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Exploring Integrative Dentistry with Dr Ron Ehrlich · Wellness by Designs - Practitioner Podcast

• 0:14
  Speaker 1: This is Wellness by Designs, and I'm your host, andrew Whitfield-Cook.
• 0:20
  Speaker 1: This is Wellness by Designs and I'm your host, andrew Whitfield-Cook.
• 0:24
  Speaker 1: Joining us today is Dr Ron Ehrlich, an integrative dentist of great renown, and it's so great to have you on the show talking about how we can care for our teeth and how we can care for our patients' teeth.
• 0:36
  Speaker 1: Welcome to Wellness by Designs, ron.
• 0:38
  Speaker 1: How are you?
• 0:39
  Speaker 2: I'm very well, Andrew.
• 0:40
  Speaker 2: Thanks for having me.
• 0:45
  Speaker 1: We're going to be exploring more than teeth.
• 0:48
  Speaker 1: Well, we will indeed.
• 0:53
  Speaker 1: Yes, that's right.
• 0:53
  Speaker 1: So let's start, though, a little bit with your history.
• 0:54
  Speaker 1: I know there's not many people out there, but some people may not know your history, your credentials and just how long you've been doing integrative medicine.
• 1:01
  Speaker 1: For Can you take us through a little bit through your dental history?
• 1:06
  Speaker 1: That sounds really weird, but what introduced you to thinking a little bit differently about it?
• 1:15
  Speaker 2: Yeah, well, it all started actually about six months after I graduated, where I rather unexpectedly found myself treating someone with chronic headache, somebody who'd come in and had a crown.
• 1:28
  Speaker 2: That was uncomfortable and it had been for the last five years, and I thought I'll adjust that, and they came back a week later.
• 1:35
  Speaker 2: So I just adjusted the bite and a week later they came back and said, yeah, the crown's fine.
• 1:40
  Speaker 2: And guess what?
• 1:40
  Speaker 2: The headaches that I've had for the last five years have gone as well.
• 1:44
  Speaker 2: And that intrigued me, and so for the last 42 years I have been exploring why that occurred, and it very quickly led me, in about 1982 or 83, to a model of healthcare related to chronic pain, because so many people said this headache is stress related and I thought, yeah, that's true, but what do we mean by stress?
• 2:08
  Speaker 2: So it developed a model that I worked with in my practice for the next 40 years, looking at stress as a function of anything that compromises your immune system and promotes chronic inflammation.
• 2:20
  Speaker 2: And so I have five stressors that I focus on.
• 2:22
  Speaker 2: And so I have five stressors that I focus on emotional, environmental, postural, nutritional and, of course, dental stress.
• 2:28
  Speaker 2: So that was really the catalyst for my education for right up until this very day and it got me in.
• 2:44
  Speaker 2: About 1996, I did a fellowship in nutritional and environmental medicine.
• 2:47
  Speaker 2: I've done a lot of research in postural stress and nutrition, as well environmental stress.
• 2:52
  Speaker 2: I've obviously been very involved with the Australasian College of Nutritional and Environmental Medicine I was the president there, just before the last president, which was quite a unique experience.
• 3:03
  Speaker 2: I wrote a book which summarized all of my learnings up to this point, up to 2018, which was called A Life Less Stressed the Five Pillars of Health and Wellness.
• 3:14
  Speaker 2: And then I got a fellowship in lifestyle medicine and then I became an executive and health coach, and that is where I find myself today.
• 3:20
  Speaker 2: So it's been quite a journey, andrew.
• 3:21
  Speaker 2: The more I learn, the that is where I find myself today.
• 3:24
  Speaker 2: So it's been quite a journey, andrew.
• 3:25
  Speaker 2: The more I learn, the more I realise I don't know.
• 3:28
  Speaker 1: Well, that's the whole thing about learning Anybody who thinks they know it all.
• 3:31
  Speaker 1: Hang up your shingle and go and do an accountant, be an accountant or something, because you've just turned arrogant.
• 3:36
  Speaker 1: But I love your eternal curiosity.
• 3:41
  Speaker 1: Can I ask you, ron, who was your best mentor when you were learning, when you were just starting on this journey of integrative medicine?
• 3:53
  Speaker 2: Yes, well, I attended a great many courses in a great many areas and I went to a course in America given by a chiropractor who had that stress model, so his name is George Goodhart.
• 4:05
  Speaker 2: But then in 1989, I had the pleasure, the honour, the privilege of attending a six-day program with Dr Janet Travell, who wrote a book called the Myofascial Trigger Point Manual.
• 4:19
  Speaker 2: She used to be President Kennedy and President Johnson's physician in the White House and she ran a six-day course when she was 92 years old and it was brilliant.
• 4:31
  Speaker 2: And the lesson I got from that was that if you ask your patients the right questions and listen carefully to their answers, not only will they often tell you what's wrong with them, but they'll often tell you how to fix it.
• 4:44
  Speaker 2: So that was really a catalyst for a very patient-centred approach.
• 4:49
  Speaker 2: So they've been my two.
• 4:50
  Speaker 2: Oh, look, there've been actually so many mentors, it wouldn't be fair, but they're two that immediately spring to mind.
• 4:58
  Speaker 1: Okay, so let's dive right into the topic, and I know we're going to branch way out from just the oral cavity.
• 5:05
  Speaker 1: But what constitutes oral diseases?
• 5:08
  Speaker 1: How common are they?
• 5:10
  Speaker 1: What's the prevalence?
• 5:11
  Speaker 1: And are we seeing differences, by the way, in prevalence of certain diseases with changing health initiatives?
• 5:20
  Speaker 2: initiatives.
• 5:22
  Speaker 2: Yeah well, oral diseases would be a combination of gum diseases, periodontal diseases, tooth decay and narrow jaws and crowded teeth, and they would be the main areas.
• 5:40
  Speaker 2: So there are essentially two epidemics that are going on right underneath people's noses and it affects their general health and it's often overlooked and ignored.
• 5:48
  Speaker 2: Now, who did a global oral health report in 2022, end of 2022, and they did an assessment of all the major degenerative diseases non-communicable degenerative diseases and I think we could agree that malignant cancers is an important one 100 million people apparently suffer from malignant cancers globally.
