How to Improve Oral Health & Its Critical Role in Brain & Body Health - Dr Andrew Huberman

The Seventh Pillar of Health

Dr Andrew Huberman introduces oral health as the seventh pillar of mental health, physical health, and performance, adding to the existing six pillars: sleep, light exposure, nutrition, exercise, stress management, and relationships. This is highlighted as a non-trivial step, emphasizing the profound influence oral health has on general bodily health. Oral health extends beyond just teeth and breath to include the oral microbiome, palate, tonsils, and the entire oral cavity. It is inextricably linked to cardiovascular, metabolic, and brain health, playing a role in staving off diseases across these bodily compartments.

Understanding Oral Biology and Cavity Formation

• Tooth Anatomy and Remineralisation: Teeth are layered structures with an outer translucent enamel layer and an inner Dentin layer. Cavities form as bacteria burrow through the enamel into the Dentin. A crucial insight is that teeth can repair cavities if they haven't penetrated too deep, through a process called remineralisation. The mouth is constantly in a state of either demineralisation or remineralisation, largely dependent on the pH (acidity) of the mouth and saliva production.
• Saliva's Critical Role: Saliva is an "incredible substance" that helps rebuild tooth strength and supports the health of the oral cavity, gut microbiome, and body generally. Healthy saliva with the correct pH encourages remineralisation.
• Gum Health: Gums (gingiva) are vital for stabilising teeth and form a critical barrier, a "seal," between the oral cavity and deeper bone layers and the bloodstream. When this barrier is compromised by bacteria, it can lead to periodontal disease, which is associated with serious issues like Alzheimer's disease, cardiac, and metabolic health problems. The oral cavity, despite being a "gaping hole" exposed to constant bacteria, heals with nearly zero scarring, showcasing its remarkable robustness when treated correctly.
• Mechanism of Cavity Formation: Cavities are not caused directly by specific foods like sugar, but by bacteria, primarily Streptococcus mutans, that feed on sugars (including complex carbohydrates) and then produce acid. This acid degrades and demineralises the tooth enamel. Streptococcus mutans is a communicable bacteria, transmitted through sharing drinks or kissing, and is not something individuals are born with.
• Time is Key: The duration for which the mouth remains acidic (in a demineralisation state) is the most critical factor in cavity formation.

Practices to Avoid

• Alcohol: Disrupts the oral microbiome, alters saliva pH towards acidity, and kills beneficial cells in the mouth's mucosal lining.
• Stimulants: Drugs like Adderall, Vyvanse, methamphetamine, and even coffee and tea (when consumed excessively) increase epinephrine and norepinephrine, making saliva more acidic and encouraging mouth breathing, both of which promote demineralisation.
• Smoking and Vaping: Cigarettes, cannabis, and vaping are detrimental to oral health, promoting degradation of gum tissue and potentially causing pre-cancerous conditions.
• Excessive Sugar and Carbohydrates: While not the direct cause of cavities, they provide food for Streptococcus mutans to produce acid. Rinsing the mouth with plain water after consuming these is advisable.
• Mouth Breathing: A leading cause of tooth decay and severely depleted oral health, as it dries out the mouth and shifts its environment towards demineralisation. Nasal breathing is strongly encouraged whenever possible.
• Acidic Foods and Drinks: Citrus fruits, carbonated drinks, and other acidic items can demineralise teeth. While not requiring complete avoidance, limiting exposure time (e.g., drinking quickly, using a straw, rinsing with water afterwards) is crucial.
• Most Mouthwashes: Especially alcohol-based or strong antiseptic varieties, are detrimental as they disrupt the healthy oral microbiome, deplete the mucosal lining, and reduce the production of nitric oxide, which is important for vasodilation and overall health.

Essential Protocols for Oral Health

• Prioritise Night-time Brushing and Flossing: If one can only brush and floss once a day, it should be at night before sleep. This is because saliva production dramatically decreases overnight, reducing the mouth's natural defence against bacteria and acid. Twice daily brushing and flossing is recommended where possible.
• Create Gaps Between Meals: Allowing stretches of 2-6 hours or more without eating or consuming acidic liquids during the day, particularly in the morning and midday, provides an opportunity for healthy saliva production and tooth remineralisation. This supports the principles of intermittent fasting for oral health.
• Brushing Technique: Use a soft toothbrush with gentle, circular motions on all tooth surfaces to break up biofilm without damaging gums. Vigorous brushing with medium or hard bristles is not recommended. Electric toothbrushes should also be used with light pressure.
• Brushing Gums: Lightly brushing gums can increase blood circulation and nutrient delivery to deeper tooth components, potentially reducing tooth sensitivity.
• Flossing Technique: Floss correctly by gliding the floss down the side of the tooth, slightly under the gum line, with a circular motion, rather than just forcing it down. If gums bleed when flossing correctly, it indicates a need to floss more consistently. Water picks are suggested as a gentler and effective alternative to traditional floss. Children with significant gaps between their baby teeth may not need to floss.
• Xylitol Use: Chewing Xylitol-based gum or mints immediately after meals is highly beneficial. Streptococcus mutans consumes Xylitol but cannot produce acid and is subsequently killed. Xylitol also reduces gum inflammation and stimulates saliva production.
• Toothpaste Choices:
  • Toothpastes containing Xylitol are beneficial.
  • For those wishing to avoid fluoride, toothpastes with hydroxyapatite (the naturally occurring mineral that forms tooth enamel) are recommended as they support natural remineralisation.
  • Mild abrasives in toothpaste are also helpful for breaking up biofilm.
• Tongue Care: Lightly brushing the tongue, ideally with a separate toothbrush, once or twice a day helps remove unhealthy bacteria that accumulate there. This prevents cross-contamination of bacteria between teeth and tongue.
• Supporting the Gut Microbiome: Consuming 1-4 servings of low-sugar fermented foods daily, ensuring adequate prebiotic fibre intake, and getting sufficient sleep (6-8 hours per night) supports a healthy gut microbiome, which in turn influences oral microbiome health and can help prevent and heal canker sores.

