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The Neuro Experience
How Your Mouth Reveals the First Warning Sign of Menopause | ft. Dr. Leedia Riman
00:56:53
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- [00:00]
A
Your saliva is the golden elixir in your mouth. Our salivary glands have estrogen receptors. 85% of menopausal women have xerostomia. Dry mouth. And it's because of that salivary drop.
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B
Nearly one in two women will experience gum disease after menopause. And most of them are told it's because they're not brushing or flossing enough. What if the real cause isn't your toothbrush? It's in your hormones?
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A
I believe it needs to be the standard of care where we test the microbiome for every single woman, any woman going through a fertility journey to post menopause.
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B
You're a biological dentist. What is that?
- [00:37]
A
That is a pillar of full body health. When I do my exams, the last thing I look at is your teeth.
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B
Joining me today is Dr. Lydia Reiman, a biological and integrative dentist who's helping women discover the bridge between their hormones, oral health, and whole body well being.
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A
What's in your mouth travels to the rest of your body.
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B
How do those pathogens get there?
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A
When your estrogen drops, your microbiome starts to shift because you have less blood flow, you have less collagen, less strength.
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B
We uncover how declining estrogen changes the mouth from bone density to blood flow, and why your oral health could be the first warning sign of hormonal imbalance. Your gums are on fire.
- [01:17]
A
Her tongue. And that is one of the symptoms that can occur when you're going from perimenopause to menopause with that estrogen decline. What?
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B
I'm Louise Nicola and this is the Neuro Experience. Well, hello, my friend. Welcome.
- [01:32]
A
Hi. Thank you. Happy to be here.
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B
I'm so excited to be here. We met. We were brought together by friends in the industry, and once I heard your story, you're so remarkable, I had to bring you on the podcast. The podcast is very much geared towards human optimization, but also helping midlife women navigate this stressful time, which is defined as perimenopause and menopause. And what we don't hear a lot of is how our oral health and microbiome can be linked to this transition. So why don't you tell everybody what you do? You're a biological dentist. What is that?
- [02:12]
A
It is integral. It is a pillar of full body health. So when I do my exams, the last thing I look at is your teeth. I go through nutrition, I go through past experiences, I go through hormonal fluctuations. If you're a woman, from puberty to egg freezing to ivf, how many rounds of ivf, number of pregnancies, miscarriages, abortions. Each one of these is a season that your body has gone through and it does show up in your mouth. Birth control, how long you've been on birth control for. So I look at things from a completely different perspective, from a root cause perspective. And then when I look at somebody's mouth, it kind of like puts everything together with the microbiome testing that I also do for everybody. Your microbiome is different than mine. We're bi individual. So biological integrative dentistry, we gotta integrate. We can't just look at teeth. And I went to a great dental school. I went to UCLA School of Dentistry. I'm very proud of where I went. It was a wonderful four year program and they made us really great technicians. You see a cavity in a tooth, you drill it, fill it. Beautiful. But we also gotta bring back the critical thinking and the bio individuality for each patient.
- [03:30]
B
So you're doing a very thorough patient history, which is so different to when I went to the dentist. And they just, you know, open your mouth and let's look around in the cavities. And I find that so interesting. And that's why I brought you on. And I'm first going to open up with this question. Can you explain what's actually happening in the mouth when estrogen starts to decline?
- [03:50]
A
Such a great question. I love this question. So did you know that our salivary glands have estrogen receptors? So our parotid and our submandibular glands have estrogen receptors. Alpha and beta, the two types of estrogen receptors. So there is a lot of estrogen receptors. Our oral mucosa also has estrogen receptors.
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B
Oh my God.
- [04:12]
A
Our jawbone, our alveolar bone, Voila. Exactly, has estrogen receptors. So our periodontal ligaments have estrogen receptors. So the increases during certain times, like pregnancy and fertility treatments, et cetera, impact our mouth. And during perimenopause and menopause, that decrease causes a lot of the way I would say it, you have a light in a room. When you have good estrogen, you're beautifully lit up. And then when the estrogen drops, it starts to dim and things start becoming a little more difficult from speaking, chewing, because there's a decrease in salivary flow and not only a decrease in salivary flow that happens with estrogen decline, it's also salivary quality, which ties into microbiome.
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B
So we have salivary glands which are responsible for.
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A
Your saliva is the golden elixir in your mouth. And it's produced by your salivary glands. So we have salivary glands down here and here, your submandibular salivary gland glands, and your parotid saliva. Those are the main ones. There's a lot more, but those are the main ones. And in our salivary glands, we have estrogen receptors, beta and alpha estrogen receptors. So when there is a decline in these estrogen receptors, that has a huge impact on the salivary flow and the salivary quality that we produce.
- [05:43]
B
That's so interesting.
- [05:44]
A
I read Something Wild before I came on the show because I was doing some more research that American Dental association just came up with the fact that 85% of menopausal women have xerostomia dry mouth. And it's because of that salivary drop.
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B
I never understood that.
- [06:03]
A
Yeah. So xerostomia is dry mouth. It's very uncomfortable if you're going through it. But it's not only uncomfortable, it's really incredibly not harmful. But it sets off your microbiome, so it shifts your microbiome. So even if you had a great, healthy microbiome, when you have dry mouth, that golden elixir that is literally showering your gums and your teeth and keeping things nice and moist and fresh, it goes away. So it becomes very pasty in there. It becomes very dry. And what happens? The opportunistic bacteria, such as F. Nucleatum, T. Denticola, T. Forsythia, those increase. And when those increase, then you get systemic implications.
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B
Oh, my gosh.
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A
Saliva's so important.
- [06:47]
B
So saliva is really responsible. It's like a shield, then. And it cleans your mouth as well, and it's fantastic. And when we don't have it and we see a decline in saliva, I mean, this is quite icky to talk about, but when we don't have that saliva, then it allows for the bacteria to come in. And I've actually seen studies that we've noted on the podcast that this F. Nucleatum is a certain bacteria that can seep into your oral microbiome, can actually be a precursor or a cause of pancreatic cancer.
- [07:21]
A
Yes. Colon and pancreatic cancer, which is so interesting.
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B
Where else are the estrogen receptors?
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A
Our mucosa.
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B
Mucosa.
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A
Okay. Mucosa is the soft tissue.
- [07:29]
B
Okay.
