← Feel Better, Live More with Dr Rangan Chatterjee
Feel Better, Live More with Dr Rangan Chatterjee
What Your Mouth Is Trying To Tell You: The Hidden Connection Between Oral Health & Chronic Disease with Dr Victoria Sampson #511
01:48:04
When you think about improving your health, do you ever think about the health of your mouth? If you heard last week’s episode with Dr Emily Leeming, you will know just how important your gut microbiome is, for many aspects of your health, but did you know that your mouth also has its own microbiome, and the health of it is just as important?
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- [00:03]
Dr. Rangan Chatterjee
Hey guys, how you doing? Hope you're having a good week so far. My name is Dr. Rangan Chatterjee and this is my podcast Feel Better Live More when you think about improving your health, do you ever think about the health of your mouth? Well, if you heard last Week's episode with Dr. Emily Leeming, you will know just how important your gut microbiome is for many aspects of your health. But did you know that your mouth also has its own microbiome? And the health of it is just as important. This week's guest is Dr. Victoria Sampson, a functional dentist and researcher based in Central London whose work has been recognized all over the world, resulting in her becoming a scientific advisor and clinical lead to to several international dental companies, as well as a topical team member of the European Space Agency and NASA. Victoria has published numerous scientific papers. She was the first dentist in the world to link gum disease with worse Covid complications, and she recently launched her own oral microbiome test, Auralis1, which assesses the saliva for bacteria, inflammatory markers and genetic mutations. In this fascinating conversation, Victoria reveals why we must stop treating the mouth as separate from the rest of the body and explains how the oral Microbiome, home to 700 different species of bacteria, influences everything from our blood sugar control to the health of our hearts. She also shares compelling research showing how treating gum disease can improve our blood sugar levels, why men with poor oral health are nearly three times more likely to experience erectile dysfunction, the relationship between the oral microbiome and autoimmune disease, the surprising link between oral health and fertility, and so much more. And of course, throughout the conversation, Victoria shares practical tips that we can all use immediately to improve our short term and our long term health. Whether you're dealing with persistent dental problems despite good hygiene, managing a chronic health condition, or simply want to optimise your well being, this conversation offers a powerful reminder that the path to better health might just start in your mouth. You say that the mouth is is the gateway to the rest of the body. What is it that most of us don't understand about the mouth that you would like us to know?
- [02:56]
Dr. Victoria Sampson
I think that for, you know, decades we've always thought that the mouth is a completely separate entity to the rest of the body. So doctors and dentists go to different universities, they study different things, and doctors are kind of like, oh, that's a mouth issue, that's for the dentist. And the dentist is like, oh, that's a, you know, an arthritis issue that has nothing to do with me. But actually if you Rewind. From long, long before, Hippocrates actually thought that there was a really strong connection between the mouth and the rest of the body. And he actually claimed that he took a tooth out and he helped improve someone's rheumatoid arthritis. So at that time we knew that there was a connection. But then there's been this kind of separation between medicine and dentistry because of universities and the way that we've been trained. And I think in the most recent, kind of five, 10 years, there's more and more research starting to come up that actually if you want to improve your general health, you have to factor in your oral health. And if you have, for example, something like gum disease, you also need to be looking at other systemic conditions that could be connected to it.
- [04:02]
Dr. Rangan Chatterjee
There's so much to unpack there that we'll get to throughout this conversation just to really ground this for people at the start. What kind of physical health conditions that people may be familiar with can be linked to the health of our mouth?
- [04:19]
Dr. Victoria Sampson
So I'd say the most researched one is diabetes. So there's a very strong bidirectional relationship between diabetes and gum disease, but also things like cardiovascular disease, even chronic kidney disease, infertility, Alzheimer's, arthritis, a lot of other inflammatory conditions, and the list goes.
- [04:42]
Dr. Rangan Chatterjee
On cancer as well.
- [04:44]
Dr. Victoria Sampson
There has been some promising research, particularly for colorectal cancer, where they found a specific oral bacteria called Fusobacterium nucleatum in over 50% of patients who have colorectal cancer. And they're finding also specific strains of that bacteria which are making certain cancers more pathogenic and more aggressive.
- [05:04]
Dr. Rangan Chatterjee
Okay, so the health of the mouth linked to lots of different conditions that you've mentioned. Okay, so let's get to where most people, I think, are in society with how they view their health and their oral health. Okay, so they might go, as you said, go see the doctor for their physical health and maybe their mental well being as well. But you go somewhere separately for your teeth. And many people are scared of going to dentists. Many people don't go as often as perhaps they should. But I think, or I'd like to think that most people, and perhaps you could enlighten me on this. I think most people are brushing their teeth twice a day. Two minutes in the morning, two minutes in the evening. Is that true?
- [05:51]
Dr. Victoria Sampson
No, actually, unfortunately it isn't. So gum disease or periodontal disease is the sixth most prevalent inflammatory condition in the world. And the World Health Organization came out quite recently saying that actually gum disease is Entirely preventable, but it affects over 3.5% people in the world and over 10% of the global population has periodontal disease. So I think that, I don't think people are brushing twice a day, or if they are, they're not doing it correctly. Because another issue is that the way that we get taught how to brush our teeth and take care of our mouths are often passed on by our parents. And if our parents don't have very good habits, then they'll pass that on to us. And, and unfortunately, dental professionals, a lot of them are not necessarily teaching people how to brush their teeth. And even when I sometimes I'm like, can I show you how to brush your teeth? People are like, I know how to brush my teeth. I'm like, but you actually don't. And you're not brushing for two minutes. You're not spitting out the toothpaste and not rinsing with water. And so a lot of people actually don't know how to do it properly.
- [06:58]
Dr. Rangan Chatterjee
Yeah, this is super fascinating. So let's go into this because a lot of the things that I talk about on this podcast are, yes, they're health related. They're about the simple things that we can all do each day that are going to have a huge impact on our short term and our long term health. Now, let's take the topic of nutrition, for example, which of course is relevant to the mouth. I've often wondered if one of the problems is that we have so many nutrition experts these days. That is in a different time where we didn't have all of this ultra processed food and convenience foods. We didn't really get educated on nutrition. We just ate what our families and our cultures ate. Okay. So we'd learned the good principles of healthy eating from our family and what we saw growing up. And you're saying that that's in some ways similar, whereby we observe how our parents and our family and the people around us when we were kids looked after their teeth. And, and we learned that. So I grew up in an Indian family and many Indian families eat with their hands. And I remember mum and dad, after eating, would always rinse their mouth because they would, you, you eat with your right hand. Okay. They'd finish eating and so then you put the plate in the sink, they'd wash their hand, and as part of the washing the hand process, they'd put water in in the palm of their hand and they'd rinse two or three times. The more I've learned about oral health over the last Few years, I think, wow, that's actually a pretty phenomenal practice because you're taking the food out, all those remnants straight away after each meal. So, you know, what's your take on that cultural practice that I observed growing up?
- [08:45]
Dr. Victoria Sampson
I actually think that there are some cultures who, they, they knew how to do things without maybe even knowing that they were doing it well. And like, that's amazing. I didn't even know that. But even now, often recommend to patients that if they're having like a bad treat or something like sugary or acidic, that they rinse their mouth out with water or even mouthwash, but they never actually go and brush their teeth because if you go and have something super acidic and then you run to the bathroom and you brush your teeth, you're just going to grind all that acid into your teeth. So rinsing with water is actually Perfect.
- [09:20]
Dr. Rangan Chatterjee
You said 3.5 billion people on the planet have some form of gum disease.
- [09:25]
Dr. Victoria Sampson
Yep.
- [09:26]
Dr. Rangan Chatterjee
That's almost half the world's population. Why is it, what's going on in the modern environment that means so many of us are struggling?
- [09:38]
Dr. Victoria Sampson
That's a big question to answer. I think it's obviously, it's multifactorial. I think one is find potentially lack of education on how to take care of your gums well, because as the World Health Organization said, it is entirely preventable. The second is, again, like you said, a lot of people don't necessarily acknowledge or appreciate how important their oral health is for the rest of their body. So they might not prioritize going to the dentist, spending money, going and having a hygiene. The number of patients I see where I'm like, oh, you know, you should be having hygiene a minimum every six months. And they're like, like, that's a waste of money. Like, that has such a strong impact with everything else.
- [10:19]
Dr. Rangan Chatterjee
That's a really interesting point, isn't it, whereby when we think about health, we might persuade ourselves, you know, I know physical activity is good for me. I keep hearing all these longevity experts telling me it's the most important thing. You might go, actually, you know what? Yeah, I'm gonna sign up and join the gym, let's say. Right, so there's a model in society for making that connection, isn't there? Where we go, oh, yeah, muscle strength is important. As we get older, we must do some resistant exercise. I can justify signing up for a gym. Now, depending on where you live, obviously, gyms can range anything from, I don't know, 15 quid a month to maybe 100 quid. A month, you know, maybe even more for some real high end ones. How much is a standard hygienist appointment? Ish. Privately. And I know you work in London, but across the country do you know.
- [11:08]
Dr. Victoria Sampson
Roughly, I would say from what I have seen, it can vary between 50 pounds to maybe the highest I've seen is like 100 and, or actually 200. So. So depending on where you are in the country, if it's NHS or if.
- [11:21]
Dr. Rangan Chatterjee
It'S private but not incomparable, if that was done twice a year, not incomparable to, you know, gym membership or maybe cheaper.
- [11:31]
Dr. Victoria Sampson
Yeah, yeah. And there's been so much research to actually show that even for example, just one professional hygiene, it can reduce your levels of inflammatory markers. If you have diabetes, it can reduce your blood glucose level. So your HBA1C just from seeing a hygienist, just from seeing a hygienist and having a regular hygiene. Because a lot of people also, they think that like hygiene is more of an aesthetic cosmetic treatment. It's just to remove stains and to make them feel fresh. But actually you're reducing someone's bacterial load, you're reducing their inflammation and you're reducing these retentive factors. So things like calculus, that hard stuff that you get on the insides of your teeth, that is trapping lots of plaque and bacteria and causing the inflammation.
- [12:11]
Dr. Rangan Chatterjee
Okay, so when you say a hygiene, this is going to see a hygienist to get your teeth cleaned, is that right?
- [12:17]
Dr. Victoria Sampson
Yeah.
- [12:17]
Dr. Rangan Chatterjee
Okay. You said something very interesting there. Well, you said more than one thing. Very interesting there. Okay. The first thing is that we think about our teeth and our gums through the lens of looks. Yeah, right. Which is again, just to draw the analogy with physical health, a lot of people initially are bothered about going to the gym or working out for vanity reasons.
- [12:39]
Dr. Victoria Sampson
Okay.
- [12:40]
Dr. Rangan Chatterjee
And you know, I get that, I totally get that. Right. But people are learning more and more that it's not just for vanity. It's not just to have a lean body or a body that you like the look of. It's also important for your hormones, for your longevity. And so we can draw that analogy again, can't we, with our teeth? It's so much more than just having nice teeth that look good, which of course everybody wants. It's so much more than that. So let's talk about the oral microbiome. Right. Because everyone who listens to my show I think by now is quite familiar with the gut microbiome. There's also an oral microbiome that you are, I Would say one of the leading experts in, from what I can tell. So can you explain what is the oral microbiome? And then let's start to unpick how the health of the mouth, for example, can impact your blood sugar control.
