Latest / Rebellious Aging Podcast / Rebellious Aging: Teeth & Mouth
Transcript
- speaker-0: Hello, welcome to the Athena Studios and today we're going to be continuing with our series on rebellious aging. This podcast today is gonna be about teeth and the oral cavity and the mouth. I'm your host, Dr. Bob Peterson. speaker-1: And I'm Mina, Doctor Peterson's co host for today. speaker-0: But as I said, today we're going to be talking about the mouth and the teeth. the oral cavity and teeth are actually very important for the rest of your body as well. It's not just dentistry, it's not just the teeth, but the whole area is actually an ecosystem into itself. So the teeth are really, really important, and they're also a really nice illustration of One of the concepts that we've been thinking about, which is the difference between regenerative tissue and non regenerative tissue. As you know, the teeth are kind of regenerative and kind of not, because you start off with a training set of teeth when you're little, and these get replaced by your permanent teeth. Once you get the permanent teeth though, those are permanent. And once the teeth have grown in, any damage that occurs to those teeth then is with you for the rest of your life. Conversely, other tissues in the mouth, the gingiva, the oral mu the oral mucosa, the tongue lining, those regenerate constantly and are and are always turning over. So those are highly regenerative. So these two things both coexist within the mouth and we're gonna be talking about that today. So let's break this down into two parts. first would be surprising facts, a lot of people may not know, as well as some inconvenient truths that I think would be good for us to prepare for in the future in our aging bodies as well. so starting with some surprising facts, fact number one is that you get two sets of teeth and that's it. Teeth are not, in fact, permanent, they're just final. speaker-1: Yeah, that's right. As I said, the you have the children's teeth, deciduous teeth, the first ones, and those are kind of practice teeth. And then they also are it's important because your mouth is much smaller when you're younger. So the teeth have to be smaller correspondingly. Those then get replaced in your in your youth by the the permanent teeth. and as you said, those they're not permanent in the sense that they're indestructible. They're permanent in the sense that those are the last ones you get and you gotta take care of Mm-hmm. speaker-0: Okay. And then also is that enamel is the hardest substance in the human body, but gradually thins and becomes more brittle with age. speaker-1: Yeah, so enamel is the outer covering of the teeth. And it's it is the hardest substance in the human body. But because it's it's the hardest substance in the human body, it doesn't have very many cells in it. It's pretty much just a mineral, you know, composition that's hard and and but it's also a little bit brittle and it's subject to wear and chipping and and all the, you know, things that can happen over the course of a life. And so Even even in somebody who takes really good care of their teeth, abrasion from brushing your teeth, wear from eating and grinding will thin the enamel a little bit. And so the enamel will thin and as we said it doesn't really repair itself, it doesn't regenerate. So the enamel will thin over time. Because the enamel is white and the dent and the t the tissue inside of it is yellow, as people get older, their teeth get more yellow. Mm. And that's actually one of the signs of aging is the yellow of the teeth. And that's due to the fact that the the the enamel is getting thinner. speaker-0: the teeth darken naturally over time as dentin thickens, like you said, beneath the thinning enamel, coffee gets only partial blame. So it's not a lifetime of being a coffee drinker or a wine drinker, it's actually just that your enamel's thinning. speaker-1: That's right. And and any other change to your enamel. If you chip a tooth, the tooth will stay chipped forever unless you get some dental restoration. If you lose a tooth, the tooth is gone. so the the teeth are gonna are gonna show what's happened to you over the course of your lifetime and and they're a they're a sort of a a diary of everything that's happened to you, a ledger. speaker-0: book a good record keeper. speaker-1: Yes. That's too good. Mm-hmm. speaker-0: Okay, another fact, reduced saliva production with age dulls taste, accelerates decay, and makes swallowing harder. speaker-1: Yeah, so saliva is really important. Mm-hmm. And that's what I said. It's it's not just teeth. And so the mouth is an entire ecosystem. And an average adult will make a half a liter to a liter and a half of saliva a day. That's a lot of saliva. And saliva has a really important job. saliva will buffer the acid in the in the perioral area and that's helpful. It also provides antibodies and helps to fight infection. It helps to help start the digestive process and and it also washes, you know, washes things away. So if you decrease