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A
So our oral mucosa is very similar to our vaginal mucosa.
- [07:35]
B
Yeah.
- [07:36]
A
So there's estrogen receptors down there, et cetera. And a lot of my patients, I see most of the women in our clinic, and I focus a lot on pregnancy, perimenopause and menopause, because that's when we need the most help. So there's a lot of similarities. So there's estrogen receptors on our mucosa and in our ligaments that surround our teeth. So our teeth are housed in ligaments. And then that is what we see in our alveolar. That's what sits in our alveolar bone. And we also have estrogen receptors in our alveolar bones, our jawbones, the maxilla and the mandible.
- [08:09]
B
Do we have progesterone and testosterone receptors too?
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A
Yes. Progesterone for sure? Yes.
- [08:15]
B
Because that's interesting because what I'm trying to get across to women is this trifecta of hormones. It's all about estrogen, but it's actually about estrogen, progesterone, and testosterone. And I would think that men would have an abundance of testosterone receptors there as well. And so as we experience the loss of this, that's when we can start to get even cavities.
- [08:36]
A
You described it so beautifully. Saliva is a shield. So when we lose that saliva opportunistic, our streptococcus mutants, that's the cavity causing bacteria, they start having a rave with no saliva. And then cavities start to occur. And literally I've had patients that I haven't seen within like a year, they're going through this and they come back with like six to seven cavities, specifically along the gum line. Okay, so that takes us to our peri. So we have estrogen receptors on our periodontium. So when that decline happens with our estrogen, the collagen drops as well. So over, I believe it was 20 to 30% of your collagen in your mouth drops after you go through perimenopause and menopause. That's a significant amount. So that causes recession. Recession is when your gums literally recede off of your teeth. And that causes a lot of sensitivity.
- [09:36]
B
In 2019, there was a landmark study that came out linking, this is my first, what I first saw, linking periodontal disease to Alzheimer's. And when I was looking into this study specifically, it was because of these. The bacteria was actually able to go into the gum, Travel through the 10th cranial nerve, and go up into the brain, which is interesting because the cranial nerve, the vagus nerve, is also connected the brain to the gut. So it's like this bidirectional access that you're seeing. And these pathogens are going up and down. And that was my first incline into. Oh my gosh good oral health is extremely linked to systemic disease, but also how well your brain is aging 100%.
- [10:22]
A
So women are twice as likely to have Alzheimer's if they have a poor oral microbiome. I actually just recently, last week did a microbiome test on a woman who was suffering from colon cancer or a stomach cancer. I forgot which one. But it was genetic. If you look at her, she's gorgeous, healthy genetic cancer that she has. So she sent me her stool test as well. She had high levels of F nucleatum in her mouth and high levels in her stool.
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B
Oh my gosh.
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A
I believe it needs to be the standard of care where we test the microbiome for every single woman, especially from pregnancy or any woman going through fertility, through a fertility journey to post menopause.
- [11:09]
B
You guys know how I feel about blood work. And if you care about your brain, your future, things like getting Alzheimer's disease, then you can't be flying blind for years. I'd get the standard annual labs and still walk away with questions. Why am I still tired? You know, is this stress level actually starting to damage my brain? What's happening with my hormones, my lipids, my inflammation markers? This all changed when I started using Function Health. It's the first time that I anyone has ever given me a genuine 360 degree view of what's happening inside my body. Over 100 biomarkers from thyroid and liver function to glucose, lipids, inflammatory markers, all tracked over time in one place. It's the difference between guessing and actually knowing where your health and your brain are headed. If you've ever had that little voice in your head wondering am I actually okay? This is how you answer it. Visit functionhealth.com louisa or use code NEURO100 to get $100 off at signup. This is how you take your health into your own hands. Functionhealth.com Louisa or use code NEURO100. Something shifted for me when I realized that it made no sense obsessing over my health. If I was cooking in pots and pans that were leaching chemicals which obviously caused so much harm because most traditional nonstop stick still contain PFAs. They are those forever chemicals that don't break down. And we now know microplastics and certain industrial compounds don't just affect hormones and metabolism, but they're being investigated for the impact on brain health. That's why I swapped everything in my kitchen for caraway, their pans and ceramic coated and non toxic. And they've seen me through everything from Quick solo dinners to holiday feasts. They heat evenly, they look beautiful on the stove, and they clean up effortlessly. And this means that I actually get to enjoy being in the kitchen again. So the holidays are closer than ever. So it's time to get that gift, whether it's for you or whether it's for somebody else. Visit caraway.com neuro to take advantage of this limited time offer. You'll get 20% off your next purchase. That is caraway.com/neuro to get kitchenware that is non toxic and made modern. What's the oral microbiome?
- [13:44]
A
So we have a skin microbiome, we have a vaginal microbiome, we have a gut microbiome, and they're all very connected. And if, for example, you floss and you bleed, you have a leaky gum. So there is an opening, a direct opening from your mouth to the rest of your body, to your brain and to the rest of your body. So there are 11 main dysbiotic bacteria. Dysbiotic means these, these bacteria are not good for you. They're not causing, they're causing the bad breath, they're causing the cavities, they're causing all the issues that we have. So there are specific ones that they have done very, very in depth research. So F. Nucleatum is one that has been linked to Alzheimer's and cancers. There's also P. Gingivalis. That's.
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B
Oh, that's the, that's the one linked to Alzheimer's.
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A
Alzheimer's, yes. That one is. I read an incredible article where they were able to reproduce the neuroinflammation in mice after they inoculated them with F. Nucleatum. So that one, when I see it, I take it really seriously for my patients. But there's P. Gingivalis as well. And P. Gingivalis has been linked to fertility issues, premature labors, lower birth weights. They've been able to isolate it in placentas. It travels. So what's in your mouth travels to the rest of your body.
- [15:05]
B
How do those pathogens get there?
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A
So when your estrogen drops, your microbiome starts to shift because you have less blood flow, you have less collagen, less strength. You start mouth breathing a little more as you get older. So that's why I'm always talking about mouth breathing. The biofilm. So the pictures that I send you, I'm staining the biofilm. I call it biofilm mapping. And your biofilm map is very different than mine and it's different than My mother's and your mother's.
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B
Okay.