- [13:31]
Dr. Victoria Sampson
So the oral microbiome is the second largest and most diverse microbiome after the gut. People actually say that they're extensions of each other. And the oral Microbiome has over 700 different bacteria in it, which make up 2 billion bacteria. What's quite interesting about the oral microbiome is that within the same mouth, or ecosystem, let's call it, you have lots of different environments. So if you think about the bacteria that would want to live under the gums or on the teeth or at the back of your throat, they're very different environments. Some are hot, cold, different proteins. And so therefore you get different mini environments within the same ecosystem with lots of different types of bacteria. So it's a very highly variable microbiome, and it is quite strongly associated with the rest of the body because you can swallow bacteria, it can travel actually through your blood via your gums, or it can be inhaled as well.
- [14:31]
Dr. Rangan Chatterjee
Wow. So type 2 diabetes, you said if someone has that, or if. Let's say, even if they don't. Right. Let's just. I guess I'm trying to help people understand. You said before that actually if you go and see a hygienist, it could potentially improve your blood sugar control.
- [14:51]
Dr. Victoria Sampson
Yes. Yeah.
- [14:53]
Dr. Rangan Chatterjee
So I think that's brand new information for a lot of people.
- [14:58]
Dr. Victoria Sampson
Yeah. So they've actually done a study. It was mainly for patients who had periodontal disease at this point, and they found that by treating the patient's periodontal disease, who also had type 2 diabetes, their HbA1c reduced by 0.4%, which. That's a lot. Yeah. I was gonna say for a lot of people, they're like, oh, that's nothing. I'm like, no, that's the equivalent of a patient having a second medication put on top to help reduce their HbA1C levels.
- [15:27]
Dr. Rangan Chatterjee
Yeah. Or depending on where you are, that could take you from being pre diabetic to no longer being diabetic. So it's pretty profound. 0.4. Yeah. Okay, so do we know how this works?
- [15:42]
Dr. Victoria Sampson
So there's a couple of different kind of mechanisms. A lot of it's to do with reducing your inflammatory load. So your mouth and your microbiome, if you have gum disease, what happens is that you have high levels of certain bad bacteria. Bacteria and they release inflammatory markers and those inflammatory markers can travel through to the rest of the body and cause something we call low grade chronic inflammation. So it's this kind of constant firing of inflammation from the mouth elsewhere to the rest of the body. And it's been shown that it has a strong impact with your blood glucose levels and helping to regulate it as well.
- [16:20]
Dr. Rangan Chatterjee
If we just look at this through the lens of blood sugar, it kind of relates to what you said right at the start of this conversation, which is we've for far too long kept the body and the mouth separate. What's really interesting there for me is that in that study, they already had pre existing problems in the mouth. Right. So that was potentially driving inflammation around the body. And so when you correct that, you start to correct other issues in the body that are also coming from that inflammation. And that could be blood sugar control. Yeah, we see similar things, don't we, with the gut microbiome? A lot of the research over the last 10 or 15 years has been very much about how, wow, we're now seeing that a unhealthy gut microbiome, for want of a better term, because I think we're still trying to define what that actually is, is linked with all kinds of different things. You know, Alzheimer's, cancer, rheumatoid arthritis, depression, skin problems, all those things. And for me, it just speaks to this wider point, which is the body is interconnected massively.
- [17:32]
Dr. Victoria Sampson
Yeah. And I think for one day, not yet, but one day we will connect the oral gut, vaginal, urine, all the microbiomes, and we will actually understand what true health is, because it's a complete symbiosis and ecosystem. And in my opinion, you can't have a balanced gut microbiome if your oral microbiome is imbalanced. And you can't have a balanced vaginal microbiome if your gut microbiome, you know, it all has to be balanced for it to work properly.
- [18:02]
Dr. Rangan Chatterjee
And then following on from that, then through the lens of just blood sugar, how can we properly look after our patients with prediabetes or type 2 diabetes if we're not also addressing their oral health?
- [18:19]
Dr. Victoria Sampson
100%. Yeah. And I think that one of the issues that I see is actually from the medical profession, a lot of them are not aware that periodontal disease is such a big risk factor for diabetes and complications. So actually we now say that periodontal disease is the seventh complication of diabetes after your, you know, diabetic foot and your nephropathy and neuropathy all of those things. Gum disease is also one, and it's bidirectional. So if you have diabetes, you're at a much higher chance of getting gum disease, and if you have gum disease, you're at a much higher chance of getting diabetes.
- [18:55]
Dr. Rangan Chatterjee
The gut brain axis is something we often talk about on this show, this bidirectional communication between gut and brain.
- [19:02]
Dr. Victoria Sampson
Yeah.
- [19:03]
Dr. Rangan Chatterjee
And I had Emily Leeming on a few weeks ago, microbiome expert, who was saying that it looks as though 90% of the messages in this gut brain axis going from the gut to the brain, and only 10% are down from the brain to the guts. I've been diving into your research over the past 24 hours or so, and it's really fascinating, and it made me think that as we think about gut brain axis, we perhaps should be thinking about mouth brain axis as well. Right?
- [19:35]
Dr. Victoria Sampson
Yeah, yeah. And even oral gut brain axis as well.
- [19:40]
Dr. Rangan Chatterjee
Yeah. So do we have any research so far as to what it means, you know, the health of our mouth, how that relates to our brain health?
- [19:50]
Dr. Victoria Sampson
Yeah. So there's been a lot of research, particularly in the last maybe five to 10 years, on cognitive decline and Alzheimer's and again, periodontal disease. So what a lot of research is finding is that patients who have Alzheimer's, they have checked their. They've looked at their cerebral spinal fluid, and they have found a specific oral bacteria called porphymon's gingiva in over 97% of these patient samples compared to healthy patients, where they don't have that oral bacteria in their cerebral spinal fluid. And if we actually, you know, zoom into this bacteria, so P. Gingivalis, we see that P. Gingivalis is a very aggressive, not a nice bacteria. And there are some strains of that bacteria which can release what we call virulence factors. And they're basically. It's kind of like a. A bad guy shooting something out of the gun, and it's bad things that they're shooting out, basically. So these virulence factors have also been found to be much higher in patients who suffer from Alzheimer's. And these virulence factors specifically are called gingipains. And again, gingipains have only been found in patients who suffer from Alzheimer's and periodontal disease in their cerebral spinal fluid. So this is more of an association or correlation. There has been a lot of research to look more into the causation between potentially Alzheimer's and gum disease. And one which I think does start to show it is, okay, Fine, you already have Alzheimer's, but would actually improving your periodontal health or your gum health reduce your cognitive decline? And so this study looked at patients who already had Alzheimer's. They had half the group who had gum disease and the other half that did not have gum disease. And they followed them for six in 12 months. And they found that the patients who had gum disease and Alzheimer's had a much more rapid cognitive decline than those who didn't have gum disease.
- [21:53]
Dr. Rangan Chatterjee
It's so fascinating. There's a neurologist in America called Professor Dale Bredesen who has done some quite remarkable research on Alzheimer's and early stage cognitive decline. And can this be reversed? And he has shown that in some individuals, if you take a different approach to what is the standard medical approach, you can actually get some pretty outstanding outcomes. I've actually spoken to some of the patients and families and seen and gone and helped him actually on some immersion about, I don't know, six, seven years ago. It's really quite remarkable. One of the things he would look at and make sure we're addressing is their oral health.
- [22:36]
Dr. Victoria Sampson
That's great.
- [22:36]
Dr. Rangan Chatterjee
Yeah, it's really good. Because I think you're doing a great job, I think, at bringing light to this research, and hopefully by you coming on here and sharing it, it's gonna get to more people. I think there are some quite progressive clinicians around the world who've known for a number of years that there is a strong link. And so Dale's approach with Alzheimer's, for example, is he would say the standard medical model is to try and hit these symptoms with one approach, a drug. And he's not saying that that can't work. He's saying. Or he said, and I don't want to misspeak for him today, that let's say you've got a. Let's say you've got a leaking roof in your house. And he says, in Alzheimer's, they've identified 36 possible leaks. Right. So he says using just one drug is like trying to address that leak by just addressing one of the holes. And so his approach is, let's address as many holes as we can and let's see if we can get a threshold effect where this starts to improve someone's cognitive decline. So that might be. They address diets, they might address, you know, ketone production and all kinds of different things. Right. Toxic load in the body, addressing all of those things. And also your dental health. Yeah, yeah, yeah, yeah. I don't know if you've heard about any of this work or not?
- [23:52]
Dr. Victoria Sampson
I have, actually. And also, so there's a charity called Food for the Brain, which I'm an advisor for, and I'm their kind of their mouth representative. And they're doing quite similar work as well, where again, they're showing that Alzheimer's is a multifactorial disease and just one drug is not going to treat it. But also what I find quite unique about oral health, out of those risk factors, is that it is entirely preventable and you can change it. So, for example, if you go and you check your genetics and you find out that you have the APO4 gene, you can't really change much about that. But if you were to go and look at your oral health and. And you find out that actually you have gum disease, or you also maybe have really high levels of Porphyromonas gingivalis, this bad bacteria, then, you know, okay, I need to reduce that and I need to get rid of maybe that Porphomonas gingivalis. And there are ways to do it. You can test your microbiome, you can go see your dentist and see if you have gum disease.
- [24:53]
Dr. Rangan Chatterjee
I've been sort of super fascinated in gut health maybe since, I don't know, 2012. So really keeping an eye on the research and seeing what's happening. And what's been really interesting to me is seeing how things have evolved. So things that we thought were problematic in the guts, let's say Blastocystis hominis, for example. Right. I remember the school of thought maybe eight, nine years ago, was if you do your gut microbiome, do a stool test, get it examined, and there's Blastocyst hominis. Many practitioners would try and kill that go, actually, this is a problem. We don't want this parasite in your guts. But over the years, the school of thought has started to evolve and going, actually, it seems as though that can be helpful for some people at reducing their risk of autoimmune disease. So I guess my question is, where are we at the moment with the state of research in the oral microbiome? Because I've seen things change a lot with gut health and what we think is good and what we don't think is good, like even the science idea that a diverse gut microbiome is healthy. When I spoke to Emily, I said, how do we actually know that? Do we know for sure that that is the case? And I think there's a lot we still don't know. So where do you think we are Currently, with what we know about oral health and the oral microbiome, I think.
- [26:17]
Dr. Victoria Sampson
It'S a great question because I think that gut microbiome is ahead of the curve. It's the one that's had a lot more attention compared to the oral microbiome. And in terms of the oral microbiome, it's quite. We don't still fully understand whether or not a diverse microbiome is healthier than a undiverse microbiome. And so a lot of research teams, including my own team, we have a lab and we're doing a lot of research. We're actually trying to look at clinical parameters. So we're looking at patients, we're seeing what is healthy in their mouth and then kind of pairing that to their oral microbiome. And what we have started to realize is that it's not just necessarily the balance or ratio of bacteria in your mouth which will dictate whether or not it's healthy. It's also to do with certain strains of bacteria. So me and you, we can have the same bacteria, but I might have a very virulent, aggressive strain which is releasing loads of virulence factors. And you might have a very, very good, you know, non pathogenic, very good bacteria. So we also, we need to go strain level. And the second thing which I think is the most important is that it's also how your body responds to that bacteria. So it's that host immune response element to it. So again, me and you, we can have exactly the same oral microbiome and have all the same bacteria, but I might end up having terrible gum disease and lots of decay and you might be completely fine. And we see this a lot where we see patients who say, you know, I brush five times a day and I take such good care of my mouth, but I have terrible gum disease. And that missing link is those genetic mutations. It's that host immune response and how inflammatory that person is. So I might have the smallest amount of bad bacteria, I might take very good care of my hygiene, but my body responds in a very aggressive way, which has been determined by my genetic makeup.
- [28:14]
Dr. Rangan Chatterjee
Wow. Super interesting. So you do a lot of oral microbiome testing?
- [28:18]
Dr. Victoria Sampson
Yeah.
