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Oral Health with Dr. Ryan Nolan: Rational Wellness Podcast 92

Dr. Ryan Nolan discusses Oral Health with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Itunes, so more people will find The Rational Wellness Podcast]

 

Podcast Highlights

4:35  In Functional Medicine, the health of the gut is one of the keys to our overall health. Dr. Nolan explained that the gut is the distribution center of the body and it’s also where a lot of bacterial interactions occur, so the gut is going to determine how healthy you are.  If your gut lining is leaky, then bacterial toxins are going to get released into your system. Think of a castle as the gut and the mouth is the moat. If the castle door is open, then you want to make sure that they don’t get past the moat. If the mouth is not very healthy, then the patient is more likely to have heart disease or diabetes. The mouth is the gateway into the gut.

6:42  There is a connection between periodontal disease and Alzheimer’s Disease.  According to Dr. Nolan, periodontal disease is the diabetes of the mouth because periodontal disease can affect every organ system in the body. If you have periodontal disease, you most likely have bone loss. If you have inflamed gums, then you will have bacteria that can easily get into the blood stream, such as spirochetes, which have been proven to cause heart disease. If you have periodontal disease, you are five times more likely to get Alzheimer’s.

11:10  We know that the mouth is the most vascular area of your body and a small infection in your mouth is the equivalent of your whole forearm being completely infected. But patients don’t realize this and sometimes ignore infected teeth for years.

12:53  There is a controversy about whether it is better to get a root canal or an implant?  One of the problems with root canals is that it is not possible with the very complicated canals that the roots and nerves travel in to get all the bacteria out, so some say implants are better. Dr. Nolan said that even though you can’t get every single bit of bacteria out, but that doesn’t mean that it will turn into an infection or that the tooth will fail. He said that if there is enough tooth structure left, he will lean more towards root canal. If there’s not enough tooth structure and we don’t think we’re going to get at least 10 years out of the tooth, then it is better to do an implant.

15:19  Oral DNA is a company that allows us to assess the oral microbiota using PCR DNA analysis.  We can look at periodontal and other oral pathogens.

20.45   A biofilm is an array of bacteria stacked on top of each other that act as a functional unit and dental plaque is such a biofilm.  Brushing and flossing and using a healthy mouthwash with some natural biofilm busting agents can be helpful, though commercial mouthwashes or rinses with antibiotics can be harmful to the healthy bacteria in the mouth.  Also the natural pH of the healthy, commensal bacteria in the mouth are between 7.5 and 8, whereas the pathogenic type bacteria that lead to dental caries are acidogenic and acid tolerating species.  Some of the bacteria in the mouth will adapt to the conditions in the mouth. If you eat a lot of sugar and the pathogenic bacteria start releasing acid, these commensals will also start releasing acid in order to compete with the pathogens, so it is the conditions that make these organisms act in a beneficial or a harmful way.  It’s a bad idea to use mouth rinses that contain antibiotics, since they are ineffective at breaking up biofilms and they lead to antibiotic resistance.  Most commercial rinses are also very acidic, which tends to promote the pathogenic bacteria and leads to the demineralization and breakdown of the teeth and leads to dental caries.  Saliva, which naturally has a pH of 8, naturally helps to break down plaque and allows calcium to penetrate into the plaque and stop the demineralization that is resulting from the acid buildup of the plaque.

32:22   Dr. Ryan has developed a mouth rinse product that is alkaline with a custom engineered nano silver compound in combination with a plant compound that helps to break down the biofilm and allows the calcium in the product to penetrate and alkalinize the plaque.  It also allows saliva to penetrate the plaque, which also helps to alkalinize the area and protect the teeth. It is called NanoSilver Mouth Rinse and is available at Elementa Silver. Here is a link to the paper that Dr. Nolan and his fellow dental researchers published on the effectiveness of using a  Nanosilver mouth rinse to prevent dental caries: Anti-caries Potential of Silver Nanoparticles via Modulation of Free Calcium Activity within the Plaque Fluid of the Oral Biofilm: A Pilot Study.  

 

 



Dr. Ryan Nolan is a dentist and researcher in private practice in Orem, Utah.  His research has a focus on the role of biofilms in the oral cavity and his biofilm busting mouth rinse is available at elementasilver.com

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.



 

Podcast Transcripts

Dr. Weitz:            This is Dr. Ben Weitz with the Rational Wellness podcast bringing you the cutting edge information on health and nutrition from the latest scientific research, and by interviewing the top experts in the field. Please subscribe to the Rational Wellness podcast on iTunes and YouTube and sign up for my free ebook on my website by going to drweitz.com. Let’s get started on your road to better health.  Hello, Rational Wellness podcasters; thank you so much for joining me again today, Dr. Ben Weitz here. For those of you who enjoy listening to the Rational Wellness podcast, please go to iTunes and give us a ratings and review. That way more people will find out about the Rational Wellness podcast and please subscribe either an iTunes or YouTube or wherever you get podcasts.

