Functional dentist Dr. Mark Burhenne explains the oral microbiome, the dangers of fluoride, and why diet matters more than brushing.
Dr. Mark Burhenne is a functional dentist, best selling author, and TedX speaker. At the core of his years of learning, practicing functional dentistry, and teaching is that the state of our oral microbiome directly affects our overall health. Known by his patients (and much of the internet) as Dr. B, Mark is also extremely caring, kind, and refreshingly optimistic about how our everyday actions can reclaim our health.
The topic on everyone’s minds lately is immune health. What is the relationship between the mouth and the immune system?
The immune system is very active in the mouth. It turns out that one of the great risk factors in COVID-19 infection rate (and even fatality) is oral health. The mouth has its own biome, just like the gut has its own biome.
The mouth has a variety of micro-environments that host different bacterial populations: the tongue, the hard palate, the teeth, the area around the tooth surfaces, above the gums, and below the gums.
There’s a lot of permeability in the mouth. Oral pathogens are involved in almost every chronic disease. The mouth is the only place in the body that a biofilm exists by design. The oral microbiome is a unique system that is integral to your health, yet it has been largely ignored by the medical community for years.
How we breathe (nasal breathing as opposed to mouth breathing) has an effect on the immune system. What happens in the mouth happens in the body.
When it comes to taking care of our oral microbiome health, which practices and products are necessary? Many of our readers live a low-waste lifestyle and want to know what’s essential so they’re not creating waste.
I applaud them, and I try and do the same. There’s a lot of waste in the oral health category. Think about all the floss, toothbrushes, and tubes of toothpaste in our landfills. I’m sure a bunch of that stuff is floating in the Pacific Ocean as well, and it doesn’t break down.
The good news is that a lot of the smaller companies are providing better solutions. I use a recycled toothbrush handle and replace the head because I really like the toothbrush. There are also wooden-handled toothbrushes so you can avoid plastic. You can also find biodegradable floss, made from silk.
Bite tablets come in a recyclable glass jar. It contains hydroxyapatite, which is a safe alternative to fluoride, and it doesn’t contain emulsifiers. The toothpaste I generally recommend is by Boka.
However, toothpaste is only 10% of the equation. If you had a perfect diet and weren’t mouth-breathing, you could get away without using toothpaste. And forget mouthwash. You don’t need it, so that saves one product and one container from the landfill.
Most modern diseases, which were nearly unknown to our paleolithic ancestors, are the result of a “mismatch” between the environments we evolved in for the last two-million years (Homo habilis) and the new environments we have created for ourselves and live in now. This is the premise Harvard evolutionary biologist Dan Lieberman puts forth in his book, The Story of the Human Body: Evolution, Health, And Disease. In other words, our bodies are matched to the environment we’ve had for most of our evolutionary history — not to the environment which we just recently created for ourselves. Natural selection has not been able to keep up with the rate of human innovations like farming, sugar, and processed foods.
The recent changes in our lifestyle create a “mismatch” for the mouth, which evolved under vastly different environments than what our mouths are exposed to these days. Our mouths evolved to be chewing tough meats and fibrous vegetables. Sugar-laden fruit was a rare and special treat for our paleolithic ancestors. Now, our diets are filled with heavily processed foods that take hardly any energy to chew — smoothies, coffees, and sodas high in sugar, white bread, and crackers to name just a few.
Can you clarify about mouthwash… It isn’t necessary? Or it’s harmful?
There are a lot of chemicals (alcohol, detergents, pesticides) in mouthwash. In dental school I was told that the mouth is a dirty place and you have to disinfect it. But it’s actually a place that needs to be nourished.
There are good and bad bacteria in your mouth, and as long as the population ratio is commensal, you’re fine. Even natural mouthwashes with essential oils are bactericidal. One health influencer burned his mouth on a homeopathic mouthwash and lost his voice. One study found that if you use too much mouthwash, it actually elevates your blood pressure.
It kills off a bacterium that produces nitric oxide. Again, this super organism – the combination of human bacteria and other nonhuman bacteria and viruses and E cells, fungi – is present in your mouth for a reason just like it is in the gut. Using mouthwash every day is like using an antibiotic on your gut every day.
Fluoride is in commercial toothpastes, and it’s in our water. Drinking fluoride treated water has been shown to lower IQ. What is your professional opinion on the safety of fluoride?