- [28:21]
Dr. Rangan Chatterjee
If you had never seen a patient but you got their results, do you think that you know enough about the oral microbiome now to actually start building up a picture of who that patient is and what they might look like? Or is that we're not quite there yet? Today's episode is sponsored by eight Sleep now. Eight Sleep have a technology called the Pods and the Pod is a high tech mattress cover that transforms your existing bed into a sleep optimization powerhouse and clinical studies have demonstrated that the Pod can increase quality sleep duration by up to one hour per night. It offers a temperature range from 55 degrees Fahrenheit all the way up to 110 degrees Fahrenheit and this is particularly important because it allows for the manipulation of our core body temperature which plays a crucial role in our sleep quality. It also incorporates sensors that monitor several key physiological parameters including our sleep stages, heart rate, variability and respiratory rate, and many athletes, business leaders and friends of mine have found it to be absolutely transformative. The Pod can be especially helpful if you share a bed with a partner as it enables both sides of the bed to have a different temperature. So if you're ready to take your sleep and recovery to the next level, head over to 8sleep.com livemore and use the code LIVEMORE to get up to $600 off your Pod 4 Ultra purchase when bundled. This offer ends soon so don't miss out and the Pod currently ships to the us, Canada, the uk, Europe and Australia. Just taking a quick break to give a shout out to Bon Charge who are sponsoring today's show now. Something I often cover on this podcast is the importance of sleep and how beneficial better sleep can be for our health and wellbeing. Now often it's the small things that really can make a big difference. And for me there is no question that when I swapped out my usual bedside bulbs to the low light ones from Bon Charge it made a huge difference. In fact, in my house for many years now, all of the bedside lamps contain Bon Charge's amber low light bulbs. Bontrage also make fantastic blue light blocking glasses which I think are some of the highest quality out there. There are products of theirs that I really like that many of you I know also are big fans of is their infrared sauna blanket which is much cheaper and more accessible than having a sauna in your own home. It's really easy to set up, takes less than a minute and you can basically enjoy a 30 or 40 minute session whilst relaxing, reading or watching TV. And this can help with all manner of things including relaxation, stress reduction and sleep. If you go to boncharge.com livemore and use the coupon codes livemore they are giving you an incredible 20% off all of their products. That's B O N C-H-A-R-E.com LiveMore and use the coupon codes LiveMore to save 20%.
- [32:06]
Dr. Victoria Sampson
We're definitely not there yet for systemic diseases. So things like cognitive issues or diabetes or heart disease through the oral microbiome. It's something that a lot of people are working on at the moment in terms of oral diseases like your gum disease or your decay or even bad breath. I think that we are actually at a good place where we can, I would not say diagnose, but we could definitely flag up people who are at risk of gum disease or decay. And there has been a ton of research to show that there are certain bacteria which we know cause gum disease or we know cause decay. So, for example, at our lab, we have been working for two years nearly on building an algorithm. So we actually have built an algorithm where we incorporate the patient's dental history, what they do at home, what, you know, how much they're brushing, flossing, their age, their medical history, as well as the bacteria they have, the genetic mutations, the inflammatory markers all together to then give them a risk, you know, of their oral diseases. And I wouldn't say. I don't have, like, a specificity of saying, okay, we're 100% accurate, but the way that we've done it is by testing all of our patients and then seeing, okay, were we. Were we right with our prediction or were we not? So I would say we are. We are very much on our way to getting there for oral diseases.
- [33:31]
Dr. Rangan Chatterjee
You know, there's a phrase, something like what gets measured gets addressed, or something like that. Right. So I guess when I hear about this oral microbiome test, I'm thinking, let's say someone doesn't have any toothache or any overt symptoms from their mouth, which is encouraging them to go and, you know, change their lifestyle or change their diet or go and see the dentist or the hygienist.
- [33:55]
Dr. Victoria Sampson
Yeah.
- [33:56]
Dr. Rangan Chatterjee
If they had an oral microbiome test that showed, oh, there's a few issues here, I wonder if that might be a good way going forward for some people to start taking their oral health seriously.
- [34:11]
Dr. Victoria Sampson
Yeah. So we've actually just got our preliminary results. We did a questionnaire, like a survey, and we sent it out to everyone who's done our oral microbiome test just to say, like, how likely were you to go and book an appointment with your dentist or your hygienist after getting your results? And we had an over 90. I think it was a 95% success rate which had gone to the dentist within one month of taking the test or getting their results, basically. And I think that shows that. I think the issue with oral health as well is that it's always been something that dentists know, and we kind of tell our patients what's wrong, and patients don't understand what is going on. So we're like, you need three fillings, you need one root canal, and you've got gum disease. And patients are like, but why, why do I have all of these, you know, cavities, and how did I get gum disease? And they don't understand that gum disease is a. It's a bacterial infection. It is increasing your inflammation and it's traveling through the rest of their body. They just think it's something cute.
- [35:10]
Dr. Rangan Chatterjee
You know, this is so fascinating to me, right? So because I'm as I'm hearing all of this in my head, I'm sort of superimposing it on other principles that I try and adopt and share with people. So let's go through this in real time, right? I'm thinking that let's say blood sugar, because we mentioned that already, and metabolic health is a topic that I've covered on multiple occasions and will continue to cover on multiple occasions because it's so important for our short term and our long term health. Okay? So I've shared many times that one of the issues I have with the way that we practice medicine today is that the way we report results is very black and white. And we don't recognize as a profession enough, or we certainly don't inform our patients enough that health exists on a continuum. So let's take average blood Sugar. You mentioned HBA1C before and you shared that study where if they had periodontal disease and they treated it, on average, their A1C went down by 0.4, which is remarkable. Okay, so just to ground people in the UK, if your HBA1C, which is your average blood sugar marker for the past two to three months, is 6.5 or above, we call that type 2 diabetes, 6 to 6.5. That's pre diabetes, and under 6 is considered normal. Now, I would argue that 5.9 is anything but normal. It may not be in the pre diabetic range, but we should, should not be reporting it as normal. But it commonly is. Right? So if we try and use that model for what you're saying, is there a similarity with dental problems? So by the time you have gum disease, that's like your A1C is 6.5 or above, right? So, oh, now you've got a problem. I'm gonna come and see Dr. Sampson and get this sorted. But are There earlier indications, which is showing us actually you don't have gum disease yet, but things aren't where they should be.
- [37:15]
Dr. Victoria Sampson
Yeah.
- [37:16]
Dr. Rangan Chatterjee
Does that analogy work?
- [37:17]
Dr. Victoria Sampson
Yeah, yeah, fully. I actually love it. I think we should start using it more. We should say, like, you're pre periodontal disease.
- [37:22]
Dr. Rangan Chatterjee
Yes.
- [37:23]
Dr. Victoria Sampson
Or like, you know, so. Yes, you're totally right. Periodontal disease is kind of like a spectrum, I call it. So on one side you've got super healthy, everything's amazing gums, and then on the other side is you've got severe periodontal disease. Your teeth are falling out. You know, it's. You've lost all of your bone. It's. It's really bad. But actually within. Along that spectrum are lots and lots of different types of kind of gum disease, where it starts as healthy gums, then it becomes inflamed gum. So that's the patient who brushes their teeth and their gums bleed a little bit. At that point, they should be thinking, this isn't great, I should go and see their dentist. And if they don't go and see their dentist, then that will progress and they'll get even more gum inflammation. And if that still isn't addressed, then that becomes gum disease. And the gum disease, what marks it is that you start getting bone loss. So it's not just gum inflammation anymore. You're actually also losing bone around the teeth. And as you lose that bone around the teeth, the gum disease progresses and gets worse and worse, eventually resulting in tooth loss. The annoying thing with gum disease is the only real, I would say, warning sign, early warning sign, is bleeding gum, which a lot of people don't think is a warning sign, and they should think that it is.
- [38:42]
Dr. Rangan Chatterjee
How common is bleeding gums?
- [38:44]
Dr. Victoria Sampson
Very, very, very common. I don't know the exact statistic, but I would say it's definitely over 80% of patients will have experienced bleeding gums at some point.
- [38:52]
Dr. Rangan Chatterjee
Is that patients who come and see a dentist. So in your experience, about 80% of your patients have complained of bleeding gums, or do you think even across a general population it might be something as high as that?
- [39:04]
Dr. Victoria Sampson
I think across the general population, they will have experienced bleeding gums at some point in their life.
- [39:08]
Dr. Rangan Chatterjee
Yes. And you're saying that bleed, bleeding gums, generally speaking, should not happen?
- [39:14]
Dr. Victoria Sampson
No. I mean, if you had a. Your eye was bleeding, you'd probably be a little bit worried, Right. You probably go and see your. Your, your doctor. Or if your foot, your. Your nail kept on bleeding and there was pus coming out of it, you probably want to get that sorted out. But when it comes to the mouth, we often don't know if we have pus coming out of our gums because you can't really taste it very well. And bleeding gums, people think is just entirely normal.
- [39:40]
Dr. Rangan Chatterjee
Why is it, do you think that if we had, you know, a bleeding eye, we go and see the doctor, but we don't with a bleeding gum. Is there a PR problem with dentistry? Is it the fear that many people have when their kids are going to the dentist? What is it? Because when you put it like that, it's quite obvious a part of your body is bleeding. There's no obvious cause for it. Like a cut, which we understand, oh, you know, I cut my foot, it's gonna bleed.
- [40:07]
Dr. Victoria Sampson
Yeah.
- [40:08]
Dr. Rangan Chatterjee
Why don't we do that for our mouth?
- [40:11]
Dr. Victoria Sampson
I don't know. I think it is, it is a PR problem. I think dentistry needs to hire a very good PR person.
- [40:18]
Dr. Rangan Chatterjee
That's what you're here for.
- [40:19]
Dr. Victoria Sampson
That's what I'm here for.
- [40:20]
Dr. Rangan Chatterjee
Good PR for dentistry.
- [40:23]
Dr. Victoria Sampson
But I think it's a lack of importance. People don't think that your mouth is that important. And then on top of that, I think people don't trust their dentist. They're scared of their dentist. So they're like, oh, it's bleeding, I'll just brush harder or I'll just start using mouthwash.
- [40:41]
Dr. Rangan Chatterjee
Why are people scared of the dentist?
- [40:43]
Dr. Victoria Sampson
I think that stems from there's a big thing about vulnerability. And I know a lot of people feel extremely vulnerable when they're in a dental chair and they're laying back and they've got someone else's hands in their mouth. It is, it's a very invasive thing. And it doesn't help that in the previous decades, dentists were seen or known to be pretty heavy handed. And there have been some bad experiences for patients. And it still happens to this day, I'm sure. But I think that, you know, I've heard some terrible stories from patients now who are like, oh, when I was 10 years old, every time I went to the school dentist, I'd have a tooth taken out or I would have a filling and there was no anesthetic. And so they get that in their head. They teach it to their kids. And I see it all the time where these parents are like, oh, no, you're going to the dentist, like, you'll get chocolate afterwards. I'm like, no, you're teaching your child to think, think that the dentist is a bad thing and we can be Great. We can be really fun sometimes.
- [41:42]
Dr. Rangan Chatterjee
You are fun. Go to the dentist.
- [41:43]
Dr. Victoria Sampson
There we go. So we can be a real party if you give us a chance.
- [41:50]
Dr. Rangan Chatterjee
But that's a really good point, actually. It's a really good point that I think people don't think about enough. And I go into this area with caution because I know it's what you just said there has so many implications as a parent. What are we teaching our kids? What do I want my kids picking up from me? I don't want them picking up all the kind of insecurities I may have had. I actually don't want that for them. And so that was my biggest drive to actually change a lot of this stuff. And so let's go back to dentistry then. People are scared to go often because of that. What are some other reasons? I mean, do you see people sometimes who come to you for the first time and you see the state of their mouth and you're like, how come you weren't here five years ago? Do you sometimes see mouths in a pretty awful state?