So our topic for today is oral health. And I’m happy, we have dentist Dr. Ryan Noland with us today.  Like in the gut, there are healthy bacteria in the mouth that are beneficial for us. We can refer to this as the oral microbiome or microbiotic, and it’s estimated that there are 500 to 700 different species of bacteria, that’s right, in your mouth that can exist there. And there’s even an online human oral microbiome database. Any of these bacteria are helpful, known as commensal, sometimes we get an overgrowth of some bacteria that throws the oral microbiome out of balance.  We could also get pathogenic bacteria, or viruses, or fungi that can grow there and cause problems. Microorganisms in the oral cavity have been known to cause tooth decay, periodontitis or gum disease, and various other oral infections. It’s also known that most of these oral infections are caused by a group of organisms organized in a biofilm; rather than by a single pathogen. This biofilm on the teeth is generally referred to as dental plaque, I believe. There’s also increasing evidence linking bacteria in the mouth to cardiovascular disease, diabetes, pneumonia, preterm birth and other conditions.

Dr. Ryan Noland is a dentist and researcher located in Orem, Utah, and he’s been focused on the role of biofilms in the oral cavity; and he’s developed a type of specialized mouth rinse product to target these biofilms and raise the pH, and improve the health of the teeth in the mouth.  He’s published a scientific paper focused on this product entitled Anti-caries Potential Of Silver Nano Particles Via Modulation, A Free Calcium Activity Within The Plaque Fluid Of The Oral Biofilm: A Pilot Study.  Dr. Noland also has a podcast, the Biofilm Factor. Dr. Noland, thank you so much for joining me today.

Dr. Nolan:            Oh, hey, thanks again for having me, appreciate it.

Dr. Weitz:            Before we get to the tough questions or before we get to the scientific questions, I’ve got to ask you, is your dad a baseball fan? Because every time I write your name, I go “Noland Ryan, no, no, Ryan Noland.”

Dr. Nolan:            So it’s funny, so we’re Canadian, originally, so I’m American naturalized; so I’m a US citizen, but so we’re all from Canada. Mom and dad didn’t know famous baseball pitcher.

Dr. Weitz:            Okay.

Dr. Nolan:            But, from a strange turn of events, we ended up living in Dallas, Texas, for six years.

Dr. Weitz:            Really?

Dr. Nolan:            So, yeah so when I lived there, everyone called me Noland like it was my first name; so I got used to that. Then I moved back to Chicago and I didn’t … People would say, Ryan, I’d go “Who’s that, that’s not me, I’m Noland.” So, yeah, it ended up affecting my life a little bit more probably than you think. But yeah, no, no, he’s great, I still watch some of the older stuff that everyone follows; but I have no baseball skills, unfortunately, can’t help you there. But no, no he didn’t even know, my parents were clueless as to this famous pitcher, but yeah.

Dr. Weitz:            Okay so in Functional Medicine, which our podcast is really focused on, we often focus on the health of the gut as one of the keys to our overall health-

Dr. Nolan:            Absolutely.

Dr. Weitz:            And the oral cavity is really the first portion of our intestinal tract. So can you talk about the importance of the oral cavity for overall health.

Dr. Nolan:            Absolutely. So, if you consider the body a bunch of windows, I would say that basically the first window that really reflects what’s going on in the body is your mouth. But the reason why that is, is because the second window, which is your gut, is actually the most important part of your entire body.  The reason why is it’s because the distribution center.  It’s where all the energy goes, it’s where everything gets distributed and piled, and it’s also where a lot of bacterial interactions with the body also occur.  So naturally speaking, the gut is really going to determine how healthy you are. If you don’t have a functioning gut, if the lining is leaking, if for some reason there’s a bacterial overgrowth or other kinds of bacteria that are releasing toxins; those are going to get into your system. So it’s essentially like, how would I put this? The mouth is probably the moat, and if the castle door is open, that would be the gut. So you don’t want to let them get past the moat; that would be kind of my thinking about it.

And we see this a lot with patients that come in, they have a horrible mouth, and it’s … I can almost to the “T” tell now, look at someone’s mouth and be like, “Okay, this person probably has a good chance of heart disease, probably has diabetes, probably has this.” And believe it or not, nine out of 10 times, I’m usually right and it’s sad, it’s really sad.  But basically, we look at the mouth as more of a gateway into the gut, and since the gut is such an important feature of how our health functions, especially our immune system, it just ends up being a pretty damning representation of how things are going.

Dr. Weitz:            Yeah, no I totally agree with everything you’re saying. In fact, I was just talking to Dr. Vojdani, who’s going to speak at our Functional Medicine meeting tonight-

Dr. Nolan:            Nice.

Dr. Weitz:            And there’s a connection between periodontal disease and Alzheimer’s disease, because of that gut brain connection, etc.

