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260: Oral Microbiome-Skin Rash Connection w/ Dr. Mark Burhenne

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Raise your hand if you've ever used mouthwash or bleached your teeth. Probably everyone has at some point, right? My guest today will make you rethink your idea of having a “dirty” mouth that needs to be sterilized!

Today's guest, Dr. Mark Burhenne, attended the University of the Pacific Dugoni School of Dentistry in San Francisco. In his bio, Dr. B writes, “In my 30 years of practice as a dentist, I’ve seen a lot of misinformation and people who have fallen through the cracks due to our healthcare system’s failure to understand the oral-body connection” – which is where his focus on “whole body care” really started.

Dr. B is passionate about getting people the right information they need to be healthy – a passion we share! He founded askthedentist.com in 2010 as an avenue to advance that passion. Ask the Dentist promotes oral health for total wellness and empowers people to understand how the mouth is a window into the health of the rest of the body. It's fast becoming one of the sources for the best dental advice on the net with millions of viewers per month.

Dr. B is also is the author of the best selling book The 8-Hour Paradox: How We are Sleeping Our Way to Fatigue, Disease, and Unhappiness. He recently started a podcast, and is helping connect functional dentists to functionally minded patients via a worldwide directory.

Join us as we chat on all things relating to functional dentistry- from sleep to the oral-systemic connection to the oral microbiome. (And yes, we will talk about some oral care products!)

Have you noticed a skin rash pop up after having dental work or something go awry within your mouth? Tell me about it in the comments!

Or, listen on your favorite app: iTunes (Apple Podcasts) | Spotify | Stitcher | TuneIn | Subscribe on Android

In this episode:

  • How oral health can impact + worsen skin problems
  • What is the oral microbiome?
  • Why you should NEVER disinfect the mouth
  • How bleaching your teeth could lead to dysbiosis
  • Should you DITCH toothpaste? (cankersores, anyone?)
  • Hydroxyapatite – what is it + how is it helpful for your teeth
  • Testing you can order to assess your oral microbiome

Quotes

“Anytime we talk about health, whether it's systemic health, oral health, we have to talk in that fashion as being a super organism and having this complex, interacting, synergistic system in our mouth. And when it goes wrong, it's not necessarily just the human DNA, it's a combination of everything.” [5:03]

“There's a little girdle of tissue that tries to seal off the bugs in the mouth and prevent them from getting into the body. The bad news is that it happens quite frequently. For example, every time you go in for a dental cleaning, within 20 minutes, those bacteria in the mouth are in the blood in your bloodstream… And that's called Bacteriema.” [15:38]

Links

Connect with Dr. B online

Follow Dr. on Instagram | TikTok

Check out the Bristle Test here

Order a copy of Dr. B's book: The 8-Hour Sleep Paradox: How We Are Sleeping Our Way to Fatigue, Disease and Unhappiness

Healthy Skin Show ep. 020: How Your Mouth Microbiome Can Mess Up Your Skin w/ Trina Felber

 

260: Oral Microbiome-Skin Rash Connection w/ Dr. Mark Burhenne FULL TRANSCRIPT

Jennifer Fugo: Hi, Dr. B. Thank you so much for being here today.

Dr. Mark Burhenne: Hi, Jennifer. Thanks for having me. I'm very pleased to be here. Always like connecting oral health to whatever you got today.

Jennifer: Well, I feel like a long time in the coming, we had tried to orchestrate this whole thing for a while. And I've been wanting to have a conversation more about oral health and how it connects to chronic skin issues. So I know that all of the listeners are going to be really excited for today's conversation. And I know you've got a lot of good research for us as well.

Jennifer: So let's just kick it off with where in your eyes of having been a dentist and all of your knowledge and your research, there is this amazing microbiome that lives within the mouth. We focus a lot on the skin, a lot on the gut, but we forget about this one area that I guess we brush our teeth and we think we just want it to be clean. So with that being said, can you talk to us a little bit about what the mouth microbiome is supposed to look like? And then we can dive into how that connects to different skin conditions.

