Why You Should Care About Your Oral Microbiome

Episode 107

Dr. Spencer Wood, DDS, joins the show today to talk about his integrative approach to dentistry and using dentistry to improve our overall health. He utilizes an innovative test to determine the health of our mouths and gums and then utilizes a holistic treatment algorithm to fix what needs to be fixed. We discuss that approach and how he spearheads the movement to pay the dentist not to do dental work.

Connect with Dr. Wood

Nimbus Healthcare

Lifestyle Medicine

Episode Transcript

Dr. Richard Harris MD  00:00

One of the things that’s very important to our overall health is the health of our mouths. we’ve alluded to this on the podcast before, but I really wanted to bring in someone who encompasses an integrative and holistic philosophy for dentistry and I found Dr. Spencer wood. Who is that Dennis? We’re going to talk about his approach to preventing dental disease and why he doesn’t want you to pay him to do procedures. Are you ready to boost your health, EQ and IQ Cue the music? Join me Dr. Richard Harris as we strive to unlock the secret to the human body. Strive for Wellness strive for great health. Follow the show on iTunes, Spotify, Google and Android. Now a word from our sponsors. Our sponsor is Nimbus healthcare, the company that I co founded personalized medicine personalized results, I’d Nimbus we don’t believe that there’s a one size fits all when it comes to treatment. And the data is starting to show that there’s a large variety of how people respond to certain things. And we’re in the Age of Science where we can use things like genetic testing and biomarkers to truly customize a plan just for you. And that’s what we do at Nimbus healthcare. We are in the hair loss and the hormone space. And what we do is we use lifestyle medicine, supplements, and compounded prescription medication to tailor and individualize a plan just for you. If that sounds like something that you’re looking for, you can check out Nimbus healthcare.com. Or click the link in the show notes. One of the things I get asked all the time is Richard, how can I support the podcast and the best way that you can support what we do at the strive for great health podcast is to invest in your health, with our lifestyle medicine course. The course is essentially everything that I do for myself and my loved ones to keep us in optimal health. It covers nutrition, exercise, sleep, stress management, we also dive really heavily into mindset and do commitment into willpower, intentionality and habit change. This is something that has been life changing for me. And I really think if you want to support the podcast, the best way you can do so is invest in your health, or invest in the health of someone else around you. Through our lifestyle medicine course. It’s 4999. And as listeners of this podcast will give you 10% off using the code podcast. Before we dive into the episode, I wanted to talk about a brief update, and that is on Blue Zones. So I read an interesting paper recently the called into question the validity of some of the information that was presented in previous Blue Zone data. When you look at it, this author said that a lot of these blue zones are in areas where we don’t have good records. They’re actually in areas with high poverty. They’re in areas with low income. And so these are all things that are associated not with longevity. And the author was basically saying that there’s probably a fair degree of error here. And so we shouldn’t just take these areas as longevity hotspots. We need to look into this more. And I don’t think this means that oh my gosh, there’s nothing we can learn from Blue Zones. I think there are things that we can learn from societies that have a more ancestral lifestyle on things like social connection, purpose, meaning, those types of things. And there’s always more to learn. So I’ll keep my eye on more information regarding that. Let’s get into this week’s episode. Welcome to strive for great health podcast with your host, Dr. Richard Harris. And I have with me on the show someone I’ve actually been looking for for a very long time, I’ve been looking for a holistic focus dentist that come talk to you for a long time. And that just shows you how hard it is to find someone in this field. But I have Spencer with me on the show Spencer. How are you doing today,

Dr. Spencer Wood  04:34

dude? Wonderful. Thank you very much.

Dr. Richard Harris MD  04:37

Yeah, absolutely. It was great talking to you offline. We had a we had a great conversation. But I want to start first with the importance of oral health like the importance of taking good care of your mouth because many people really don’t know, but there are tons of systemic complications associated with poor oral health. What are some of these complicated Asians that what can happen if you don’t take care of your gums and your teeth?