Fluoride is a byproduct of the phosphate fertilizer industry. They take this product which they would have to pay to get rid of because it is a toxin when it comes out of the smokestack, and filter it. Then they truck it to a municipal water supply and sell it, and then it goes into the water.
When we raised our three daughters, my wife and I went to distilled water right away. They didn’t get fluoride supplements, and they don’t have any cavities.
Your at home care – brushing with the proper toothpaste and flossing – should be enough. The goal is not really a removal of biofilm, but a removal of stuff that sticks to the biofilm that can produce an immune response like inflammation of the gums. Fluoride is a broad reaching kind of bandaid that has lots of implications for the health of our society.
This one was new to us when we started reading your Instagram Stories. Can you share about the benefits of mouth taping at night?
Using mouth tape forces you to breathe out of your nose (instead of your mouth). This is a simple way to reap the benefits of better sleep and improved oral health.
When you breathe with your mouth open, you are a different person because your blood pH is different. Your heart rate is higher. Your sympathetic tone is greater. Your respiratory rate is higher.
The big factor from a dental perspective is if you are mouth breathing, your oral posture is definitely altered. It’s in a state of dysfunction because you can’t breathe through your nose. And because of that, the tongue is in a different position, causing the lower face to develop in a different way. This lower face develops from birth to age six. If you are mouth breathing, you’re going to have a narrow face. If you have a narrow face, that means all the little parts of your airway have been made smaller.
Essentially, there are three boxes in the lower face. There’s the mouth box, the nose box, and then the airway box. It’s the mouth box that if it grows to its proper width, with that along goes the growth and width of the airway box and the nose box, meaning we can breathe better. But if the mouth stays narrow, vaulted arch, the tongue sits low in the mouth or back up against the airway, all of those things that we see in mouth breathers, that will determine who you are later in life.
Let’s say your child is a mouth breather, and what do you do? I have one and two-year-olds mouth taping. There’s a product called Myotape that was patented by Patrick McKeown, a breathing expert and author of The Oxygen Advantage. It’s a tape that doesn’t actually seal up over the lips. It’s more like a frame. It’s essentially what Native American women would do with their kids when they came off the breast. If the baby’s mouth was still open after breastfeeding, they would pinch the lips shut.
You don’t want your child sleeping with their mouth open all night long, so this tape pinches the lips closed. If they want to open, they can. There’s nothing blocking the airway. That means the nose will come online eventually.
Now, if there’s severe anatomical issues and they can’t breathe through their nose, it’s something beyond allergies and lack of using the nose over time, then you’d need to see a pediatric ear, nose, and throat specialist.
Is it possible to heal or remineralize a cavity?
Yes. I think a lot of people are shocked by that, but you probably will remineralize a small cavity in your mouth at some point today. Now, if you have a dry mouth and you’re eating a lot of carbs, then the process of demineralizing will have too much emphasis where the remineralization can’t catch up. It’s happening to our bones as we speak. The more exercise you do, your bones get stronger. It’s the same thing.
But yes, teeth can remineralize. You have to give your teeth a chance to remineralize, and intermittent fasting is great for that. Instead of snacking constantly where your teeth are always demineralizing, try eating two meals a day that are six hours apart, and the rest of the time you’re remineralizing your teeth. If you’re developing cavities, I recommend intermittent fasting, and of course, modify your diet and eat whole foods and grass-fed foods. Make sure you’re supplementing with K2, Vitamin A, D3, and getting enough sunshine
Do you recommend oil pulling?
Oil pulling can reduce pathogenic bacteria, like the ones that cause cavities and gum disease, in the mouth. Rebalancing the oral microbiome is one of the key benefits of oil pulling. Scientific studies show it also reduces gum inflammation, among other benefits.
Once when I was congested (which doesn’t happen as often since I started mouth taping) and my mouth was dry because I couldn’t tape, I would oil pull for three days for about three minutes maybe once or twice a day. That was enough to thin that biofilm without scrubbing it away and using caustic mouthwashes and preserving the oral microbiome because it’s not that strong of an emulsifier and it doesn’t have chemicals in it.
Oil pulling is simple. Floss and brush your teeth, then place a tablespoon of oil (coconut is the most popular) in your mouth. Swish the oil around for about three minutes, and then spit it out in the trash can (not down a drain because it can clog when it hardens), then rinse your mouth with water. If your oral health is good, oil pulling once or twice a week is enough to get all the benefits.
You can find a full list of Dr. B’s product recommendations in his functional dentistry online store.
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