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A
Depending on where we're living, what we're eating, how we're breathing, and how strong our body is as we're going through these transitions of life as women. So when we stain the biofilm, I am fascinated by the biofilm maps for every individual because it shows me where that bacteria is sticking to in your teeth and how long it's been there. So it's so wonderful because I get to tell you, like, hey, you're not brushing really well up here. And this is its implications because especially in women, I see a lot of circumferential decay around the gum line, and that's where they commonly miss. So when I do a biofilm map and I have a microbiome test and I show them, I'm getting amazing results. I'm getting women who are vested in their health because they see it. Have you gone to the dentist? They just do a cleaning and they're like, okay, bye. We'll see you in six months. They're doing their best. It's what we've been taught. I was taught that in dental school, too. So, like, no harm, no foul done. But I think our women deserve a little more and they deserve specific answers and specific direction because you may have a great microbiome. You don't need as much as me. I've had three pregnancies. So it's very important that we do bio individual testing. And part of it is the microbiome and the biofilm mapping that I send you.
- [16:55]
B
Yeah. One of the fascinating things is that you mentioned that a lot of women who are suffering with fertility issues, maybe they've gone everywhere, they've seen the ob, they've seen reproductive endocrinology. Nothing seems to be working. You map their mouth, you see that they've got higher levels of F nucleatum and then. Or P gingivalis maybe. And then you do your course of action to either correct the microbiome, get rid of that, and then they're falling pregnant within around two to three months.
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A
There is a research study that shows that it takes two to three months longer for women with oral dysbiosis and periodontal disease to get pregnant than if you have a balanced mouth.
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B
Do OB's know about this?
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A
They need to. We need to be working in partnership because this isn't just so. We're focusing on women now, but this also applies to the men. This oral inflammation increases sperm apoptosis. It decreases sperm motility.
- [17:53]
B
That's insane.
- [17:54]
A
Every OB needs to be talking to their patients about the dental checks, so I recommend a check at the end of the first trimester, and the second, a cleaning and a checkup. But ideally, I recommend making sure the essentials are taken care of before you even start your fertility journey, because not only is it important for you, but it's also important for your baby. We pass on our microbiome to our children.
- [18:18]
B
That's insane. Yeah, I've seen. Yeah. There's been so many studies that actually link the. What? Whatever's happening in the mother can also happen in the fetus.
- [18:27]
A
Yeah. Yeah. They say it's genetic. I think 10% of it, 5 to 10% of it is genetic. I say the majority is familial. So what's in your mouth is really impacting a lot more than you think. And if your partner or your husband has dysbiosis and periodontal disease and you're kissing, you're getting that. So it's really important to have that balance.
- [18:51]
B
Maybe they'll get these bio films that you've done and insert it on the dating apps, like. Show me your. Show me your.
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A
Show me your biofilm.
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B
Yeah, show me your biofilm. Have you seen women coming to you with all sorts of issues and then you can map it back to their biofilm?
- [19:05]
A
Yes.
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B
Okay. What are some other issues that you're seeing midlife women complain about?
- [19:10]
A
I'm usually the third and fourth opinion. When they've come to me, they've exhausted. Because we're not looking at this. We're not measuring it, too. Yeah, we need to be measured. When you measure it, you can create. You can research it. When you research it, you can validate it.
- [19:23]
B
What's a cavity?
- [19:24]
A
A cavity. You have your tooth. Your tooth is made out of calcium, phosphates, minerals. When there is imbalance in the body and the oral cavity, a cavity starts occurring in your tooth, where literally the strep mutants, that's the main cavity, produces. It produces an acid, and that acid melts your tooth structure. So that's why on an X ray, you see a cavity. It's dark because the calcium, all the minerals are melted away. And it's literally a hole in your tooth. So when you remove that. Okay, you can teach anyone to remove a cavity, but it's very important to find out why you got that cavity first in the first place.
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B
Well, we used to think it was because of what, sugar intake?
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A
Yes.
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B
Yes.
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A
Which.
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B
Primarily, it. That's one.
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A
It can't. It's a source. It's a Source. But I start looking at how are you breathing? What's your airway like? Where are you in your cycle? How many children have you had? What's your nutrition? What are you snacking on? How often are you snacking?
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B
Why does number of live births, if that's what you're.
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A
You're pregnancies.
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B
Okay? Pregnancies, not live births. Okay, so what. What. What does pregnancy have to actually do with a cavity?
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A
So when you get pregnant, you get a surge of estrogen in all your hormones, and that increases the blood flow to your mouth, and it makes you extremely sensitive to the plaque. And the biofilm map that we are able to showcase, and we make sure that we disturb it makes you a lot more sensitive to the plaque. When you're more sensitive to the plaque and you're pregnant, you're a lot more tired. You're not brushing your teeth as well. If you're vomiting, morning sickness, nausea. I was vomiting seven to 14 times a day with my first pregnancy. Yes. I had something called hyperemesis gravidarum. And that's what really got me into all of this. I'm like, oh, my God, I didn't learn about any of this in dental school. And so pregnancy does a number on your body, including your mouth. So when the blood supply increases, you're more sensitive, you're more inflamed. A lot of women are told not to see the dentist during their pregnancy because it's dangerous. Absolute myth. Please see a dentist during your pregnancy because if there is a problem starting or if you have there's something called a pregnancy tumor that occurs in your mouth. I can't believe they called it a tumor. It's not a real tumor. It's like a granuloma that occurs. High estrogen, high sensitivity. It's a literal growth that occurs, and it bleeds a lot, and it's very uncomfortable.
- [22:02]
B
And how does it show up? Does it show up like a little.
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A
Like a bump? It's a growth.
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B
Like a little cyst?
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A
Like a little cyst, Absolutely. And then it usually resolves after pregnancy. But if you have a tremendous amount of dysbiosis and you're not brushing your teeth. Well, I've gone to sleep many times without brushing and flossing when I was pregnant. I was that tired. Yeah. So I was getting cleanings every month and a half. My brother was cleaning my teeth because I was in a very compromised state. And also, what do you snack on to curb your nausea? Usually it's like the saltine crackers. It's like, you're doing your best. I'm not here eating my chicken liver that I eat usually. I'm like, surviving. So we need to support our pregnant women. So a lot more recession occurs with multiple pregnancies because of that inflammation to your gum. And then inflammation decreases. And then when you hit the perimenopause menopause stage of life, the estrogen drop just makes everything collapse.