that saliva production, you lose a lot of the benefit that that it's bringing to the teeth and then the teeth are sort of left to their own devices. And as we talked about anything bad that happens to a tooth is gonna be permanent. the and then the the the most interesting thing is that the saliva can actually help the teeth remineralize a little bit in the other parts. they they can help the teeth recover from acid etching and things like that a little bit. So saliva is extremely important. speaker-0: Yeah. In relation to teeth. speaker-1: Yeah. speaker-0: also that tooth root becomes more vulnerable to cavities as gums recede, a unique risk for older adults. speaker-1: Yeah, so this is this is really important and it's a difference that I think a lot of people don't appreciate, and I certainly didn't appreciate it. When you're young, you have gum up to the hard part of the tooth, the the enamel, the the the crown, which is really pretty durable. And when you're young, when you get a cavity, it's usually what's called pit and fissure, that they're little grooves in the top of the teeth. And The groove may have a little bit of a attack on it that that causes a small opening, that's a cavity, and and that can be fixed. but the dent the enamel is quite resistant to that that cavity getting bigger. As you get older, the gums sort of start to recede, they get smaller, they they come down. And when that happens, the tooth roots that are holding up the crown will start to become exposed. And when the tooth roots are exposed, if you get the same process, a cavity forming in the tooth root, the tooth root is not as hard as the enamel, and it's easier for the the cavity to spread more quickly. that will cause the tooth to become unsalvageable oftentimes and it'll lead to tooth loss. the net effect of which is that you you need to really, you know, keep that area clean. gingival health is super important and getting it checked frequently and getting plaque removed from the roots at frequent intervals is is really important. And root carries are a a different animal than the the crown carries that are more common in younger people. speaker-0: another surprising fact, genetic factors heavily influence enamel quality and cavity susceptibility. Some people just have luckier mouth. speaker-1: Yeah, that's right. It turns out that the teeth are not all the same. that some people's enamel is harder, more resistant. and that's genetically programmed. And that difference will be pretty much finished off when the teeth mature. So by the time you're twenty, your teeth may be really strong and your neighbors or friends' teeth may not not be quite so strong. So even if you have the same environmental factors, you may be more prone to cavities or they may be more prone. surprisingly enough, you think that you think that when you think of DNA you think of living, you know, tissue, you think of muscles and heart and things like speaker-0: Yeah. speaker-1: that. Right. You don't think of it actually affecting the mineralization of your of your enamel in the teeth. But it does. speaker-0: Interesting. Okay, and then number seven, teeth shift position over time, even decades after braces, because the jaw and ligaments keep remodeling. speaker-1: Yeah, that's right. So when we think of teeth, we usually think of this, you know, rigid thing set into a bone and it's just, you know, anchored in there. There's actually the bone and then the tooth sits into the pocket in the bone, but there's there's a padding of tissue around that. And that tissue is living tissue. It has blood flow, it has nerves, and it's constantly interacting with the with the bone in the in the jaws to remodel that. And so if a tooth gets a little bit loose, the it can actually fix it. It can it can put new bone down and and re-anchor it. but that also allows the teeth. to move a little bit. That's why you can that's why you can have braces. You actually can put braces and the teeth will move through the bone a little bit by little bit by little bit by taking away a little bit on the front side and putting a little bit more on the back side. there's of course a limit if you if you move the tooth more quickly than it can re re mineralize the part behind, then your teeth could become loose and that's that's not good. So teeth movement is is a problem. That's why if you're gonna have braces, it's best to have them when you're young. Yes. Because the teeth can move and and lock in and in the right place. If you get to be older and you need and you wanna have braces, there's a decent chance that the teeth will get loose from using the braces. And that's something you want to evaluate really, really carefully with your dentist prior to trying to to put then, you know, yeah, bracing at older age. speaker-0: another surprising fact is that the frequency at which you consume sugar or even carbohydrates, right, is more important than how much we consume in a sitting. speaker-1: Yeah, this was a big surprise for me. speaker-0: No, me too. I didn't know that. You