Dr. Burhenne: Well, no doubt the oral microbiome is a big part of the oral systemic connection which we'll talk about how oral health can affect skin disorders. But pretty much any systemic disorder, disease, irritation. But I mean, it wasn't that long ago where dentist and the patient, all of us, Colgate, Crest, the whole oral health industry, we just thought of the mouth as an area that had to be disinfected. It just had a lot of potential for producing infections. We would see the infections, the puss, and the bleeding, and the gums, and the recession loss of tooth structure, loss of teeth, loss of tooth structure of course is cavities. And that was it. It was a very mechanistic view. But now we know better. And again, the gut microbiome is what, post-2000, it's part of this century, and the oral microbiome of course didn't take long to follow and it turns out the two are connected and the oral microbiome is probably the second largest biome in the mouth microbiome.

Dr. Burhenne: It's certainly the most diverse which is interesting. We'll talk about that, more diverse in the gut microbiome. But a lot of this is still poorly understood. This is a new thing. And again, as you know and as many of your listeners will know, things take time to switch over to the newer information. And we're in that transitional period now. You'll hear that if a study comes out, it takes 15 years for that, whatever the result of that study is to be in effect and to change the modalities and protocols and treatment and the way we look at things. And that's going to vary a little bit. But we're not there yet. And not all dentists are going to talk about what I talk about because it's not talked in the curriculum.

Dr. Burhenne: So what is the oral microbiome? It is the gut microbiome with more diversity in the mouth. And what is that? That's a bunch of bugs, 700 different species, probably more. We haven't mapped it all. We just announced that we've mapped the human genome. That was big news. I laughed when I heard that it's because there, the microbiomes, the gut, the armpit, the hair, the brain microbiome, the vaginal biome, all these microbiomes in our body haven't been really mapped yet. And they're more numerous than all the human DNA. So that's what the oral microbiome is. It's a bunch of bacteria like the gut and the other biomes. It can be viruses. It can be yeast cells, fungi. It's this very complex organism that lives on top of us, in us, synergistically it works with us. We are dead without it.

Dr. Burhenne: There are studies now with, I think, mice or with rats where, I don't know how they did this, but they removed the gut microbiome and the mice failed. I mean, they didn't thrive. And so it's clear that this is an important part of us but we're all excited about the human DNA. Well, it's really about the human DNA and this alien DNA. I mean, alien in the sense that it's not human. It's not from outer space. Although there are some people that say that the microbiome and human DNA was from a fragment of a meteorite that crashed into this fertile, lava-like planet, whatever you want to call it. And here we are after billions of years of evolution.

Dr. Burhenne: But anyway, and it gets a little Wilder than that too. There's some Stanford professors that have some crazy ideas on the biome. But I think of myself now, based on all the research and clinical stuff I've seen, as a super organism, I am not just human. I'm human and this other alien DNA. And I haven't quite figured out how the two mesh. I mean, I know a lot about it clinically through studies, and I think more is coming. So if that's the case, then anytime we talk about health, whether it's systemic health, oral health, we have to talk in that fashion as being a super organism and having this complex, interacting, synergistic system in our mouth. And when it goes wrong, it's not necessarily just the human DNA, it's a combination of everything.

Dr. Burhenne: So it's a big deal. And the oral microbiome now explains better this connection between what happens in the mouth, happens in the body. Inflammation in the mouth, ignites, stimulates, is causative for inflammation in the body. There's now a little link coming back, so it's circular. And so the mouth gets forgotten. And again, medicine and dentistry diverged a long time ago. And so it's always been the shy cousin at the party that is sitting in the corner that's been forgotten and nobody wants to talk to. So, but that's changing and functional dentistry is practicing in a more global systemic, just like functional medicine. So that in a nutshell is I think it.

Jennifer: Well. So one thing that came to mind as you were talking was this idea, and this is an interesting point you made in the beginning, is we think of our mouth as dirty. Everything is approached with the mouth as it being dirty. Do you think that that's an accurate way to describe your mouth and it's microbiome and the environment there?

Dr. Burhenne: Well if you did, then you would say the rest of the body is dirty. Your gut is dirty. I mean, dirty is a very simplistic term. It can become dysbiotic and very infection prone, but that's not something that can be cured just by disinfecting it. So that whole germ theory and I mean, it's too simplistic. We are very complex being. So no, the mouth is not dirty. It does not need to be disinfected. In fact, disinfecting the mouth, let's say you want to use a mouthwash that your dentist has prescribed to you, chlorhexidine for example, or over-the-counter, you can get alcohol-based mouthwashes, even mouthwashes with a lot of essential oils in it. All those mouth washes are bactericidal. And yes, they do have a kill rate and a kill count, and they can take down pretty much indiscriminately all the bugs in the mouth, just like antibiotics, take down the bugs in the gut.