- [23:00]
B
It's what, as I'm learning more and more, it's about the actual. It's not about the. It's about the rise and decline. It's these sharpness intervals and shifts that we have to be worried about. Which is so comparable to glucose spikes. Right. We want to maintain with glucose and insulin. We want to maintain this beautiful, steady linear process. And exactly like our blood pressure, we don't want to see these huge spikes and falls. And that's so interesting.
- [23:30]
A
And the first major spike occurs at puberty.
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B
Yeah.
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A
And that's when I start seeing a lot of gingival disease, gingivitis, in our young woman. And that's like a population that I really want to focus on because that kind of sets the tone. And here in America, they're not eating very well. Braces go on emotionally. They're not. They're compromised in a different way. And the last thing they want to do is see their dentist. And then they usually come in when the breath starts getting impacted. And the bad breath is due to also that estrogen rise and periodontal disease and decay.
- [24:08]
B
I don't think a lot of women are aware of this.
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A
No.
- [24:11]
B
Okay. So a lot of women are not really linking, like the menopause transition to oral health. But if we actually flip that, could you say that, for example, oral health can be an early warning sign of menopause, even before hot flashes and brain fog.
- [24:28]
A
Absolutely. Because when I had a woman come a few weeks ago and she went to everybody under the sun and she's like, I have burning mouth syndrome. My mouth is burning. It's tingling.
- [24:39]
B
Like your gums are on fire.
- [24:40]
A
Or her tongue, her tongue, her tongue. And that is one of the symptoms that can occur when you're going from perimenopause to menopause with that estrogen decline.
- [24:49]
B
It's wild.
- [24:50]
A
Yes.
- [24:51]
B
I didn't even know this, because when you see, like the. When you see the quote unquote, the symptoms, it's like, okay, brain fog, forgetfulness. I'm feeling not like myself. I've never heard of burning tongue. Burning tongue as a symptom of perimenopause or a warning sign?
- [25:06]
A
Yes, yes, yes. So I felt for her, and then I did my full exam. We looked at everything, and I started talking to her about hormone health. And she was like, oh, my God, I am starting to feel different. I am more foggy. I did go through mold. Like, she started putting the pieces of the puzzle together, and it just comes together. Cause what happens is that the mouth is a very intimate area. It's very important that you trust and feel good with your dentist or you won't continue going to them. Or if you do, it's rushed and you don't take the time to look at things and measure the pockets around your gums. And so I measured the pockets around. So if this is your tooth and this is your gum, I measure these pockets every single exam. Why? It's very important because a lot of times, especially in my menopausal women that decrease in estrogen, it increases MMPs, metalloproteinases. This is a. It's a protein. It's an enzyme that breaks collagen down. When the collagen is broken down into your gum, the pockets. Your mouth to your body has a very, very direct. Yeah, so it's not sealed.
- [26:18]
B
So the pockets are loosening.
- [26:21]
A
Exactly, exactly. The periodontal ligament is getting compromised. It's loosening.
- [26:26]
B
So there's a gap there that will allow for the bacteria to get in. And when they're in the gums, that means they're in the bloodstream.
- [26:34]
A
Yes.
- [26:34]
B
And then when they're in the bloodstream, that can then travel. That can cross the blood, brain barrier, evidently.
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A
And the placenta, all sorts of issues.
- [26:41]
B
Placenta, heart, everywhere, pancreas, colon, colon, all of that.
- [26:46]
A
Everywhere.
- [26:48]
B
I have been using Huel. It's a complete meal, not just a protein shake. But this is what I love about it. It has 35 grams of protein, it's got fiber, and 27 essential vitamins and minerals. So. So on the days when my schedule is stacked, I grab a Huel. On the days when I'm running between the lab, the studio, the gym, I grab a Huel ready to drink. And I know my brain and body are actually being fueled. Their daily greens cans have become an easy micronutrient insurance policy. It's got 42 vitamins, minerals, and superfoods in a light, low sugar drink that I can sit between sessions. Huel makes healthy eating super simple. They've also just launched into Target stores nationwide. So you can get it there. But if you want to try both products and get 15% off your purchase. You can with my exclusive code, which is neurohuhl.com neuro or use code neuro to get 15% off at checkout. Okay. There are days when my brain feels like it has 37 tabs open. I know it sounds crazy, right? But if I don't deliberately downshift, I pay for it in my sleep, my mood and my focus. And that's where calm has become a real tool for me. Not just an app on my phone. 10 minutes of guided breathing between meetings or a sleep story at night. It's often the difference between laying awake, replaying my day over and over again and actually letting my nervous system reset. So if you are in that fight or flight zone quite regularly, right. Sometimes that's me. And you kind of want to switch off your brain, but you don't know how. Use calm. Calm your mind. Change your life. Calm has an exclusive offer just for listeners of this show. Get 40% off a Calm premium subscription at calm.com Louisa that is C-A-L-M.com Louisa calm.com Louisa for 40% off. So my question now then becomes, can we use hormone replacement therapy to fix the oral microbiome?
- [28:57]
A
This is the hottest topic for me. It's not studied, obviously. I wish there was more studies.
- [29:03]
B
Are there studies on it?
- [29:04]
A
There's a few. Some studies say it doesn't, but I beg to differ. And some studies say does hormone replacement therapy does improve your oral health.
- [29:11]
B
So are they correlation studies?
- [29:13]
A
They're correlative, yes. Yeah. So this hasn't been studied. I've read them all. And from my experience, I've been seeing women for over 14 years now. Not only women, I see men, but mostly women. And it all started when I went to Aramco. Have you heard of Aramco?
- [29:33]
B
No.
- [29:34]
A
It's the biggest oil company in the world. I was hired to be their dentist in Saudi Arabia. One of their dentists. They have 55,000 employees. So they needed an American trained doctor that spoke the language and who was a woman for their women. And I was hesitant to go at the beginning, but my program director at UCLA was there. He was like, lydia, you gotta come. It's great. I'm like, okay, sure, let's move to Saudi. Let's move to Saudi. It was a great three year run. I had a great experience, but I saw mostly women and all the expats. So all the CEOs, the Americans, Brits, and all the women. And it was then this light bulb started going on in my head. Because money isn't a problem there. They have full access to care. Everybody has equal care. Right. Because you think, oh, socioeconomic status, they don't have access to care. No. So that wasn't a thing there. And I saw these women with complete and utter destruction in their mouth, their gums, the amount of recession, the amount of sensitivities, decay. And that's when I started digging. I'm like, I was never taught about this in dental school. Like, I know how the disease progresses, but why. Why am I seeing. And then I am seeing some of their husbands. And then I was talking to my program director. His name is Dr. Reynolds. Love him. He's wonderful. And I was like, do you see this in the men? He's like, yeah, but not to this extent.