Dr. Spencer Wood  05:03

Yeah, so when we talk about oral health, what we’re really talking about is the oral microbiome. So this is a community of micro organisms that live inside of your mouth. And it’s like an ecosystem. There’s 700 species of bacteria that live in the mouth. They do all sorts of important jobs for us. They help us digest our food, they make nitric oxide, which lowers our blood pressure, they keep the environment stable, which protects the teeth and gums. But there is a very small number of bacteria that can cause disease, and we call these periodontal pathogens. And when you have certain conditions like poor diet, stress, dry mouth, intestinal problems are poor sleep, the pathogens will increase in number. And when the number of bad bacteria outnumbers the good bacteria, we call this an oral dysbiosis. So in the gut, you can have a gut dysbiosis in the mouth, you get leaky gums, and these bacteria into the bloodstream, traveled to other organs where they can cause disease in the other tissues in the body.

Dr. Richard Harris MD  06:23

And we’re starting to find out more and more about the importance of these microbiomes and how the different micro biomes talk to each other and can influence each other as well. And so what are some of the issues with having your your oral microbiome off? What diseases do we know the research shows are linked to these complications?

Dr. Spencer Wood  06:45

Well, I’ll give an example of one of these pathogens. It’s called PG, or porphyromonas, Ginger valance. And this bacteria has been found in the blood clots of people who’ve had heart attacks and strokes. It’s been found in the brain tissue of Alzheimer’s patients. And it’s being found in the resected joints of people who’ve had total joint replacements. There is no known health benefit for this bacteria. So if you have it in your mouth, you absolutely want to get rid of it. And this was one of the main reasons why I wanted to offer salivary testing to my patients for their microbiome. Other conditions would be things like heart disease, autoimmune disease is type two diabetes and premature births. You can also look at microvascular disease. So this is things like erectile dysfunction, kidney disease, and even vascular dementia.

Dr. Richard Harris MD  07:47

Wow, it’s incredible, when you look at all of this research and see that this is all tied to something that is relatively small, our oral health can have dramatic impact on your overall health. And that’s because of, you know, what we’ve talked about on the podcast before our microbiome influences a lot of our health through helping with digestion and making different proteins and other molecules that actually influence our health for the good, or for the bad. Now, let’s talk about this salivary testing this oral microbiome testing. How did you get into that? And then how does that work? How does that flow work with your clients?

Dr. Spencer Wood  08:31

Now, when we talk about salivary testing, it’s really all about prevention. It’s about detecting a disease early, trying to catch it early before it helps contribute to the systemic diseases. Right now in America, the average retired couple over the age of 65 can spend $320,000 on health care during their retirement, and the average difference between your life expectancy and your healthy lifespan is 13 years in America. These are some of the things I’m thinking about when I decide to discuss this with a patient. And I’d like to tell one story that kind of illustrates this. You might remember Tim Russert, he was a reporter for Meet the Press. And Tim was 58 years old. He saw his physician. He was being treated for his blood pressure and his cholesterol. And he exercised regularly. He took a stress test. And his doctor said, you know you pass your stress tests with flying colors. I predict you’ll have a have a less than 5% chance of having a heart attack in the next five years. Two months later, he dropped dead of a heart attack. So what was his doctor missing? You know, and our dental office is currently He partnered with a physician who specializes in heart attack and stroke prevention. So in the last eight years, his patients have had zero heart attacks, zero strokes, zero stents and zero bypass operations. So this is the power of that personalized medicine approach. And the way I got interested in all of this is a book that I read. It’s called beat the heart attack gene by Dr. Bradley bale and Dr. Amy Dineen. And so they have a method to halt, reverse and stabilize arterial disease. But the only way they can do that is when a dentist and a physician work together on this. And that’s what salivary testing is, it’s the dental component to chronic disease prevention, and especially arterial wellness.

Dr. Richard Harris MD  10:57

That’s incredible. And that takes into account what we talked about all the time and what we believe in, which is that integrative system of health, and that you really need the right people looking at the right systems and collaborating together to optimize health outcomes. And you know, a lot of people put their eye health and their oral health on the backburner because they just don’t think it’s that important when really, it’s a key contributor to their overall health. Now, you had talked to me when we met offline about nutritional approaches to improving dental health and even just like how you chew and what you’re chewing and things like that can impact your oral health. So what are some strategies that you talk to your clients about when they want to improve their oral health through nutrition?