Dr. Burhenne: And we all know that's not good. Most of us now know that that broad indiscriminate disinfection, even now people realize that using triclosan soap actually dries you out, but can also cause skin infections, even cancer. I mean, the skin absorbs things. It's the same thing with toothpaste and mouthwashes. And we have plenty of studies indicating that killing the bacteria in the mouth, especially the ones that mouthwash attacks on the back of the tongue for example, those are the ones that help produce, convert substances into nitric oxide, and that lowers our blood pressure. So we now we have two or three studies. They're 15 years old. I mean, they're not that new, although there are new ones supporting the older ones, saying that mouthwash actually elevates your blood pressure. Well, how does it do that? It's disinfecting your mouth. And the kill rate is for 10, 15 minutes, but imagine killing your bacteria in your mouth continually. The dysbiosis, it will never be able to regrow.

Dr. Burhenne: It's like spraying your garden with insecticides and pesticides. It's never going to grow. It's always going to struggle. The weeds will come out. The bad weeds will come out. Maybe the bad plants that are more resistant will come out. That's what happens in the mouth. That commensal, complex system, that super organism I was talking about, that goes awry. And then the wrong bugs become dominant, pathogenic, and then you start getting cavities, gum disease, canker sores and then other things. That when those bugs spread into the rest of the body via the mouth, three different mechanisms for that, that oral systemic connection, then you start talking about bigger diseases that start in the mouth or are aggravated by things that happen in the mouth.

Dr. Burhenne: So yeah, disinfecting the mouth. How did we ever get it there? And I blame the profession. We supported that whole notion. Crest and Colgate, the big corporations, they ran with it. So maybe that's why we got kicked out of the club back in 1839, actually. Medicine was more evidence-based back then. We were more mechanistic, mechanical. We were treating hard tissues and fixing holes and the science had enveloped. But that's not the case now. Oral medicine is highly developed and medical doctors aren't really aware of it.,Don't have knowledge of it. And then oral medical experts, functional dentists, oral pathologists, they are aware of their little niche. But again, those two need to realize what's the subset there? It's chronic disease.

Jennifer: Yeah. Well, so can you share with us a little bit about some of the connections that you see in literature or maybe you saw when you were practicing in dentistry that impact skin health? Because I think it's one of the most overlooked pieces. We'll ask people, in our practice, I have an intake form that asks clients, “Hey, have you had any dental work?” And a lot of times they don't fill it out. So my associate will go back and ask them. And they're like, “Oh yeah, I've had two root canals. I have this, I have that.” And they completely ignore any connection between what has gone on in their mouth and what could be going on on their skin. So what does the research say?

Dr. Burhenne: Well, there are many different ways. You asked when I first noticed something. So I was a young dentist and the first thing I noticed, because in dental school, I didn't get anything remotely talking about if you put a neurotoxin into someone's mouth, like a metal filling, that's going to have systemic issues. Even today, there's a lot of resistance to that amongst established dental professionals and curriculums. But what I noticed first, and this is important, young people, mostly young people, that would brush with toothpaste and let it all foam up and it would dribble out down here, the marinate lines here, and they would get little bumps and it wasn't psoriasis, it was more uticaria maybe, or it was just a reaction to what was in the toothpaste.

Dr. Burhenne: And it followed the drool line. It wasn't over here. It wasn't over here. So wherever that toothpaste made contact with, it would cause a reaction to the skin. That was the first thing I noticed. And for a while there, we thought it was fluoride. But really it's all the surfactants, the emulsifiers. It's what most people that have skin conditions stay away from, all these drying agents in cosmetics and shampoos and hairs and skin creams and all that. I mean, we know that that's a trigger. It certainly doesn't help. And it's the same thing with toothpaste, which by the way, is under the same umbrella, cosmetic goods. There's no FDA approval or an ADA approval. All they're looking for is fluoride and toothpaste. That's it. But there's a lot of stuff in oral care products that dry your skin.