Dr. Nolan:            Yep. So basically if you look at it, people who have periodontal disease … I always say this and I don’t think I’m alone now in saying that periodontal disease is the diabetes of the mouth. The reason why is periodontal disease affects every organ system in your whole body. It is not an isolated issue to the mouth, these organisms are able to, basically, get through these junctional epithelium. If you notice, anyone whose got periodontal disease, they have bone loss.  But on top of that, they have constantly inflamed gums, and so basically these organisms can easily get into the bloodstream, at that point, because there’s no junction that basically prevent that. Typically, a lot of the organisms that cause these diseases are motile, meaning that they have very good ability to move around.  And one of the organisms, in particular, it’s called a spirochete, it kind of looks like a corkscrew. These things have been directly, not correlated, but actually proven to cause coronary artery disease, so we know that they can increase your risk for a heart attack, among other things. And it’s nuts, because when you really start thinking about it, that’s just one of the issues, people with Periodontal disease-

Dr. Weitz:            For people who aren’t familiar with spirochete, these are a particular type of bacteria and Borrelia burgdorferi, which is the cause of Lyme Disease is a very prominent spirochete.

Dr. Nolan:            Absolutely. And I was just gonna say too, there’s been recent studies coming out linking periodontal disease to … Well, it’s already linked to diabetes, as you know, but it’s also linked to Alzheimer’s. And if I remember correctly, the one study said that if you have periodontal disease, you’re five times more likely to get Alzheimer’s, which is nuts, okay. So some stuff going on in your mouth, you’d think it’s be isolatory, it’s actually affecting your entire body and not just your brain, your heart, or any of these other things.  I think the other thing we should mention too, just real quick is a lot of research has been done as how the gut functions. And one of the things that when periodontal bacteria, they get into a home where they’re really not supposed to be in. So they’re in a foreign home, but they end up having this mechanism whereby they can start controlling how certain gut functions.  So they can actually … Every time you eat, the gut actually tissue opens ups to accept the nutrients to go into your bloodstream. So they can find ways of getting not just through bloodstream, through your mouth, but also once they’re in the gut, it’s like they have free highway ride to wherever organ they want to be in. And that’s really scary because we know that they’re … And if they’re in a home they’re not supposed to be in, they’re going to cause more damage.

Dr. Weitz:            Yeah, I understand. Once in the mouth, there’s actually a route directly to the brain through-

Dr. Nolan:            Yes, yeah so-

Dr. Weitz:            Some of the nerves pass through, right?

Dr. Nolan:            Yeah, so it’s more prevalent, actually, in your front eye teeth, so your canines. There’s been people who have died because they got an abscess, or an infection closer to that area because there is actually a connection to the brain through the blood way path going forward. I don’t remember all the anatomy, I just know that there’s been a lot of cases where people have gotten abscesses in that region are hospitalized and die. And that’s really scary.

Dr. Weitz:            Yeah, I know some Functional Medicine practitioners who, in a hacking sort of way, will sometimes use certain nutrients in the mouth [or the nose] in a certain hacking form because they’ll be taken into the brain and actually help improve brain function also, so.

Dr. Nolan:            Well, you say that, it’s funny because we know that the mouth is the most vascular area of your whole body. So, basically, if you have a small infection in your mouth, now it might only look small, but that would be the equivalent of being your whole forearm covered in essentially being completely infected in terms of surface area. Because if we look at all the blood vessels, that surface area is equivalent to basically your whole arm having an infection. And I don’t know anybody who wouldn’t go to the hospital if their a whole arm was infected, but they don’t see it that way. And so, it ends up causing so much damage, even if you don’t think it. I had this patient and he had waited and waited … He had an infection from one of his wisdom teeth.  He waited and waited and waited; didn’t realize it was an issue. So we took the thing out, and he came back a week later and goes “Doc, I’ve never felt so good in my entire life. I can’t believe what that was doing. I was constantly getting sick, my immune system wasn’t working properly, because I had this infection that I was fighting for 15 years because I didn’t go to the damn dentist.” And so we know these things are happening, and to deny it is just ludicrous, to me.

Dr. Weitz:            So, did you do a root canal or did you do an implant?

Dr. Nolan:            For that one, since it was a wisdom tooth, it was actually, believe it or not, semi impacted and so it actually required removal. So that wasn’t something we had to replace, because wisdom teeth are the spare tires of the mouth. So we never ended up having to do that, it was just lucky that it was where it was and didn’t have to lose a functional tooth.

Dr. Weitz:            What do you think about the whole controversy about when you do a root canal, it’s really hard to get the last bits of bacteria out from the complicated canals and that-

Dr. Nolan:            Oh sure. So, as a dentist, I can tell you just clinically, you’re never, ever, ever going to be able to remove every single little bit [of bacteria]. You have to do the best that you can with the technology that we have. Luckily, things are getting better. I actually started using … The tools are getting better, let’s put it that way. Now nothing’s perfect, just like with what you do, nothing’s perfect. But look, I would say probably about 90, 95% of the root canals that are done, are done to a very high standard, especially in the United States.  I mean, people here are great. I can’t say without a doubt that some of them are not going to fail; however I, in my personal opinion … So I have a root canal, okay, if that gives you an idea. I cracked my tooth chewing on ice.

Dr. Weitz:            So like a root canal versus implant, you come down more into the root canal side?

Dr. Nolan:            If there’s enough tooth structure remaining, I lean towards root canal.