- [30:49]
B
Like, why?
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A
He's like, I'm not sure. Like, huh. Okay.
- [30:53]
B
But why did you see so many in the women in Saudi Arabia? Is it just because you had an influx of.
- [30:57]
A
I have an influx of women. I was.
- [30:59]
B
So it wasn't that. There's something happening over there.
- [31:01]
A
No, just women. They have a lot of babies there. There's a lot of childbirth. There's a lot of vitamin D deficiency. So then I started looking at Nutri. So they don't.
- [31:10]
B
Nutritional deficiencies.
- [31:11]
A
Nutrition deficiencies. Vitamin D deficiency is huge over there. Like, I have patients that have had 13 kids.
- [31:18]
B
What?
- [31:19]
A
Yeah, 12 kids. Five. That's when the bulb started going on in my head. Like, what is it about women? Right. What about these women? Because beforehand, I was at the VA in San Antonio. That's where I did my residency. And there I only saw men. So I didn't see this in the men there. Right. So I came back. I got married, got pregnant, and then I started having gum issues. I had an infection around a front tooth. I lost the crown on my. I was walking around with no front tooth for three months.
- [31:45]
B
It was.
- [31:46]
A
Did I tell you the story? It was very sexy. Look.
- [31:50]
B
Yeah, I can imagine. And I was.
- [31:53]
A
Nausea, hyper amus, gravity. It was really, really, really tough. So then one night, I'm like, why is this. Like, this is so weird.
- [32:00]
B
Yeah.
- [32:01]
A
I've never been taught about this, et cetera. So I go on a mommy Facebook group at midnight one night. Julia was only three months old. I was really. I was not in the best place in life. And I messaged the group. I'm like, this is happening to me. Like, my gums are so sore. My teeth hurt. I have. You know, I was still without a tooth because I back actually four months before, sort Of I had a tooth back in. Anyways, has anybody else gone through this? Within one hour, I had like 200 responses of women saying, simar, I've lost a tooth for pregnancy. My dry mouth was out of control. That's when I'm like, oh my God, what is happening? So then I started reading every paper under the sun and just tying things together. I'm like, it's hormones, it's hormones. Our hormones, our salivary glands, our mucosa, it's all compromised. As we're going through these phases of life as women. The ADA also just. I saw a staggering statistic. 85% of women over 50 don't know about the menopause oral connection.
- [33:10]
B
I mean, I'm not in my 50s, but I'm mid-30s. But I don't know this. It's unbelievable.
- [33:16]
A
So that's when I'm like, okay, I think one of my life calling is to take care of this. So I started seeing a lot more women and then I got into microbiome.
- [33:27]
B
So as you were seeing these women in Saudi Arabia, what did you start to do to help them?
- [33:31]
A
The first thing that you got to do as a dentist, and a lot of dentists ask, okay, now what? So, okay, the women are going through this. What do you do? How do you help them? Right? So in Saudi, I was helping them get rid of infection. Like, if you need a deep cleaning, you get a deep cleaning. Like, you can't just get a regular cleaning. If you have infection, you need to make sure that the source of the infection is removed.
- [33:51]
B
Okay. So we've got to clean. So like step one, I call it.
- [33:55]
A
The essentials in my office. I need to take care of your teeth. I need to take care of your infections. And the infection can be in your bone, in your teeth, or your gums. Okay. I also need to take care of any toxic materials that can be in your body, like mercury in your fillings. Like, we should not have mercury amalgam fillings in our mouth. Like, it doesn't. Metal doesn't belong in our mouth. Construction site is good. We can put metal there, but not in our mouth. Like, why are we putting metals in our mouth? So especially mercury.
- [34:25]
B
So you're doing like a toxic load, heavy metals test. Yes.
- [34:29]
A
So if somebody has a lot of mercury, they have a lot of brain fog. A lot of. So that's where we look at a holistic and integrative approach to our. It's not just your tooth. You're more than a tooth, you're Louisa, I need to look at your life and what you've gone through. We take tests, and we found a lot of people with mercury poisoning. So we do hair, saliva, hair, blood and urine test to check for inorganic and organic mercury. Because not all the mercury comes from your teeth.
- [34:58]
B
It's often. You can get it through a hair analysis.
- [35:00]
A
Exactly. So that's what we do. So we take care of what I call the essentials. Once we get rid of your gum disease, we get rid of your cavities, any source of inflammation, etc. Then we have to look at making some lifestyle shifts so that we can support our bodies.
- [35:18]
B
Okay, so you get rid of this. How, though? How would you get rid of the infections?
- [35:22]
A
So, infections. So, for example, so I don't use as much antibiotics as normal because we have something called ozone in our office. We do ozone biofilm airflow cleaning. So. So we stain your biofilm so we see exactly where we need to clean. Have you ever gone to a cleaning and they just scrape the crap out of all your teeth?
- [35:40]
B
It's the most, like, traumatic experience. When they get that. That silver thing, they. And you can hear it and you're like, I just want this over. And then when you leave, you kind of feel like there's holes all in your teeth.
- [35:51]
A
Yes.
- [35:52]
B
Yes.
- [35:52]
A
Yeah. No. So we don't do that.
- [35:55]
B
Okay.
- [35:55]
A
So we only scrape where it really needs to. Where you really need to scrape. Okay. So that's why we map it. And then. So there is a beautiful technology, and this is something that I think every dentist should have. It's called the airflow technology. It's an investment, but it's amazing because it uses air and water. Air, water and powder to remove the biofilm so gently.
- [36:17]
B
Oh, that's so much nicer.
- [36:18]
A
It's much nicer.
- [36:19]
B
Less invasive.
- [36:20]
A
Way less invasive. And then after we do that, we check to see if there's calculus. Do you know the difference between plaque and calculus? So I just had breakfast. Did you have breakfast? So you have plaque on your teeth, right? Just from your breakfast. The reason you're supposed. Do you know why you should brush your teeth twice a day, morning and night?
