dr Victoria Sampson

Dr Victoria Sampson is an award-winning functional dentist, researcher, and founder of the multidisciplinary oral health centre, The Health Society Labs. She is also the first dentist in the world to link gum disease with worse COVID complications.

The Oral Microbiome: Gateway to Full Body Health

• The oral microbiome is the second largest and most diverse microbiome in the body, after the gut. It contains approximately 700 different types of bacteria, totaling about two billion bacteria overall.
• Unlike the gut microbiome, the oral microbiome is considered a lot easier to change. However, the teeth are the only non-shedding surfaces in the body, meaning mechanical disruption (brushing, flossing) is regularly necessary to remove plaque and bacteria.
• Everything we do—breathing, eating, drinking, and kissing—impacts the oral microbiome, and when we swallow or breathe, that bacteria can travel to the rest of the body and cause systemic problems.
• Globally, 3.5 billion people suffer from some form of oral disease, and 10% of the world population suffers from severe gum disease, making it one of the most prevalent inflammatory conditions in the body.

Strong Causal Links Between Oral Health and Systemic Diseases

• Research indicates that more than 90% of diseases can be traced back to an imbalanced microbiome. Specifically, an imbalanced oral microbiome increases the risk of numerous systemic diseases, moving beyond mere correlation to strong causation.
• Heart Disease and Stroke: Oral bacteria can travel to the heart valve and cause problems, such as infective endocarditis. Gum disease is associated with a 20% higher chance of high blood pressure. Individuals with gum disease are twice as likely to have a heart attack and three times as likely to have a stroke. Toxic enzymes released by oral bacteria can damage blood vessels, stopping them from widening or constricting properly, which is linked to heart disease.
• Alzheimer's and Cognitive Decline: If gum disease persists for more than 10 years, there is a 70% increased chance of developing Alzheimer's. A specific oral bacteria, *Porphyromonas gingivalis* (*P. gingivalis*), can cross the blood-brain barrier and release toxic enzymes called Gingipains, which break down neurons and brain tissue. These Gingipains were found in 97% of Alzheimer's sufferers' cerebral spinal fluid compared to 0% in those without the disease. For patients who already have Alzheimer's, having gum disease leads to a much more rapid cognitive decline.
• Infertility and Reproductive Health: Oral health is linked to fertility, with over 90% of subfertile men having an oral disease. Treating these men's oral infections led to a 70% improvement in pregnancy success for their partners within eight months, alongside better sperm quality and motility. For women, gum disease can delay conception by two months longer. Pregnant women with gum disease are at a higher risk of pre-term birth, low birth weight, and preeclampsia.
• Cancer: Specific oral bacteria, such as *Fusobacterium nucleatum*, have been found in high levels in the breast microbiome of women with breast cancer and in the colons of more than 50% of patients with colorectal cancer. This oral bacteria can make cancer more aggressive and harder to treat. Studies in mice also show this bacteria can accelerate tumour growth.
• Rheumatoid Arthritis (RA): There is a strong bidirectional relationship between RA and gum disease. Patients with RA are eight times more likely to develop gum disease than those without it. Treating severe gum disease in one patient significantly improved her RA to the point where she could stop medication and walk again.
• Erectile Dysfunction (ED): Men with periodontal (gum) disease are 2.85 times (285%) more likely to suffer from erectile dysfunction. The link is that the inflammation and toxic enzymes from gum disease restrict blood flow, preventing the blood vessels from dilating sufficiently.
• Other Diseases: An imbalanced oral microbiome is also linked to high blood pressure, diabetes, and erectile dysfunction.

Mechanism of Oral Disease Impact (Inflammation, Bacteria, and Blood Vessels)

• Spread of Bacteria: Oral bacteria can travel through the blood vessels, or be breathed or swallowed, allowing them to cause super-infections elsewhere. For example, oral bacteria causing pneumonia was the cause of death for most COVID patients in some autopsy studies, not the virus itself.
• Systemic Inflammation: Gum disease releases large amounts of inflammatory markers. When combined with other inflammatory conditions (like COVID-19's "cytokine storm" or rheumatoid arthritis), this adds "petrol to the fire," making the systemic inflammation much worse. Even low-grade chronic inflammation from gums can contribute to inflammation in joints.
• Vessel Damage: Toxic enzymes released by oral bacteria can travel through the bloodstream and damage blood vessels, impairing their ability to dilate and constrict effectively.
• Bleeding gums are a clear sign of inflammation and should be treated seriously, not viewed as normal.