- [42:39]
Dr. Victoria Sampson
Yeah. I had one patient quite recently and the weird thing about him was that on the outside he was so well dressed. I mean, amazing three piece suit, I mean like beautiful tie, everything. And he comes in and he probably hadn't gone to the dentist in like 20 years. He smoked like 40 cigarettes a day and he basically didn't really have any teeth left and his teeth had fallen out and sorry, this is a bit gross for some people, but he would then put the tooth back into the hole that it was in previously so that when he was talking to people it looked like he had teeth but he couldn't eat. And he would always eat at home or without people and he'd take all of the teeth out of his mouth and eat. And so I think this is just such a prime example of someone who clearly takes very good care of themselves and you know, aesthetics are quite important to them. But they are terrified of the dentist and I think it's a self perpetuating cycle where they think that the dentist is going to judge them. So then they keep on not going and then it gets worse and worse and they, yeah, they don't really trust us either.
- [43:50]
Dr. Rangan Chatterjee
That's a great point. Fear of judgment, right? Because if, you know, you haven't been looking after your teeth, teeth particularly well for whatever reason, or you've been indulging in a bit too much sugar for whatever reason. Right. Which many people do, especially when they're stressed, maybe that fear of judgment stops people going as well. Cause they're like, I actually don't want that dentist to look. I never really thought about this. Very vulnerable, isn't it? You're opening that part of your mouth that nobody gets to see. Really?
- [44:21]
Dr. Victoria Sampson
Yeah, yeah. I mean, the number of patients who have cried in my chair who have gum disease, and I think they. They think that it's their fault. They've been told, they've been blamed by others, by other dentists or hygienists and being like, you're not brushing well enough, you're not taking care of your mouth. And I think it. It stems much larger than that of how that patient was educated and whether or not they had the money to go see the dentist. There's so many factors that could cause that patient to be in that place, and it's unfair to be judged for that. But it is an extremely emotional thing. And actually, one of my patients once, she said she was like, every part of your body, you know, if you have a problem or you have some sort of trauma, you can hide it, but in your mouth, your mouth shows so much, you can actually get a lot of trauma and scars, and we can always see it. So, for example, if a patient was bulimic when they were younger, I can see that. I know that if they maybe didn't have a childhood where they ate very good food and they weren't taking good care of their teeth, they will have lots and lots of decay and lots of fillings. And. And so it's interesting because you do. You can tell a lot from someone's mouth. And I think that some people do feel like they're going to be judged for that.
- [45:34]
Dr. Rangan Chatterjee
If we think about this through an evolutionary lens, do we know the state of dental health in more traditional societies? So. So if we look at. Through the lens of the gut microbiome, we'll often talk about the Hadza tribe in Tanzania, whose lives are still relatively untouched by modernity. So gut microbiome researchers will go there and study and look at their stool and see what's going on. And yes, we see that actually a lot of them have much more diverse microbiomes than we do in Western urban populations. Has that been done yet for our oral microbiomes? Do we know the state of their health? You know, because it's striking to me that nearly half the planet have some form of gum disease. I imagine that wasn't the case in traditional societies. Or was it?
- [46:28]
Dr. Victoria Sampson
So, in terms of oral microbiome studies, there have been a lot to compare different Societies, for example, just even comparing different diets in different countries, more westernized diets versus others who are not. So yes, we have been able to compare that, but what I'm not aware of is studies from maybe communities which are very non industrialized or haven't had kind of more processed foods in their diet. There has been a lot of research by a guy called Weston Price and he did show that there was a significant change in the mouths of people who were in areas which were less industrialized compared to areas which were. So they had twins, for example, one who was having lots of kind of processed foods versus the other twin who was not having processed foods. And the way that their jaws developed, the amount of decay that they had, were massively different.
- [47:34]
Dr. Rangan Chatterjee
Yeah, it's remarkable, isn't it? Because if you think about a lot of these ultra processed foods there, they're softer, they're easier to chew. Right. So that if we think about it, we know, for example, our bone density, let's say in our legs, is going to be heavily influenced by the amount of pressure you're putting through walking, running, jumping. All these things are putting pressure on the bone and the bone's growing back stronger. And I guess if your child is having a lot of soft, soft, mushy, ultra processed foods, they're not getting that kind of mechanical stimulus to the jaw and the teeth.
- [48:14]
Dr. Victoria Sampson
Yeah.
- [48:14]
Dr. Rangan Chatterjee
Is that what we're seeing?
- [48:15]
Dr. Victoria Sampson
Yeah. So they're showing that the, the jaw is not developing as much because you're not using the jaw under the pressures that it's meant to. So even it goes from as early as like breastfeeding to even as they grow older, whether or not they're having processed foods. And so a lot of people are now trying to teach their children to eat harder foods. I've even seen like, there's these gadgets that they're giving their children to like chew on so that they like develop their jaws. I would not go that far. I think just make sure that your child has quite a balanced diet and they're having things like hard, crunchy carrots just to help develop their jaws a little bit more.
- [48:58]
Dr. Rangan Chatterjee
Yeah. Or even, you know, I appreciate not everyone eats meat for a variety of different reasons, but if you do, you know, chewing, trying to get that meat off the bone. Yeah, that's again, you're giving it a mechanical stimulus. It's going to have an impact on your bone health in your mouth, your dental health. It's pretty remarkable. Let's go into this 3.5 billion statistic right because I can't get it out my head. Why is it that so many of us are struggling today with our oral health? Health. Right. It's remarkable, if I think about human evolution, something so important. You're calling the mouth the gateway to the rest of the body. You mentioned the link between fertility, cancer, Alzheimer's, autoimmune illness, and I'm sure the list goes on and on. We've mentioned some of the reasons we don't come and see the dentist, but what's going on in the modern lifestyle? Maybe we can talk about food, sugar, tea, coffee, all these sort of things. I mean, can you sort of walk us through the things that are. Are helpful and the things that are potentially harmful if we don't pay attention?
- [50:02]
Dr. Victoria Sampson
Yeah. So I think again, if you go into like the Stone Age times, there hasn't been much evidence to show that people had lots of decay or lots of gum disease, but they also didn't have hygienists and dentists, and they weren't getting root canals done. So what was so different about their diet compared to what we're doing now? And part of it is that they were having hard, chewy foods, foods. They weren't having sugar, there was no processed foods. They were not snacking. They were eating as and when food was there. And then you come to our society now where a lot of our foods is processed. A lot of us do. Snack and snacking is one of actually the worst things for the mouth in particular, because every time you snack, your saliva, the acidity of the saliva will become more acidic. And as the saliva becomes more acidic, then the teeth can demineralize and then you can get decay. So I always say to patients, you know, if you're, if you're a sweet tooth, I mean, obviously you can probably tell them that they shouldn't be having sugar. I will tell them that if they are going to have their sugar, have it all in one go, just once, and then have some water afterwards, and that is it. So if you have a bag of Skittles, I'd rather you ate the whole bag of Skittles in one go. Then you ate a skittle every five minutes or so. Because what happens is the saliva is not able to neutralize and then it just stays in an acidic state. And that's when you start getting demineralization and decay.
- [51:27]
Dr. Rangan Chatterjee
Yeah, that's so interesting. Okay, so just so no one misinterpreted that you're not recommending that someone goes and has a whole bag of sweets whatever that brand might be. But what you're saying is, if you are going to. Because the truth is, some people are.
- [51:44]
Dr. Victoria Sampson
Yeah, yeah.
- [51:45]
Dr. Rangan Chatterjee
Because people eat for a variety of different reasons. Not just physical hunger, emotional hunger is often a big driver of our eating habits. You're saying that sort of steady, constant drip of sugar throughout the day is not allowing your mouth to rebalance, basically.
- [52:02]
Dr. Victoria Sampson
Exactly. And that's the same with drinks as well. So if you're someone who has some sort of sweeteners or something in your water or you're having fizzy drinks, you know, we're all human. You know, we all have bad things. It. In my opinion, that's how you have that bad thing and what you do to basically get back into a good and healthy state. So, you know, if you're having your Coca Cola, have it all in one go. Don't sip it and drink some water afterwards and also drink it through a straw as well. The Coca Cola.
- [52:31]
Dr. Rangan Chatterjee
Okay. There's so many little practical things you put in there. Let's go through them one by one. Okay. So sugar.
- [52:36]
Dr. Victoria Sampson
Yeah.
- [52:36]
Dr. Rangan Chatterjee
I think a lot of us know or are aware that sugar or excess sugar is not going to be helpful for our teeth. Okay. So sugar comes in a variety of different forms. You mentioned that we can drink sugar, which I don't think they were doing in traditional society. So we can drink a lot of sugar in a very short period of time. We can add sugar to our tea, or we can have sugar in sweets or a biscuit, whatever it might be. So let's just make it really clear for people, because everyone's got a different relationship with foods. Maybe we'll start out with, you know, a hot drink with sugar in it through the lens of our dental health. We're not talking about diabetes or weight or anything like that. Through the lens of our dental health. Is that okay?
- [53:22]
Dr. Victoria Sampson
So it has been shown that when the drink is hot and you've got the sugar inside it, then it also will exacerbate the acidity of the saliva. So it'll make it even more acidic and it would be more difficult for that. That saliva to rebalance again.
- [53:37]
Dr. Rangan Chatterjee
So hold on. Just. Just so I'm clear, so let's say you had a. Your. A hot beverage in front of you.
- [53:43]
Dr. Victoria Sampson
Yeah.
- [53:44]
Dr. Rangan Chatterjee
And you had on a teaspoon some sugar.
- [53:49]
Dr. Victoria Sampson
Yep.
- [53:51]
Dr. Rangan Chatterjee
For your dental health, are you saying you're better off putting the sugar straight in your mouth and swallowing it and then having the hot drink separate? Are you basically saying that when the sugar's dissolved in the hot drink.
- [54:01]
Dr. Victoria Sampson
Yes.
- [54:02]
Dr. Rangan Chatterjee
It becomes more problematic.
- [54:04]
Dr. Victoria Sampson
Yes. Yeah, so that's been shown to be more problematic because it's hot, I guess. Yeah.
- [54:10]
Dr. Rangan Chatterjee
Yeah, that's super interesting. Okay, what about fruit juice?
- [54:16]
Dr. Victoria Sampson
That's also pretty bad as well. Just even. And dried fruits as well. So again, that's where I guess there's kind of conflicting supporting arguments because fruit juice and dried fruits are good for your general health, but they're actually quite bad for your dental health. So you should be following the same rules of, you know, have it all in one go, don't snack on it. So if you're having dried fruits, for example, I always recommend to mix it with maybe some nuts as well so that roughage can help get rid of the whatever dried prune that is stuck in your teeth.
- [54:52]
Dr. Rangan Chatterjee
Okay, so let's say someone has indulged in something sweet for whatever reason, what is the best thing they can then do to reduce the potential problematic effects on their oral health? The teeth, their gums, not the gut bugs, the mouth bugs that we want in there. What are some helpful things that they can do?
- [55:16]
Dr. Victoria Sampson
So like I said, have it all in one go. Straight after, you can just rinse it with some water.
- [55:21]
Dr. Rangan Chatterjee
Straight after?
- [55:22]
Dr. Victoria Sampson
Yeah, straight after.
- [55:24]
Dr. Rangan Chatterjee
But they may not want to do that because they probably like the aftertaste.