Dr. Burhenne: And the oral mucosa is very fragile. It's one cell thick. It's like the gut lining, but it is skin. And then the epidermis is thicker. It's got more keratin in it of course. But it can also absorb things and it's also very sensitive to toothpaste. So toothpaste, I saw that early on. It took me a while to figure it out. There is data now. There are studies that show pictures and correlate that with certain products that are in toothpaste. The bigger connection of course is, I mean, okay, let's stick with the localized one. So then later, much later, I realized that there was a connection between acne and saliva. So if you're brushing, a lot of saliva will get just deposited in this area. And lot of kids get acne down here. A lot of it was because of this mental fold here they thought it was.

Dr. Burhenne: But I mean, it's really caused not necessarily, it could be aggravated by or predisposed by the drying agents in the toothpaste, but just saliva alone, there are bacteria in your mouth. And if they become pathogenic, there's one bacteria in particular, streptococcus, that when it gets outside and it's particularly pathogenic or virulent in the mouth, in other words, there's a dysbiosis. And most teenagers are eating junk and they're not taking care of themselves so they have this dysbiosis. They're also getting a lot of cavities. There's a connection there, of course, almost the same bug, but certainly due to a dysbiosis. That streptococcus will get out in the skin and it'll get caught in one of the pores, the follicles, I guess, and it will cause cystic acne. And there is a study on that. In the show notes, I can give you that link. I think it's a Canadian journal, Association of Oral Health and Skin Disease.

Dr. Burhenne: So again, that's a topical way of getting it from your mouth. Certainly there's this whole oral systemic condition. That's a lot to talk about. The overview on that is that there are a lot of infections that occur in the mouth that will get into your bloodstream. Bacteriemias, they can get in there several different ways. It's not just the bacteria. In other words, it's not just an infection that occurs outside of the mouth somewhere in the body. It can be injury from a toxin that is as a result of the infection or in the bacteria. It's almost like food poisoning. There's an endotoxin. There's also injury to the tissue. So there are lots of different ways that bacteria in the mouth can injure the rest of the body.

Dr. Burhenne: But typically it's through absorption, swallowing, but mostly through the blood. In other words, there's a very complex area of the mouth that is trying to prevent that from happening. And it's the only place in the body where you have this hard tissue erupt through the gums, through soft tissue and the bone. And there's a girdle, there's connective tissue, there's periodontal ligaments. There's a little girdle of tissue that tries to seal off the bugs in the mouth and prevent them from getting into the body. The bad news is that it happens quite frequently. For example, every time you go in for a dental cleaning, within 20 minutes, those bacteria in the mouth are in the blood in your bloodstream.

Jennifer: Really?

Dr. Burhenne: And that's called Bacteriema. Yep. That happens every time. But if you're healthy and you have a good oral microbiome, the body's used to that. It happens every time you cut yourself. Bacteria from the skin will get into the blood. But if you're a healthy person, the body's used to this. It's always trying to prevent invasion from the outside or from inside the mouth into systemic tissues. And the body's set up for that. But if there's a lot of dirt, for example, on your skin, that can lead to tissue necrosis. You've heard about these terrible diseases that eat away at your tissue. And that's partly due to your immune system being compromised. And then the other category would be epigenetic factors. Mercury is one of them, things that we use in the dental office, monomers. You could even argue that bleaching your teeth leads to a dysbiosis which can lead to hormonal changes, which suppresses your immune system.

Dr. Burhenne: That's bad if you have psoriasis, for example. That's a trigger. There are other things dentally related. I'm just giving you the big picture here. We can go more into depth if you want. If your mouth breathing and you can't breathe your nose, that's going to affect the histaminic response. In other words, you're going to have very dry, nasal mucosa because there's no humidified air going in and out. Nose breathing is key for so many things, but it's part of the oral microbiome and it's going to create a dysbiosis, which means your tissue will swell up even more. It's actually a histaminic response due to dryness. I mean, a lot of skin triggers are dry and cold air, for example. It's the same thing with the skin inside your nose. It needs mucus layers. It has that little hair layer that whisks away at a very rapid rate via a carpet of mucus bacteria.