Modern Diet and Jaw Development

• The modern westernised diet, which is high in processed foods and sugar, requires less chewing, leading to underdeveloped jaws and muscles at an early age.
• This underdevelopment results in teeth crowding and smaller jaws, requiring more orthodontic treatment (braces). Teeth size has not changed, but there is less space for them to grow.
• The historical observation by dentist Western Price showed that twins living in non-industrialised areas, eating harder foods and less sugar, developed perfect teeth with no crowding or decay.
• The lack of jaw space in modern humans results in a higher occurrence of impacted wisdom teeth.

Lifestyle and Hygiene Recommendations

• Sugar Consumption ("Sugar Attack"): It is better to have all sugar in one go ("a sugar attack") rather than sipping sugary drinks or snacking constantly over long periods. Every time sugar is consumed, saliva becomes acidic; frequent sipping prevents the saliva from neutralising and can lead to decay and erosion.
• Timing of Brushing: You should never brush straight after consuming anything acidic or sugary, as this grinds the acid into the teeth. Instead, wait 30 minutes or use sugar-free gum or chewable mints to neutralize the saliva quickly.
• Rinsing After Brushing: You should only spit, not rinse with water, after brushing, as rinsing washes away the beneficial active ingredients of the toothpaste.
• Toothbrush Type: An electric toothbrush is generally preferred because it helps ensure the user brushes for the full two minutes (the average is 20-30 seconds) and prevents brushing too hard via a pressure sensor, reducing the chance of gum recession.
• Mouth Taping and Nose Breathing: The nose acts as a filter, protecting the mouth from breathing in unfiltered bad things, unlike the mouth which has no filter. Mouth breathing is associated with a host of issues, including ADHD-like symptoms, bedwetting, teeth grinding, and a higher risk of inflammatory conditions and chronic fatigue in adults. Children who suffer from sleep-disordered breathing are 50% to 90% more likely to develop ADHD-like symptoms than nose-breathers. Mouth taping can be a helpful tool to check if one is a mouth breather and can lead to better sleep and oxygen levels.
• Straws: Using a straw for acidic, sugary, or staining drinks helps bypass the teeth, reducing the chance of decay, tooth wear, and staining.
• Substances to Avoid/Mitigate:
  • Smoking and Vaping cause dry mouth, which harms the oral microbiome. Nicotine constricts blood flow, meaning smokers often don't have bleeding gums despite having gum disease. Smoking is one of the biggest risk factors for gum disease.
  • Coffee and Tea can dry the mouth out, reducing saliva (the "delivery service" for good bacteria) and allowing bad bacteria to grow.
  • Alcohol dries the mouth out and contributes to poor health choices that impact the skin.

Personalised Oral Health and Testing

• Oral Microbiome Testing is an emerging field, with one of the first tests in Europe developed to provide a deep snapshot of an individual's oral health.
• Oral microbiomes are highly unique and influenced by genetics. Two people (e.g., partners) may have similar bacteria, but their outcomes differ based on how their body genetically responds to that bacteria and the strains they possess.
• Some people can have immaculate hygiene and diet yet still suffer from terrible gum disease due to genetic mutations that predispose them to inflammation and an aggressive, destructive immune response to even small amounts of bacteria.
• Testing allows for personalised treatment plans, including specific recommendations for probiotics, supplements (like green tea for killing specific bacteria), toothpaste, and dental routines. For instance, green tea is extremely effective at killing *Fusobacterium nucleatum*.
• Saliva testing was used during the COVID-19 pandemic to link poor oral health with higher complication risks, specifically finding that patients with gum disease were nine times more likely to have COVID complications.
• Personal self-care can be the first thing to decline when under stress or mental health decline, making oral health a potential "big sign" of internal distress. Stress, such as losing a baby, can cause temporary but massive collagen breakdown in the gums.