Dr. Weitz:            Okay.

Dr. Nolan:            If there’s not enough tooth structure, and we don’t think we’re going to get at least 10 years out of it, then we that we do an implant because it just makes more sense, at that point, to do it. But no, you’re completely right. Look, some of these canals systems are so complex, that no matter what you do, you’re never going to be able to get it.  However, there is this idea of threshold levels of bacteria.  So even if you miss something even just a little bit, is it going to develop an infection?  It really just depends on how much bacteria were in there or how much didn’t get cleaned out.  So we can still see … I’ve seen these cases with guys that had half done root canals from the 1960s or earlier and the tooth never had any issues. So it’s hard to say, because it’s like, how is the immune system, how is all these, so there’s a bunch of factors. But generally speaking, we just do our best, and we hope that it works out, and if it doesn’t, then the second option is an implant, and usually those are very high success, so.

Dr. Weitz:            How do we assess the bacteria in the mouth? Is there a reliable way to test the oral microbiota?

Dr. Nolan:            There is, there’s a couple of companies that are coming out with more sophisticated methods using PCR which is DNA analysis. So one of those companies is Oral DNA; I’ve used them pretty extensively. And it’s pretty cool because what you can do, is you can actually get an array of periodontal or decay effective causing bacteria, or even fungus and get an idea of exactly what’s going on in that person’s plaque, or saliva, or whatever. Because basically what we’re looking at is we’re looking at threshold levels.  Once you start understanding disease only occurs at a threshold level, that’s where pathogenesis occurs.  So we just only going to start seeing pathogenesis if certain kinds of bacteria are all the above threshold levels.  And they’re ranked in order of individual pathogens in terms of their risk and it’s like you’re saying though planktonic bacteria, which are just bacteria by themselves, and biofilms are completely different animals.  And if you think … I used to think early on, so I’m in my 30s, every bacteria’s bad, get rid of them all, you don’t need them, they’re horrible and, by the way, these are the three that cause disease, end of story, close the book. Now we’re kind of looking at it like, “Wait a second, is that true or is that pathogenesis more complex than that?” And what I mean is when we look at pathogenesis, it’s evolved to be … Okay so there’s commensal bacteria and there’s pathogenic bacteria.

Dr. Weitz:            Commensals are good bacteria-

Dr. Nolan:            Yes.

Dr. Weitz:            And pathogenic are bad bacteria.

Dr. Nolan:            Right. So there’s inherently bad bacteria and there’s inherently good bacteria. I mean some to the extent have even been studied showing that they actually release calcium in the event of a carries attack. Meaning, let’s say you have a lot of sugar, and some of these bad actors start releasing acid, as a result, which we know it dissolves teeth. Some of the good bacteria, say, “Hold on a second, we’re going to release some calcium to help the host because we want to survive with the host.”  And then there’s others that they want us to sequester the calcium out, so there’s a constant battle of titans really going on between these bacteria. What I’ve shifted my focus to is kind of the newest … And I talked to you a little bit yesterday about this, but I’ve kind of shifted to the newest paradigm and this hasn’t been well adopted. So I’m still kind of on the front end of exception, I guess. But I kind of feel like it’s the conditions that set whether or not an organism is going to lean towards being more commensal or being more pathogenic; it’s not a pure, this is commensal and this is pathogenic all the time.

And the reason is because certain organisms adapt to the conditions which you give them; meaning that there’s some commensal bacteria pH of seven, that when you put them in an environment of pH five, all of a sudden they have to compete with a pathogen and they develop more pathogenic features in order to compete.  So they start releasing acid as a response, as well, and that comes from stressors and things like that. So, so we look at it, not just from a purely genetically or originally this is commensal or abnormal conditions, but rather, does the condition to determine whether or not it’s more commensal or more pathogenic?

 



Dr. Weitz:            We’ve been having a great discussion, but I’d to pause for a minute to tell you about a laboratory that I believe in and that we use their testing in our practice. Many practitioners understand that the gut is central to overall health and wellness; especially Functional Medicine practitioners. The medical literature indicates that an unhealthy microbiome, that’s the gut and our colon and other mucous membranes in our body, is associated with a variety of chronic illnesses; including autoimmune disorders, cognitive function, among others.

That’s why Diagnostic Solutions Lab developed the GI map. The GI map uses the most advanced quantitative PCR based technology to detect microbes that can cause illness and gut problems. This DNA based technology looks at bacteria fungi, viruses and parasites to see why many culture based stool analyses simply can’t fight.

Precise results offer previously unseen window into our gastrointestinal health. And insights allow functional medicine practitioners to personalize our treatment plans to address the underlying causes of illness, rather than merely treating symptoms. When your patients present with GI complaints, don’t just guess, test with the GI map from Diagnostic Solutions. And if you’re a patient, ask your practitioner to run the GI map for you. And now we’ll get back to our discussion.



 

Dr. Weitz:            So what are some of the most important ways to take care of the mouth and the teeth in terms of brushing, flossing, is water picking good?