- [55:26]
Dr. Victoria Sampson
And they're like, no, stay. You can chew some sugar free gum. And just by chewing sugar free gum, it helps to stimulate your saliva. And that saliva will wash away whatever's stuck in your teeth, but also will help to neutralize the saliva quicker. There's also some really cool like mints and pastels which have probiotics or have of alkaline solutions to help neutralize the saliva as well. So you can even pop one of those in afterwards.
- [55:56]
Dr. Rangan Chatterjee
Okay, let's look at this through another lens. We all live different lives. We all have different taste preferences, we have different times that we eat. But I don't know if you would engage in this thought experiment. What does the perfect day look like from a dental health perspective?
- [56:20]
Dr. Victoria Sampson
Right.
- [56:21]
Dr. Rangan Chatterjee
With the understanding that this may not be achievable. But I'm just wondering what might not perfect, but really good dental health look like. Just taking a quick break to give a shout out to AG1, one of the sponsors of today's show. Now, if you're looking for something at this time of year to kickstart your health, I'd highly recommend that you consider AG1. AG1 has been in my own life for over five years now. It's a science driven daily health drink with over 70 essential nutrients to support your overall health. It contains vitamin C and zinc which helps support a healthy immune system, something that is really important, especially at this time of year. It also contains prebiotics and digestive enzymes that help support your gut health. All of this goodness comes in one convenient daily serving that makes it really easy to fit into your life no matter how busy you feel. It's also really, really tasty. The scientific team behind AG1 includes experts from a broad range of fields including longevity, preventive medicine, genetics and biochemistry. I talk to them regularly and I'm really impressed with their commitment to making a top quality product. Until the end of January, AG1 are giving a limited time offer. Usually they offer my listeners a one year supply of vitamin D and K2 and five free travel packs with their first order. But until the end of January they are doubling the five free travel packs to 10. And these packs are perfect for keeping in your backpack, office or car. If you want to take advantage of this limited time offer, all you have to do is go to drinkag1.com livemore that's drinkag1.com livemore before we get back to this week's episode, I just wanted to let you know that I am doing my very first national UK Theater tour. I am planning a really special evening where I share how you can break free from the habits that are holding you back and make meaningful changes in your life that truly last. It is called the Thrive Tour. Be the architect of your health and happiness. So many people tell me that health feels really complicated, but it really doesn't need to be. In my live event, I am going to simplify health and together we are going to learn the skill of happiness, the secrets to optimal health, how to break free from the habits that are holding you back in your life. And I'm going to teach you how to make changes that actually last. Sound good? All you have to do is go to drchatterjee.com tour and I can't wait to see you there.
- [59:32]
Dr. Victoria Sampson
Okay, so you wake up in the morning. For some patients they might be taking off their mouth tape. So that's something which is relatively newer that people are learning about to help encourage nasal breathing. Exactly. Yep. And stop introduction of bacteria and drying the mouth out. So they're, they're taking off their mouth tape or if they already breathe with their mouth closed, then fantastic wake up and then they will go brush their teeth and then afterwards they might have some breakfast, ideally something which is not sugary. So maybe they're having just some porridge or some eggs. And then this is me, for example. So. And then I'm gonna get my. I have a coffee, and then I get to work. I usually will have a. Like a neutralizing mint at that point as well. So that just helps to freshen my breath. I am a dentist, so I want to make sure that my breath smells nice, but then also just help to neutralize everything. And then I will have lunch, rinse my mouth with water after I've had my lunch.
- [60:41]
Dr. Rangan Chatterjee
So you do that. That's interesting.
- [60:42]
Dr. Victoria Sampson
I actually do, yeah. And then I will have my dinner. By the way, I don't drink anything other than water during the day or coffee, so there's no sugar involved.
- [60:53]
Dr. Rangan Chatterjee
And I know that you're also not snacking on this ideal day.
- [60:58]
Dr. Victoria Sampson
Yeah, So I really try not to snack. And then I will have my lovely dinner. And then I'll wait a minimum of 30 minutes after my dinner before I go and brush my teeth. And usually I first will floss, and then I will brush my teeth. And then I will not rinse with water. I'll just spit out the toothpaste, no rinsing. And then I. I personally will pop in a probiotic pastoral. So I have, like, a probiotic mint before I go to sleep, and that's that.
- [61:32]
Dr. Rangan Chatterjee
Okay, this is fascinating. Okay, thank you for sharing that, because I'm now trying to plot that out and what I could potentially apply. Okay, so let's just go through that. Right. So mouth tape. We have covered this before, but if people haven't heard my initial conversations with James Nestor and a few others about mouth tape, they may not be familiar. So we're talking about a practice that some people can do to help encourage them to breathe through their nose at night. Why is nasal breathing. And you sort of covered it, but just to make it super clear for people, why is nasal breathing through the night important for your oral microbiome?
- [62:10]
Dr. Victoria Sampson
So if you're breathing with your mouth open, you're introducing bacteria into your mouth for however many hours, but more importantly, your mouth dries out completely, and saliva is so, so, so important for oral health. And so people who have a dry mouth, be it because of medications they're taking or certain, you know, medical issues that they have, it is really important for them that they try and lubricate their mouth as much as possible, maybe it through mouth taping or whatnot. So it is really important for that. And we've actually seen a lot of patients. And this is just in my own clinic who were originally mouth breathers. And we actually went and fixed their. Their jaws completely or their teeth and how they meet through orthodontic treatments. My sister's an orthodontist, so she'll fix that. And then they don't even need to mouth tape because their lips will close at rest in a much more comfortable way. And they. They don't breathe with their mouth open.
- [63:11]
Dr. Rangan Chatterjee
Yeah, that's really interesting. So sometimes the mouth breathing that many of us are doing at night is a consequence of our jaw placements.
- [63:21]
Dr. Victoria Sampson
Exactly, yes. Yeah. And then we've also done microbiome testing of patients before and after they've had their orthodontic treatment or whatnot. And we've seen that there's been a really big improvement in their gum health, in obviously their saliva production, and also their oral microbiome as well.
- [63:38]
Dr. Rangan Chatterjee
This is fascinating. So, again, drawing the analogy with our guts, people are so interested in what they can do to improve their gut health. And there are things you can do with your food, but there's also things with your stress and sleep and movement that also impact our gut health. Right. So the things that we can do to improve our oral health and the bugs in our mouth that we want, simply going from mouth breathing to nasal breathing at night, in and off itself, is going to make a positive impact.
- [64:11]
Dr. Victoria Sampson
Yes. Yeah. And I always recommend to patients that they start with mouth taping and they'll probably feel a significant improvement in how their mouth feels, maybe how they're sleeping, their focus and concentration the next day. And if they do feel those significant improvements, they might be more inclined to go ahead and do maybe some orthodontic treatment to fix their teeth.
- [64:31]
Dr. Rangan Chatterjee
When my wife first did mouth taping, and I think it was after my second conversation with James Nestor on this podcast, because, you know, she probably won't listen to my advice, but she'll listen to James giving that advice, which I think is the thing in all relationships. But when she did that, it was remarkable.
- [64:53]
Dr. Victoria Sampson
Really?
- [64:53]
Dr. Rangan Chatterjee
Yeah. She's like, I've got so much energy. The following day, after the first time, her energy was through the roof. So for some people, it can be game changing, but that was from an energy perspective. It's fascinating to me that that can also improve the health of your oral microbiome, which kind of makes sense when you start to think about it. Right. Okay. You said on this ideal day you'd brush your teeth straight away.
- [65:17]
Dr. Victoria Sampson
Yes. There's no real difference whether you brush your teeth before or after breakfast. For me, it really Depends on what you're eating for breakfast or if you're someone who's gonna have an orange ju and you like your sugary cereal, then it's actually better to brush your teeth before you have your breakfast because you shouldn't brush your teeth straight after having anything acidic or sugary. Otherwise you grind it into your teeth.
- [65:42]
Dr. Rangan Chatterjee
So a lot of people wake up with bad breath. Okay. So one of the incentives for people to brush their teeth, I would say, is. Yes, how it's going to look. But also they want their breath to smell nice. Right? Right. A lot of people will have coffee or tea in the morning if they don't brush their teeth. I don't know. Let's say they even have a glass of water when they wake up. Are there bugs in the mouth that are maybe contributing to bad breath? Maybe. We've been mouth breathing all night and we've got a slightly dysbiotic or oral microbiome and say this slightly unbalanced one. If you then consume things like water or tea or coffee without brushing or rinsing your mouth, are some of those, you know, inverted commas problematic bacteria going then into your body, or do we not know?
- [66:35]
Dr. Victoria Sampson
We don't know. Well, I don't know. What I do know is that most oral bacteria, a lot of them are not going to survive in the gut.
- [66:47]
Dr. Rangan Chatterjee
Stomach acid.
- [66:47]
Dr. Victoria Sampson
Yeah, it's the stomach acid. So it's only really like very, very bad, bad bacteria from the mouth, which are even going to survive. And those bad bacteria are not going to just find themselves all of a sudden in the middle of the night and then be swallowed and cause a problem that's much more of a slower, long burn.
- [67:07]
Dr. Rangan Chatterjee
So is the reason you think or do you advise people brush their teeth straight away? Is that for any particular reason or is it just habit? It's kind of be easy. You know, you get up, maybe you go to the toilet, you brush it at the same time so it's done.
- [67:19]
Dr. Victoria Sampson
It's like, for me, it's more habit and whatever is easiest for the patient. Like I said, there's no real difference between brushing before or after your breakfast, as long as your breakfast is not a super sugary, acidic breakfast.
- [67:31]
Dr. Rangan Chatterjee
Okay. So there are some other cultural practices which I'm aware of that I think are relevant here. So in Ayurvedic medicine, which is traditional Indian medicine, there's two things that are often done. Number one, oil pulling. Don't know if you're familiar with this practice or not, where first thing in the morning, you would put some coconut oil in your mouth and swill it around for anything from either 2 minutes to 10 minutes depending on how much you want to do it, spit that out, rinse your mouth. And so I think, and I'm not an Ayurvedic practitioner, I think the thinking is that you are removing some of those kind of impurities or the bad bacteria that built up over the night before you start consuming things. The other practice that I think a lot of Indian families do is tongue scraping. So I remember mum and dad literally every single, you know, they'd brush their teeth and it's a no brainer. You just, you know, you scrape your tongue afterwards with these metal tongue scrapers. And you know, when we go to India every other summer for six weeks, we'd come back, we'd go to the local market and come back with like 30 of these silver metal tongue scrapers. Right. So I don't know. Again, I don't know if these things have been studied or not. And if they haven't, it doesn't mean they don't work just because we haven't studied them. But I find it interesting that those practices do exist certainly in Indian culture. I'm sure other cultures have their own practices as well. Do you know much about those two practices and their potential benefits?
- [68:56]
Dr. Victoria Sampson
Yes. So thanks for reminding me because I actually would recommend tongue scraping and that is part of my routine. So if we start with tongue scraping, it is actually very beneficial. You need to be quite careful with how aggressive and how often you scrape your tongue because what can actually happen is if you tongue scrape too aggressively, you can cause overgrowth of the, the filiform or the buds on your tongue and that can make your tongue, it's not very nice. It's called like a hairy tongue. So you can have a hairy tongue, black hairy tongue. And that can actually trap even more bacteria and it's like this self perpetuating cycle. So I would always recommend to patients that they do tongue scrape with the iverdic metal tongue scraper maybe a couple of times a week, not, not every single day and not very aggressively. The coconut oil pilling one there, I have a lot of patients who swear by it and they say that it has changed their life. But if we look at the actual evidence behind it, there is no research that I'm aware of that shows that it has any, you know, direct improvements to someone's oral health. And a lot of it is more anecdotal. But with that being said, like I said, a lot of My patients love it and there's no harm. So all of this research has shown that there's no positive gain from it, but there's also no harm from doing it. And if you actually want to be doing coconut oil pulling correctly, you should really be doing it for, I think it's about 15 minutes. So for most of my patients, I don't recommend it just because I like to keep things really, really like, just brush your teeth twice a day, like as quick and easy as they can. And a lot of people can't do that for 15 minutes. But some people have found that it improves their hydration in their mouth. They say that their teeth feel whiter, they have less ulcers. So definitely, if you're listening and you want to try it out, go for it.