Relationships, Kissing, and Oral Sex

• Kissing: It takes more than 11 kisses a day for partners to start sharing the same oral microbiome. Kissing can transfer good bacteria, but the effects are not necessarily long-lasting.
• Oral Sex: Oral sex can lead to the transfer of bacteria between partners. There are case reports of women developing inflamed gums (gingivitis) due to receiving bacteria from a new partner who had recurrent urinary infections.
• Dr. Samson noted she has tested a former partner's oral microbiome and continues to try to get her current partner to test his.

Oral Care Products and Other Treatments

• Probiotics: Probiotics (good bacteria) can be supplemented, often in powder or chewable tablet forms, and are recommended based on which beneficial bacteria an individual is genetically missing.
• Water Flossers: These can help remove plaque, although they are not as intense as the professional tools used by a hygienist, which are often restricted to prevent patient self-damage.
• Whitening: Stains can be superficial (extrinsic, removed by a hygienist) or deep. Whitening should be done professionally to avoid damaging the enamel, as many abrasive whitening toothpastes or over-the-counter products can thin the enamel, leading to sensitivity and a yellower appearance over time.
• Multidisciplinary Approach: The future of health will involve fully integrated Dentistry and Medicine, where saliva tests at the dentist can flag issues like heart disease or diabetes, leading to seamless referral to specialists. Some cardiac surgeons are already working with dentists to achieve better patient outcomes.

Chapters

00:00:00 Intro
00:02:02 The Oral Microbiome
00:03:22 What Impacts Our Oral Microbiome?
00:04:01 2 Million Bacteria in Your Mouth
00:05:14 How Many People Have Oral Diseases?
00:06:47 Body Diseases Linked to Oral Microbiome
00:08:33 Steven Adjusting Chair?
00:10:46 Research Linking COVID-19 and Oral Hygiene
00:13:06 Can Your Oral Microbiome Kill You?
00:13:55 How Food Shapes Your Mouth
00:17:03 What’s a Wisdom Tooth?
00:18:22 Do Wisdom Teeth Need Removal?
00:19:07 Why Do We Need Dentists If Ancestors Had Good Teeth?
00:20:33 Is Everyone’s Microbiome Massively Different?
00:22:22 How Oral Health Improves Overall Health
00:24:22 Can Swallowing Saliva Make You Sick?
00:26:16 Inflammation and the Oral Microbiome Link
00:28:18 Rheumatoid Arthritis Strongly Linked to Oral Health
00:30:43 Heart Disease and the Oral Microbiome
00:33:30 How Oral Bacteria Filters Through Your Body
00:33:48 Erectile Dysfunction Linked to Oral Hygiene
00:35:56 Emerging Research: Breast Cancer and Oral Microbiome
00:39:53 Green Tea Benefits for Oral Health
00:41:12 Impact of Coffee on Oral Health
00:42:14 Effects of Hot Drinks & Sugar on Teeth
00:44:02 Link Between Brain Health & Alzheimer’s
00:50:39 Can Mental Health Be Seen in the Mouth?
00:51:40 Spotting Eating Disorders Through Oral Health
00:52:18 How Stress Affects Your Oral Health
00:53:54 Mouth vs. Nose Breathing: Health Impacts
00:57:36 Higher ADHD Risk in Mouth-Breathing Children
00:58:31 Kissing and Bacteria Transmission
00:59:32 Oral Sex and the Oral Microbiome
01:01:55 Switching to Steven - Transition
01:02:35 Oral Health and Fertility
01:07:01 Ad Break
01:08:00 Study Results on Oral Health
01:16:59 Best Time to Brush Your Teeth
01:18:05 Good vs. Bad Oral Products
01:26:46 Should You Spit or Rinse After Brushing?
01:31:16 Whitening Products: Do They Work?
01:34:20 Importance of Drinking Through Straws
01:35:13 Smoking and Vaping Effects on Oral Health
01:37:58 Last Guest Question