Dr. Burhenne: Well, if you don't have that mucus and you're dried out because your mouth breathing all the time, which by the way, has dental origins, poor facial development, breastfeeding, lack of tongue ties, those kind of things, not being able to breathe properly then that leads to sleep apnea. So again, that's just the overview. But there are a lot of things that if things aren't going well in the mouth, it's going to trigger whatever inflammatory disease you have, whether it's psoriasis, or diabetes, Alzheimer's. In fact, oral bacterium are actually causative in terms of some diseases like Alzheimer's, not just seeding it or irritating it or promoting inflammation, they actually cause Alzheimer's. We've got those studies, the gingipain substance that crosses through the blood brain barrier from the mouth, and then stimulates amyloid plaque protein build up.

Dr. Burhenne: And the other one is heart disease. There are some direct connections there. So again, just, just want to emphasize how important the mouth is. Hopefully I'm doing a good job. I don't want to scare anyone. But here's the thing. If I had any skin disorders, anything, I would make sure that I have a really good oral microbiome. I mean, you obviously have to see your dentist. You have to get frequent cleanings. You have to have the right diet. We can talk about how to nourish the oral microbiome, not nuke it like we were talking about earlier by disinfecting it, so yeah.

Jennifer: Yeah, because the one thing I'm thinking as you're talking about all this is so a lot of the biologic drugs, for example, are impacting different interleukins or tumor necrosis factor, depending on whether we're dealing with psoriasis or eczema and whatnot. And so I have the episode for all of you listening, if you're like biologic drugs, I'm not sure what that is. I'll put that episode in the show notes so you can go back and ground your knowledge in that episode, which was great. But I'm hearing from you that there is we have the gums that are meant to be almost suction cupped around your teeth. But if that's not happening, that there's almost like with the gut, it's a leakiness factor in the mouth. So it could be the normal bacteria flora as well as unfriendly bugs that get access essentially to your blood supply.

Dr. Burhenne: Yep. And again, a lot of these bacteria were never meant to be in other parts of the body. Different parts of the body are trying to colonize in the way that is beneficial to them. But when there's a lot of crossover due to leakage, leaky gut is an example, there's going to be an inflammatory reaction. That's the first thing that happens. But in the mouth, I mean, there are a lot of bacteria that we've labeled as being just the bad boys, the bad ones. And then there's some that are great. Well, it's not really that simple. It's really about the community. For example, we have E. pylori bug, which is the one that causes the stomach ulcers. That's in our mouth. We have yeast cells in our mouth. But when they get out of control, dominant, too numerous, or the other bacteria that help keep them in check are under attack maybe due to a mouthwash or dry mouth, dry mouth, by the way is a big factor in dysbiosis because we need saliva for that oral microbiome to work well, we need a certain pH, then things go wrong.

Dr. Burhenne: I mean, it's about how the good and bad bacteria are interacting. It's not as simple as saying, “Oh, we found this one bug and we got to go after him. Let's make a pharmaceutical drug that attacks that drug.” We now know that's it's too simplistic, and dentistry, we're very guilty of that. Have been for decades.

Jennifer: Yeah. Well, so I want to ask, because I think the question is going to be how do we get away from that idea of cleaning the mouth? Because cleaning implies that it's dirty.

Dr. Burhenne: Yep.

Jennifer: What is your suggestion then? Because I would imagine someone listening to this going, “Okay, well I switched to a ‘natural' mouthwash,” which I have one upstairs. I don't ever use it, but I thought that was better when I bought it who knows how long ago. And I have a more natural toothpaste, but maybe I'm still not doing what I need to do to actually help support this area. And there may be some listeners who haven't even gone to that place and they're still using Crest or Colgate or the sensitive toothpaste because their teeth are sensitive. Who knows? So where do you start with trying to really support this area without also going crazy?

Jennifer: For me, I'm probably not going to be doing oil pulling. There's some things where I'm just like, “I don't have time for that.” And I also don't like the charcoal because it turns your teeth black and then you spit and you got black stuff all over the wall and the sink. It's messy. So what can we do practically to start actually dealing with this? Aside from obviously like you said, see a dentist, maybe find someone who's a little more holistically minded or integrative. What do we do?