- [70:52]
Dr. Rangan Chatterjee
Have you seen then some studies looking at this?
- [70:54]
Dr. Victoria Sampson
There have been studies that looked at it and they haven't found any statistically significant improvement in any oral health parameters. But there's also no negative to it either.
- [71:03]
Dr. Rangan Chatterjee
And it'll be interesting to know what they actually studied and how long. And I've got a few friends who are dentists, and a couple of them have said to me anecdotally, the patients who have done it or do it regularly, their teeth look really good. Now, that doesn't mean it's that that's doing it. There could be other practices, of course, as well. And again, my bias is that that's a practice that I've seen in my culture growing up and in my family. So it's fascinating, isn't it? Okay, so back to your perfect day. You have scraped your tongue because it's one of those two occasions a week where you do it. On this day, you already mentioned that you try your best not to snack. And we've covered why that is. You also said that on this day that you would rinse your mouth after your lunch. Okay. Why is rinsing your mouth after food such a good practice? If you're able to do it, just.
- [71:57]
Dr. Victoria Sampson
Helps get rid of the bacteria and the food. Sorry. It's just as simple as that. Just if you've got food stuck in your teeth or your mouth, you just rinse it out and it helps.
- [72:06]
Dr. Rangan Chatterjee
Yeah. Okay. Flossing. You said in the evening you floss before you brush your teeth.
- [72:13]
Dr. Victoria Sampson
Yeah.
- [72:14]
Dr. Rangan Chatterjee
Is that just preference or is there a reason for that?
- [72:18]
Dr. Victoria Sampson
So there is no real difference between if you were to floss before or after you brush for me. So over 30% of the bacteria in your is in between your teeth. So when you're flossing, you're getting rid of 30% of that and there's always going to be some food and some stuff stuck in there. So I like to floss, get rid of all of it and then I brush and then spit everything out. Whereas if you were to brush and then spit out your toothpaste and then you were to floss, then you just have to spit out again and it's just not as easy. So I just find that. I find that easier and it's kind of weirdly be quite nice to be like, ah, you know, and take everything out. So.
- [72:58]
Dr. Rangan Chatterjee
Yeah, because you also like to keep the toothpaste in afterwards.
- [73:01]
Dr. Victoria Sampson
Exactly right.
- [73:01]
Dr. Rangan Chatterjee
So why do you keep it in?
- [73:04]
Dr. Victoria Sampson
So I always compare it to sunscreen. So if you were to spend two minutes putting sunscreen all over your skin and then you were to have a shower before you go out into the sun, then you've just washed off all the goodness and it's not going to do anything. So it's the same with brushing your teeth. You spend two minutes applying all that toothpaste onto your teeth teeth and if you were to rinse out with water, then you're actually just removing all of the goodness from the toothpaste out of your mouth.
- [73:28]
Dr. Rangan Chatterjee
Is there a risk that some toothpaste, and I'm no expert on toothpastes, but is there a risk some of them have got harmful chemicals in that maybe are working in the short term to help our teeth look better, but they're not necessarily the sort of chemicals you might want for eight hours overnight whilst you're asleep on your teeth.
- [73:46]
Dr. Victoria Sampson
So, yeah, so I would always try and avoid SLS in your toothpaste. So that's sodium lauryl sulfate and it's a foaming agent. It makes toothpaste really foamy and nice and everyone likes that. But actually it's been shown to not be great for the microbiome. It can strip the soft tissues inside the mouth and make them more irritated and can cause ulcers as well. So you don't need that. But otherwise just spitting out is enough that you shouldn't have gotten all the toothpaste all over your, your tongue and your cheeks anyway. You should just be brushing your teeth and spitting it out is more than fine.
- [74:22]
Dr. Rangan Chatterjee
And what's your take on mouthwash?
- [74:25]
Dr. Victoria Sampson
Mouthwash is good for some people, but not needed for most people, in my opinion. It really needs to be kind of prescribed by a dentist.
- [74:35]
Dr. Rangan Chatterjee
For a particular problem.
- [74:37]
Dr. Victoria Sampson
Exactly. For a particular problem, be it bad breath, gum disease, Sometimes if you have lots and lots of decay, sometimes we'll also give you a mouthwash for that.
- [74:45]
Dr. Rangan Chatterjee
Isn't the downside, though, that some of them are. Well, I know some contain alcohol.
- [74:50]
Dr. Victoria Sampson
Yeah.
- [74:51]
Dr. Rangan Chatterjee
So, you know, we mentioned at the start of this conversation the importance of a healthy oral microbiome. So a good balance of bacteria in our mouth.
- [75:00]
Dr. Victoria Sampson
Yeah.
- [75:01]
Dr. Rangan Chatterjee
Is there a risk that some of these mouthwashes are going to disrupt that balance?
- [75:06]
Dr. Victoria Sampson
Yes. Yes, it definitely can. And that's why it's important that it's only used by certain people if they have a certain problem. So, for example, in my clinic, we will test a patient's oral microbiome and we'll see exactly what bacteria they have high levels of. And I can recommend a mouthwash which would be more effective for that patient based on what bacteria they have. So we're not knocking out the whole microbiome and killing everything.
- [75:29]
Dr. Rangan Chatterjee
Again, trying to draw these analogies to sort of concepts that people are familiar with. Is that a bit like an antibiotic, then, where we. You wouldn't just take an antibiotic every day to stop yourself ever getting ill? Cause we know that that's gonna be problematic. Right. For your gut microbiome and all kinds of other things. But a doctor will prescribe it for a specific problem for a discrete period of time.
- [75:51]
Dr. Victoria Sampson
Yeah, exactly.
- [75:52]
Dr. Rangan Chatterjee
Do you think we need to start thinking about mouthwashes in a very similar way?
- [75:55]
Dr. Victoria Sampson
Yes, definitely. And even within that, no mouthwash that we recommend should have alcohol. I mean, at this point in day, like, we shouldn't be having alcohol in any of our mouthwashes. And you. You can still get very effective mouthwashes without alcohol in them. But, yeah, definitely it should be used if you have a problem to fix that problem. And if you are someone who just has. Maybe you just had something really garlicky and you're about to go on a date or something like that, fine, you can use some mouthwash, but you should use it like a. Like a perfume or an aftershave, just to help freshen the breath once or twice when needed. Good.
- [76:33]
Dr. Rangan Chatterjee
Because some people are having it twice a day. It's part of their dental care regime. And I would say, although I haven't seen anything recently, I think sometimes these things are marketed like that, aren't they? Yeah, because of course, it's, you know, there's more sales if someone's using it twice a day than, you know, once every three years when prescribed by a dentist.
- [76:53]
Dr. Victoria Sampson
Exactly. And also, even if you are going to be using mouthwash, it should be at a separate time to brushing. So going back to the toothpaste analogy of sunscreen, if you were to brush your teeth and then you rinse with mouthwash straight after, then they actually kind of cancel out each other's effects. The toothpaste and the mouthwash, you end up not really having anything. So if you do have to use mouthwash, you should use it at a separate time to your brushing. So I always recommend, like, at lunchtime. So after your meal, instead of rinsing out with water, rinse out with whatever mouthwash you've been recommended to use. Use.
- [77:29]
Dr. Rangan Chatterjee
If we look at the health of the oral microbiome, then, and the things we can do to improve it or keep it. Well, we mentioned food and drinks and some of the things that we can do right around that. We've mentioned that nose breathing at night, as opposed to mouth breathing, is something that's going to have a positive impact. There are other things in our lifestyle that we know, for example, impact our gut microbiome. So I talk about these four pillars of health and have them for many years. Food, movement, sleep, and stress management. We know that all four of those independently impact the health of our gut microbiome. I wonder if we could just go through them through the lens of our oral microbiome. We've mentioned food, as I say, you mentioned nasal breathing, stress, and sleep. Do we know what chronic stress does to the health of our teeth and our oral microbiome?
- [78:28]
Dr. Victoria Sampson
So stress, definitely. It obviously increases your cortisol levels. And actually, one of the most tried and tested ways of testing your cortisol is through a saliva test, which shows that saliva is an extremely valuable diagnostic tool. That was just more of a fun fact. But actually, we're also seeing that if a patient is under a lot of emotional or even physical stress, then that can actually show itself within the mouth. A patient can start getting gum disease. You can get lots of ulcers. It depends on what that stress is. So we do, at our clinic, we do a test. It's called collagen breakdown. So we've got lots of different types of collagen in our body, and our gums are made out of a certain type of collagen. And essentially gum disease is collagen breakdown. But the problem with gum disease is by the time we can see it in your mouth or you're having problems, it's kind of too late and the destruction's already occurred. But we know from a biomolecular level that collagen breakdown is happening up to a year before in the saliva. So we test our patients for their collagen breakdown. It's a certain enzyme called ammp. We test for this enzyme constantly, every patient, and it kind of flags up patients who are at risk of gum disease, some sort of collagen breakdown. But also what it shows is a patient who's under potentially a lot of physical or emotional stress. And that was something that I found really wild. Wow. So we started doing it. I've probably been using this Test for like 5 years now. Started using it just to test people for gum disease. And then I would get someone whose gums were actually really healthy, but they had really high levels of this collagen breakdown. I was like, I don't understand. And they were like, oh, you know, I'm in the middle of chemotherapy. Or you know, some. One of the women, for example, perfect oral health, but she just lost her child. And those types of things can really have a massive impact on our bodies and definitely our mouths as well.
- [80:28]
Dr. Rangan Chatterjee
Yeah, fascinating. I guess chronic stress can also directly impact teeth and jaw clenching, you know, tension and all that sort of stuff, as well as the kind of potential impact on gut. I keep saying gut bugs, mouth bugs. Yes, yes. And I guess that's one of your goals, isn't it, to get this more front and center of people's minds?
- [80:49]
Dr. Victoria Sampson
Yes. Yeah. I think the first thing is for people to acknowledge and respect their mouths more and understand that there's a really, really strong connection with the rest of their body. And I want, you know, patients, I want doctors, everyone to understand that. Because I think that in our society where chronic diseases and inflammation is just on the rise, we need to find the low hanging fruit and the things which are easy to treat that can reduce our inflammation, like gum disease. But my ultimate, ultimate goal is that one day we might be able to flag up patients who are at risk of systemic diseases through their mouths and through saliva testing.
- [81:34]
Dr. Rangan Chatterjee
Yeah, fascinating. Absolutely fascinating. If we go back to this relationship between the mouth and the rest of the body, it's really fascinating. I've heard you talk before about the link between our oral health and our fertility and for men, erectile dysfunction. So could you talk about some of those statistics? What is that relationship? Because I think it just really highlights just how linked the health of the mouth is to the health of the rest of the body.
- [82:04]
Dr. Victoria Sampson
So for women, there's actually been a lot of research to show that women will actually start to get gum issues during pregnancy. It's a very common side effect of pregnancy. It's what we call pregnancy gingivitis. And if that is not under control, and if we go back to my spectrum of like very healthy gums and then you've got your inflammation, bleeding gums. If that's not gotten under control, then that can become gum disease. And research has found that in women who do have gum disease and are pregnant that they're at a significantly higher chance of preterm birth and low birth weight of their babies.
- [82:44]
Dr. Rangan Chatterjee
Wow.