see my coffee, I drink this for maybe more than an hour every day, so I'll have to break the habit, but maybe not today. speaker-1: So what the reason for that is is that it's it's really interesting. As I said, the mouth is its own ecosystem. And there are bacteria that live next to your teeth. And those bacteria do something which is not useful, which is they take sugars that you that you eat and they turn that sugar into acid. And then the acid dissolves the minerals in the teeth. just physically dissolve the mineral. And if you if you eat a bunch of sugar all at once, eat a a piece of cake, then you know there'll be 10 minutes where you're getting a lot of sugar. But then wonderfully the saliva will come in and wash away some of the acid and buffer it. And the saliva also provides minerals minerals to remineralize some of the the tooth that's been dissolved. So the acid will break it up and then the saliva will come provide back some calcium and some phosphate and and patch the whole metaphorically. And so you're you you've eaten cake and you know so there's a ten minute assault on the teeth from the bacteria breaking that down. But then the saliva comes to the rescue. So that's why saliva is so important. If there's not enough saliva, then that breakdown continues or doesn't get patched. But if instead of eating the cake all at once, if you take you know a little bite every now and again over the course of the afternoon, then every now and again you're gonna be having an acid dose from the bacteria, breaking that down into acid and and dissolving the teeth. And the saliva will do its job, but if you have multiple ten minute assaults on the teeth over the course of the afternoon, it may be that that they're that you are constantly having feeding the bacteria and constantly having a an acidic breakdown of the tooth where it's you know it doesn't finish one before the next one starts. And so you can have hours in a row of having assault on your teeth. So it's actually it's actually better to eat it all at once and then wash out your mouth. and and unfortunately it's not just true of sugar, it's also true of carbohydrates. The carbohydrates are broken by the the mouth enzymes into sugars which then feeds the bacteria which then makes the acid. So Eating chips one by one over the course of the afternoon is probably really not good for you. so I guess the moral of the story is eat the whole bag at once. Right. speaker-0: Don't don't try to savor that. speaker-1: Right. speaker-0: Okay. another fact. Tooth loss leads to jawbone loss, which complicates dental implants and changes your facial shape. speaker-1: Yeah, so the the bone of the jaws is really another example of use it or you'll lose it. That the problem is that unless there are stresses on the bone, the bone will get weaker. And the bone will thin. So when that happens it makes it really hard to put something strong into it if you want to put an implant or a dental restoration. It's just not strong enough. And that's on the maxillary bone. Now the maxillary bone, the the top teeth, they sit right under the maxillary sinus. So the bone already isn't that thick to begin with. And if it gets thinner because you're not loading it, you're not giving it stress to keep it in in you know i working, then it can be quite challenging to put an implant in the maxillary area. And I often have times we'll have to do bone grafting. On the mandible, the mandible if you lose your teeth, the mandible gets thinner and and sometimes they'll be too thin. There's no room to you know to put in a restoration because it it's just too thin and the nerves, you know, run through there too. And so if you think you know, if you sort of imagine an old person with no teeth with their with their gum practicals, so it it you know, their gums will come in because the the bone is eroded. But then also because there's no teeth, your oral height gets lower. Yes. That When you close your mouth instead of the teeth doing this and keeping the the jaws apart, the jaws will be just right up next to each other, and your and your lower jaw will come up and it gives you a shunken and really short chin look. So yeah, that's the the the teeth keeping the bone strong and then the bone keeping the teeth speaker-0: Makes you look how you look. speaker-1: right is is really important. speaker-0: Important. Okay, and then the last fact is that the oral microbiome forms a sticky biofilm called plaque, and that's surprisingly hard to remove and it shifts with age. speaker-1: Yeah, so we've talked about microbiome a little bit in other lectures. And the microbiome is the collection, it's the ecosystem of the bacteria that live in your mouth. And in the mouth there are over 700 different kinds of bacteria that coexist, and that's second only to the gut in terms of the number of different bacterial species. And sometimes one strain or another strain will proliferate and predominate, you know, sort of win out in the competition in the ecosystem of the mouth. And in particular, they