[00:00:00.090] – Dr. Lemanne

There is an association between the number of teeth you have left and your longevity and including your cancer risk. You have found your way to the Lamont Gordon podcast where Docs talk shop. Happy eavesdropping. I'm Dr. Dawn Lamont.

[00:00:24.270] – Dr. Lemanne

I treat cancer or patients.

[00:00:25.920] – Dr.Gordon

I'm Dr. Deborah Gordon. I work with aging patients.

[00:00:29.710] - Dr. Lemanne

We've been in practice a long time.

[00:00:32.170] - Dr. Gordon

A very long time.

[00:00:33.770] - Speaker 2

We learn so much talking to each other.

[00:00:35.980] - Dr. Gordon

We do. What if we'd let people listen? In today's episode, Dr. Lamont and I explore some new information about the health of our mouths. You, of course, have heard from your dentist about the importance of healthy teeth and gums. Now let's hear about the oral microbiome health and its importance. We want to share with you some surprising tips and changes you can make in your oral health routine that can reduce your risk of cancer and another that might improve your sleep. Let's listen.

[00:01:15.830] – Tom Freeman, Sound Engineer
You're rolling?

[00:01:19.270] - Dr. Lemanne
I think we should have been rolling five minutes ago. This was the best stuff. I think maybe what we've already said we can go home now.

[00:01:25.520] - Dr. Gordon
Let's see if we can drum it up again.

[00:01:27.390] - Dr. Lemanne

All right? Hey, Deborah.

[00:01:30.470] - Dr. Gordon

Hey, dawn. How are you doing?

[00:01:31.890] - Dr. Lemanne

Good. I wanted to ask you if you knew a behavior that's associated with a decreased risk of cancer, and it's not exercise, and it's not sleep, and it's not diet, and it's not taking supplements, et cetera.

[00:01:47.970] - Dr. Gordon

I have a feeling where you're going with this, but I'm going to have to ask you to clarify.

[00:01:52.460] - Dr. Lemanne

All right, well, I won't be so coy about this. It's flossing your teeth.

[00:01:58.470] - Dr. Gordon

Flossing your teeth?

[00:01:59.870] - Dr. Lemanne

Flossing your teeth. It's associated with longer life. It's one of the behaviors, along with not smoking and not drinking too much, that actually is associated with life extension.

[00:02:12.330] - Dr. Gordon

So I want to know about the magnitude and the definition of flossing your teeth. Do those little white picks in between meals count?

[00:02:23.490] - Dr. Lemanne

Well, I suppose anything's better than nothing. I think you want to get in there with the string and go up and down all sides of the teeth. I've been wondering about that. When you have those little fancy little toothpicks with the little feathers and things, and you stick them and they're like pipe cleaners, right?

[00:02:38.920] - Dr. Gordon

They are like pipe cleaners.

[00:02:39.980] - Dr. Lemanne

Yeah. So those are great, but they don't get all the way down through the entire crack between your teeth. That bothers me.

[00:02:48.840] - Dr. Gordon

So I feel like we've skipped a step. So how on earth does flossing my teeth help me live longer?

[00:02:58.110] - Dr. Lemanne

Okay.

[00:02:58.480] - Dr. Gordon

Well, yeah, other than it seems longer.

[00:03:01.610] - Dr. Lemanne

That's a fair question. Gum disease. So everybody knows what gum disease is. The gums, especially with aging, recede, there are exposures of the parts of the teeth into the mouth that shouldn't be exposed. The teeth can actually loosen and fall out because the bones are damaged. And all of that is associated with an increased risk of cancer.

[00:03:25.470] - Dr. Gordon

Cancer?

[00:03:26.360] - Dr. Lemanne

Yeah. So that's my interest in this. I'm an oncologist, so I am interested in things that can decrease one's risk of cancer. And keeping track of your gum health is one of those things. So gum health is associated with a decreased risk of cancer?

[00:03:43.290] - Dr. Gordon

Of oral cancer?

[00:03:44.530] - Dr. Lemanne

No, all cancers, breast cancer, colon cancer, pancreatic cancer, esophageal cancer, colon cancer. Did I say colon cancer?

[00:03:51.600] - Dr. Gordon

No.

[00:03:52.040] - Dr. Lemanne

All of those cancers are associated with gum disease. Now, we don't know. You asked the actual statistics. That's pretty hard to put a finger on. I'm not going to be able to do that because nobody can. But there is an association that's pretty strong, and people who don't have gum disease have fewer cancers than people who do, and people who have bad gums when they start. And that is especially, you know, how you can tell? No, there is an association between the number of teeth you have left and your longevity and including your cancer risk. So the more teeth you've lost, one is not so great compared to someone who's not lost no teeth. But if you're missing 2345 teeth, that's an issue and that's a sign of overall poor health.

[00:04:43.710] - Dr. Gordon

So what if you've lost them? Many things to say, because that same correlation exists for Alzheimer's disease, by the way, the more teeth you've lost in your mouth that's right.