- [82:45]
Dr. Victoria Sampson
Yeah, so. And that's quite a strong. It's an easy thing again to treat. So I'd always recommend for patients who are pregnant that they come and have a hygiene every three months. Even if they think their gums are great. Just come and have a hygiene. It's worth it.
- [82:58]
Dr. Rangan Chatterjee
Yeah, that's interesting. Okay, so that's the link between it and preterm birth.
- [83:03]
Dr. Victoria Sampson
Yeah.
- [83:03]
Dr. Rangan Chatterjee
You mentioned some sort of hormonal associations there. What about menstruating women in their cycle? Does the health of their gums change throughout?
- [83:15]
Dr. Victoria Sampson
Sorry, I wish I had more answers on that. And it, it upsets me that they don't because there's not enough research on. There's very little research on what we. On menstruation mouth or on menopause mouth, which is really sad. I would say. Anecdotally, I see a lot of women who are particularly perimenopause and menopause who start to get gum disease or they get gum recession and the consistency of their gums changes a little bit. They also might get lots of ulcers. And then one that menopausal women often suffer from is burning mouth syndrome. And it's a really horrible syndrome or symptom. It's basically their mouth feels like it's constantly on fire and we don't see anything in their mouth, but they often can't eat a lot of foods. They are constantly in pain, even brushing their teeth can hurt them. And at the moment, we don't even have a solution or a cure for this. And we don't even know how it's caused. But there are so many women who have it. The only thing that has been shown is that sometimes if a woman in her perimenopausal stage controls her hormones better, maybe through HRT or whatnot, there has been shown to be a lower chance of that woman getting burning mouth syndrome when she's menopausal. So maybe that's suggesting that the hormonal fluctuation increases the risk of burning mouth syndrome.
- [84:48]
Dr. Rangan Chatterjee
But yeah, yeah, hopefully there'll be more Research into that.
- [84:52]
Dr. Victoria Sampson
Yeah. There. There needs to be it like, really. Because at the moment all that we recommend is often patients are put on antidepressants and that will help with their. Their pain. But I just think that's. This is just a personal thing. I just think that's. That's just wild. That's not, that's not fair to tell a woman who's menopausal.
- [85:14]
Dr. Rangan Chatterjee
Yeah.
- [85:14]
Dr. Victoria Sampson
To take antidepressants because her mouth feels like it's on fire and we can't see it. So I really hope that there's more research that comes out.
- [85:21]
Dr. Rangan Chatterjee
What about the relationship between our oral microbiome and a woman's ability to get pregnant?
- [85:28]
Dr. Victoria Sampson
So there has been some research to show that if a woman has gum disease pre pregnancy, that her. It will take her approximately two months longer to conceive a child. And that's to do with the kind of hormonal fluctuations again, and also inflammation.
- [85:48]
Dr. Rangan Chatterjee
Wow. There's also links between a man's ability to be fertile and their oral health. Right. Which is again, when we start to really absorb this idea that the body is interconnected, it all starts to make sense. I'm not sure many people would still make the link between male fertility and the health of their mouth, though.
- [86:12]
Dr. Victoria Sampson
Yeah. So the most kind of common or the biggest one is that men who have gum disease are 2.85 times more likely to have erectile dysfunction. And that's to do with certain oral bacteria. They release kind of enzymes and inflammatory markers. These can travel through the blood vessels and they can impact how your blood vessels vessels dilate and constrict and therefore how much blood travels to parts of your body. So that is the underpinning mechanism for things like cardiovascular disease, where blood is not, you know, traveling to the heart, and also erectile dysfunction, where blood is just not traveling to the penis as well as it should. And then for. In terms of fertility. So there has been some research where they have looked at men who are sub fertility and they've done a oral examination on them and they found that over 90% of those men had some sort of oral disease, be it gum disease, decay, an infected wisdom tooth, whatever it is, they split that group into two. Half the group had the treatment that they needed to resolve that infection. And then after six months, there was a 70% improved pregnancy outcome with the half that had the oral disease disease sorted out compared to the half that had not had their oral disease sorted out.
- [87:33]
Dr. Rangan Chatterjee
Wow. It's pretty remarkable, isn't it?
- [87:35]
Dr. Victoria Sampson
Yeah. And they showed Also an improvement in spermatic parameters. So the. The quality and the motility of the sperm also improved when the periodontal disease or any other oral disease was improved as well.
- [87:46]
Dr. Rangan Chatterjee
Yeah, this. This whole idea of this interconnection between all the different parts of the body is. It's just profound. We know in medicine that if a man starts to complain of erectile dysfunction, it could be the first sign of coronary artery disease. So we're trained to know that if that's happening, we must also screen them for coronary heart disease, risk factors, blood pressure, do the blood tests, all that kind of stuff, because, again, we're talking about blood vessels and the blood vessels in the heart, blood vessels, other parts of your body, you know, the health of them is not completely separate. And it goes back to what you said at the start. Right. For me, this idea that the mouth and the body are not separate, but it goes bigger than that for me. For all the advances in modern allopathic medicine, of which there have been many incredible ones, I think one of the weaknesses is the separation between mouth and body. But even within the body, between heart and lungs and kidneys and guts, we have specialists for all of these different organs. And it's just really clear when you look at the science, actually, these things are all linked. Things don't happen just in one part in isolation. Do you know what I mean?
- [89:17]
Dr. Victoria Sampson
Yeah, yeah, massively. I think it's a really big issue with modern health care, I think, is that we are all stuck in our own little bubbles of our specialties. And you're totally right, if we want to really achieve full body health for a patient, we need to be looking at every single system and organ in the body and try and get everything to be connected.
- [89:39]
Dr. Rangan Chatterjee
Yeah. And you do that in your clinic, don't you?
- [89:41]
Dr. Victoria Sampson
We try. It's hard. So, yeah, we have tried to integrate a lot of medicine into the dental practice. So we do blood tests, IV drips, we do gut and oral microbiome testing, we have a nutritionist, we have a functional medicine doctor. We are trying to, again, just put the mouth back into the body and connect everything.
- [90:02]
Dr. Rangan Chatterjee
Patients must love that. I would imagine.
- [90:04]
Dr. Victoria Sampson
They do. Yeah. I mean, I would say from our side, running the clinic, it's logistically very difficult. And part of that is, for example, like, NHS hospital records, the medical and the dental are not integrated.
- [90:19]
Dr. Rangan Chatterjee
Yeah.
- [90:19]
Dr. Victoria Sampson
And it's like. Like the amount of research that you could get to connect the dental and medical together would be phenomenal. And it's just things like that Where So instead we have to sit there. Even our dental booking systems, we can't integrate medical into it. So we have to have two different booking systems and two. I mean, it's just the way that our society is, is that it's two separate things.
- [90:41]
Dr. Rangan Chatterjee
Yeah. The mouth is the window, isn't it? Into the rest of the body.
- [90:45]
Dr. Victoria Sampson
Yeah. So we're trying to also do at the clinic is like kind of create a hub where we can collect lots of data and try and strengthen that mouth body connection. So during checkups, we have the option to check patients blood pressure, we check their blood glucose levels, their vitamin D levels, and also obviously their microbiome as well.
- [91:05]
Dr. Rangan Chatterjee
But that's really fun, right. When I say fun, I mean that's really exciting because what it means, if I think about it through the eyes of a patient, you're coming in, let's say, because there's a problem with your tooth. Right. So, okay, I've neglected my health for years, my oral health, so I'm gonna go and see a dentist. But just the fact that you then offer blood testing and blood pressure and all this other stuff, it's starting to put in the mind of the patients.
- [91:34]
Dr. Victoria Sampson
Yeah.
- [91:35]
Dr. Rangan Chatterjee
That my mouth health is not just about my mouth health.
- [91:39]
Dr. Victoria Sampson
Yeah, yeah, exactly.
- [91:40]
Dr. Rangan Chatterjee
Which I think is brand new information for a lot of people.
- [91:43]
Dr. Victoria Sampson
It is. And even when we do a checkup, a lot of the time we say like, medically, is there anything that we need to know about? Are you on any medications? And previously a lot of patients would be like, oh, it's nothing that you'd need to know about. And I'd be like, what does that mean? And then like, it turns out I check their medical history and they have diabetes, heart disease, high blood pressure, they have everything.
- [92:01]
Dr. Rangan Chatterjee
But it works both ways. Like, I would argue that the medical profession actually perhaps need to be educated more about just how important dental health is.
- [92:09]
Dr. Victoria Sampson
Yeah, exactly. Right.
- [92:10]
Dr. Rangan Chatterjee
Because I'm pretty sure in a lot of type 2 diabetic consultations, I'm sure there'll be some clinicians who are doing this, but in many consultations, they're not also being told about their mouth health. So this is something I'm really passionate about. When that patient is sitting in front of you as a doctor, you may only get them once. Right. So how you interact with them, the language you use, whether it's empowering or disempowering, the tools that you offer to them, you may only get one hit. So I've always taken that really seriously. You must be very Careful what you're saying. And even if you just, you tell them about their blood sugar results, but say, hey, listen, there's a strong association with your oral health. When did you last go and see the dentist? Yeah, you may not be able to do anything about that as a doctor, but just dropping it into their heads means that they walk out, they get their car, they're driving to work and thinking blood sugar. But yeah, actually, you know what, I haven't checked. I haven't gone to the dentist for two years. Maybe I should. Which is why I think it's so, so important.
- [93:17]
Dr. Victoria Sampson
Yeah. And on the flip side, from our side, as a dentist, we often will see patients much more regularly then they will see their doctor. Because unfortunately most people go to the doctor when they're sick, but they should be going to the dentist for a six monthly checkup or for their hygiene. So if we can pick up things in the dental setting, such as high blood pressure or elevated blood glucose levels, and refer that patient effectively to their doctor, then we can actually flag those issues before they become real problems and treat it.
- [93:48]
Dr. Rangan Chatterjee
And this oral microbiome testing that, that you offer, I know you're involved with creating an oral microbiome test. You're very motivated, you really wanna make a difference and actually get this out there to people, which is really exciting. I've got mine sitting at home. I haven't actually done it yet, but I'm going to do it. Cause I can't wait to see what comes out of it. For people who've heard this conversation and are thinking, actually I wouldn't mind doing it, do they have to book in to see you or can they just go online and get it done themselves?
- [94:19]
Dr. Victoria Sampson
So actually you can go online and get it done yourself and it will give you a beautiful snapshot of what's going on inside your mouth at that moment. We do always recommend that you do go and visit your dentist or hygienist after getting these results. And often. So I check every single patient's results and I write my own clinical comment at the top of it. So it does not replace the need to go to your dentist, but it might urge you or push you to go to your dentist. And it, it can kind of empower you to have more understanding of what's going on inside your mouth.
- [94:52]
Dr. Rangan Chatterjee
And for people who do want to, you know, take advantage of that, which, you know, I'm sure a lot of people probably haven't heard of oral microbiome testing. Right. So where do they go? What's the website.
- [95:05]
Dr. Victoria Sampson
So the test is called Oralis1.
- [95:08]
Dr. Rangan Chatterjee
So that's O R A L I S1, Oralis1.
- [95:13]
Dr. Victoria Sampson
Okay. And the website is thslabs.co.uk.
- [95:19]
Dr. Rangan Chatterjee
Okay. So people can go there. So that's the UK address. People listen to this show all over the world. Can people get it in different countries or is it just UK at the moment?
- [95:29]
Dr. Victoria Sampson
At the moment, just uk. But actually we're hoping by beginning of January we'll be expanding. So we've got a waiting list. So even if you can't buy it right now, send us an email or inquire and we can put you on the waiting listen and let you know when we're open.