Dr. Nolan:            Yes.

Dr. Weitz:            And what is the goal. Do we want a certain … We talked about biofilm a little bit, maybe why don’t you explain what a biofilm is.

Dr. Nolan:            Absolutely. So a biofilm is an array of bacteria, so individually bacteria, which come together and kind of a Tetris stack. So if you ever played Tetris, and you’re trying to get rid of all the blocks, you’re actually just rearranging the blocks in a certain order. And what we’re actually seeing from studies now is that they’re specific orders in which certain bacteria like to attach the tooth, and then they attached to another bacteria, and then they attach to another bacteria.  And depending on what kind of stacking occurs actually can determine pathogenesis, but you got to remember with threshold levels, if there’s more bad actor around, you’re going to have a worse stack. And so you’re more likely to have a more pathogenic stack, if that makes sense. It’s like if you’re playing Tetris and you’re getting behind, and you can’t seem to find the right block, everything just kind of comes together, and you lose the game.  It’s not a fun, but basically it’s a myriad of bacteria that come together and act as a functional, single unit. So together, they’re acting and combining all their features, which is why we have such difficulty dealing with them because now you have bacterial resistance mechanisms from one organism.  But guess what?  It’s being complimented by two or three other organisms, now, and those organisms have the defenses that that one doesn’t have, and so they work together just like a community to kind of prevent things from happening that will affect them and kill them.

Dr. Weitz:            Now biofilms can be helpful or harmful, is that right?

Dr. Nolan:            Yeah.

Dr. Weitz:            I mean, I mean if the good bacteria are forming a biofilm to improve their survival, then that’s a good thing, right?

Dr. Nolan:            Yes, absolutely. So like I said, I think that there’s definitely … You can’t paint them all with the same brush. However, that being said, the second you remove a biofilm, whether that be brushing or through chemical methods, it actually re-establishes within seconds.  It’s not like you have to worry about eliminating everything, I mean, there’s always going to be bacteria; we’ve evolved with bacteria.  So, I don’t think the ultimate goal is entire elimination.  I think the goal is to reduce threshold levels of bad bacteria, compliment the good bacteria, and set up conditions whereby it mimics what your saliva and what the natural human body wants to do; which is to just keep it enough at bay all the time. So it’s more of a maintenance issue, than it is an elimination issue.  And that’s a key distinction that we’re perceiving because it used to be like “Oh, you gotta get rid of.”  You can’t get rid of it, it’s always going to be there, so you just kind of have to accept what you have and set the conditions up for the host.

Dr. Weitz:            So therefore, products that contain antibiotics that might just wipe out a lot of healthy bacteria-

Dr. Nolan:            Sure.

Dr. Weitz:            Are not the way to go, right?

Dr. Nolan:            I would never, ever recommend antibiotics unless you absolutely need them.

Dr. Weitz:            And some of these mouth rinses have them, right?

Dr. Nolan:            Yeah, so this is kind of how I’d put this. Let’s say you have a sniper rifle, and you know exactly which person in the crowd that you need to kill; to make sure that things don’t go awry, because we’re looking out for the guy on the podium. And instead, what we do is we just basically hack and slash at every single person in the crowd; we save the guy. It’s the most archaic way of dealing with the biofilm; and not only that, antibiotics are one of the least effective ways of dealing with biofilms, because biofilms or about 1,000 times more resistant to antibiotics.  So there are companies which have come out with antibiotic rinses. Gosh way to give yourself antibiotic resistance without actually taking the antibiotics orally; what a mistake. I mean, I actually just made a post about this the other day; there’s an image floating around online, and it says … I’m sure you’ve seen this 10 year challenge thing where everyone’s showing them their pictures for 10 years ago, and they’re showing their pictures today.  So someone got a picture of a Petri dish with three or four different types antibiotics and showed that in 2009, there’s actually a clear border where the bacteria won’t grow. And then they showed a picture in 2019 and there’s no border; they’ve literally all become resistant to all four different antibiotics in the span of 10 years sitting on a dish. So the point is that antibiotic resistance is scary.

We know that these organisms, especially in a biofilm are much better at getting co-evolutionary mechanisms like sharing DNA, sharing resistance features. So why would we want to limit the things that’s currently working for systemic infections and things like that?  Why would we expose bacteria and give them a free shot at getting resistance because of a mouth rinse, when there’s other solutions out there?  It’s just, to me, that was my mind. That’s so archaic; are we trying to reinvent the wheel here like at putting spikes on it? The point is, it’s just to me that’s very, very not prudent and stupid, really, to be honest.

Dr. Weitz:            Right. So what you’re saying essentially is, don’t use some of these commercial mouthwashes that claim to kill all the bacteria because they have antibiotics in them and they’re really, ultimately, going to be harmful for your oral health?

Dr. Nolan:            Yeah, additionally, I should say-

Dr. Weitz:            Likewise, toothpaste that happens to have it as well.