they form a biofilm, and a biofilm is a colony of bacteria that work together almost like an organism. And and this is and you know as you said, it's it's hard to remove. You have to actually scale it off. You have to scrape it off. Physically speaker-0: We'd take it off, yeah. speaker-1: scrape it off, 'cause it you can't brush it off. It's it's too hard. It's like barnacles. It's kind of like the the the barnacles on your teeth. And just like barnacles, you can't just wipe them off with a cloth. So that's why dental cleaning is so important because the dental cleaning they will remove the plaque. and And so trying to prevent the buildup of plaques is really important. That's why you have to brush your teeth and that's that's why some they they're plaque reducing mouth rinces and things like that. But but trying to keep the plaque under control either by what you can do yourself or if you need help going to the dentist for you know, dental cleaning is really important for oral health. speaker-0: That is important. I'm gonna I'm gonna definitely follow up with my dentist on that too. so that kind of wraps up, I guess, our surprising facts, a lot of things that we didn't know, a lot of things that we're you know happy to be privy to now. And I think that we can delve into our inconvenient truths time to see what we kind of need to know and what we should be able to plan for in the future while we age. So Dr. Peterson, let's go into our inconvenient truth section. For the first inconvenient truth, tooth loss is still common in older adults affecting eating, speaking, and confidence. speaker-1: Yeah, 'cause like we talked about the the teeth are are your final set and if something happens to a tooth, that's it. If you lose a tooth, it's gone. dental restorations come in, but teeth can be lost for a variety of reasons. You can by trauma, you know, you can you can bump your teeth and they can come out. you can crack a tooth. Some people clench their jaws so forcefully that they actually crack you. I've done that myself. it's called bruxism. when it's when it's at nighttime. Sometimes people grind their teeth at night. And you know when you grind your teeth you're gonna sometimes get a place where you can get a really good grind and a really good you know clench. And speaker-0: Force coming down on too. speaker-1: it is and you can you can break the tooth and if you break off a piece of tooth then the the tooth roots exposed and it's possible to get an infection in there and then lose the tooth that way. you can lose tooth from an infection. and then the teeth just wear down. over time your teeth get you know get get worn flat from grinding them back and forth. And and if you grind them far enough down then eventually you'll actually expose the the soft pulp area and then that that predisposes to tooth loss. So they archaeologically it's interesting. when they examined old teeth from Incas and people like that, they they they ate corn and they would grind the corn and because they wouldn't remove all of the sand and whatever they used to grind the corn to make the cornmeal, the the old Incas oftentimes had you know very flat teeth but they'd been ground down by Wow. speaker-0: Can you also tell like the status of the person's health at that time by their teeth? speaker-1: You can tell a lot. There's a whole branch of forensics where they look at the teeth and the teeth as they age, several different things happen. The pulp space gets narrower and it gets narrower for two reasons. One is that the v blood vessels and nerves get smaller, but also over time the blood vessels come up in the inside, and they will deposit more tooth substance. And as as they do that, they kind of narrow the tunnel. And and then sometimes you'll get little calcifications, little stones in there. And that's one of the ways that the forensic you know examiners can can you know give an estimate or a you know guesstimate of the age of the person is by examining their teeth. speaker-0: Interesting. A second inconvenient truth is that dental insurance is famously thin coverage. Many seniors face huge out of pocket bills for restorative care. speaker-1: Yeah. So that's just an accident of the fact that the you know, dentistry and and conventional medicine have branched off and and that's why I said at the outset that we consider the mouth its own separate thing, but actually it it's part of the body and it is intimately interconnected with with the rest of the body in terms of function and and so it's it's you know it's too bad that it's separate off because there's some things where the dental care really significantly impacts the rest of the body. and in particular the the microbiome, there's a there's one strand of bacteria that's that's been found with a high rate of prevalence in people with heart disease and in dementia. And it's entirely possible that the bacteria getting to your brain is is not good for you. But because it's covered by dental insurance and not Health insurance. Yeah. speaker-0: There's also gum