• 6:16
  Speaker 2: Cardiovascular disease another one that's obviously the biggest killer 500 or 600 million people globally suffer from cardiovascular disease.
• 6:26
  Speaker 2: Mental health is being identified as a major problem and, according to this report, a billion people globally are diagnosed and that's important diagnosed with a mental health issue.
• 6:40
  Speaker 2: But three and a half billion people are diagnosed with oral diseases, as in tooth decay and gum diseases, and I would honestly say that that is an underestimation and we can talk about why that is.
• 6:56
  Speaker 2: But oral diseases encompass those two major epidemics the infections of gum and teeth and the narrow jaw and crowded teeth and 90% of the population have some experience of both those things.
• 7:14
  Speaker 1: You know I get underreporting.
• 7:16
  Speaker 1: Underreporting is an issue with all of the diseases that are taken into report, but that's a staggering difference between, say, cardiovascular cancer and oral cavity diseases.
• 7:32
  Speaker 1: That's huge.
• 7:35
  Speaker 2: Yeah, well, I mean, I think the interesting thing about that is that it's now almost universally accepted that chronic inflammation is the common denominator in all diseases, be it physical and even mental.
• 7:49
  Speaker 2: Okay, so if you accept that premise, which is well accepted, then to ignore oral diseases is to ignore the most common chronic infection and chronic inflammation in your patients and possibly in the people listening to this right now.
• 8:08
  Speaker 2: So you know, the oral cavity is really the black hole of healthcare, and it's a black hole for two main reasons.
• 8:19
  Speaker 2: One is that the vast majority of medical and allied health practitioners know very little about oral diseases, in fact, will often assess their patients by asking them these not very in-depth questions have you been to the dentist lately?
• 8:37
  Speaker 2: Yes, I have.
• 8:38
  Speaker 2: Was anything done?
• 8:39
  Speaker 2: No, not really.
• 8:41
  Speaker 2: Are you in any pain?
• 8:43
  Speaker 2: No, I'm not.
• 8:43
  Speaker 2: And tick that box.
• 8:45
  Speaker 2: We've now covered oral diseases.
• 8:47
  Speaker 2: So from the health practitioner's point of view, it is often overlooked and it requires a comprehensive oral exam.
• 8:57
  Speaker 2: From the dentist's perspective, dentistry is such a stressful job.
• 9:04
  Speaker 2: I mean, that's kind of almost folklore now.
• 9:07
  Speaker 2: We wear it as a badge of honour, but we are literally involved in minutiae.
• 9:13
  Speaker 2: We measure success of fillings and crowns in microns, that's a thousandth of a millimetre and we're dealing with patients who are stressed, that are awake in the most sensitive part of their body.
• 9:26
  Speaker 2: So it is a really intense profession and it's easy to get lost in the oral cavity and forget that there's a hell of a lot more going on there besides just oral health.
• 9:38
  Speaker 2: So it's working both ways and I don't think a lot of patients.
• 9:43
  Speaker 2: It's a lose, lose, lose.
• 9:45
  Speaker 2: Really it's a loss for the medical profession, it's a loss for the dental profession and, most importantly, it's a loss for public health.
• 9:55
  Speaker 1: Is a comprehensive oral exam the same for an orthodox practitioner and an integrated practitioner, or are there vast differences in how you approach your exams versus an orthodox dentist?
• 10:10
  Speaker 2: Well, in our practice, which is the Sydney Holistic Dental practice, our new patient exam would typically go for an hour and that would involve a very comprehensive medical history, more than just do you want any medications?
• 10:26
  Speaker 2: Do you have high blood pressure?
• 10:27
  Speaker 2: Because we're worried about the anaesthetic we're giving.
• 10:30
  Speaker 2: We want to know people's metabolic health, things like their thyroid function, their cardiovascular disease.
• 10:38
  Speaker 2: Do they suffer from reflux, heartburn, indigestion?
• 10:41
  Speaker 2: Do they have regular bowel movements?
• 10:43
  Speaker 2: Do they have diarrhoea or constipation, giving us a clue as to gut health?
• 10:47
  Speaker 2: Do they sleep well at night?
• 10:50
  Speaker 2: Do they wake up feeling refreshed?
• 10:52
  Speaker 2: A whole range of questions.
• 10:55
  Speaker 2: Then we would do a very comprehensive oral exam which would include an oral cancer screening.
• 11:02
  Speaker 2: Oral cancer is now one of the top 10 cancers in the world and the best way of dealing with it is to detect it early.
• 11:09
  Speaker 2: So every six months we routinely would do an oral cancer screen, but in a comprehensive exam.
• 11:17
  Speaker 2: That's where we start.
• 11:18
  Speaker 2: Then we would do an assessment of the patient when we would chart really what fillings, what type of fillings, what the condition of those fillings are.
• 11:28
  Speaker 2: Then we would do a comprehensive assessment of a person's periodontal health.
• 11:35
  Speaker 2: The gum should be like a tight collar around the tooth and there's a little crevice that runs around the gum which is about two to three millimetres deep.
• 11:44
  Speaker 2: So we would assess six points on every tooth to assess whether there is periodontal disease there.
• 11:53
  Speaker 2: Then we would take x-rays.
• 11:56
  Speaker 2: You cannot see things in the oral cavity without x-rays, and that would include small little 2D x-rays bite wings and periapicals, but a panoramic x-ray to give us an overall view of what they've had and if they have had a lot of treatment.
• 12:14
  Speaker 2: Then we would routinely be taking a 3D cone beam x-ray and have that read by a dentofacial radiologist.
• 12:25
  Speaker 1: Right.
• 12:26
  Speaker 1: Can you take us through that 3D x-ray?
• 12:29
  Speaker 1: Because it's to my knowledge and please forgive, please correct me if I'm wrong but to my knowledge it's TTA approved, it's authorised, certainly, as you said, for more complex issues, but not very often utilised.