[00:04:53.840] - Dr. Lemanne

The more teeth you've lost. So we can keep score by counting people's teeth. Right. We should be doing that in the physical exam.

[00:05:00.460] - Dr. Gordon

One, two teeth. But is there a difference between so the only tooth I've lost in my life is one of my wisdom teeth because he said, I can't open your mouth wide enough to put your filling in that you need. So the dentist extracted that tooth, which raises the question for me, does it matter if your teeth fall out because of the pathological process you described of receding gums and floppy teeth? Is that different from the dentist saying, you're getting a lot of crowding here, let me take two or three out and just put an implant in?

[00:05:34.110] - Dr. Lemanne

Yes. The tooth loss from gum disease is what we're talking about here, not from accidents or extractions for other reasons. Absolutely, you're right. So we're talking about bad gums leading to bad teeth in bad jawbones, resulting in the tooth falling out or having to be extracted.

[00:05:57.490] - Dr. Gordon

Some people end up and it really.

[00:05:59.410] - Dr. Lemanne

Impairs their ability to eat, I imagine.

[00:06:02.870] - Dr. Gordon

I have a patient who all last year, whenever we were talking about her digestive problems or her energy levels, I'd mention anything about food, and she couldn't chew anything because she had so many teeth missing. She seems very bright and she's actually quite old, so I'm not otherwise generally worried about her. But not being able to eat normally, you can't go out to dinner at the very social level of things. There's so many foods you can't eat or chew unless you can pulverize them. And eat them like baby food. You'd have to get a baby food mill.

[00:06:38.670] - Dr. Lemanne

You mean like a blender?

[00:06:39.990] - Dr. Gordon

Well, they're mini blenders that you have on your tabletop. So when your baby is getting ready to eat a little bit of meat but has no teeth, you grind it quickly and give them a spoonful.

[00:06:49.850] - Dr. Lemanne

Oh, okay. Yeah, that would be kind of gross for an adult.

[00:06:54.230] - Dr. Gordon

Exactly. And decreasing the nutrients. But how much care do I have to take in my mouth to reduce my cancer risk?

[00:07:08.650] - Dr. Lemanne

We don't really know, but the general recommendations are to brush after each meal and to floss at least once a day. And I think those are reasonable recommendations. I follow those I actually floss after. Well, this is going to be a little extreme, but I'll let you know. I floss after every meal if I'm home.

[00:07:29.970] - Dr. Gordon

If you're home.

[00:07:31.280] - Dr. Lemanne

Yeah, I do.

[00:07:33.730] - Dr. Gordon

This is a total I cannot validate what I'm about to say, but a medscape mass email today said, do you know how soon after you eat you should brush your teeth? You should wait at least 30 minutes. What do you think about that?

[00:07:48.940] - Dr. Lemanne

It depends on what you eat. I mean, the acids being formed from a carbohydrate rich meal, for instance, I believe, form within the first three to five minutes and start eating away at the enamel. But was there some reason for this recommendation? Did it have to do with the nitrate production by certain oral bacteria that we need?

[00:08:10.240] - Dr. Gordon

They did not mention that. I think the thinking was that you were going to be more abrasive to your teeth in a complex digestive juice environment. Tell me about the nitrate.

[00:08:25.220] - Speaker 2

Oh.

[00:08:25.570] - Dr. Lemanne

So, for instance, if you want to increase the nitrates in your system by eating, say, beets, if you take a good swig of mouthwash right before your meal and eradicate most of the normal oral flora temporarily. And then you eat the beets, you don't get the bacterial transformation of the contents of the beet like betane and all of that into the beneficial nitrates. So you don't have the same effect. And athletes, for instance, like to eat beet juice before a meat because it can improve their oxygen carrying capacity or their metabolism in some way that's beneficial for their performance. And you can block that response with a good swig of mouthwash before you eat. So I would certainly say you wouldn't want to have clean your teeth and your mouth carefully before you eat. Perhaps that might interfere with things because.

[00:09:27.430] - Dr. Gordon

Your microbiome is actually in your mouth. And I just threw that word out, but I have a lot more to say about that. But the environment in your mouth is interacting with your food. It's not a blank slate that the food writes itself on. But I didn't know they used beet juice for high performance. I just use it to increase nitric oxide in my older patients who show a deficit of it.

[00:09:51.470] - Dr. Lemanne

So it's nitric oxide. I think you're correct. I think I'm not correct about the nitrates. So yes. And athletes, there have been some studies suggesting that athletic performance is improved by nitric acid, especially foods that are processed into nitric acid, like beet juice.

[00:10:09.410] - Dr. Gordon

And they do that partly by the interaction they have with a healthy mouth.

[00:10:16.250] - Dr. Lemanne

Exactly, yes. One that's not been recently bathed.

[00:10:20.390] - Dr. Gordon

So after each meal, sometime, maybe within the first half hour, do you recommend flossing? And so I imagine this comes up in your practice because you see many people who either want to prevent a familial cancer or they have a cancer and they want to prevent a second cancer. And so what would your dental hygiene advice be optimally for them?