Fluoride: A Polarised Debate

Fluoride is a substance that can replace natural hydroxyapatite bonds in teeth, making them "hyper strong" or "super physiologically strong" and increasing resistance to cavities. This is why it's added to drinking water and many toothpastes. However, there is a significant debate regarding its safety, with concerns about its potential impact on thyroid and brain health, especially in children, if levels are excessive. The bonds formed by fluoride also look different, described as "wavy" compared to natural smooth bonds. The decision to use fluoride or avoid it is a personal one, with options to filter water or use fluoride-free toothpastes containing hydroxyapatite.

Low-Cost and Zero-Cost Oral Health Solutions

• Baking Soda Toothpaste: A mixture of baking soda and water can be used as a gentle, low-abrasive toothpaste to disrupt biofilm and clean teeth.
• High Salt Solution Rinse: Swishing a high concentration salt water solution (not swallowing) followed by a plain water rinse can improve the mouth's pH and promote healthy bacteria.
• Avoid Hydrogen Peroxide: Hydrogen peroxide is generally too abrasive for the oral cavity and can cause harm, as exemplified by an experience of mouth ulcers.

Dental Visits and Fillings

• Frequency of Visits: The general recommendation for twice-yearly dental visits makes sense for "routine cleanings" to remove tartar and identify deep cavities. However, daily home-based protocols are paramount for preventing issues and promoting remineralisation. Dental visits also serve as a check-up to assess the effectiveness of daily practices and establish a baseline of oral health. Genetic predispositions can influence the necessary frequency of dental visits for some individuals.
• Cavity Treatment: If cavities are too deep into the Dentin layers of the tooth, remineralisation through daily practices may not be sufficient, and drilling and filling are often necessary. Leaving deep cavities untreated allows bacteria to proliferate and can lead to serious health issues.
• Metal Fillings: Older metal fillings sometimes contained mercury, which can be harmful if liberated into the bloodstream. Dentists generally advise leaving existing mercury-containing fillings undisturbed and avoiding activities like chewing hard gum (e.g., Mastic Gum) or hard candies that could disrupt them. The use of metal fillings is becoming less common or being phased out in some regions due to these concerns.

Chapters

00:00:00 Oral Health
00:03:28 Sponsors: Mateina, ROKA & Helix Sleep
00:07:13 Oral Health Quiz
00:13:53 Teeth Biology, Cavity Repair
00:20:01 Mouth, Gums, Saliva
00:27:23 Sponsor: AG1
00:28:51 Cavity Formation, Bacteria, Sugar, Acidity
00:35:10 Teeth Remineralization, Fluoride, Water
00:42:57 Sponsor: InsideTracker
00:43:58 Tools: The “Do Nots” of Oral Health, Mouth Breathing
00:54:48 Tools: Fasting & Teeth Remineralization; Nighttime Toothbrushing
01:03:23 Proper Teeth Brushing; Tooth Sensitivity & Gums
01:08:16 Bacteria, Plaque & Tartar; Tooth Polishing
01:11:02 Proper Flossing Technique, Waterpik; Children & Flossing
01:14:23 Tool: Xylitol, Bacteria & Cavity Prevention
01:19:43 Toothpastes: Xylitol, Fluoride, Hydroxyapatite
01:22:38 Mouthwash & Alcohol, Antiseptic Mouthwash
01:26:29 Tools: Baking Soda, Hydrogen Peroxide?, Salt Water Rinse
01:32:36 Alcohol-Based Mouthwash, Nitric Oxide
01:34:52 Tools: Canker Sore Prevention & Gut Microbiome; Sleep
01:37:47 Tools: Tongue Brushing; Toothbrush Care
01:41:38 Teeth Sealants; Metal Fillings, Mercury, Mastic Gum; Root Canals
01:48:43 Dentist Visits, Daily Routines & Oral Health
01:54:17 Practices for Oral Health, Oil Pulling
01:58:21 Outro