Dr. Spencer Wood  11:46

Well, nutrition is the number one strategy that we have to treat oral dysbiosis. The commonly given advice is brushing your teeth twice a day, flossing your teeth twice a day. Both of those things are wonderful, but they do not change the behavior of bacteria. And that’s really what we’re trying to influence. So I’m going to give three pieces of advice, nutritional advice that someone can do, without really making any drastic changes in their diet. The first is something called prebiotic. And the best prebiotic that we know of in dentistry, is called xylitol. And this is a natural sugar that’s made from Birch trees. So the bacteria take it in, they can’t make any energy. And they basically fall off the tee. So by taking small doses of xylitol throughout the day, if you were to do this over a several month period, you can get plaque reduction by up to 80%. And there is no other treatment that can really come close to this. I want to also mention to anyone listening that Xylitol is toxic to dogs, so you have to keep it away from your pets. The second nutritional advice is something called teeth protective foods. So at the end of every meal, you want to have some food with protein, fiber or fat in it. This could be like a glass of milk, a piece of cheese, some almonds of avocado. This is whenever you have sticky carbohydrates, like dried freeze energy bars, that type of thing. And if you do this, you can protect your teeth. I’m a dentist, I eat chocolate every single day in my life. I haven’t had a dental inner intervention in over 20 years. And I do not eat a perfect diet by any means. I use these tooth protecting foods at the end of a meal or a snack. And that will protect your teeth and gums. And then the third bit of advice which many people may not be aware of, but if you’re eating or drinking constantly throughout the day, this will damage your microbiome. Because it’s like a source of stress for your teeth. It’s kind of like going to the gym and you work out your muscles and you break them down and then later they repair. Well when you eat the acid levels drop and your saliva comes in and repairs the tea. But if you’re constantly eating and drinking, your mouth doesn’t have enough time to recover. You want to basically eat or drink and then put it away for 30 minutes or an hour and give your saliva time to come in and repair the tea. There’s are three things you can do Xylitol to protected foods and letting your mouth rest. And that’s what zero changes in your diet. And I’d like to quote a dentist, his name is Dr. Roger Lucas. He says that didn’t feel disease is 100% preventable with a diet. And there’s lots of people who are frustrated because they go to their dentist every six months, they get their teeth cleaned. They follow all that, and they can’t figure out why they’re still having problems. But these three solutions are just among many of things we recommend to our patients to help with this.

Dr. Richard Harris MD  15:30

That’s great. And that’s something like you said, that’s so simple, that you don’t have to change really your overall strategy, but it can help you overall with your oral health. Now, one of the things that I really thought was interesting in love when you said it was why you’re advocating paying the dentist not to get dental work done, right? That would be like going to a surgeon for surgery. And the surgeon is like, No, we’re not doing surgery, we’re going to do this instead. And you’re like, what I came here for surgery. And I thought this was really interesting, and a really great way of thinking about it and changing that paradigm. So let’s talk about that. Why do you want people paying you not to get dental work done?