disease. So gum disease becomes harder to manage and is the leading cause of tooth loss. speaker-1: Yeah, so that's what we were talking about earlier, that when you're young, your gums come up to the to the strong enamel and they seal really tightly together. with age the the gums recede and you get inflammation of the gums. You get bacteria in the area between the gums and the teeth, which is supposed to be tightly sealed. and and then that causes a chronic inflammation of that area. the chronic inflammation then can can lead to the development of what we call the root carries that we talked about earlier. And as we said, the root carries will oftentimes spread quite rapidly and within a few months can can end up causing the tooth to be decayed to the point where you can't salvage it any longer. speaker-0: and then moving on to oral infections become more frequent and severe, sometimes serious enough to require hospitalization, kind of to build off of the last one, right? speaker-1: Yeah, that's exactly right. So infections can occur in the mouth and affect the teeth, but they they can also affect you in other ways. That bacteria from the mouth, as I said, can get to the heart and if you have a heart valve, either an artificial heart valve or you have some valveular scarring from rheumatic fever or something, the bacteria can lodge in the heart and can actually cause endocarditis, which is a a really serious infection of the heart of bacteria that got into your blood because They're right there, yes. Right in the bloodstream and then they end up at the heart and they latch on. And you know, as we said, some of the bacteria are pretty sticky. they'll stick really hard to your teeth and they can stick really hard to your heart valves too. So yeah, that can be a real problem. speaker-0: Yeah. okay number five, maintaining oral hygiene gets harder with arthritis, tremor, or cognitive changes. speaker-1: It it could be hard if you have if you don't have good grip strength. I mean we we take brushing your teeth for granted. It's easy. It's just just speaker-0: Mm-hmm. speaker-1: but if your grip strength isn't good you may need to have a a bigger, fatter toothbrush to hold on to it because toothbrushes are kinda small. If you have arthritis and you're trying to squeeze down around it, that can be problematic. And then if you have a tremor, you know, it's that that could be that could be hard. And then you have cognitive changes, you may not remember whether you've brushed your teeth or not. And so either you do it again or you just forget to do it altogether. Mm-hmm. Yeah. speaker-0: That's important too. Okay. and then inconvenient truth number six is that untreated dental disease is also linked to heart disease. speaker-1: Yeah, so we we talked about that there's a significant proportion of people with Alzheimer's that have bacteria that that particular strain from the mouth in in the brain. We don't know if that causes the Alzheimer's or if it's just an association. Maybe they had Alzheimer's so they didn't brush their teeth well. But but that notwithstanding, it seems reasonable to try and keep that bacteria under control as a potential way of of reducing your risk of Alzheimer. The one thing that we do know is that the you know oral hygiene can significantly impact diabetes, that when you control the the oral hygiene, you can reduce you can reduce the hemoglobin A1C score by half a point, 0.5 milligrams per milliliter, which is a very significant decrease and So the the oil hygiene affects the body in in a variety of different ways and and that's why it's so important. speaker-0: Mm-hmm. Okay. and then on to the next. many medications cause dry mouth or gum overgrowth as a side effect. speaker-1: as we talked about saliva is great. Saliva's our friend. Yes. It's very productive. So first of all it makes your mouth feel better. You don't feel like you have dry mouth, but second of all it's really good for the teeth. And lack of saliva then potentiates all of the other problems. It makes it more likely that you're gonna have tooth decay, root decay, and tooth loss. and a lot of medications, heart medicines bladder control medications, you know, there's over five hundred medications that decrease the amount of saliva production. And there are frequently medications that that are performing an important function, but being aware of the fact that they're decreasing your amount of saliva production and the fact that that can then lead to deca tooth tooth decay that you weren't expecting. Because you imagine tooth decays for little kids that eat that eat bubblegum. it's not for me, I'm an adult, I brush my teeth twice a day. and along that actually on that score, one of the important things to do is to consider using a higher fluoride toothpaste as you get older because the fluoridation does really help keep the mineralization of the teeth stronger and the higher dose fluoride toothpaste, you need a prescription to get that. speaker-0: Didn't know. speaker-1: Yeah, the most common one is called