• 12:44
  Speaker 1: Why is that not utilised versus the OPG, when the OPG can't tell you what's hiding behind something because it's a flat you know, basically goes, follows your jawline around and then puts it onto a flat piece of paper.
• 13:01
  Speaker 2: Andrew, we've been using 3D x-rays for the last 20 plus years and we have our 3D x-rays read by a dentofacial radiologist.
• 13:11
  Speaker 2: That's very important because we've had screens done by an ordinary radiologist a specialist supposedly and it's come back with no abnormality detected, whereas the reports we get are usually between one and two pages long and cover everything.
• 13:29
  Speaker 2: So that's very important because when we take a 3D X-ray we are revealing a lot of information and if we as dentists and we're quite we're pretty good at reading it ourselves, I have to say that we're pretty good at reading it ourselves.
• 13:43
  Speaker 2: I have to be.
• 13:44
  Speaker 2: I have to say that we're pretty good at reading it ourselves.
• 13:46
  Speaker 2: But if we missed something, oh my god, you know we just wouldn't want to do that, particularly if it was something like a tumor, or you know that we'd missed in the sinuses or in another part of of the oral area there.
• 14:01
  Speaker 2: So so a 3D x-ray gives you so much information and it never ceases to amaze us.
• 14:09
  Speaker 2: When we look at a 2D x-ray and we go hmm, there's a little bit of a shadow there.
• 14:14
  Speaker 2: I don't know, do you have any pain?
• 14:16
  Speaker 2: No, I don't.
• 14:17
  Speaker 2: We might just keep our eye on that for six or 12 months no, that's not a comprehensive oral exam.
• 14:24
  Speaker 2: We would then send them off for a 3D x-ray and what looked like a maybe is an extensive infection with jawbone, a loss of jawbone and the presence of pus and granulation tissue, and the patient has absolutely no pain.
• 14:41
  Speaker 2: So this has been, and continues to be, a constant surprise humbling for us, because sometimes we weren't sure whether we should take a 3D and we thought will, we won't, we yes, we will, and particularly if we're doing a comprehensive, first initial oral exam.
• 15:00
  Speaker 2: You know, 3d x-rays are really important.
• 15:03
  Speaker 2: Panoramic x-rays are great, a great screening x-ray, but 3D x-rays are a really important adjunct.
• 15:11
  Speaker 1: Gotcha.
• 15:11
  Speaker 1: So screening versus looking further.
• 15:14
  Speaker 1: You know there's a jump there because you've got a cost to a patient to think about there.
• 15:19
  Speaker 1: So when do you say, listen, I'm going to choose the 3D because of this you mentioned?
• 15:25
  Speaker 1: You know, having had a lot of dental work before, pain is not the deciding factor because you can have no pain but extensive infection.
• 15:33
  Speaker 1: So when do you go?
• 15:35
  Speaker 1: Listen, I think there's something there.
• 15:36
  Speaker 1: What's your, you know, professional choice.
• 15:40
  Speaker 2: Yeah, if someone came in to us with all 32 of their teeth through an imperfect alignment and had a couple of small fillings, I definitely would not and everything looked okay clinically.
• 15:53
  Speaker 2: And I should say we also take high-definition photos of the mouth.
• 15:58
  Speaker 2: That's really important because patients need to be engaged in the process and again it's a black hole because they really don't see it clearly.
• 16:07
  Speaker 2: So I forgot to mention that.
• 16:08
  Speaker 2: But if I had somebody who had one or two fillings, two or three fillings, maybe three or four fillings and they weren't particularly deep and I could very easily assess that the nerve in the tooth was alive, I wouldn't take a 3D x-ray for that.
• 16:24
  Speaker 2: But if someone came in with an extensive restorative history they've had a lot of fillings and crowns, they've got some root canal treatments in their mouth, there are some teeth there that have got really deep fillings and we're not sure about the vitality of the root, whether the nerve is alive or not then we definitely would.
• 16:41
  Speaker 2: Then we definitely would.
• 16:43
  Speaker 2: We would go and do a more comprehensive.
• 16:45
  Speaker 2: So you know there are shades of grey in between all of that.
• 16:48
  Speaker 2: But if, like many patients are sent to the practice with complex medical histories by health practitioners wanting a comprehensive oral exam, and if they had a history of dental work, then we would definitely explore that for sure.
• 17:06
  Speaker 1: Gotcha.
• 17:07
  Speaker 1: Can I just ask as a last note there expected cost-ish sort of like ball of string?
• 17:14
  Speaker 1: What's the patient looking at out of pocket?
• 17:18
  Speaker 2: expenses.
• 17:18
  Speaker 2: Well, in our practice, for that one hour consultation which involves all the things I've just mentioned, including an OPG, we take our own panoramic x-rays and we take four basic bite-wing x-rays and we take those high-definition photos.
• 17:36
  Speaker 2: The cost of that examination is around $295, $350.
• 17:41
  Speaker 2: If we take more x-rays in that first appointment.
• 17:44
  Speaker 2: Well, if we take more x-rays in that appointment, we generally don't charge.
• 17:48
  Speaker 2: But then if they get sent to have a cone beam, a 3D x-ray and it to be read by the radiologist, I think the cost is around $400 or $500.
• 18:01
  Speaker 2: But honestly, if you've got a complex medical history or patient I mean, considering three and a half billion people have oral diseases you'd want to get on top of that one first, wouldn't you?
• 18:13
  Speaker 1: I'm sorry, I'm with you.
• 18:14
  Speaker 1: Like, if you think about the prevalence of disease and what we're going to talk about, with how faranging oral disease can go and affect the body, $500 is a very good investment when you think about just doing a coronary artery.
• 18:33
  Speaker 1: Calcium score is, like you know, up around the $300 mark.
• 18:37
  Speaker 1: That's just one test and that's late in the game.
• 18:41
  Speaker 1: Yes, no no, so I'm sorry, I'm favouring this hugely, um, okay, so so, gingivitis, periodontitis, you mentioned before.
• 18:52
  Speaker 1: Where do we start with this?
• 18:53
  Speaker 1: So, um, you know what?
• 18:57
  Speaker 1: Let's go with the basics.