Dr. Nolan:            Oh yeah, you wouldn’t want any antibiotics in your oral care regimen. The other thing is to say about these commercial products. One of the things that we really looked at, when we were looking at commercial products, is they are so acidic. And it wouldn’t seem like it’s an issue because a lot of these things, even though they’re acidic, they do kill bacteria. But they don’t do so in a fashion that really sets you up for a win after. So what do I mean by that? A lot of the organisms that cause disease in your mouth love acidic conditions.  So you’re giving … So let’s say you use something and not could it dissolve your teeth because it’s acidic, let’s say it does kill some bacteria and then just leaves the acid behind as it slowly deletes away. Now we’re setting up a condition where every organism got a free pass to an environment they love. So they’re going to multiply and come back even stronger and happier; it just doesn’t make sense. So, I looked into this and I really, really put a lot of thought into it. And what I ended up finding is the part of the reason why this is is because they don’t have preservative mechanisms that work in the alkaline range. Meaning that they, literally, have no choice but to use preservation and techniques and antibacterials, because they only work in acidic conditions; which blew my mind a little bit.  Because if you’re thinking about it, now we’re using archaic systems that only kind of work, we’re giving some of the bad bacteria some advantages, were dissolving teeth in the process; and on top of it, there’s nothing that seems to be being commercially made in the alkaline range. Which is where, by the way, your human saliva if simulated, is close to a pH of eight.  So why the heck are we not mimicking what your body’s naturally trying to do?

Dr. Weitz:            So the natural mouth pH is eight, you said?

Dr. Nolan:            So there’s something called unstimulated saliva and stimulated saliva. Stimulated saliva is basically where your body starts releasing saliva; it happens throughout the day, but let’s say you’re chewing gum or you have something you’re eating. The pH of your saliva actually goes up when that happens. So yeah, so your saliva likes to be in a probably about a pH range of seven and a half to eight; that’s the ideal range for-

Dr. Weitz:            Is that … And I know bacteria, some, in the gut, acidophilus, are acid loving bacteria.

Dr. Nolan:            Correct.

Dr. Weitz:            Got more alkaline. So when you’re talking about a pH of above seven, you’re talking about a pH that’s alkaline.

Dr. Nolan:            Correct.

Dr. Weitz:            Being a bacteria is the mouth, the healthy ones generally prefer more alkaline environment?

Dr. Nolan:            Yes, so commensal bacteria are seven or above. And it’s funny because even some of the bad actors stop releasing acid when the biofilms’s at a pH of seven, seven and a half or eight. They don’t seem to be able to function properly, and it reduces their threshold levels as a result to low enough levels that they essentially act as a pseudo commensals.  Meaning they’re providing competition, but they’re not exerting pathogenesis.  And so we’ve actually determined that this is the primary reason why.  So if you set the playing field in the host’s advantage, which is us, you’re going to have a better chance of not exhibiting disease, perhaps.  The other thing I should mention too, real quick, and it’s a little more advanced but there have been studies on calcium and fluoride penetration into the plaque. Obviously, these things are helpful, once they get into the plaque. The question is, do they actually get there? And the answer is no. So one of the big issues and what saliva actually does for us is it actually not only kind of breaks down the plaque, it actually releases calcium into the plaque, but it sometimes can take up to an hour or two.  So we know that’s the mechanism of how things work. So there’s been studies done on how much of these agents can actually get into the actual plaque where the interface between the tooth is where all this de-mineralization and acid build up is occurring.

Dr. Weitz:            So just let me stop for a second.

Dr. Nolan:            Sure.

Dr. Weitz:            So one of the things you’re talking about is the plaque on the teeth, which is hopefully what you’re getting rid of with brushing and flossing, and when you go to get your teeth cleaned, that that plaque can lead to a breakdown of the calcium and de-mineralization of the teeth?

Dr. Nolan:            Yes, sir-That’s correct. So, um, what we’re finding is that the penetration ratio of neutralizing agents is only about one to two percent; that is abysmal. And not only that, at a low pH, even … So at a low pH, these things enter at half the rate of a higher pH.  So it’s kind of really counterintuitive now to use something that’s acidic, because not only is it not going to be able to deliver what we want, but on top of it, it’s going to cause all these other potential issues.  So it’s funny because the more and more I get into it, the more I realize just how bad of an idea it is; and hopefully that makes sense to you. But essentially, it’s just we want to mimic what saliva does.  And in order to mimic what saliva does, we have to have something that’s able to deliver neutralizing agents better than two percent.  I don’t know about you, but two percent is, that’s a joke.  I mean, it may as well not even happen; it’s not enough, so.

Dr. Weitz:            When you’re talking about a neutralizing agent something like calcium, which is alkaline can help to neutralize an acidic plaque-

Dr. Nolan:            Correct.

Dr. Weitz:            And it can’t penetrate and now you have developed a mouth rinse product that can help with that?