Prevident. and and that has five thousand units of of fluoride as opposed to one thousand normal toothpaste. And then the other thing that is a surprising fact we didn't cover is the best way to use your toothbrush and your toothpaste is to use a fluoride toothpaste. and then if if you're older, use a high fluoride toothpaste, brush your teeth and then spit it out and don't rinse your speaker-0: so what should we do and how should I be brushing my teeth at home? Because I thought that it was just only in the movies where I saw that they they just brush their teeth and they just spit it out and I was like, What? Did we do that? Because I was taught to rinse my mouth out after. But I mean some people do also have like a water cup that they use to rinse their mouth after. But you're saying in terms of dental health that the fluoride we need to keep on our teeth to protect it, right? speaker-1: Absolutely right. Yeah. Okay. So yes, and I was taught to do that and I do that too. I I rinse my mouth out and spit out all the toothpaste that I just put on. But actually the recommendation is to leave the toothpaste on your teeth because it has fluoride and and I guess just have minty, fresh taste in your mouth for the until you eat it. But yeah, that's that's the way you're supposed to do it. speaker-0: and then on to the next. Crown bridges and implants aren't options for everyone. Bone loss and medical conditions disqualify many people. Yeah. speaker-1: Right. So I I mean ideally you want a full set of teeth because I mean it's people feel really goofy if they're like missing a tooth, they feel like a a hillbilly. there are limited numbers of ways that you can camouflage that and do restorations. And and if you are missing tooth structure and bone structure, it makes it hard. speaker-0: and then bringing us to our last truth, oral cancer risk climbs with age and it's often caught late. So what is oral cancer? speaker-1: So a cancer of the tongue or of the gingiva or your buccal mucosa. So cancers of the soft stuff in the teeth, between the teeth and the bone. That's that's quite uncommon. And of course the teeth themselves don't usually get cancer. They're they're they're you know they're not dividing that right now. speaker-0: Right. They're not reproducing anything. speaker-1: Right, right. But tongue cancer and then also floor with the mouth cancers can occur. And the the best way to check for that is for the dentist to just you know feel around inside your mouth and look under your tongue. You feel your tongue. And and if caught early then frequently they're quite they're quite curable. If caught late of course, then they it's a real problem. You know, you might lose a large part of your tongue speaker-0: You know what the treatment looks like? speaker-1: Well, there's different treatments depending on how far advanced it is. For early treatment, it just you know, if it's a superficial lesion, it's sort of like dermatology of the mouth. If it's a superficial lesion you can you can freeze it or colorize it or use a chemical or you know, use medication. but if it's a more advanced lesion it requires reconstruction. Wow. And yeah. speaker-0: Okay, well I think that wraps up our inconvenient truths section. speaker-1: What what should speaker-0: Our routine, what what we should speaker-1: we do? Well okay. The important thing is that you wanna the the probably most important thing about brushing your teeth isn't the brushing. It's it's the cleaning out the area between your teeth and your gums, the forty five degree angle brushing with a soft brush. Mm-hmm. And then the fluoride. The floor that's in the toothpaste is actually really important, but it's important to to let it stay on there. And then the other thing is everybody thinks about the the teeth, you know, the teeth part, the w the the white part, the the front, the backs, But the in between the teeth part is also really important. And you no matter how well you brush, you can't get the part that's in between the teeth. So something that cleans the in between parts of the teeth is actually really important too. And when you're younger then th they're close together and you have to use dental floss because you can y you know, pull it down between. as you get older, oftentimes because the gingiva recede, there's a little bit of a gap and the it's hard to clean that whole gap well with with floss. speaker-0: Thinness flood. speaker-1: And so there's little they're called intra intradental brushes. They look like little teeny tiny Christmas trees. And using those to push in between the teeth, is is actually probably better. Okay. So just some speaker-0: Have you have you ever heard of expanding floss? speaker-1: yeah. speaker-0: I wanted to ask you what your opinion was on that. speaker-1: I think it's interesting. I've tried it. It's Yeah, it's y y you you put it through and then it and it kinda gets bigger. speaker-0: when it gets wet in your mouth then it like expands to like not just kind of like a thicker, puffier gloss. Right. So that