Dr. Spencer Wood  16:16

I love that question. That’s gonna raise some eyebrows. We’re following the medical model with that philosophy. And this goes back to an essay that was written by Dr. Atul Gawande. He’s a heart surgeon, but he also is a writer for the New York Times. He wrote an essay in 2017 called the heroism of incremental care. And the subtitle is, we devote vast resources to intensive one off procedures, while starving the kind of steady intimate care that often helps more people. The top paying specialties in medicine are all based on intervention, cardiology, gastroenterology, dermatology, the lowest paying specialties are all prevention oriented, family medicine, pediatrics, and internal medicine. So we spend $4 trillion on health care every year in America. And it’s believed that 75% of that expense is to manage conditions that would benefit from this type of incremental care. This means having a conversation with your patient, what are their goals? What are they willing to do to achieve those goals. And it takes longer than 10 minutes, which is about the average time of the average medical visit. So I have a colleague who’s a dentist, he decided to offer incremental care to patients at his dental practice, he decided he wanted to do this philosophy. This means that he was doing fewer crowns, fewer root canals, fewer extractions, he offered nutritional counseling, his outcomes improved dramatically, and his complication rate went down. His patients got healthier, and they were keeping their teeth longer. Guess what happened to his dental practice, he almost went bankrupt. And this is exactly what you would predict what happened. Because the same thing happens in hospitals. When the surgical outcomes improve, the hospital revenues go down. And when surgical outcomes stay the same or get worse, the patients have to stay longer to recover. There’s more complications. And that’s actually more revenue for the hospital. And this was the whole movement behind value based health care and bundled payments. So this incremental care, it has a fundamental problem, which is, the better you become at doing it. You put yourself out of business. So my friend, the dentist, he looked to what physicians were doing in this is called the concierge model or direct primary care where the patient pays a set monthly fee to the doctor’s office. And that doctor’s job is to keep the patient as healthy as possible, and try to lower the total cost of care. And another name for this is fee for value. Instead of just fee for service. And physicians. They’ve been able to create entire networks based around this concept. The largest one is called MD VIP. And the VIP stands for value in prevention. And if you go to their website, they say on the front page very first page of our website, our outcomes and prevention are among the top 10% in the country. And they are actively trying to partner together dentists and physicians, because they know that by doing that, they can go from the top 10% to the top 1% and outcomes from the combined efforts. So dentists have affiliated networks, they’re called DSOs dental service organizations, I went to their websites of the largest ones, they talk about service, they talk about technology, they talk about high quality care, but not a focus on prevention. And I have a, an idea for why that might be. Because all of these DSOs participate with dental insurance. So this means the monthly payments, that would go towards incremental care, instead, they’re going to dental treatments, they’re going to shareholders in the form of dividends, and they’re going to executives in the form of bonuses. So, you know, it is good that the patient gets a discount on one service. But health care is very complex. And we need to be focusing on the total cost of care, rather than saying, Oh, you saved money on one surface. So I would love to see a dental support organization that is focused on measuring our outcomes, and lowering the total cost of care, sorta like the dental version of MD VIP. And we would gain tremendous credibility with the general public, when they’re a group of dentists who joined together and say, This is how we believe that dental care should be delivered. And I know that there are a lot of dentists out there who would love to work in this type of practice. But when you’re by yourself, I’m discovering for myself how challenging it is. And I don’t have gray hair yet, but I’m just waiting for it to appear. Because of all the functions that you need to do with educating patients, training staff, you have to find a revenue model that works, you have to do compliance, you have to measure your outcomes. And right now we’re all doing it by ourselves. This direct primary care model, is the reason why you would be willing to pay a dentist or a physician not to have treatment done. I believe that most patients just want to be healthy. And this is the best way that I can find to offer them that

Dr. Richard Harris MD  22:54

I completely agree with you there. And a lot of my friends who are kind of like us more preventative focused and really patient or client focused, are moving towards that direct primary care model. And we’re starting to see people being more receptive to that model as well. And then using the insurance as kind of a supplement if in case they need prescription medication, or hospital or imaging or something like that. I have never talked about this on the podcast. But I think one of the fundamental problems that you have in traditional care is I’m going to receive services from somebody but I’m not paying them directly. And so therefore, you’re far less likely to listen or or show up on time or do something because you’re not paying that person directly. It’s like if you hire a trainer, and you pay that trainer, 120 bucks, what are the chances you’re showing up? Pretty high? Pretty high. Yeah. Because you’re not going to miss that session, because you paid that money, you invested the time you invested the thought. But then it’s the same way in the traditional medical practice, we get no shows all the time, people were just coming in there. I’m here for my insurance. I’m here because my spouse made me, you know, they don’t want to be there. So they don’t want to be there. There’s nothing I can do. I can give him all the advice, the best advice, best care in the world, I’m still gonna have a poor outcome. And I think the the direct primary care model where you are paying someone directly for a service you receive from them aligns incentives, and that’s a big problem that’s missing in the current system. And speaking of aligning incentives, one of the things I’m seeing online all the time right now is fillings, and there are people out there saying oh my god, you have to get your fillings removed. They’re toxic, they’re killing you. And I’m just like, wait, wait a second, man. Like there are tons of people who have fillings. Most of them are doing just fine. And we talked about why you aren’t getting your fillings removed. Oops. So I want to hear directly from a dentist, why you are not getting your fillings removed?