[00:10:45.900] - Dr. Lemanne

So it would be the same as for anyone, which would be to keep the teeth clean. So after eating is the time to clean the teeth. Hopefully people aren't eating four, five, six times a day.

[00:10:59.250] - Dr. Gordon

Could we embolden that in gold and put it in giant letters and take it through the sky on one of those skyriding planes?

[00:11:08.390] - Dr. Lemanne

So I'm not a big fan of grazing all day. It may be important for certain people at certain moments, but I wouldn't recommend that as a lifestyle for very long periods. I think that we really want to have long periods of no food ingestion for decreasing cancer risk. And that would make it a little easier also to clean your teeth. It's much easier to clean your teeth twice a day than four, five, six or more times a day. So, yes, I think cleaning the teeth twice a day, or if you do eat three meals a day, three times a day is reasonable. There have been arguments by dentists who wonder, well, should you brush first and then floss? Which I think is a common way to put those two together. And I don't know if we have a good answer for that, but I really like one dentist who said, well, I think it's important to floss first and then brush, because then you brush away all the things that you've dislodged by flossing. But that dentist also finished by saying, but just get it done. If you want to floss second, fine, just do it.

[00:12:20.850] - Dr. Lemanne

And I think that's important to acknowledge, just do it.

[00:12:24.770] - Dr. Gordon

But I am of your dentist school of thought. It does seem like a more logical way to do it.

[00:12:31.310] - Dr. Lemanne

Well, you can get pretty fancy with it, too. Those little pipe cleaners that you can put between your teeth. I dip those in black seed oil.

[00:12:40.490] - Dr. Gordon

Oh, what does the black seed oil offer?

[00:12:42.440] - Dr. Lemanne

The black seed oil kills one of the most carcinogenic oral bacteria, fusobacterium nucleotum. Now, fusobacterium nucleotum is found, it's thought to be causative for colon cancer, for possibly for pancreatic cancer. It's found in some breast cancer tumors. In other words, if we actually take those tumors and culture them, we can find this organism in there. It's particularly nasty. It makes a bad biofilm, and it decreases local immunity so that if there are any incipient tumors, they grow faster. It's just a nasty, nasty bug. We see it in colonic polyps. We see more of it in advanced colonic polyps, and we see the most of it in advanced actual colon cancers. And we think that the fusobacterium actually facilitates metastases of these tumors. So the colon cancer is often metastasized to the liver. And we think that possibly colon cancer cells in the colon that are infected with this particular organism inside the colon cancer cells actually make it easier for those colon cancer cells to soften their cellular capsules, squeeze into the vasculature, and make their way through the bloodstream to the liver and then squeeze out there and grow. So fusobacterium nucleotom is a really nasty organism.

[00:14:05.990] - Dr. Lemanne

It is one of the major causes of dental plaque. So if you have dental plaque, if you go to your dentist every six months or however often they tell you to go and they scrape off all this white stuff, that's possibly probably a lot of biofilm from fusobacterium nucleotum.

[00:14:22.890] - Dr. Gordon

I am blown away.

[00:14:24.790] - Dr. Lemanne

Hence the black seed oil.

[00:14:26.270] - Dr. Gordon

Right. So I want a little bit more the mechanism. But, Dawn, I've spent a lot of time thinking about preventing colon cancer personally and with my patients because, of course, it's got a high and increasing incidence rate, and I've never heard this before, so please be really specific. And is there an alternative? Black seed oil sounds gross.

[00:14:52.680] - Dr. Lemanne

Is it? I don't really like the taste. Some people cook with it. It's used culinarily. The formulation I have comes from, I think, Greenland, Iceland, somewhere up north. And it's wildcrafted, and I think it has a peppery taste when it's really fresh, sort of like really fresh olive oil. And it's okay in small amounts. I will often dip my dental floss into a little bowl of this oil and use that to floss my teeth so that I'm sure to get it up in there. I like to do that in the morning because before I have my big glass of water or coffee, I clean my teeth because I don't want to have a big bolus of fusobacterium nucleotum that is washed with my first few drinks of water and or coffee down into my colon. So I clean my mouth before I have my first drinks in the morning.

[00:15:54.120] - Dr. Gordon

I think of seeds as having names like sesame or sunflower. So there is actually a black a seed that's just named by its color.

[00:16:02.440] - Dr. Lemanne

Yeah. The botanical name is Nigella Sativa. Nigella Sativa, I believe you probably are pronouncing it correctly. I have horrible pronunciation, so thank you.

[00:16:12.440] - Dr. Gordon

I have really good pronunciation. I took two years of Latin in junior high school.

[00:16:15.960] - Dr. Lemanne

Oh, there you go. Junior high school, berkeley.

[00:16:19.120] - Dr. Gordon

You know, kind of ahead of its wow. So I'm impressed nigella Sativa or black seed oil, just run through the gum border of your teeth is where it's likely to control this fusobacterium.