Dr. Burhenne: Well, the first thing I would do, if let's say I had some skin disorder, let's just use that as an example. But this applies to so many things. One of the first things I would consider, and hopefully you're seeing a dentist or a physician that would recommend this. For example, a teenager with acne. First thing I would tell him, “Let's get off of toothpaste altogether. Let's just stop that. You've probably already stopped using certain creams on your face.” Well, toothpaste is just millimeters away. It's still being used. It does come out occasionally, but it can cause a dysbiosis in the oral microbiome. So you can use baking soda. You can use salt. You can just brush and floss. I mean, toothpaste is-

Jennifer: So brush with nothing? Brush like a-

Dr. Burhenne: Brush with nothing, no toothpaste. If I had any skin disorder on my face, especially, but I would try that. So for example, what we do in dentistry, most of us, and it works. Whenever someone comes in presents with canker sores, we right away take them off toothpaste. Off toothpaste for six weeks, canker sores resolve.

Jennifer: Really?

Dr. Burhenne: Yeah. And then, and then we'll bring in something that's more natural, something like even coconut oil with some baking soda. I mean you can do a DIY recipe. Right now, there are toothpaste that I recommend because it has one ingredient in it that I really like because it replaces fluoride. It's hydroxyapatite, but they're not perfect toothpastes. They still have emulsifier surfactants in it, drying agents. So I would stop using toothpaste altogether. Now obviously you're going to consult with your dentist. If you have a very high decay rate, you're going to have to keep putting fluoride in your mouth.

Dr. Burhenne: Yes, fluoride topically, not ingested, or hydroxyapatite. The reason I say fluoride is because a lot of dentists don't know about hydroxyapatite or it's difficult to get a prescription strength form of it. In Europe, it's not impossible. In Japan, it's not impossible. But here it is. So I don't want people to get cavities because they took away toothpaste. But that's something I would do. We know that canker sores resolve immediately within two to three weeks. And it's the same thing with any skin condition. Your question's a good one. Overall, you want to nourish promote, protect, use products that are compatible with that nourish and protect the oral microbiome. Unfortunately 99% of the products that we recommend that are out there, that everyone thinks is an oral health product, even the ADA recommends it, FDA doesn't get involved, cosmetic product again, not sure that's a good idea. But these products worsen oral health and they take down the oral microbiome.

Dr. Burhenne: So if you have a dysbiosis and a way to know would be you could test for it. There's a now a great test out of San Diego called Bristle. I'll give you the link to it. You've got a kit. Your dentist can get it for you. You can get it directly. You don't need a dentist. You spit into a little vial and you get back this nice report of the status of your oral microbiome. What's the likelihood of getting cavities? Halitosis, a gut connection score. I mean, it's fantastic. So find out. Find out if you have a skin disorder, find out more about your oral microbiome. You're probably doing everything else because that's mainstream, the medical side of things. Hopefully you haven't reverted right away to prednisone or that kind of thing. Hopefully you're trying to take care of it naturally first.

Dr. Burhenne: But as you would imagine, diet is a big aspect of the oral microbiome. So if you're feeding your mouth a lot of starches, carbohydrates, fermentable carbohydrates, junk food, processed food, if it's not a Whole 30 type of diet, or a Paleo diet, sorry vegetarians. I mean, fiber is good. Make sure you're getting your protein. But if you're eating only vegetables, truly eating and preparing them properly, those are all good things. Those are prebiotics and good foods for your oral microbiome. Not only that, the prebiotic nature of foods, but the carbs, like Goldfish crackers, for example. It doesn't have to be candy or Fruit Roll-Ups. A cracker very highly refined, you chew on it, bunches up on your teeth.

Dr. Burhenne: The bacteria that can consume that become more prevalent and they become pathogenic. So what you're doing is you're altering that community that I was talking about and you're disrupting it and you're creating a more violent, more pathogenic, damaging, dysbiotic whatever term you want to use, oral microbiome, which by the way, feeds the gut microbiome. They're connected. We swallow a liter and a half of saliva day and in that are trillions of bacteria from the mouth. So we're feeding and seeding the gut. So if you don't take care of your oral microbiome, you are going to trigger most any skin condition. Most have an inflammatory component, so.

Jennifer: I wanted to ask. You mentioned about shifting the pH balance of the mouth. What is the pH of the mouth supposed to be and do the products tend to shift the pH? Because people who have listened to this show enough know that the pH balance does matter. The pH on the skin is very specific and helps to control, regulate what's there. The pH of the GI tract is important. So is that the same for the mouth?