Dr. Nolan:            Yes, correct. So one of the things that we really, really looked at is we looked at all the existing agents on the market. And I pretty much couldn’t find an anti-bacterial agent that was basically above six. Almost exclusively about 95 percent of them are pH of five and a half or below. And a pH of five and a half is actually called the critical Ph. The reason why it’s called the critical pH, is because that’s when demineralization and decay actually occurs.  So the tooth starts dissolving pretty heavily at a pH of less than five point five.  So now we have all these agents commercially available that literally can dissolve your teeth, and they’re supporting an environment that’s not great.  So what we did, is we looked at the most recent technology available.  So my background’s actually nanotechnology; I’ve worked on carbon nanotubes, in college, and so I actually met up with a good colleague of mine in school, his name is Matt Hollister; really, really bright guys.  So he knew that I worked on nanotechnology applications, and I actually was, at that time, actually still kind of endeavoring in that and researching that. And he goes, “Brian, what if we could do something where we could use some of these nano compounds to effectively enhance the remineralization cycle?” So, we kind of got our heads together and started kind of hypothesizing some of these things really early on, even in dental school. And basically what we ended up doing is we spent three years and we actually custom engineered a nano silver compound, among others, but a nano silver compound that we found can actually increase the amount of neutralizing agents that get into the plaque.

And we did a clinical study on it, and found that when you add nano silver to a solution … And we’re talking only about 10 parts per million; it’s very dismal the amount that you have to use. It increased the amount of calcium that got into plaque over the control by 4.6 times; it is nuts; the results that we got were insane. So it basically is a perfect delivery system for getting into the biofilm. On top of that, when we engineered these, one of the major issues we had was how do we ensure that these actually are kind of more selectively targeting the biofilm, and how do we basically make sure the stuff’s alkaline and, on top of that, we want to make it non toxic?  So we actually ended up going the route of using plant compounds to synthesize these nano particles. And if you already know, I mean, a lot of plant compounds are very biocompatible. So, basically, the outer surface of the nano particles is actually covered in a plant based compound, and it’s actually is able to pretty selectively attach to biofilms.  So now we have something that acts like a cactus spine, gets on the biofilm, gets in the biofilm penetrates it, and opens up channels for calcium, saliva, and other things to get in. So it’s kind of an ingenious system, because not only is it alkaline-

Dr. Weitz:            Is it the plant compound, or the silver that breaks the biofilm?

Dr. Nolan:            So the plant compound allows it to approach the biofilm and attach to the biofilm and enter.

Dr. Weitz:            And what compound is this?

Dr. Nolan:            I can’t actually tell you because we have our patent pending. But I can say it’s from a plant, and it’s from a pretty cool plant at that.  But that information will probably be more available probably towards the end of the year. But, the silver nano particles are essentially … How would I put this? Silver nano particles that are like carriers. So basically, what they do is they’re able to get kind of close enough and enter the biofilm, kind of rip it into pieces, if you will, put a bunch of holes in it.  And silver ions are actually what ends up getting released after from the nano particle over time. That enhances its anti-bacterial capacity, but also keeps things … It targets the areas which are going to be caused … Which are building up the acid, which is the deeper layers of plaque. And so that’s kind of the way it works; it basically acts as a delivery system for other neutralizing agents. So instead of two percent, we’re seeing maybe 20 or 25 percent, which is a huge deal because it also helps saliva do its job.  So what we’re doing really is we’re mimicking what natural saliva is going to do in a much faster time period. So instead of saliva after … Let’s say you eat a bunch of sugar, saliva might take an hour to neutralize that plaque acid that’s already started building up. We’ve seen the neutralization effects within a couple minutes; I mean it’s pretty astounding. So, it pretty much works instantly, and so we’re basically just mimicking what the body wants to do. And we’re helping it out, so.

Dr. Weitz:            That’s great. I know you mentioned fluoride also I’m a big fan of calcium, but not such a big fan of fluoride.

Dr. Nolan:            Totally understand.  So here’s the thing. I mean, I’m not anti-fluoride, but I will say this I am pro-progress. I’ve tested along the fluoride stuff, and I just haven’t seen the same level of efficacy. So when people asked me am I anti-fluoride, I mean, you guys don’t put fluoride in your product. Yeah, but I also didn’t see when we were doing all these tests, I just didn’t see the same level of efficacy. And to me, I care more about what the end result is.  And it just so happens that it just didn’t end up with my product because of that. So, to me that matters more than the politics behind fluoride. I know a lot of people aren’t a big fan, but it’s great, because there are people like yourself who were like, “Look, I just want something that’s going to work that doesn’t have fluoride in it because I’m concerned. I’m not concerned, I use it all the time, but I can understand that. And so it’s great because then you have an alternative instead of everybody else using it, and then you don’t have an option. It kind of feels he got shut out of the market is anyone looking out for me?

Dr. Weitz:            Just to go into it for a second. Fluoride is a toxin in some levels, and it’s given off by the fertilizer industry and things like that. And the type of fluoride that’s in the water; even if we decided that fluoride was a good thing, it would be nice if we agreed on that. And then we decided to put a super purified form of fluoride in, but instead we’re putting this industrial waste product into the water. I forgot the exact name of it-

Dr. Nolan:            Fluorosilicates, instead of sodium fluoride, I think that’s what you’re saying, right?

Dr. Weitz:            Is that what it is?