[00:16:34.710] - Dr. Lemanne

Yes. I also use it to brush my teeth and tongue. I don't use toothpaste. I use baking soda to brush my teeth. I use black seed oil to brush my teeth. I'll often combine them or do them serially. And I use a mouthwash that I like afterwards, sometimes, not always, but several times a week, I'll use a mouthwash to kind of shake things up in there and make things a little harder for some of the bad bacteria.

[00:17:07.270] - Dr. Gordon

This should be common knowledge. I mean, I really am floored. I have a list I hand out to patients if they have colon polyps. I have a different list if they have familial colon cancer. And this is quite remarkable, and it seems a pretty easy do in one way or another. And I wonder if it's included in any toothpaste or mouthwashes.

[00:17:31.350] - Dr. Lemanne

Oh, that's a good question. I haven't seen it.

[00:17:33.920] - Dr. Gordon

I'm going to start looking for it, and I'm definitely going to put it on my shopping list for that.

[00:17:38.770] - Dr. Lemanne

I have seen dental flosses infused with, say, tea tree oil. Yes. And that's a thing, but I haven't seen black seed oil.

[00:17:47.180] - Dr. Gordon

Oh, well, now I'm going to be on a hunt for it, because that sounds like a great tip. Those are the cancers. Even though heart disease might be our number one foe, really, for our long lives, everybody really is more worried about breast cancer and colon cancer.

[00:18:02.510] - Dr. Lemanne

Yes. And colon cancer is particularly deadly. Breast cancer. Most people survive breast cancer, so out of all comers through all stages, 90% to 95% of breast cancer patients do survive breast cancer and go on to die of something else. And that's because most breast cancers are caught in fairly early stages, stage one, two or three, stage four breast cancer is a different story. But that, unfortunately, is rarer, increasingly rare.

[00:18:32.130] - Dr. Gordon

But the people I know who've had a bad time with colon cancer are the ones where it was not found early, and in a couple of cases, because they were outside of the window of when they were recommended to have colonoscopy screening. So an 82 year old woman who was told she didn't need it anymore, found to have an advanced colon cancer and died from it, who was an otherwise vital and healthy woman.

[00:18:56.130] - Dr. Lemanne

Yeah, that's a shame. And the guidelines are often troublesome if you're outside of the screening populace. So those are things that you really want to talk to your doctor about. If you think you need a particular screening test, you can push for it. Even if you're outside the recommended guidelines, you might have to pay for it. So I don't know if Medicare, for instance, would have paid for the 82 year old woman's screening colonoscopy. Do you know?

[00:19:23.560] - Dr. Gordon

I don't know, but I think they are semirational beings that might be approached with proper argument. Does Cologuard work? Does that screening for the it's not the old fashioned screening for blood we did in medical training, but it's the one that's particular to the kind of bleeding that comes from polyps or early cancer. Is that Cologuard home test, an adequate screening for an older person.

[00:19:49.130] - Dr. Lemanne

So I think Cologuard is that the DNA test for tumor DNA in the fecal stream or is it a heme? It is test.

[00:19:58.050] - Dr. Gordon

It's a heme test. But it's not a regular heme test. No, it's a test for genetic material in the blood that would have come from a polyp.

[00:20:06.780] - Dr. Lemanne

But it is my understanding is it's looking for abnormal DNA from a neoplastic growth in the colon, a tumor or polyp cancer, those kinds of things.

[00:20:16.860] - Dr. Gordon

High sensitivity, high specificity, but not 100% like a colonoscopy.

[00:20:21.490] - Dr. Lemanne

So I have patients for whom I recommend cologuard. I don't think it's a great test, but it is a tool and it's better than nothing. And like any tool, you use it to the best of your ability and see if you can get some good from it. And so yes, I think all tools can be brought to bear on cancer screening and treatment. I think Cologuard would be part of the toolkit.

[00:20:47.560] - Dr. Gordon

Well, we're not really talking about colon cancer today, although you really threw me a boomerang there.

[00:20:55.650] - Dr. Lemanne

Well, we are talking about it because Fusobacterium nucleotum has been so closely associated with colon cancer and there are a few other denizens of the gut that are also associated and I'd have to look up the names. It comes from the mouth. I mean, that's where most people carry Fusobacterium nucleotum and it is one of the major causes of dental plaqueing, which is a biofilm. And biofilms are, when they're in the colon, are associated with an increased risk of all sorts of colonic diseases, including cancer.

[00:21:30.590] - Dr. Gordon

Right. And a biofilm is kind of obvious from what its name is, but I describe it to people as something like a raincoat or a tent that your body surrounds locus of infection or bacteria or fungus or something and makes it more impermeable to our normal immune maintenance system. So a biofilm has more durability than just a couple of fusobacterium sitting here or there.

[00:22:00.950] - Dr. Lemanne

Right. And I like your picture there. I think of biofilms as umbrellas that bacteria make to put over themselves so that the body's immune system can't get at them. They seal themselves in.

[00:22:18.410] - Dr. Gordon

I use a raincoat, you use an umbrella. I don't really like umbrellas. That might be either.

[00:22:23.160] - Dr. Lemanne

Yeah, I hate umbrellas. I'd rather get wet.