Dr. Burhenne: It is. I mean, the skin has a lot of variabilities because it's out in the open, what I call the pole position. The mouth is similar. When you breathe in air, a lot of things happen. The gut is hidden away in a very dark corner. And that pH is, as you said, very important, but it's easier to keep stable. But yeah, the pH in the mouth is very important and most of these oral products, it has a drying effect. And then pH is very important. 6.8 to 7.1 in the mouth, as you would think, a neutral pH. But yeah, a lot of these products will affect the pH in your mouth. And of course, as you get down into the acidic pHs, as you get lower, then you're more likely to get cavities.

Dr. Burhenne: That's when your teeth start getting demineralized. There's this equation where the teeth are, like bones, they're always remineralizing and demineralizing. They're fixing themselves as they lose calcium, and it's this equilibrium,.but if it becomes more acidic, then the remineralization side of the equation is wasted. It just can't catch up with the loss of tooth structure and that's how we get cavities.

Dr. Burhenne: Now you can make that worse. It's not just oral care products. Even worse are acidic drinks like sodas, even a diet soda. Diet sodas are actually more acidic than regular sodas. They add aspartic acid to give it that tartness because it's an artificial sugar, wine, coffee, a lot of acidic drinks, even teas, tap water. I lived in an area once that had tap water, the pH was 5.5.

Jennifer: Oh wow.

Dr. Burhenne: I mean that's when demineralization begins at 5.5. We know when teeth start dissolving in the mouth. We know the pH. Now if you're there for a few minutes, let's say you do do lemon juice in the morning and rinse with water. Don't brush of course for a half hour. The body can can adjust. But if you're in this low pH demineralization mode all day long, guess what? You're not only going to get gum disease, you're going to get holes in your teeth. That's cavities.

Jennifer: So if somebody is drinking lemon water all day long, that might be problematic?

Dr. Burhenne: Yeah, that would be problematic, yeah.

Jennifer: Uh oh.

Dr. Burhenne: Yep.

Jennifer: Uh oh for everybody listening. Because I've had people ask me, “Isn't it good for liver detox?”

Dr. Burhenne: It is.

Jennifer: People claim that lemon water is this panacea of… and I'm like, there could be a downside.

Dr. Burhenne: Yeah. Well, I do apple cigar vinegar first thing with a tall glass of water and then I rinse with water. I don't brush for about an hour. My wife does as well, but she has coffee in the morning. I have a fermented iced green tea. I mean everyone has their guilty pleasure. Both are good. Coffee's fine. But you don't want to be scrubbing your teeth. A lot of people will scrub their teeth after tea, after wine, after coffee, because they're afraid of the staining. Well you're in a acidic state and you're probably brushing off layers of enamel which may be able to repair themselves. For example, the perfect example for me was when I practiced in the Silicon Valley, I had a lot of programmers as patients, as you could imagine, Google, Apple, Facebook. They would sit in their cubicles and they would sip.

Dr. Burhenne: And of course it was all free to them. You would just go down the aisle, grab whatever foods you wanted. So snacky foods, they would be snacking on crackers and they could be healthy crackers, doesn't make any difference, rice puffs and then a Diet Coke, for example, or even a fruit juice. I mean, that's acid all day long. Our ancestors weren't doing that. They were walking, the hunting and walking and migrating. And then if they were lucky they had one meal maybe before dinner, before it got dark. I mean, and then they would sit by the fire. I mean, totally different lifestyle. And these are all mismatched diseases, mismatched to our lifestyle.

Jennifer: Yeah. Everything that you're speaking about, I feel like I could go in a million directions because there's so many different connections between what drives inflammation. And I have a million questions to ask you, too, about root canals, but that's for another day. But I feel like we definitely have to sit down and make some time to go even deeper into some of the research. I think this is really helpful because I feel like one thing I've noticed in my own journey is that as soon as you get into something, you're bombarded by a million things you need to do. Otherwise, if you don't do all these things, then you're failing, so why bother? And most people get overwhelmed.

Jennifer: And I appreciate what you've shared, that they are simple places to start and that you, too have some matcha, your wife drinks some coffee. You're very much living in the real world, not saying, “Don't do any of this. You'll fail if you do it.” You've actually provided us some really good practical steps of here's how to live in the real world right now, that most people can appreciate. And I think this is a really great place to start because if you don't, it's easy to get overwhelmed and do nothing.

Dr. Burhenne: Absolutely. And it gets very depressing.

Jennifer: I don't want anyone to feel that way.