• 18:58
  Speaker 1: I'm going to pick on dentists here, the different strategies of cleaning your teeth throughout the decades Clean your teeth in a circle, brush away from the gum.
• 19:12
  Speaker 1: The best one, I'm sorry.
• 19:14
  Speaker 1: The best one is brush your gums and you will inadvertently brush your teeth and I actually favour that one.
• 19:22
  Speaker 1: But you know there's been so many strategies for cleaning one's teeth.
• 19:26
  Speaker 1: You know, if you've got an electric toothbrush, don't rub it, just press it on each tooth.
• 19:32
  Speaker 1: Da-da-da.
• 19:33
  Speaker 1: And they change.
• 19:35
  Speaker 1: They've changed five, six times throughout my time.
• 19:38
  Speaker 1: Where are we at?
• 19:40
  Speaker 1: Why do they change and what's the good way?
• 19:44
  Speaker 2: I don't think it's changed that much and I think the main point is I like to multitask and if I can multitask by using my toothbrushing as a mindfulness exercise, so I use brushing my teeth or cleaning my mouth as a mindfulness exercise.
• 20:04
  Speaker 2: I don't rush it, I take my time, and the protocol that I generally use is I start by having a rinse out because I want to remove all the little bits and pieces that come out easily.
• 20:14
  Speaker 2: I don't want to be driving that into the gums.
• 20:16
  Speaker 2: I will then floss carefully or I will use a water pick to get out the in-between bits and I'll rinse out again and then I will carefully and mindfully brush the surfaces of my teeth the outside, the top and the inside.
• 20:32
  Speaker 2: Now, whether you do that as a rotary or you know really, I mean it's not that big an area.
• 20:39
  Speaker 2: So if you've got a toothbrush in there and you are mindfully cleaning all the surfaces of your teeth, whatever works for you, andrew, that would work for me too.
• 20:48
  Speaker 2: So I don't think we need to get too bogged down in that, other than to be serious about it and to take it seriously.
• 20:56
  Speaker 2: I mean, you know, back in prehistoric times, before we were exposed to our Western diet.
• 21:03
  Speaker 2: We didn't brush our teeth but we didn't have tooth decay and we didn't have gum disease.
• 21:07
  Speaker 2: Our teeth, but we didn't have tooth decay and we didn't have gum disease.
• 21:11
  Speaker 2: So you know, this is a fact of modern life and it's a good investment in your health to spend, I don't know, two minutes in the morning, two or three minutes at night, cleaning your teeth.
• 21:21
  Speaker 1: Yeah, cool.
• 21:22
  Speaker 1: I have to ask about water picks consumer-based versus professional.
• 21:27
  Speaker 1: You know, some dentists were sort of against the consumer ones but I've heard dramatic recoveries with people even with metabolic disease.
• 21:35
  Speaker 2: Yeah, look again, you can't compare what a dentist does with an ultrasonic cleaner to remove deposits that build up on teeth, that's with a water spray to the water pick that occurs in, that is in the home use.
• 21:51
  Speaker 2: So the only warning I would have is to approach it carefully and keep your mouth closed while you're doing it, because your bathroom mirror will be sprayed all over the place.
• 22:00
  Speaker 2: But you know this is just getting into a routine.
• 22:03
  Speaker 2: I think it's an adjunct, it's not a must-have.
• 22:06
  Speaker 2: Floss still does its job reasonably well, as long as you again do not rush it.
• 22:12
  Speaker 2: You know that's important.
• 22:17
  Speaker 1: And flossing was a big one, so we'll get into sort of oh no, we'll get into it now.
• 22:23
  Speaker 1: Why not?
• 22:24
  Speaker 1: Correct flossing technique how deep do you go along the margins, and what if you experience things like bleeding when you're flossing?
• 22:36
  Speaker 2: Well, that's a good question.
• 22:37
  Speaker 2: Do your gums and this is a question that health practitioners can ask their patients do your gums ever bleed when you brush or floss your teeth?
• 22:46
  Speaker 2: And the answer is often yes, they do, but only when I floss, and if I stop flossing for a few days it doesn't happen.
• 22:53
  Speaker 2: And I will often say to a person well, that's so interesting.
• 22:57
  Speaker 2: If every time you washed your hands and the cuticles of your nails bled, would your response to that be oh, I just won't wash my hands for the next two or three days, and she'll be right, mate.
• 23:10
  Speaker 2: No, it's bleeding for a reason, and the reason it's bleeding is because the gums are inflamed.
• 23:15
  Speaker 2: And there's a very interesting article which says bleeding on probing is an indicator of raised C-reactive protein, which is a risk factor in cardiovascular disease.
• 23:27
  Speaker 2: So one could argue that bleeding on flossing is also an indicator of inflammation and perhaps even raised CRP.
• 23:35
  Speaker 2: The way to floss properly is not to just click through the contact to go click, click, click, click, but think of your teeth as a little bit of a V shape.
• 23:47
  Speaker 2: In fact, if you look in the mirror, you'll see your gums do form a V between teeth, and you just gently pass the floss up and down that V and then move on and go gently through using a soaring action, not pulling through to get through, and then you go up and down the V and move on to the next tooth.
• 24:07
  Speaker 2: So that's the way that I would recommend people floss.
• 24:12
  Speaker 1: And what about relevant nutrients that might help practitioners to treat Like?
• 24:17
  Speaker 1: Obviously you've got dental hygiene is the foundation, but things like you know.
• 24:24
  Speaker 1: I remember old Japanese research looking at coenzyme Q10, but we swallow a capsule, we don't put it on directly.
• 24:30
  Speaker 1: Should we be squeezing a paste on directly?
• 24:33
  Speaker 1: Are there better nutrients like curcumin?
• 24:35
  Speaker 1: You know certain mouthwashes?
• 24:38
  Speaker 1: Take us through this.
• 24:40
  Speaker 1: How can we look after our gums better?
• 24:42
  Speaker 2: Well, it's so interesting that you should say coenzyme.
• 24:44
  Speaker 2: I think coenzyme Q10 has been shown and certainly so has vitamin C, and there have been other things as well.