[00:22:26.590] - Dr. Gordon

It's so interesting to think of the oral microbiome with any precision because you just think of your mouth, you eat, you talk, you drink. But to think that it has a collection of bacteria in it that is almost as diverse as that, that we all know we have in our colon.

[00:22:46.790] - Dr. Lemanne

Yeah, in fact that's where the ones in the colon come from. I think that's where they come from. That there's a direct path from the mouth to the colon.

[00:23:00.410] - Dr. Gordon

Yes, a direct path. But that doesn't mean something that's in the colon has a permanent residence in the mouth because the colon's numbers and diversity are both greater, I believe, than those in the mouth. So it might be that you get a seeding from what comes in the mouth, or you eat a lot of sugar and then your little bit of yeast that you have in the mouth becomes a great deal of yeast in your intestinal tract.

[00:23:27.610] - Dr. Lemanne

So things are they get in through the mouth, but they may not be able to live in the mouth, but they do find a home in the more permanent home in the gut. Is that what you're thinking?

[00:23:36.140] - Dr. Gordon

That's what I'm wondering. Because it is more numerous and more diverse in general. It said the colonic microbiome compared to the oral one.

[00:23:45.400] - Dr. Lemanne

Yeah.

[00:23:46.710] - Dr. Gordon

As we were preparing to think about this and talk about this, I have gone through I think I told you about this a sleep experiment of taping my mouth shut at night.

[00:23:58.330] - Dr. Lemanne

Yes.

[00:24:00.890] - Dr. Gordon

And I was doing it primarily for sleep because I think an hour or two after I fell asleep, my mouth fell open and then the cold air woke me up.

[00:24:08.190] - Dr. Lemanne

What do you tape your mouth with?

[00:24:09.600] - Dr. Gordon

I do it with a specific mouth taping device, which is more easy to remove. It's a little X that has its cross point right over the middle of my mouth between my upper and lower lip, and it peels off and goes back on if I have to get up and take a drink of water in the middle of the night.

[00:24:27.020] - Dr. Lemanne

So there's a special type of tape for this because I was just imagining the Scotch tape on my desk and when I finish work, just zip up.

[00:24:35.770] - Dr. Gordon

I think better you would go to your wound kit and pull out some of that clear plastic tape that we used when we put on dressings.

[00:24:44.330] - Tom Freeman

You're rolling?

[00:24:46.410] - Dr. Gordon

No, actually, there are a lot of specifically designed for mouthwear tapes, some specific ones for men who have facial hair and ones that are more or less sticky. And I found the one I like. There's a lot of options. But what's remarkable to me about it is when I tape my mouth shut at night, I don't wake up with such a dry mouth in the morning. And in thinking about the health of the microbiome and I think people can imagine that smoking is not good for the microbiome, but just too much air isn't good for it either. So having your mouth hang sloppily open, whether you're awake or asleep, dries out your oral microbiome and impairs its health.

[00:25:32.920] - Dr. Lemanne

Well, I think saliva is really important and keeping the mouth moist. So people who have an impaired Salival production have more tooth decay.

[00:25:42.100] - Dr. Gordon

Right.

[00:25:42.730] - Dr. Lemanne

And so I think you're really onto something. How did you decide to do this?

[00:25:47.570] - Dr. Gordon

Oh, it was, as I said, really for sleep. But now I'm on a mission. Even when I feel like I'm going to sleep really well at night, I tape my mouth shut. I'm so aware from what I do during my daily routine with patients how important the mouth is, all the different inputs to and now I have a new one to add. We have to add black seed oil, but all the when you have a glass of wine or eat some blueberries, you get polyphenols that you think of as supporting your entire digestive tract. But that starts in the mouth. And if you leave your jaw hanging open or smoke, you're drying out that saliva. And what you really want is healthy gums.

[00:26:31.670] - Dr. Lemanne

Oh.

[00:26:32.140] - Dr. Gordon

Have I ever told you never miss an opportunity, Deborah, to talk about hormones that taking hormone replacement therapy and menopause enhances the vitality and the circulation to your gums and the ability to hold onto your teeth and the ability to chew, and the ability to do all that reduces your risk of Alzheimer's disease.

[00:26:52.730] - Dr. Lemanne

So hormones are important for gum health.

[00:26:55.510] - Dr. Gordon

Is what you're saying they can contribute to gum health? I would say that people so younger women with better estrogen levels or older men who have slightly better estrogen levels probably have greater estrogen enhanced circulation to their gums and a little bit of a boost keeping their teeth.

[00:27:16.150] - Dr. Lemanne

So let me ask you something, a little bit about something that I heard inside there oral microbiome and dementia, alzheimer's disease a connection?

[00:27:27.650] - Dr. Gordon

Yes, in really two ways. So in that big general way of if you don't have a healthy microbiome and you lose teeth, you stop chewing so much. And chewing is a beneficial brain input, just like body exercise.

[00:27:45.530] - Dr. Lemanne

Do you think the mechanism then, of Alzheimer's disease is just a loss of chewing?