- [36:37]
B
For breath.
- [36:38]
A
To break the biofilm. So biofilm. So right after I brush my teeth this morning, biofilm starts to accumulate on your teeth, right? And you have breakfast, and then you have your pop, and whatever you have, and it accumulates. So at night, you floss and you break it down again.
- [36:55]
B
Okay.
- [36:56]
A
We do a perfectly imperfect job at home, and that's why you need to come visit a dentist. So that they can go a little deeper. Okay. That plaque, when left for long periods of time, it calcifies, it hardens, and it becomes like little tiny rocks called calculus on your teeth. And it's very common in the areas of your glands, your parotid, and submandibular, because there's a lot of minerals in your glands. So it sticks to the plaque and it calcifies. So that's the only areas where you need, like, not only. Only areas, but that's usually where you need to scrape a little further. Okay. But not much scraping is needed if you're getting frequent cleanings. So back to the woman. You get rid of their gum infection if their gums are infected. Their body, it's a source of toxins for the body. It's. We have limited energy in our body. The last thing you need is to be fighting off a chronic infection in your mouth. It takes away from other things.
- [37:57]
B
Did you ever see. Have you ever seen pre and post hormone replacement therapy?
- [38:01]
A
I've seen it in America, not in Saudi. So hormone replacement therapy wasn't a thing there. Yet here I've seen women feeling better with better salivary flow after hormone replacement therapy, but it needs to be in conjunction with what I'm. So if you have infection, you know, infection is infection, and if you need antibiotics, you need antibiotics. Like, I'm not. It's important. But hormone replacement therapy, it's replenishing the estrogen and the progesterone, and with the amounts of estrogen and progesterone receptors that we have in our mouth, it just makes sense to me that it will improve. And I have seen. I have seen significant improvements, specifically in salivary flow.
- [38:44]
B
Yes. So maybe. So hormone replacement therapy can not only help with everything in your body. Your brain, your bones, your muscle. It can also help eliminate dry mouth because of the. The optimized salivary gland.
- [39:02]
A
Exactly. Exactly. We have a lot of estrogen receptors in our salivary glands. I want to say one more thing, too, with regards to alveol bone loss.
- [39:11]
B
Oh, yes. Guys, if you are tuning in on YouTube, Henry is joining us today for the first time on my podcast. And so we're talking around here.
- [39:20]
A
Yes.
- [39:21]
B
Yes.
- [39:21]
A
This is your album.
- [39:22]
B
Okay, great. We're pointing down where.
- [39:23]
A
This is your mandible. This is your maxilla.
- [39:27]
B
Yeah. So down there, where a lot of that actually changes as you get older, it kind of widens, which is interesting. I've seen my face change as, like. Like as I'm getting older. Yeah.
- [39:38]
A
Well, it looks great to me.
- [39:40]
B
Most of us think that hydration is for dry skin or feeling thirsty. But from a neuro perspective, if you're dehydrated it shows up as brain fog, slower reaction time, headaches, the exact opposite of how we want to feel. And I started using CURE Nutrition because I wanted something that actually replaces electrolytes without a ton of sugar or artificial colors. It's actually based on the WHO's oral rehydration science. A specific ratio of sodium, glucose and water that helps your body absorb fluid more efficiently. I hear tons of people say I drink so much water but I just don't feel hydrated. It's probably because you're not absorbing it because you're dehydrated in electrolytes. So I use these little sachets. I use it before long training sessions on flights and for those days where I realize I've been talking and thinking for six hours straight and barely touched my water bottle. For the neuro experienced listeners you get 20% off your first order at cure hydration.com neuro with code neuro and if you get a post purchase survey make sure to tell them where you heard about cure. It really helps support the show. I have been living in Vuori's dream knit performance joggers for about two months now. They're ridiculously soft, genuinely the most comfortable joggers I've ever owned. But. But they still look pulled together enough that I can wear them from a flight or straight into a meeting. They're extremely versatile, lightweight, breathable, with enough stretch that I can move, stretch or sit and write for hours without thinking about what I'm wearing. It's such a small thing, but when you stack enough of these small things like the clothes you're wearing, your environment, your routine, your brain reads it as safety. And a safe brain is a high performing brain. So. So if I'm in something stiff and restrictive, guys, after a long day, my nervous system just feels terrible. Vuori is an investment in your happiness. For our listeners. Fiore is offering 20% off your first purchase. Get yourself one of the most comfortable and versatile clothing pieces on the planet. I swear. Go and have a look at them. Look at your color. I generally wear black and white if you haven't noticed. Just go to vuori.com neuro for 20% off your purchase plus free shipping on any US orders over $75.
- [42:11]
A
We have estrogen receptors in our alveolar bone as well. When that estrogen decreases, the osteoclastic activity increases. When estrogen is at a good level, the Osteoblasts increase and the osteoclast. So osteoclasts. Osteoblasts, yeah.
- [42:29]
B
Tell me what they are.
- [42:30]
A
So osteoclasts are breakdown bone. Bone and osteoplast blasts build bone. Okay, so when the estrogen decreases in your body during perimenopause and menopause, the osteoclasts increase.
- [42:46]
B
Yeah, the breakdown of the bone. The breakdown of the bone, which is similar to osteoporosis.
- [42:50]
A
Voila. Exactly. So it's like, we know a lot about what happens in the body, in the bone, but it's very similar. Like, your mouth is part of this.
- [42:58]
B
Body and the skull.
- [42:59]
A
And the. And the skull. The skull. And it's right next to your brain.
- [43:03]
B
So what can actually happen if we see atrophy of the bone, the mandibular bone?
- [43:07]
A
So that's where. I'd love to see more research with hrt. I'm seeing I'm able to halt the progression of bone loss and alveolar bone loss by treating the microbiome.
- [43:22]
B
Oh, okay.
- [43:23]
A
I want to see more research on HRT and how that helps modulate the cellular breakdown that just happens innately. I'm able to modulate it from a microbiome perspective and external perspective.
- [43:40]
B
I wonder if that interferes with mastication.
- [43:42]
A
Saliva loss interferes with mastication, and also interferes with healing with less saliva, less estrogen, less collagen, less blood flow. Can you just imagine how elderly women are a lot more prone to infection?
- [44:02]
B
So what about, like, little hacks? Like, is there. I hate that word. But I heard that chewing gum can actually help with all of this.