Dr. Spencer Wood  25:06

Sure. So this has been debated for about 150 years. Since this material was first introduced, which is silver amalgam. And I have amalgam fillings in my mouth. There is not currently enough evidence to justify that, for any medical intervention. Yes, it is true that you can have blood testing done, you can have your mercury levels checked. The most vulnerable time is when you’re getting the filling placed, or the day you’re getting your fillings removed. Apart from that it basically like chemically inert material, and I don’t plan to have my fillings changed, unless there is a clear indication for it. Other colleagues may disagree with me on that. But that is the science on it. As far as I can see, there’s a second reason why I don’t have my dental work replaced at this point. And that is because every dental repair has a certain shelf life or lifespan to it. It’s a wear and tear item, like the tires on your car. And if you take all of the services that you can have done on one to a dental sealant of filling a root canal and crown, and if that breaks, you might need an extraction and inflate all of those I totaled them up, can add up to about $12,000. And that can be the cost of treating one too. That’s a conservative estimate, you have 32 teeth in your mouth. And every time you touch a tooth or the drill, you are starting a cycle of repair, which has the potential to be very expensive. It’s estimated that 80% of all dentistry is done to repair work that was previously done by another dentist. So failing might cost $150 by the you run the chance of it costing as much as $12,000. And that’s a really big mismatch. And each time you perform one of these interventions, the costs go up substantially. Sometimes it’s 10 times more expensive than the cost the previous intervention. So I have a question for you. Which tooth Do you think stays in the mouth the longest, it’s the one that the dentist never touches? The hard part here is how do we assign a value to that very first intervention that really communicates that you are starting down this path that can wind up being extremely costly for the patient. And I think currently the way we’re doing it with that first intervention, lowering the price, it doesn’t always communicate that. And you could make an argument that if you’ve raised the cost of that first intervention, you could actually save patients more money in the long run. And the reason is because it would incentivize the patient and the doctor to consider a different path. And that path would be counseling the patient and working with them to try and repair or re mineralize the tooth. And you might there’s people listening, I know they’re going to think I’m crazy for saying that. But I know dentists who’ve been doing this successfully for decades, to work with their patients to repair teeth by repairing the oral microbiome. And in my opinion, this is far superior outcome than the alternative. But it currently has no value in the marketplace. So there winds up being pressure on the dentist to do lots of interventions, because it’s the only choice that we’ve assigned value to. And there’s also a difficulty because a patient with a cavity, or a patient with gum disease is a source of revenue for a dental practice. But it’s a cost to society. And I don’t have an answer for that. Maybe someone listening has an answer to that, because that is kind of complicated. But I didn’t at least thinking about things like that and talking to others. You know, I finished dental school 11 years ago, I had no idea that I’d be working on the things that I am now or that I have this opportunity. I get patients who come in and say my mom or dad had had, you know, heart disease or had a stroke. And they’re scared that it’s going to happen to them, or they’ve been following all of their doctor’s advice, and they still had an issue. And our team just wants to help out. We want to provide information. And we want to provide the best solutions that dentistry can offer to help with these things. And the reason why patients would want to consider getting a saliva test done is because you can’t see it, you can’t feel it, and you can’t taste it. And you can have a chronic infection in your gums for years or even decades. We need to do this testing, because if a patient has bleeding gums, or they have inflamed gum tissue, we don’t know what’s causing it just by looking at it. Another reason to consider testing is because that’s how we find out if our therapy is actually working or not. And this is the standard model, you perform a test, you come up with a treatment, and then you retest to see whether it was working or not. And it can also be a form of primary prevention. Because these bacteria will show up on a test years before there’s ever any clinical signs and symptoms. The tools we have to detect the gum disease are all over 100 years old dental X rays were invented in 1890. The periodontal probe was invented in 1920. And we have all this new technology in dentistry. Now we have intraoral scanners, dental implants, CAD CAM, 3d printing, the things that I see dentists able to achieve with this, to recreate nature is incredible. But the drawback is what’s happening with the microbiome, when we put all of these prosthetic pieces in the mouth. And I’d like to tell the story of one patient who I had, he had all of his upper teeth extracted and dental implants placed. The work was done phenomenally within fractions of a millimeter. I saw him 10 years later, those dental it plates got infected. And it literally fell out of his mouth, his denture fell out of his mouth. And I looked at his bottom teeth, and his gums were clearly infected on his bottom teeth. And I had to wonder, what advice was that patient given at the time that that work was done? Was he told to brush and floss his teeth and see his dentist every six months? That advice may work for some portion of the population. But it’s not going to work for everyone. And I know that I’m sort of cherry picking one case. But it just to prove a point, you know, even though most outcomes are successful, I think if that patient had had salivary testing, and had had a strong preventive program in place, he’d likely still have that in his mouth. So why would you get 10s of 1000s of dollars of dentistry done and not have a $99 test to tell you the status of your oral health. In the future, patients will be able to access this information, oh my oh, in my opinion, there’ll be a smartphone app, there will be a home testing kit. And the dentist is going to be cut out of the loop. So we really need to be aware of our role as our job is to understand the results and help guide the patient to get this process of how they can improve their own oral health. And we need to give them back control of their own health.