[00:27:50.130] - Dr. Gordon

No, but I think it contributes to it. So we've talked a little bit about one of the brain stimulating neurotransmitters called brain derived neurotropic factor BDNF. Lot of things modify it. Chewing enhances BDNF, as does running around the block, but it's easier to chew. So in that way, the microbiome being healthy reduces your risk of Alzheimer's disease. But very particularly, there's two kinds of organisms that have been associated with an increased risk. One of them is more particular to the microbiome, which is that poor pheromoneous gingivalis, which we all have. But it is one of those organisms that's thought to be able to cross the oh so close to the mouth blood brain barrier and infect the brain.

[00:28:44.230] - Dr. Lemanne

That's not good. Right, right.

[00:28:46.540] - Dr. Gordon

And so the healthier your gums aren't excuse me, my dog's snoring.

[00:28:53.210] - Dr. Lemanne

You better tape your dog's mouth shut.

[00:28:58.970] - Dr. Gordon

So the less controlling and overabundance of porphyrimonus gingivalis is important to not get Alzheimer's disease. And I think this would circle around.

[00:29:11.630] - Dr. Lemanne

Well, now how do you do that? How do you control the amount of this organism porphyrimonas?

[00:29:15.820] - Dr. Gordon

So you can test for it in some of these oral microbiome home kits that people do. And I start out, if the dentist clears that, you don't have any back up. You ask your dentist to really clear that you don't have any deep pockets somewhere, some infections under your dental roots, because that's the kind of you're never going to affect the oral microbiome if you don't have a healthy structure underneath. So first the dentist clears that. And there's even an enhanced Cat scan, CT cone beam evaluation of the gum tissue that can confirm that you have or do not have.

[00:29:57.280] - Dr. Lemanne

Do all dentists do that cone beam?

[00:29:59.770] - Dr. Gordon

No, I think there are one or two people in our area that do it. So you'd have to have your dentist. I think I just searched for it on the Internet and found the name for the people who do it locally.

[00:30:13.580] - Dr. Lemanne

So it's not something routine.

[00:30:15.370] - Dr. Gordon

No. And if our area of so many a couple million people only has one or two dentists, they probably don't have it in eastern Oregon, in small towns, for instance. So that's the first step you do make sure that the basic structure of your mouth can handle a good microbiome.

[00:30:32.630] - Dr. Lemanne

And then meaning there are no big pockets.

[00:30:35.390] - Dr. Gordon

Exactly. And the more you have receding gums, the more likely the more assiduous you're going to have to be in your dental hygiene, which you described really well. Take a big glass of water in the morning to hydrate your mouth after.

[00:30:52.340] - Dr. Lemanne

You'Ve cleaned all the after you've cleaned, right? Yeah. So I'm careful not to drink that water until I've cleaned all those icky things off my teeth.

[00:31:03.160] - Dr. Gordon

Okay. I'm going to have to up my oral hygiene game in my recommendations, really, to my patients who are at risk for Alzheimer's disease, who don't want to get it, because it is important to keep your oral microbiome as healthy as possible. So the next step I would do if I found out. So dental hygiene, and I'm going to get all my tips from you. I'm going to ask you to review them when I finish this train of thought. But I like particularly an antimicrobial toothpaste and mouthwash, but not the nuclear devastation. Antimicrobial, chlore, hexa, whatever the commercial mouthwashes are that take away every healthy and unhealthy bacteria we have in our mouth, but rather something herbal, so something you'd get at a health food store. I particularly like the toothpaste made by Biotics. That's not the right name of the company. I'm going to fix it in the notes here. But I have a toothpaste called Dental Sidon. That is a little gel. That's an herbal antimicrobial. Great. It's actually a mild prebiotic to support the bacteria. You do want to stay there because.

[00:32:15.280] - Dr. Lemanne

Those can help your oral microbiome if you put the right bacteria. And they could. Kind of crowd out the nastier ones.

[00:32:23.390] - Dr. Gordon

In this case, you're not putting in the bacteria, but you're feeding them with.

[00:32:26.590] - Dr. Lemanne

Herbs that they like, so you're supporting them.

[00:32:28.940] - Dr. Gordon

Exactly.

[00:32:29.680] - Dr. Lemanne

They get to do their own thing, but you help them out.

[00:32:31.960] - Dr. Gordon

Right. This one has the little side benefit, in my experience of working, like the toothpaste they advertise, that takes out cold sensitivity. So this, I think, must enhance my enamel because I have less cold sensitivity when I use dental sightin. So that's the one that I like and that's the one in the first Alzheimer's reversal study that we gave to all the patients.

[00:32:56.650] - Dr. Lemanne

So dental siden.

[00:32:57.990] - Dr. Gordon

Dental siden. And you can't just get that anywhere. But I think it's going to become more widely available. I'll have to look and see if there's something comparable or some way of getting that. If you are just a member of the general public and want it. So do those supporting your microbiome choosing food that you can chew, chewing? Oh, I know what I was going to circle around to say, that I think this interacts with, I would bet, a cancer risk too. So as the gut microbiome ages, it shifts in general in most people, to an unfavorable predominance of you can pronounce this two ways, fermacutes or Fermicutes. Fermacutes. You can pronounce that either way. So that tends to predominate over bacteroidities. In the GI microbiome, as we age, same thing happens. In the oral microbiome, we have an enhanced F to B ratio, and that's generally correlated with metabolic disorders, which makes me think it might be related to some of these metabolically related cancers. Do you have a thought about the FB ratio and cancer?