• 24:51
  Speaker 2: I mean, we in the practice also use coconut oil for oil pulling.
• 24:55
  Speaker 2: If we're prescribing, obviously if we're prescribing antibiotics for an infection, then that would always be accompanied by a probiotic, not just during the course of the treatment but well beyond it during the course of the treatment but well beyond it.
• 25:11
  Speaker 2: But the question about using coenzyme Q10 and putting it on the gums, see, andrew, we have to remember and this is a really important thing for practitioners to remember the blood supply that feeds the gums goes through the whole body and so when you have anti-inflammatory or when you're building immune function, it affects you.
• 25:33
  Speaker 2: Don't have to put the vitamin C, rub it on the gum.
• 25:36
  Speaker 2: You know you're taking it because you're wanting to promote better immune function.
• 25:41
  Speaker 2: Now, when you're talking about gingivitis, which is a very superficial form of periodontal disease, now remember I said the gum is like a tight collar around the tooth and there's a crevice, and that crevice should only be two to three millimetres deep because it's easy to keep clean.
• 25:59
  Speaker 2: And when the gums, the pink that you can see in your mouth gets red and puffy and inflamed.
• 26:05
  Speaker 2: That's gingivitis.
• 26:07
  Speaker 2: But when we look at a tooth that is attached to a jawbone, what separates the tooth from the jawbone is a periodontal ligament.
• 26:16
  Speaker 2: So when that inflammation goes deeper, the gum starts to get pushed away from the tooth and we have a pocket down the side of the tooth and we start to lose support for that tooth tooth and we start to lose support for that tooth and it becomes increasingly more difficult to clean that tooth.
• 26:33
  Speaker 2: So you cannot brush and floss a pocket that is five or six millimetres deep.
• 26:38
  Speaker 2: It's very hard to do that, let alone a pocket that is eight or nine millimetres deep.
• 26:42
  Speaker 2: My God, you're really in severe periodontitis property there.
• 26:47
  Speaker 2: So this is why it is a collaboration between, firstly, establishing the ground rules of a comprehensive oral exam to determine whether you do have periodontal disease or not.
• 27:02
  Speaker 2: Remember, 90% of oral diseases, whether we're talking about periodontal disease or tooth decay, have no pain associated with them.
• 27:10
  Speaker 2: 90% it often surprises us.
• 27:13
  Speaker 2: So when you are dealing with the deeper levels, you need to have regular and professional cleans to disrupt the microbiome, certainly every 12 to 16 weeks, because by then there are over 700 microbe species in the mouth.
• 27:30
  Speaker 2: By the time you wait 12 to 16 weeks, they are more pathogenic and they start to affect bone surrounding teeth, et cetera.
• 27:40
  Speaker 2: So in terms of nutritional support, absolutely, absolutely, I think it's very useful to have some good.
• 27:48
  Speaker 2: And you talk about an anti-inflammatory like curcumin or the coenzyme ubiquinol, you know that kind of thing.
• 27:54
  Speaker 2: Vitamin c, vitamin d, zinc, magnesium, selenium very important, all very important.
• 28:00
  Speaker 2: But if the health practitioner thinks they are going to solve periodontal infections by prescribing a supplement only, it's almost as bad as a doctor saying I'm just going to prescribe antibiotic and we'll get rid of it like that.
• 28:18
  Speaker 2: No, it needs collaboration.
• 28:21
  Speaker 1: Okay, so appropriate care when you've got periodontitis.
• 28:25
  Speaker 1: You were speaking about pockets eight mil deep.
• 28:28
  Speaker 1: That's going down to the root.
• 28:32
  Speaker 2: Like we're subdued there.
• 28:34
  Speaker 1: Yes, absolutely, absolutely.
• 28:35
  Speaker 1: So that's a lot of cleaning.
• 28:37
  Speaker 1: Obviously, you've got a comprehensive treatment plan in place by this stage because you've got a medical issue going on.
• 28:48
  Speaker 1: So what sort of things are we just looking at?
• 28:52
  Speaker 1: Obviously, teaching the patient about regular dental hygiene, but you've got to think about active care there.
• 29:02
  Speaker 1: So cleaning deep with a pick and water, pick and water stream and things Is that how it's treated?
• 29:08
  Speaker 2: Okay, well, I guess it begs the first question of why do we brush our teeth?
• 29:12
  Speaker 2: And we brush our teeth to disrupt a microbiome.
• 29:16
  Speaker 2: Okay, I said there's 700 microbes species in the mouth and it's a balance.
• 29:21
  Speaker 2: It's a struggle like life between good and evil, you know.
• 29:25
  Speaker 2: So we brush our teeth twice a day and that's why a two to three millimeter crevice is easy to clean, so that's easy for a patient to keep clean.
• 29:35
  Speaker 2: And with someone like that, I would say after the initial comprehensive oral exam, they should return for a professional clean every six to twelve months.
• 29:45
  Speaker 2: I think that's pretty reasonable because if you get a look, we're all human.
• 29:49
  Speaker 2: We're all human, andrew, and even I'm this may shock you, but even I'm not perfect.
• 29:54
  Speaker 2: And so you know like I go to the hygiene, knowing everything I do, I still get a buildup of some deposits on my teeth, which I go and get professionally cleaned every six months, and I don't have periodontitis.
• 30:08
  Speaker 2: But if you have a pocket and you can't get to the bottom of that pocket, the type of microbes that start to proliferate after three to four months, 12 to 16 weeks, are the more pathogenic type of microbes and there are about 45 or 60 or 100 different combinations of those microbes.
• 30:31
  Speaker 2: But that's when, in our practice, if someone has pocketing, that goes well.
• 30:36
  Speaker 2: Three to four millimetres, if they're managing it well, six monthly cleans should be fine.
• 30:41
  Speaker 2: Five, six, seven millimetres, eight millimetres.
• 30:45
  Speaker 2: They need to be coming in every three to four months for a professional clean to disrupt that microbiome and do that you know, and keep track of and measure the progress.
• 30:59
  Speaker 1: Yeah, obviously I would have thought it would have been much more frequent than that.