- [95:44]
Dr. Rangan Chatterjee
And from what you've seen so far, I mean, first of all, how long has this specific test been around for?
- [95:51]
Dr. Victoria Sampson
So we launched it mid October. So we've been working on it for two years or so, but launched mid October.
- [96:00]
Dr. Rangan Chatterjee
Okay. And just so I'm being fully thorough in this conversation, what would critics of the test or oral microbiome testing say? Or do you know?
- [96:12]
Dr. Victoria Sampson
Yeah, you know, I do. Oh, they're shouting at hard and loud.
- [96:17]
Dr. Rangan Chatterjee
Because I think it's always nice to talk about this because then you can address it, basically.
- [96:21]
Dr. Victoria Sampson
I really appreciate that. So I would say some critics have an issue with. They say that, okay, fine, you can test your oral microbiome, but what are you going to do about it? How is that going to change the treatment that your dentist might provide to you? And my argument for that is that we give you recommendations in terms of maybe supplements or we've worked with nutritionists and functional medicine practitioners on lifestyle improvements as well for your gum health. But we are not saying that we are going to cure your gum disease through using a mouthwash. So you still do need to see your dentist and you still need to have maybe the traditional treatment that you normally would, but we would supplement that with potentially lifestyle, food, nutrition choices, or even just fine tuning your oral products. So telling you what toothpaste would work best for you, the sole kind of aim of this test is really a communication tool and to empower patients to understand more about their oral health. And this goes back to what we were saying at the beginning, that patients are scared of going to the dentist. They don't trust us, they don't understand what is going on in their mouth and how important it is for the rest of their body. And in my opinion, auralis1 answers all of those questions for a patient.
- [97:37]
Dr. Rangan Chatterjee
There's a range of people who listen to A podcast like mine, there is a subset of listeners who are really, really motivated about their health. Right. So they want to know everything. They really want to look after themselves and make those 1% gains or whatever it might be to keep themselves well for as long as they can. I'd probably put myself into that category. So I hear a test like that and I'm like, first of all, I'm doing it right, so thank you for bringing up that kit. Right. I'm definitely gonna do it and I'll encourage my wife to do it as well. Okay, so, and then let's say I get the test done right, and let's say some imbalances are identified. Is it the sort of thing or is it too early to know where I can then make some changes, you know, apply some of the recommendations and then in six months time, recheck to see if there has been a change in my oral microbiome?
- [98:34]
Dr. Victoria Sampson
Yes. And that's why, for anyone who's thinking why she named the test Oralis 1, it's because Oralis 2 is going to be coming out soon. And that's a retest tool. So the Oralis one, it looks at over 500 different bacteria. It zooms into the top 20 bacteria that we know are associated with gum disease, decay, bad breath. And then we also zoom in even more into the strain levels of the certain bacteria that we know are really, really bad. So going back to the Alzheimer's, we're talking about P. Gingivalis, and it releases these ginger pains. We look for those gingipains. We also look at genetic mutations. So we look at 10 genetic mutations that we know will make a patient more inflammatory, increase their risk of gum disease, make their saliva more acidic, which means they have a higher chance of decay. And that's Oralis 1. Oralis 2, we cut out all the mutations. We don't need to retest those. Nothing's going to change. But we look at the strain levels, the bacteria, and the ratio of all of your bacteria to see whether or not the recommendations we've given you have indeed improved your oral health.
- [99:38]
Dr. Rangan Chatterjee
And I guess also for early adopters who want to get involved with, with this, can I say new technology. Cause it feels new to me. I spend my life thinking about health and talking about health, and this feels like a new something I haven't really heard that much about yet. I guess you guys are also gonna be doing research, right? So as people retest and as it's developed in five years time, if you're sitting here Having this conversation with me, I suspect if we mirror what's happening, Gut Health, not only with the amount of research explode like it did with gut Health, but you'll probably have a much more nuanced understanding, I guess, of how often should we test, you know, what's the optimum for a certain patient, what recommendations are consistently working for everyone, which might mean some people don't even need a test or do you know what I mean? I think it's still early days, right?
- [100:30]
Dr. Victoria Sampson
It is early days, yeah. And we're working with dental professionals at the same time so that they're actually providing the testing to their patients. Patients and they're funneling back information on what their findings are. We have a team of biostatisticians who are looking at all of the data and trying to actually find correlations and connections, and then that will give us new areas that we can research. And we are also connected to a couple of universities where we're going to be starting to do some research trials with those places. Because the issue with the oral microbiome is just there's not as much research about it than there is the gut microbiome. And I think that where we have a beautiful hub of information and data and we're already seeing some crazy things like. Like musculoskeletal disorders. So we have a lot of patients who have certain musculoskeletal disorders and they weirdly keep on having the same oral biomarkers. All of them have the same biomarkers in their saliva. So it's things like that where it's like, we're super early days, but there's some really exciting and promising things coming up.
- [101:36]
Dr. Rangan Chatterjee
Before we finish, can you just mention a case that I've heard you talk about before? And this really speaks to this link again, I know we keep hammering home this point, but it's important, right? The mouth is the gateway to the rest of the body.
- [101:49]
Dr. Victoria Sampson
Yes.
- [101:51]
Dr. Rangan Chatterjee
You're talking about this bidirectional link between the mouth and many areas of the body. We haven't really gone into autoimmunity. We touched on it a little bit. But I believe there was a case where you saw someone with rheumatoid arthritis and you managed to help them in perhaps quite an unexpected way. Is that fair to say?
- [102:11]
Dr. Victoria Sampson
Yeah, definitely. Even myself, I was not fully convinced of every single mouth, body connection. And is there really going to be such a huge improvement in their general health if I improve their oral health? And so I do treat a lot of patients who have Rheumatoid arthritis. And I have a lot of rheumatologists who refer their patients to me. And so there was one patient in particular, was my first patient who I'd done any work with, and she was under the care of a rheumatologist and a functional medicine practitioner, and she had been seeing multiple functional medicine practitioners, and she was on a ton of steroids, and she was really not happy. And so she finally went to this guy, and this guy was the first one to say, when was the last time you went to the dentist? Dentist, how's your oral health? She was like, oh, I've had, like, six teeth taken out in the last year. And he was like, that's not normal. Like, you shouldn't be having six teeth pulled out. So he was like, look, I have a friend called Victoria. Will you go and see her? She likes testing people's saliva and doing weird things. So, like, maybe you could just meet her. So obviously, I tested every. All her saliva, did everything. And she had really bad gum disease. And we did a lot of treatment on her. We helped improve her gum disease. We stabilized it completely. And actually after that, about six months later, she was able to get off her steroid medication and be medication free, and her rheumatoid arthritis improved significantly. So it's not to say that, you know, I cured her and was amazing, but I think that with most diseases, they're so multifactorial, and this was a really big piece of the puzzle for her.
- [103:53]
Dr. Rangan Chatterjee
For her.
- [103:53]
Dr. Victoria Sampson
Yeah, exactly. For her. And no one had addressed that. And just by addressing it, her general systemic inflammation reduced to a point where she was able to get off medications.
- [104:05]
Dr. Rangan Chatterjee
Yeah, I love that. Thank you for sharing that. It's such a powerful case study that gives hope to people. But beyond that, there is that wider point, which, again, I just think we miss so much. Like, we look at all of these separate diseases as separate entities without realizing that a lot of the time, time, it's the same risk factors that in different people manifest in different symptoms and different diseases. We've all got a genetic predisposition to certain things. And if, let's say through the lens of the four pillars, if your food is off, your movements off, your sleep's off, and your stress is off over time, that is going to create in some people, symptoms and then disease.
- [104:51]
Dr. Victoria Sampson
Yeah.
- [104:52]
Dr. Rangan Chatterjee
And what disease you end up getting from those imbalances will hugely be influenced by your genetic predispositions. And therefore, although we study these diseases as separate, the way I practiced for Many years was to go, well, what are the root causes? Let's look at all of these root causes and see which ones we can address in an individual patient. And for that person, gum health, oral health was a big driver of inflammation. Yeah, Right. It might not be for someone else. So someone else with rheumatoid arthritis who's got really good gums, for example, they may not see an improvement, but for that person, it did, definitely.
- [105:33]
Dr. Victoria Sampson
Yeah, 100%.
- [105:34]
Dr. Rangan Chatterjee
And I kind of think we miss this so much in medicine. Vittoria, it's been so wonderful speaking to you. I think you're doing something phenomenal and even creating this oral microbiome test. I know it's early days yet, but it's really exciting if we see where gut health has gone over the last 10 years. Years. It's exciting of me to think, well, where might, you know, oral health and oral microbiome testing be in 10 years? If people want to follow you online, where's the best place to go?
- [106:03]
Dr. Victoria Sampson
Probably Instagram. So that's just Dr. Victoria Sampson or our clinic, which is the Health Society Mayfair.
- [106:10]
Dr. Rangan Chatterjee
Okay, fantastic. And then lastly, if someone's stumbled across this conversation.
- [106:17]
Dr. Victoria Sampson
Yeah.
- [106:18]
Dr. Rangan Chatterjee
And it's dawned on them that they simply have not taken their oral health seriously and the penny has dropped today. And they thought, actually, you know what, I need to sort this out.
- [106:32]
Dr. Victoria Sampson
Yeah.
- [106:33]
Dr. Rangan Chatterjee
Okay. What would you advise them to do?
- [106:40]
Dr. Victoria Sampson
Book an appointment with their dentist. And their hygienist might be a bit biased. Come over to our clinic. We'll also check your blood pressure and we'll check a few other things for you. But if you're not ready to come to your dentist yet, even just some of those really simple things that we've talked about. Brushing twice a day, two minutes. Spit, don't rinse, rinse, water out after you've eaten a meal. Those are all small steps into a better direction. And once you're ready, then you can come and visit your dentist or your hygienist, or you can do an oral microbiome test and start your journey.
- [107:19]
Dr. Rangan Chatterjee
Dr. Victoria Sampson, thanks for coming on the show.
- [107:22]
Dr. Victoria Sampson
Thank you so much for having me.
- [107:28]
Dr. Rangan Chatterjee
Really hope you enjoyed that conversation. Do think about one thing that you can take away and apply into your own life. And also have a think about one thing from this conversation that you can teach to somebody else. Remember, when you teach someone, it not only helps them, it also helps you learn and retain the information. Now, before you go, just wanted to let you know about Friday 5. It's my free weekly email containing five simple ideas to improve your health and happiness. In that email, I share exclusive insights that I do not share anywhere else, including health advice, how to manage your time better, interesting articles or videos that I've been consuming, and quotes that have caused me to stop and reflect. And I have to say, in a world of endless emails, it really is delightful that many of you tell me it is one of the only weekly emails that you actively look forward to receiving. So if that sounds like something you would like to receive each and every Friday, you can sign up for free@drchatterjee.com Friday 5 Now if you are new to my podcast, you may be interested to know that I have written five books that have been bestsellers all over the world covering all kinds of different topics Happiness, food, stress, sleep, behavior change and movement, weight loss, and so much more. So please do take a moment to check them out. They are all available as paperbacks, ebooks and as audiobooks, which I am narrating. If you enjoyed today's episode, it is always appreciated if you can take a moment to share the podcast with your friends and family or leave a review on Apple Podcasts. Thank you so much for listening. Have a wonderful week. And before you go, I just want to let you know about an exclusive January offer. If you want to listen to every episode without having to hear any of the adverts, you can do so with an Apple subscription. We're extending the free trial from seven days to 30 days, so if you want to take advantage of this offer and support the podcast and enjoy every single episode advert free for an entire year, just go to the Apple Podcast app and subscribe. And always remember, you are the architect of your own health. Making lifestyle change is always worth it because when you feel better, you live more.