[00:34:13.150] - Dr. Lemanne

So I'm not an expert in the FB ratio. But I do know that some of the studies in diabetes and gingivitis, which is periodontal disease, and the oral microbiome show that when the gum disease is attended to and cared for and improves the hemoglobin. A one C, which is a marker for the activity of type two diabetes, or any diabetes, actually improves. So improving the oral health does improve diabetes. Diabetes and hyperglycemia. Hyperinsulinemia are certainly closely associated to many cancers. Not all, but many cancers. And so improving that metabolic state absolutely would have a good impact on your risk of cancer or your risk of dying of cancer if you already have a cancer diagnosis. So, yes, the oral microbiome is super, super important.

[00:35:07.170] - Dr. Gordon

So this is really wrapping this all up in a little package that we keep getting back to one way or another for our two main interests. I think to age well, you have to have good metabolic health. To reduce your risk of certain cancers, you have to have good metabolic health. And now part of that has to be having a good, healthy mouth.

[00:35:26.470] - Dr. Lemanne

Yeah, I completely agree.

[00:35:28.830] - Dr. Gordon

And chewing meat off the bone doesn't hurt. But barring that, you could always chew on a carrot I think you told.

[00:35:37.550] - Dr. Lemanne

Me two carrots a day decreases the risk of colon cancer.

[00:35:39.860] - Dr. Gordon

I did.

[00:35:40.190] - Dr. Lemanne

Maybe it has a good effect on the teeth.

[00:35:42.370] - Dr. Gordon

Right. But I won't use that as a substitute for cleaning my teeth. I will take it to heart, what you've said.

[00:35:48.560] - Dr. Lemanne

You know what else helps the gums is Rapamycin. So in animal studies, the gum health improves in aging with the Rapamycin use.

[00:35:57.010] - Dr. Gordon

That's true. That's right. I've seen that. I don't have enough people on it to know to have an observation, do you?

[00:36:06.840] - Dr. Lemanne

No, I don't. But I think it's an interesting observation in the lab, and let's hope it pans out.

[00:36:12.790] - Dr. Gordon

Yeah. Well, as we've said before, we could take a deep dive into Rapamycin.

[00:36:18.400] - Dr. Lemanne

Absolutely.

[00:36:19.110] - Dr. Gordon

We'll do that. But this is great. I'm going to remember the black seed oil the next time I'm at the store and infuse that somehow into the deep pockets of my gums. I'm not going to leave my mouth hanging open. I'm going to keep my mouth clean and then moist, and thereby reduce my risk of certain cancers, dementia, and just the ill ease of losing your teeth and not being able to go out to dinner with people.

[00:36:46.150] - Dr. Lemanne

Yeah. And if you can't clean your teeth if it's morning and you're just not able to do that, before you take a big swig of anything and wash all of your accumulated oral microbiome organisms down into your colon, rinse your mouth out with plain, warm water. Just rinse your mouth out. Swish around, gargle a little bit. Take maybe 30, 60 seconds to do that. Even if you don't have official mouthwash, just clean rinse out a lot of those organisms before you start pushing them down into your gut.

[00:37:18.170] - Dr. Gordon

Put those organisms in your septic tank instead of your colon. Yeah, okay. Wow. I just think this oral microbiome is fascinating. It's almost as complex as our gut, and yet we put something in that microbiome many times a day, and we should treat it well, because it's an important part of our vitality.

[00:37:44.630] - Tom Freeman

This is your friendly recording engineer, Tom.

[00:37:49.180] - Dr. Gordon

Hey, Tom.

[00:37:50.200] - Tom Freeman

I got some questions. I was hard pressed to not leave the room and go brush and floss while listening to this, but I happen to be a person who is currently suffering gum disease and bone loss. And in consulting with my dentist and a periodontist two questions I asked them that I never got. What I thought was a thorough answer is, given that the gum disease is a bacterial infection, can that be treated with antibiotics? I've upped my dental hygiene in ways to try to deal with the gum disease, but I never really got what I thought was a good answer about using antibiotics to fight this bacterial infection in my gums.

[00:38:45.110] - Dr. Gordon

I'm going to take a stab at that. I'd like you to weigh in, too. But so much of gum disease can be just like if I had a skin infection. I wouldn't take systemic antibiotics, but I might put topical antibiotics on. But even first, before that, I would use soap and water and maybe some herbals and try and keep it clean. If I had a deep pocket infection deep in my muscle, I might be convinced to take oral antibiotics. So I think it matters if your gum infection is open to your mouth cavity or it's deep embedded down in your gums. Wouldn't you agree?