• 31:03
  Speaker 1: So that's encouraging, at least that you can recover from that.
• 31:06
  Speaker 1: Yeah, okay, so you spoke about oil pulling.
• 31:11
  Speaker 1: Do you ever use that in combination with things, or just the coconut oil?
• 31:17
  Speaker 1: Do you ever add curcumin or anything like that to help inflammation?
• 31:21
  Speaker 2: Yeah, yeah, we have a whole brochure in our practice on coconut pulling and I know a lot of dentists go, oh, come on, that's just total, whatever BS.
• 31:31
  Speaker 2: But actually it's been used for quite a few thousand years.
• 31:36
  Speaker 2: There is antimicrobial properties within the medium chain fatty acids in coconut oil and the fact that you can get into the nooks and crannies with something like that that is antimicrobial and relatively inert and safe without being toxic to the system is good.
• 31:56
  Speaker 2: It requires a lot of dedication on the part of the patient because you need to be doing it for well.
• 32:02
  Speaker 2: Really 10 to 15 minutes, but five to 10 minutes would be good, you know, and not a lot of patients have the, the, you know the discipline to do that, but many do and that's part of a whole program.
• 32:18
  Speaker 1: Right, and I also omitted to ask brushing.
• 32:23
  Speaker 1: Brushing with what?
• 32:24
  Speaker 1: Always a soft brush?
• 32:25
  Speaker 1: And which paste should we be using?
• 32:30
  Speaker 2: always a soft brush.
• 32:31
  Speaker 2: And which paste should we be using?
• 32:33
  Speaker 2: Look, you know, I think a softer brush is better.
• 32:34
  Speaker 2: And people say, yeah, it doesn't last as long.
• 32:35
  Speaker 2: Well, that's okay, you know?
• 32:37
  Speaker 2: So what you know?
• 32:39
  Speaker 2: Changing your toothbrush every six to eight weeks should be done anyway.
• 32:42
  Speaker 2: So there is a softer brush and you shouldn't be doing it hard.
• 32:47
  Speaker 2: You don't need to do it hard.
• 32:48
  Speaker 2: If you can't get off something with a toothbrush, you need to go and get a professional clean.
• 32:54
  Speaker 2: If you can, you can do it very gently.
• 32:57
  Speaker 2: Toothpastes look, you know, there's every toothpaste making every claim in the world.
• 33:02
  Speaker 2: I personally never have used a fluoride toothpaste.
• 33:06
  Speaker 2: I know that's heresy for many dentists, but I always find that if I see something written on a tube that says, if swallowed and this is what I meant to put in my mouth if swallowed, seek medical advice.
• 33:20
  Speaker 2: You know, do not swallow.
• 33:22
  Speaker 2: That's a bit of a problem.
• 33:24
  Speaker 2: And fluoride there's a whole story there.
• 33:27
  Speaker 2: I prefer to use something that is organic, that is simple, that is safe, that has fewer air miles attached to it.
• 33:36
  Speaker 2: There's nothing, I don't believe, too miraculous about the toothpaste, other than to have something that you like to use and that tastes good and that is not toxic and has some purported health benefits, and doesn't have too many air miles attached to it.
• 33:55
  Speaker 1: Yeah, okay.
• 33:56
  Speaker 1: So moving on to tooth decay, dental caries.
• 33:59
  Speaker 1: What are the consequences of dental caries?
• 34:03
  Speaker 1: Because, like I can wait a minute.
• 34:06
  Speaker 1: Three or four months ago I was looking at YouTube videos of these abhorrent dental health and the cleaning off of Tata which was just caked on.
• 34:20
  Speaker 1: But when we're dealing with dental caries, you know, back in my childhood it was like, oh yeah, you know, I've got three or four, I've got five or six fillings.
• 34:33
  Speaker 1: It was quite normal to have that five or six fillings.
• 34:37
  Speaker 1: Mind you, nobody told me about flossing in my early years, never.
• 34:42
  Speaker 1: So where are we at with dental caries?
• 34:47
  Speaker 1: Tell us about them and what are the health consequences?
• 34:49
  Speaker 2: where are we at with dental caries, tell us about them and what are the health consequences?
• 34:53
  Speaker 2: Well, dental caries comes under that category of oral diseases that are affecting three and a half billion people globally.
• 34:58
  Speaker 2: And the thing about dental caries is sometimes you can look in the mouth and see a decay and it's very obvious.
• 35:03
  Speaker 2: But often you look in the mouth and it's not obvious because the tooth's covered by enamel and that's very hard, and so decay goes through the enamel like a pinhole and then it hits the underlying dentine, which is much softer, and it spreads so that one day a person will bite into something and suddenly they've got a big hole in their tooth.
• 35:26
  Speaker 2: Well, it wasn't sudden, it was just that eventually the enamel caved in.
• 35:30
  Speaker 2: And when you think about that, 90% of the population over the age of 20 have some experience of tooth decay 90%.
• 35:41
  Speaker 2: Now, when you think about paleontology, you think about skeletons that are dug up millions of years old.
• 35:49
  Speaker 2: Often what you will find is a tooth and they will reconstruct a whole animal or whatever by the tooth.
• 35:56
  Speaker 2: So teeth can last literally millions of years.
• 36:00
  Speaker 2: Yet because of our Western diet, within a year or two we could decay our teeth down to the gut.
• 36:06
  Speaker 2: So that is an indication teeth down to the gut.
• 36:13
  Speaker 2: So that is an indication.
• 36:14
  Speaker 2: If you think how bad what we eat is for the rest of the body, you don't have to look very hard, just look in the mouth.
• 36:17
  Speaker 2: So once you have a hole that you have to clean up, then you've got to restore it, otherwise food keeps getting caught in the tooth.
• 36:25
  Speaker 2: So you've got to put a filling or a crown.
• 36:28
  Speaker 2: If it's a really big filling or a crown, or if the decay has gone through to the nerve in the tooth, or if the decay is really close to the nerve in the tooth, then we get what is called periapical periodontitis.
• 36:41
  Speaker 2: That means periapical, means at the tip of the root there is an infection of the periodontal ligament.