- [44:10]
A
Yeah, it does.
- [44:12]
B
Okay.
- [44:12]
A
I don't love chewing gum.
- [44:14]
B
Stevia gum.
- [44:16]
A
Xylitol. Is one in there. Yeah, I don't love stevia, but xylitol, it's a sugar alcohol, and it's. It kills the bad bacteria, but also kills the good bacteria. So it's really important to support your microbiome if you are a chronic gum chewer. But for my ladies who do have that dry mouth.
- [44:33]
B
Right.
- [44:34]
A
Let's snack on carrots and celery and cucumber. Let's chew the xylitol. Let's hydrate, but let's hydrate properly with the proper electrolytes and minerals. It's not just about drinking water. Let's eat wholesome, nutritious foods. You know, it's meat. Let's eat things that the bad bacteria cannot break down. That's what I focus on. That's what I tell Them look at your plate. Can the bad guys break something down and cause acid?
- [45:02]
B
It's simple as that.
- [45:04]
A
It's so simple. Doctors love to complicate things. It's very simple. There's some things that are complicated, but things like that is very simple also. What's your stress level? Cortisol really impacts salivary flow. Are you working out? Are you walking? Are you lifting? I do the in body on everybody in my office, especially the women, because I see them a little more frequently. And when they see that as well, I get women who are like, oh, Dr. Liddy, I lost ten pounds. Can I please do the in body so I can see my muscle mass? What I love about what you're doing, you're really educating and you're really making it easy to digest.
- [45:42]
B
I mean, I hope so. That's what we hope you are. It's interesting. We've been treating gum disease as a hygiene problem, when in actual fact, I believe it's an endocrine problem problem.
- [45:51]
A
Yes. For women in Midland, it's a mix of the two. And I've seen so many women, they're like, lydia, I've done everything. Why do I keep getting cavities? I eat well. I take my nutrient, I supplement. I'm not vitamin D deficient.
- [46:04]
B
Every time I go to the dentist, they're like, okay, it's great. I don't have. And my. I think it might be hereditary. My parents in their 70s have. Fantastic.
- [46:12]
A
Familiar. You got a great microbiome.
- [46:14]
B
Yeah, exactly. I want to now move into the action segment of the podcast. I want to know daily oral routine changes for menopausal women.
- [46:23]
A
Lemon.
- [46:23]
B
Okay.
- [46:24]
A
Do you tongue scrape?
- [46:25]
B
I do now. I bought my tongue scraper, but it's very weird for me to use.
- [46:30]
A
Okay.
- [46:30]
B
I'm not used to it. It's kind of dries my mouth.
- [46:33]
A
So I can't start my day without.
- [46:34]
B
Scraping the first thing in the morning. Scrape and brush.
- [46:38]
A
Brush, yeah. So you want to brush before you have breakfast, and you want to scrape first and then. And then brush or vice versa. But I always start with scraping. So something as simple as that, scrape, tongue, scrape is so. It's. It's so good because we detox when we sleep and our tongue. Do you ever see a white layer on your tongue when you wake up, especially if you have bad breath? Please. Tongue scrape. It's. It's so important. Okay. So I usually don't floss in the morning. Have you heard of coconut oil pulling?
- [47:06]
B
Well, that was my next question. Oil pulling. Maybe even Probiotic lozenges.
- [47:11]
A
Yes.
- [47:11]
B
That's.
- [47:12]
A
Yeah. So oil pulling is an ayurvedic treatment. That's.
- [47:16]
B
It's horrible though. It's really horrible.
- [47:19]
A
It's hard. It's not. There's some people that love it. I don't personally, for me, but if you can do it, I love it for you. So that's what I tell my patients. So coconut oil pulling is really good because it pulls the bad bacteria out. So the concept behind it is that you take about a tablespoon full of coconut oil, put it in your mouth in the morning, in the afternoon, when it's not time sensitive, positive, and you swish around for 10 to 20 minutes. 20 minutes is a magic number. But if you can get to that. And then you spit it out, please, in the trash, not the sink, because it can clog up your sink. You'll see it. It looks really nice. Once you start oil pulling and you see what's coming out, you're like, imagine that stayed in there. Yeah, that's what's more gross.
- [48:00]
B
Okay.
- [48:00]
A
Like, people are always asking me, like, isn't it gross what you do? I'm like, but imagine that stayed in there.
- [48:05]
B
Yeah, that's even like goes into your.
- [48:06]
A
Stomach, it goes into your system, causes, causes the gut dysbiosis and et cetera. So oil pulling is an adjunct that I add to my especially perimenopausal and menopausal women because they're already sort of dry and the oil is a lubricant, so it helps them feel better. And then at night, it's a non negotiable to floss. You floss first, then you brush. And if, sometimes if you have cavities, you want to floss again to get the goodness in your toothpaste in between your teeth. For my perimenopausal menopausal, I usually add a rinse, either a salt rinse or a baking soda rinse. Yes. So if you are more acidic, if I've tested your microbiome and you're very. And we. So we test your saliva, we test the nitric oxide levels, we test your ph, and we test your microbiome for candida dysbiosis, et cetera. So those are the three saliva tests that we do in our clinic. And I find that you're more on the acidic side. I want you to be rinsing with baking soda.
- [49:08]
B
Interesting water.
- [49:10]
A
So 1 teaspoon of baking soda, 12 ounces of water, cut that in half. If you want to make a smaller batch rinse for 30 to 60 seconds, and it just alkalizes the entire oral cavity.
- [49:20]
B
Okay.
- [49:21]
A
To bring it all full circle. The estrogen drop, in a nutshell, increases your oral acidity. So we need to medicate that. Yeah.
- [49:29]
B
And we can do that with.
- [49:31]
A
Exactly. We can do that.
- [49:32]
B
Baking soda is the elixir to. Absolutely. I clean with it. I do everything with it.
- [49:35]
A
I love baking soda and vinegar.
- [49:37]
B
I love it.
- [49:37]
A
Yeah, me too. That's what I clean, clean with, too.
- [49:40]
B
So I've also heard that mouth taping is a huge craze right now. I have some mouth tape next to my bed, but let me tell you, sometimes I'm petrified that I'm going to suffocate and actually die if I put it on. So that's me being a hypochondriac. I haven't used it yet.