[00:39:26.780] - Tom Freeman

Yeah, well, and one of the things that I've learned is that they do use a topical antibiotic treatment, little strips that they just put between your teeth and as far down towards the roots as I can get them. Another question I asked, I would just.

[00:39:46.010] - Dr. Gordon

Say, unlike the skin, that topical antibiotic in your mouth has a much greater chance in migrating down to your colon and becoming systemic. So if you do that, I'd kind of halfway consider that you've taken a course of antibiotics, but not as bad as coursing them through your entire bloodstream.

[00:40:03.420] - Dr. Lemanne

So I have something to add to that, too. And that's that. Absolutely. If we gave you certain, especially anaerobic antibiotics, we would completely clear up your infection. Boom. However, they have a lot of systemic side effects. They permanently possibly damage the gut microbiota such that you never again have the same complement of organisms that you have in your gut before that course of antibiotics. And once you stop the antibiotics, everything just comes right back. So it's not that the antibiotics don't clear up the infection. They do, but they can't do it permanently. So it's not a super great solution. Now, dentists will give you antibiotics if you have an abscessed tooth or a very serious gingivitis situation, but it's always temporary. And then the underlying issue has to be addressed. So unless the underlying issue is addressed, the problem will just be right back as soon as the antibiotics are stopped.

[00:41:03.670] - Tom Freeman

Okay. The other question I had for them was, the result of this gum disease, is it's creating bone loss? So I've got less and less root to my teeth embedded in bone. So my question to them was, okay, what can I do to get rid of this bacterial infection, but also try to create some bone gain to get some bone back in my jaw before I lose more?

[00:41:41.470] - Dr. Lemanne

So that's a wonderful question, and we do know what can improve bone health. So, number one, you have to get control of the infection with all of the things that you mentioned that are topical antibiotics, dental hygiene, any surgical procedures that your dentists might think are imperative, and then what? Strengthens bone resistance. So you have to chew hard things. There are actually little rubbery hard devices that you can get to clamp down on. I actually have one. And you clamp down on it, and you hold it for a certain period of time, like 30 seconds or something like that, and then you release and you do it again. It's like doing an exercise at the gym. You're just using your teeth and eating foods that are very, very hard. Like Deborah mentioned, chewing on bones and sinews. Actually, that sounds kind of awful to a lot of people, but I do that. I happen to love steak and bony steaks are great, and I actually do chew on those. Of course, crispy vegetables are available and a little bit more aesthetically acceptable to many people, but exercising the teeth and the jaw, if there's a healthy environment around, is the next step.

[00:42:58.170] - Dr. Lemanne

And then, of course, Deborah can talk to you about any hormone replacement that's needed to enhance the regrowth of bone. Those things are really important. Vitamin replacements that she will tell you about. Vitamin D, enough intake of calcium, all of those things are part of a program to enhance bone. But bone can be improved. Bone health can be improved. And it's just the same as improving bones anywhere in your body. It requires resistance. You have to put some stress on the bones so that they know they need to work on getting stronger, and you have to provide them with the underlying substrates they need and in an environment that's healthy and conducive to bone growth.

[00:43:38.430] - Tom Freeman

So lifting a dumbbell with my mouth.

[00:43:41.170] - Dr. Lemanne

Might be something I should you could certainly consider that. You might want to wrap it in some rubbery cushion like they have at the gym floor so that you don't hurt your teeth. Yeah.

[00:43:54.170] - Dr. Gordon

She mentioned vitamin D and calcium and really important for bone growth. And I just thought of this, how it's also beneficial to the oral and GI microbiome. The best way to take a probiotic is a dose of fermented foods, and it's also a really great serving of vitamin K two, which enhances calcium deposition in the bone. So I would say after you, when you're eating your meal, to be sure, include a tablespoon or two of sauerkraut before you wrap up your meal and add a little bit of black seed oil irrigation between your teeth.

[00:44:41.290] - Tom Freeman

Okay.

[00:44:45.130] - Dr. Gordon

This is a life changing conversation. Thank you very much.

[00:44:48.940] - Tom Freeman

Thank you.

[00:44:50.890] - Dr. Lemanne

Great to be with both of you.

[00:44:52.720] - Dr. Gordon

Great day. And thank you for my dog for being quiet during the whole recording session.

[00:44:57.510] - Dr. Lemanne

She wasn't. She was snoring because you didn't tape her mouth shut.

[00:45:00.360] - Tom Freeman

I heard her a few times.

[00:45:01.540] - Dr. Lemanne

I heard her a few times. Good job. Good job. Good job.

[00:45:10.210] - Dr. Gordon

You have been listening to the Lamont Gordon podcast where Docs talk shop.

[00:45:15.940] - Speaker 2

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[00:45:25.540] - Dr. Lemanne

Happy Eavesdropping.

[00:45:35.350] - Speaker 2

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[00:45:52.200] - Dr. Gordon

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[00:46:04.230] - Speaker 2

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[00:46:18.850] - Dr. Gordon

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[00:46:25.600] - Speaker 2

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[00:46:34.250] - Dr. Lemanne

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[00:46:37.830] - Speaker 2

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