• 36:49
  Speaker 2: So periapical periodontitis by some reports affect, you know, at least 50% of the population have one tooth affected by that.
• 37:00
  Speaker 2: So that is just mind boggling and again and again you could have that without any pain at all.
• 37:08
  Speaker 2: I mean I had a patient that came in because they had a little brown stain on their front tooth.
• 37:14
  Speaker 2: This was a new patient and they came in and they had a little brown stain on their front tooth and it was decay.
• 37:21
  Speaker 2: And when I looked in their mouth.
• 37:23
  Speaker 2: All of their posterior teeth, all of their back teeth, all of their back teeth had rotted down to the gum and they had never had a day's pain, or they said they'd never had a day's pain.
• 37:37
  Speaker 2: So tooth decay has consequences which affect the materials that we choose to restore the teeth, whether it requires a root canal treatment or not, whether the tooth should be extracted.
• 37:50
  Speaker 2: I mean, there's a whole story, andrew.
• 37:52
  Speaker 2: We could do a whole program just on whether to do or not to do a root canal treatment.
• 37:57
  Speaker 2: But it has all sorts of consequences that also impact on people's health, because the most common filling material used in dentistry over the last 170 years is dental mercury amalgam.
• 38:13
  Speaker 2: And the interesting thing about that and I haven't used that since 1983, and I have been through my evangelical stage in my life where I was wanting to convert the profession I gave that up a long time ago.
• 38:27
  Speaker 2: But I would often have a dentist go oh, that's a load of BS, you know the mercury issue.
• 38:31
  Speaker 2: I go okay, let me ask you this when you do a filling on someone, what do you do with the scrap, the little bit of filling material left over?
• 38:39
  Speaker 2: Oh, I put it underneath photographic fixer.
• 38:42
  Speaker 2: Why?
• 38:43
  Speaker 2: Because, according to the health authorities, this is the TGA, the NHMRC, the ADA, the AMA, the only safe place.
• 38:54
  Speaker 2: You're not allowed to put amalgam into the garbage or the toilet or down the sink.
• 38:59
  Speaker 2: The only safe place to store this very toxic material is in the mouth.
• 39:06
  Speaker 1: I see is in the mouth.
• 39:15
  Speaker 1: So orthodox dentists will argue further and they'll say but once you fix it it's now stable in the mouth.
• 39:18
  Speaker 1: So can you test the stability of mercury amalgams?
• 39:20
  Speaker 1: And what's now happening in the in the profession, in the, is that we are steering away from amalgams because of aesthetic reasons to the resins.
• 39:34
  Speaker 1: Are they safer than mercury, than mercury amalgam?
• 39:38
  Speaker 2: Okay, yeah, well, you know, to do an assessment on everybody would require a machine that costs about $50,000 or $60,000, and the results are in.
• 39:49
  Speaker 2: In 1991, for the first time ever, the WHO, in their mercury toxicity report where they'd always said fish was the greatest source of mercury to the human being for the first time ever decided to include silver fillings, because they invited a dentist onto the committee who said hang on, silver is only 20%, 50% of it's mercury.
• 40:16
  Speaker 2: We really should include mercury in the assessment, and not surprisingly, whereas if you were regularly eating fish and nobody that I know walks around with fish in their mouth 24 hours a day, seven days a week but if you did have fish, you might be exposed to two to three micrograms from that fish.
• 40:35
  Speaker 2: When you have dental mercury amalgam, you're exposed to somewhere between, depending on how many you have and a whole range of other things, but it could be between 10 and 17 micrograms per day.
• 40:49
  Speaker 2: So does it escape?
• 40:51
  Speaker 2: Yes, it does.
• 40:52
  Speaker 2: Then the question is is it toxic?
• 40:54
  Speaker 2: Well, it escapes as an inert form of mercury, an inorganic form of mercury, but, as the NH and MRC pointed out in a 2002 brochure about dental amalgam, which sadly they have since removed 2002 brochure about dental amalgam, which sadly they have since removed they pointed out that if mercury comes into contact with bacteria, that it goes through a methylation process which makes the inert form of inorganic mercury an organic form of mercury which is then bioavailable.
• 41:26
  Speaker 2: And then the question is what effect does that have?
• 41:29
  Speaker 2: Well, that organic form can displace sulfhydryl groups from some important compounds like enzymes, dna, muscle fibre, glutathione, a whole range of you know enzymes and hormones and muscles and dna.
• 41:49
  Speaker 2: So if that's not enough to cause some concern, um, you know.
• 41:53
  Speaker 1: so, yes, it does escape, and while it escapes as an inorganic form, it does become methylated and go through biotransformation so appropriate care for somebody who say, who has, let's say, one or two mercury amalgamsams, given that dental cavities are now being filled with resins?
• 42:13
  Speaker 1: So what's the appropriate care for one or two mercury amalgams?
• 42:17
  Speaker 1: Should these people be engaging in what we've termed detox or biotransformation support regularly, let's say three times a year?
• 42:27
  Speaker 1: Or do you wait till something happens, till you go there's a problem?
• 42:32
  Speaker 1: I don't think that would sit well with you.
• 42:34
  Speaker 1: How far ranging are these issues?
• 42:38
  Speaker 1: Where do we look for issues?
• 42:42
  Speaker 2: Yeah, look, in our practice there has always been two issues philosophically.
• 42:48
  Speaker 2: One is should we still be using the material?
• 42:50
  Speaker 2: And for that the answer is an unequivocal definitely no.
• 42:54
  Speaker 2: The next question is should we be removing it from everybody's mouth?
• 42:58
  Speaker 2: And the answer is no.
• 43:00
  Speaker 2: I mean, I think we need to proceed very carefully, very cautiously.
• 43:06
  Speaker 2: I mean, amalgam is not a great filling material.
• 43:09
  Speaker 2: It's cheap, it's easy to place, it's cheap, it's easy to place, it's accessible.
• 43:13
  Speaker 2: You know, all those are positives, right, but over time it expands and it cracks teeth.
• 43:19
  Speaker 2: So, and during that expansion and contraction, amalgam of material teeth will crack, gaps will open up, and so then the filling needs to be replaced.