Dr. Richard Harris MD  34:04

Awesome. Well, thank you so much for that. And there’s so much that I agree with there and using personal anecdote. I was diagnosed with irritable bowel at I believe seven, six or seven years old after I got a really bad gut infection. My mom was hospitalized. We had the same thing. Obviously the food was tainted with it was the seafood. And we had the same thing both got very, very bad gut infections. She got hospitalized, I was younger, so I didn’t I was just able to PB light through it. And then I started developing cavities after that and every couple of years you know, I brushed I flossed I wasn’t a big candy eater. I would still develop cavities and I’m like what the heck is going on and even in my 20s Every couple of years I’d have a new cavity. And once I cleaned up my microbiome, the cavity stop and I have added cavities since my 20s. And every single time I go in there, they’re like your teeth look great. Your gums look great. There’s no inflammation, nothing. That’s because I started taking care of. I took care of my gut microbiome. And I started taking care of my tooth microbiome because once I read the studies on xylitol, I was like, Oh, this could probably help me. And it does. I have a little bit of xylitol gum every single day. I just chew on it for like 1015 minutes just to help with my oral microbiome. So, Spencer, I really appreciate you coming on the show. With all the information that you gave today. If people are looking for you or your services, how do they get in contact with you?

Dr. Spencer Wood  35:36

Yeah, so our office is Bellaire dental care. We’re located in Bellaire, Texas. Our phone number is area code 713520 8400. And our website is smile bellator.com. And I’d like to add one more thing before we close, which is that I cannot do this work. And I cannot offer this to patients without the help of my team, and especially my dental hygienist. This is part of the team that is educating patients. And that is performing these therapies that are so valuable for patients. I have a phenomenal hygienist and I couldn’t do this work without her. That goes for the whole rest of the team as well. Being able to understand what we’re trying to achieve, and how to communicate that with patients. It is a team

Dr. Richard Harris MD  36:30

absolutely is 100% of team effort. And that just shows the kind of person that you are and the ethos that you have. And realizing that we can’t do it all on our own. And really the each and every single member of the team is valuable and plays an integral part in the health of the people that you take care of. So thank you so much for being on the podcast. All that information will be in the show notes. To all my listeners. Thank you for listening to strive for great health podcast with your host Dr. Richard Harris. Have a blessed day. Thank you for listening to strive for great health podcast with your host Dr. Richard Harris. It’s our mission and goal at the podcast to impact as many lives as possible to empower individuals to take control of their health and live a life full of joy and purpose. You may help us achieve this mission by leaving a five star rating and review on your preferred podcast platform. And by sharing this podcast with anyone you think it may help. If you want to support the podcast, the best way is to invest in your health or invest in someone else’s health through our five pillars of great health lifestyle medicine course. A link to that courses in the show notes. Thank you for listening and God bless

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