Dr. Burhenne: You have to start somewhere. You're not going to live a toxin-free life in this world currently. It's hard to have the perfect diet. But if you do 80/20 and you're knowledgeable and you're doing 80% of it right, you're going to have a good life, I think. I mean, you just have to be aware of this. And that's why it's great to pick your favorite Instagram feed and I mean, that's why we have our Instagram. We try and post daily. It's a way to help make that behavioral change and to keep you motivated and keep you positive. I mean, I need that. I put post-its. If I'm trying to pick up a new habit, I put post-its wherever I'm supposed to perform that habit.

Dr. Burhenne: So for example, tongue scraping. I need to do more tongue scraping. I got a slightly elevated halitosis score on my Bristle test, for example. I did really well in all the other areas. I have a perfect oral microbiome except for halitosis. So I now am tongue scraping more. And how do you do that? Well, I'm not going to tongue scrape in front of the TV. My wife won't allow that. So I put a blank post-it in front of the mirror. And when she's not around, boom, I just go in there. It just reminds me. It's simple. So one step at a time. It is easy to get overwhelmed in today's world. I mean, look at it. It's crazy out there

Jennifer: It is. And you have a great website, too. I mean, obviously you've got a bunch of resources online. I also appreciate that you've intentionally created resources that are not fear based. Because I don't like the one aspect of the health and wellness industry that has predominantly-

Dr. Burhenne: Been shaming.

Jennifer: Pushed on the fear-

Dr. Burhenne: And the shaming part of it.

Jennifer: Right, and shaming.

Dr. Burhenne: Dentists are great at shaming our patients. That's got to go. That doesn't work.

Jennifer: No, long term, it doesn't keep people with those healthier habits. And so your website, AskTheDentist.com is an excellent resource.

Dr. Burhenne: Thank you.

Jennifer: You've got your Instagram feed. Is there anywhere else that people can connect with you or find what you're sharing?

Dr. Burhenne: Well, I mean, the website and the IG feed, AskTheDentist, both @AskTheDentist, that's a great place to start. If you do have some issues you think with snoring, which basically means your oral microbiome is probably dysbiotic because your mouth is falling open. That's going to dry you out at night. That right away is a sleep issue. So you could go read my book on sleep apnea. That's just a, again, non-shaming, quick way to get the information. I discovered this when my wife and I discovered that we had sleep happening in our forties. And it was again, we're both healthcare professionals in the industry and we couldn't navigate the system. And that's why we wrote the book. My daughter and I actually wrote the book.

Dr. Burhenne: And it's just a four hour read on getting there quickly. But if you're concerned about your oral microbiome and your mouth is open all night, for example, or you're snoring, you have a dysbiosis in your microbiome. I mean, there are other reasons you'd want to fix that, of course sleep, but yeah, that would be a great place to start. And then my email is on the website and we've got a podcast as well, Ask The Dentist. You can ask a question there. And so just reach out and ask the dentist as they say, right?

Jennifer: Yes. And we'll definitely put a link to all of that as well as to your book, The Eight Hour Sleep Paradox, How We Are Sleeping Our Way to Fatigue, Disease, and Unhappiness. I just want to thank you so much for being here and for making the time. And I am actually really excited for the next time we sit down and do this.

Dr. Burhenne: Definitely.

Jennifer: Because I feel we just have so much more to unpack.

Dr. Burhenne: Oh, fluoride, root canals. It all starts in the mouth, Jennifer. Sorry.

Jennifer: I do agree with you and I feel this is why we need to share and enlighten and encourage and support people to ask better questions, and like you said, baby steps start integrating in better habits one day at a time.

Dr. Burhenne: Totally. I agree with you. Thanks for having me on the show. I appreciate it. It was fun.

Jennifer: Thank you so much. Yeah. Thanks for being here.

“Anytime we talk about health, whether it's systemic health, oral health, we have to talk in that fashion as being a super organism and having this complex, interacting, synergistic system in our mouth. And when it goes wrong, it's not necessarily just the human DNA, it's a combination of everything.”


Jennifer Fugo, MS, CNS

Jennifer Fugo, MS, CNS is an integrative Clinical Nutritionist and the founder of Skinterrupt. She works with women who are fed up with chronic gut and skin rash issues discover the root causes and create a plan to get them back to a fuller, richer life.


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