• 43:31
  Speaker 2: So, look, we have some patients that we've slowly been removing their amalgams over 20 years, and we've had other patients that have come to us from health practitioners specifically requesting it to be removed.
• 43:44
  Speaker 2: And we use what is called SMART protocols, which is Safe Mercury Amalgam removal technique, and that involves draping the patient completely and giving them a hairnet using rubber dam, which is a sheet of rubber that acts like a diaphragm so that the tooth that's worked on is sticking out and the airway is protected.
• 44:05
  Speaker 2: We have a separate nose piece so that the patient doesn't inhale a mercury vapour through their nose.
• 44:12
  Speaker 2: We have a special suction unit that sits just above the patient that is specific for mercury vapour, and we ourselves are draped and often wear masks, a gas mask as well, because it is of greater concern to the dental profession than it is actually.
• 44:30
  Speaker 2: You know, I mean, the biggest exposure is when the filling material is placed and when the filling material is removed, so that needs to be approached very cautiously.
• 44:40
  Speaker 1: Yeah, ron, there is so much I'd love to talk to you about.
• 44:45
  Speaker 1: Can I firstly pre-empt would you be amenable to rejoining us back on Wellness by Designs to dive deep into specific areas, because this is a whole area.
• 44:58
  Speaker 1: This isn't something that you can cover aptly in one podcast.
• 45:02
  Speaker 1: Would you be amenable to rejoin us?
• 45:05
  Speaker 2: Absolutely.
• 45:05
  Speaker 2: I think it's such an important issue, Andrew, and I obviously feel passionate about it.
• 45:10
  Speaker 1: I would love to Great when we do that.
• 45:14
  Speaker 1: I'd really like to dive deep into particular areas because we simply have not even touched.
• 45:20
  Speaker 1: We've mentioned, but we haven't touched on the systemic implications of poor dentition or poor dental hygiene.
• 45:28
  Speaker 1: So I'd love to really dive deeper into those at another stage.
• 45:33
  Speaker 1: But just quickly, do you have any quick case histories where people have come in?
• 45:41
  Speaker 1: You mentioned one early on, like the chronic headaches, but other systemic issues made worse by poor dentition, poor dental hygiene, that have been corrected with good dental hygiene.
• 45:56
  Speaker 1: Can you give us one or two maybe, cases that you remember?
• 46:01
  Speaker 2: Yes, absolutely.
• 46:02
  Speaker 2: I think the two encompass almost everything we've spoken about today.
• 46:08
  Speaker 2: The first one was a patient that was 60 years old, suffered from rheumatoid arthritis, heart palpitations, had been to see a rheumatologist, also was on corticosteroids, had also been to see an integrative doctor, was in the care of the integrative doctor for two years, had been on every supplement, got to the point where couldn't walk from the bedroom to the bathroom.
• 46:31
  Speaker 2: And he came in to see me and honestly, it was so bad no pain, no pain, but advanced, advanced periodontal disease, advanced periapical periodontitis.
• 46:48
  Speaker 2: We removed teeth, we cleaned up teeth, we gave him some dentures to eat with, cleared up all the infection and he recovered within a month and ended up and I definitely do not promise this for every patient that comes in to see me.
• 47:04
  Speaker 2: But he then ended up cycling from Sydney to Perth, from Perth to Melbourne and then back to Sydney, and we don't offer that as a guarantee of every periodontal treatment.
• 47:16
  Speaker 2: We do.
• 47:16
  Speaker 2: But that was one.
• 47:18
  Speaker 2: And now another patient came in with a whole range of different things, but part of the comprehensive oral exam was they had a chronic kidney infection for 10 years and they were under the care of a professor of urology at the time and they were on three antibiotic tablets for 10 years and their kidney function because it was being checked every two weeks was tracking consistently.
• 47:44
  Speaker 2: At 65, when they came in to see us for a comprehensive exam, we found a periapical periodontitis on the tip of a lower incisor tooth, that it had root canal treatment, aposectomy, no pain, but it was still infected and we recommended that that tooth come out and be thoroughly curetted out, which we did, and two weeks later her kidney function went to 95% and a month later, with the help of an integrative doctor, she was completely off her antibiotics.
• 48:18
  Speaker 2: So there was periodontitis, advanced periodontitis, periapical periodontitis affecting kidney disease, rheumatic fever, and it cuts right across the systemic health spectrum.
• 48:32
  Speaker 1: That's absolutely staggering the difference so quick.
• 48:34
  Speaker 1: If only we could guarantee that in every patient, it'd be great.
• 48:38
  Speaker 1: Ron, you know you're so well known and your dedication to your patients is so well known.
• 48:45
  Speaker 1: So thank you so much for taking us through some of these sort of practical ways in which we can intervene by getting them along, getting these patients along to see their dentist.
• 48:54
  Speaker 1: And for those dentists out there, if you could embrace the integrative approach and maybe learn from Ron and the family at Sydney Holistic Dental, it would do you well to see your patient's health in the future.
• 49:09
  Speaker 2: One more point.
• 49:10
  Speaker 2: I do have one more point and that is I'm just finalising Oral Health a User and Practitioner's Guide, which I'm hoping will have.
• 49:20
  Speaker 2: It did have RACGP accreditation and it's about to get it again and we just did an update.
• 49:26
  Speaker 2: It's available on my website, which is drronerlichcom, but that is called oral health a user, because every practitioner is a user as well.
• 49:37
  Speaker 2: A user and practitioner's guide awesome stuff.
• 49:42
  Speaker 1: thank you, ron, and I look forward to joining you again on wellness by designs.
• 49:47
  Speaker 1: It's great fun to have you on the show, thank you, and thank you everyone for joining us.
• 49:51
  Speaker 1: Remember you can catch up on all of the other podcasts and the show notes of this podcast.
• 49:56
  Speaker 1: We're going to be putting up a wealth of information, so get ready.
• 50:00
  Speaker 1: But so thank you so much for joining us today.
• 50:02
  Speaker 1: I'm Andrew Whitfield-Cook.
• 50:03
  Speaker 1: This is Wellness by Designs.