- [49:53]
A
Do you have duct tape next to you or just mouth tape?
- [49:55]
B
Exactly. So what's mouth taping going to do?
- [49:59]
A
So when we sleep, we don't produce new saliva, all of us. Okay. So if you are going through perimenopause and menopause, you are already low to begin with. You want to preserve that shield in your mouth that's going to be working all night. Okay. So when you. Mouth tape. I only tell people to mouth tape if they're able to comfortably breathe through their nose. And after they've thoroughly cleaned their nose. Okay. Or else you will feel like if you can't breathe through your nose, please don't mouth tape. If there are any, like, adenoid issues, any obstructions, please visit your A and T. So let's be responsible here. Right. And not just mouth. I don't think everybody should mouth tape unless they're able to breathe through their nose. So one thing I do before mouth tape, especially for women in the age group that we're talking about with oral dysbiosis, I add a probiotic. Yeah, And a probiotic feeds the good guys, and it drowns out the bad guys.
- [50:55]
B
Well, what's the difference? There's a prebiotic and a probiotic.
- [50:57]
A
Okay, so prebiotic. It's like the prebiotic feed is cleaning the fish tank.
- [51:01]
B
Okay.
- [51:02]
A
And the probiotic is adding.
- [51:04]
B
So shouldn't you have both?
- [51:05]
A
You should absolutely have both. Okay. Yeah. So, I mean, and I eat a very Mediterranean diet. There's a ton of prebiotics in that, like, every meal. The onions, the garlic, et cetera. There are oral prebiotics. I don't think those are needed. I love using food where I can oral probiotics if you have dysbiosis, I add that to our protocols all the time. So I have you take an oral probiotic, then you tape your mouth shut. So not only did you just rinse with some baking soda to alkalize your mouth, you added the good guys in.
- [51:38]
B
Oh, so you're having a probiotic at night?
- [51:40]
A
At night.
- [51:40]
B
Oh, that's so interesting.
- [51:42]
A
I didn't know that before you. Mouth tea.
- [51:43]
B
I thought you were meant to have it on an empty stomach first thing in the morning.
- [51:46]
A
I prefer that. I mean, you can. It's not an exact science, but if you want the most benefit. Because at night you're sleeping, hopefully for a good, good six to eight hours. What's going on in there? A lot is happening in there.
- [51:58]
B
I don't want to skip past vitamin D because you mentioned it earlier. We're huge fans of vitamin D on the podcast because we know that actually a quite recent study, a 2025 study, linked an increase of dementia by 40% with low vitamin D, which I believe is around 30 nanograms per deciliter or milligrams per deciliter, depending on where you are in the world. Yeah, yeah.
- [52:22]
A
Wow. I did not know that. But from an oral perspective, if somebody has done everything under the sun and they're still getting cavities, I look at mouth breathing and their vitamin D levels.
- [52:32]
B
How does vitamin D mechanistically link?
- [52:35]
A
Vitamin D and vitamin K2 are the two key vitamins. So I'm sure you grew up, eat more calcium, have your calcium like my grandma's. Like, have milk, have yogurt for your teeth, your hair, et cetera, your bones. It's not the calcium. There isn't a calcium shortage as much as there is a vitamin D shortages. So you need, technically, vitamin D and K2, what they do, they grab onto the calcium and they bring it into the cell and take it to the right location. You need both K2 and D3.
- [53:07]
B
Wow.
- [53:07]
A
Both. So there was a study showcasing deficiencies in vitamin K2 and D3 with regards to coronary plaque disease. And there was an excess amount of calcium.
- [53:23]
B
Wow.
- [53:23]
A
And K2 is also as magic as D3 in the dental world. And your bone quality, because you need that to modulate the calcium to get to the right cell and to the right location in the cell. So that's how it works.
- [53:37]
B
Oh, my God. That is so amazing. So key labs to check. Would it be estradiol, fsh, hcrp, vitamin D? The whole kit, the.
- [53:45]
A
The full thing. We do micronutrient testing and it's so important. So like the blood test, the microbiome test. Before any surgery, we check vitamin D levels. If you're severely low, I don't want to do surgery on you.
- [53:56]
B
What type of surgery?
- [53:57]
A
Dental surgery. Implant. Yeah, we place zirconia implants, we remove infected root canals, wisdom teeth surgery. So if you are low in vitamin D, you're not going to heal as well.
- [54:09]
B
Okay, that's interesting because to, you know, if you take a course of even 5,000 IUs, it's still going to take around, it's a hormone. So it's still going to take around 90 days for that to.
- [54:18]
A
So we got to prep your body three months ahead of surgery. Yeah, that's unless it's of course, if it's an emergency and infection and then we talk about that after. But if you're coming and you're prepping your body, we have you increase your protein intake, we check your vitamin D levels, we put you on specific supplements or if you do your own research, you choose your supplements and there are certain levels that we look for that they need to be at before we cut into your jaw.
- [54:45]
B
If you had a 52 year old woman in front of you with bleeding gums and brain fog, where would you start with her?
- [54:52]
A
I want to tell her that this is so common and she's heard and seen and we need to start with doing some testing, looking at her lifestyle, what she's eating, what her oral hygiene routine is like and then we have to start with some treatment. We don't want to get too aggressive because she's already going through a lot. So baby steps, let's fix the bleeding gums.
- [55:22]
B
Okay, let's do that. Yep. Let's figure out the root cause and also patch it up.
- [55:26]
A
Exactly, exactly. Once that is patched up and I've connected with her and I've gained her trust because who am I for her to trust?
- [55:33]
B
Me.
- [55:34]
A
Me especially. And a lot of them come to me after they've gone to many doctors. Then we start working together because I am her partner in her health journey to get her to optimal.
- [55:44]
B
So I'm going to come in very soon to do this biofilm.
- [55:48]
A
I would be honored to have you. I'm sure you're, I mean you have such a beautiful smile, great quality teeth.
- [55:53]
B
But let's you never know what's hiding under the hood. Well, Dr. Lydia, you have really provided an amazing overview of oral microbiome. It's literally link to hormone replacement therapy, but also declining hormonal levels. So thank you so much for educating us on that and thank you for being part of the youe Experience podcast.
- [56:14]
A
Thank you for having me.
- [56:23]
B
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A
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B
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A
Mint is still premium unlimited wireless for a great price. So that means a half day.
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B
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