it gets more contact, right? Right. speaker-1: I've tried it. It's I found it a little inconvenient to use. So the inconvenience factor for me at least overwhelmed any potential advantage. But it's probably a good idea. I just like I said I I found it a little harder to use. speaker-0: What if once it expands you can't use that same section? Okay. speaker-1: Right. That's what I was thinking. Yes. But it makes it hard to use. Yeah. So and also I have tight I have a couple places where I have tight inner dental space. So so I need to use like the the vortex one PTFE. speaker-0: Right. Right. okay. That's a no. I wanted to know. Yeah. Bob Peterson: ready. Okay, well I'm a plastic surgeon, so we can't talk about the mouth without talking about the lips. Yes. Very important. Because that's how people come in to see us for quite frequently. And what they don't like is they don't like the lip lines, either the vertical lip lines or the you know the the s so called smokers creases. Yes. and then the other thing they don't like is that the lip is long. And your lip actually elongates you know, from your nose to your lip, it gets about a centimeter longer as you get older. And that's because the muscles around the mouth are what's called a sphincter muscle. They there's a circular muscle that that holds the mouth closed, you know. So you can you can really squeeze it and and keep water and things from getting in your mouth. but because it's always always contracting like this, it's constantly pulling. this down and it stretches the head out over time. And then also it thins a little bit. so the action of the orbicularisorus muscle this muscle combined with the the attenuation of the tissue causes things to to pull down. So sometimes we'll fix that by doing a lip lift, you know, to to bring it back up. and then the the smokers lines, they're you know, they're they're ridges like this. So you can fix them by sanding down the top of the ridge with a laser with derm abrasion, with chemical peel. or you can fill up the bottom, pump it up by filler. and and then the the third choice is that the the lip lines are caused by muscle activity. if you put Botox that that can that can make it so that the the muscle isn't creasing it so so forcefully. On the other hand, then your lip gets kind of right you gross looking mobility. Yeah, and and you you may look a little unexpressive. So Botox if you use it you have to use just a teeny tiny bit. I have had a lip flip before and it was pretty it was interesting to try to drink out of a straw or even a cup sometimes. Uh-huh. certain noodles and foods and things like that. So I don't do it anymore, but I've tried it. It's not bad. It does relax your lip to give the illusion of a fuller top lip. And it did prevent whatever kind of movement I had in that vermilion border area. But I I wouldn't do it again just because of convenience sake. Yeah, right. So it's one it's in the category of it works but not worth it. Right. For me. Some people really love it still. Yeah. So the the the our go to on that is is we we use filler. Because it's there's no recovery. In the old days we used to do s really strong chemical peels or really strong laser, but the recovery is really pretty dramatic. Also in a place that moves so much and gets so much activity, like the food that goes in in the water and the all kinds of talking and movement and things like that, I would think that it's a little bit more harder, longer of a recovery time too, for those chemical peels and germ abrasions and things like that. we used to do that before we had fellers and and Botox, you know. But they've kinda fallen into disfavor now because we have other choices that are much easier to tolerate. Mm-hmm. They did work. the other the other problem with the with the really strong treatments is that they they oftentimes would take away some of the pigment. Hypothesis. Yeah, you would get hypopigmentation of the upper lip. and you know, if you got an infection, if you got cold sores or something on top of the lasering, it could cause actual scarring, scarring. Mm-hmm. And sometimes that would be unfavorable as well. So pretty much all all accumulating of the mouth and everything that we were talking about today. Is there any kind of note that you want to leave off on for our our listeners or our anyone that's tuning in? Yeah, I think just the you know, the mouth is part of the rest of your body. And it it interacts with it and you know and just treat it as such. You know, be careful with it. It is important. We have to be aware. Yeah. And it's it's not just it's not just teeth. There's a lot going on in there and and so it impacts the other organ systems and and it's it's separated out just because of the historical division of dentistry and and you know other physicians. Mm-hmm. Well thank you so much for educating all of us today. This is so great to know. I'm gonna take this home. I'm gonna bring some of the these questions to my dentist as well. Okay. Mm-hmm. All right. So tune in next time. Thank you.