Dr. Nolan:            Yeah.

Dr. Weitz:            I know it’s a-

Dr. Nolan:            It’s a green looking-

Dr. Weitz:            Byproduct of the fertilizer industry and basically it’s a way for them to dispose of this waste product. And then in the bone, it’s replacing the calcium and so just because it gets incorporated into the bone, I’m not convinced that it’s a healthy thing; we’d be much better off with calcium in there.

Dr. Nolan:            Yeah, so here’s my thoughts. Definitely some things that I would say is that there is always a level where something’s going to be a toxin, no matter what. However, I think one of the things you really should focus on is how much benefit do we get from it being in the drinking water? As you know, the United States is one of the few countries that still mandates fluoride in water. One of the things that we’ve looked at is basically outside of developmental, meaning if you’re a kid and you’re drinking the fluoridated water, adults don’t really benefit very much from drinking fluoridated water. So the reason is is because the concentration’s usually 1.7 parts per million.  So topically, that’s not going to do anything because it’s not really going to penetrate your plaque. So the only thing that’s going to do is basically just accumulate in your body, it usually enters the bone. But it doesn’t really offer you really much benefit past the age of eight, in my humble opinion.  So it just makes sense that … So then you have to ask yourself “Okay what’s happening in other countries, what does their decay rate look like, the ones that have taken fluoride out of their system?” So a study in 2015 actually compared a bunch of different countries that haven’t had fluoridated water in some time. And the decay rate approaches the same decay rate that we have in the United States. So the question becomes, “Okay, is orally ingesting fluoride helpful?” And the data doesn’t look as promising as what we originally thought in the 70s and 80s; and there could be a number of reasons for that.

It could be that more people are using topical agents, it could be a number of people care more about their oral health, it could be a number of different things. But the one issue I have with some of these studies done in the 70s, is they just don’t have very good controls. And anytime you look at a study, you have to have a pretty good control, and you also have a pretty good idea of all the variables that you should control for. So I’m not so hot, necessarily, on removing it from the water, but I’m also … I’m able to come in with an unbiased opinion and say, “But is it really helping to the extent we thought it was?” And the answer is probably not.  The other thing is, is I still use topical fluoride agents; luckily you’re not digesting them or anything like that. But I can understand why someone … There seems to be a fair amount of people concerned about it. I mean fluoride is the most reactive element on the table, I mean, we know that it reacts pretty readily. And one of the things it reacts with this is organic compounds, and we’re an organic compound, essentially. So, I mean, look, having concerns about it is okay, I think people need to be okay with that.

Dr. Weitz:            By the way, throw in one more thing. And I know we can go on and on about this. But one of the concerns about fluoride is it can replace iodine, because it’s a very similar compound; it’s in the same row in the periodic table, and so therefore it can impair thyroid function. And that’s one of many concerns I have about fluoride.

Dr. Nolan:            Yeah. So the other thing too, as you mentioned, is we started seeing a lot of something called fluorosis and I’ve seen it a lot in my clinical career. But basically what happens is, if you have too much fluoride, you can actually develop these pit and fissures that are actually more likely to break down and get decay. I’m sure you’ve seen-

Dr. Weitz:            I understand it’s fairly common, yeah.

Dr. Nolan:            Yeah, it’s very, very common, So the question becomes, is there a point where there’s too much fluoride and I would say yes.

Dr. Weitz:            Especially if you’re consuming fluoride in the water, and they decided “Okay, if you have this much water.” But what if you’re cooking in the water, drinking the water, then you using a fluoride toothpaste-

Dr. Nolan:            Showering with it.

Dr. Weitz:            And you’re doing a fluoride mouth wash, so the compound total amount of fluoride, yeah.

Dr. Nolan:            So you’re exactly right. So there’s many routes of exposure. I think it becomes a question of how much good versus how much possible harm.

Dr. Weitz:            And plus, if we wanted diabetics to have Metformin, we want them to have a specific dosage-

Dr. Nolan:            Sure.

Dr. Weitz:            We wouldn’t put it in their tooth paste, their mouthwash, water, they’re getting a completely uncontrolled dosage, and you have no idea how much you’re actually getting.

Dr. Nolan:            Right, so you’re-

Dr. Weitz:            So it’s a very inefficient way to, basically, give a chemical, a drug to the population.

Dr. Nolan:            Right, so I say this from a clinical perspective, I like flouride and I like topical fluoride the most. I don’t know, like I said, I’m still kind of debating whether or not having it in the water makes a ton of sense. I’m going to need some more studies to have a official opinion on that. However, you’re right in saying that everybody’s dosages seem to be very different. And that seems to be a concern, because you get people have too much, you get people that maybe aren’t getting any.  And so you have a wide array of people that don’t seem to be getting consistently dosed and so that’s a problem, and we live in the United States, which is 75 percent fluoridated water, and we’re comparing against these other countries that don’t, seem very similar and points in the decay rate.  So, you know what? You wouldn’t be a good scientist unless you actually questioned it. You got to understand why things happen and you can’t just say, “Oh, well, it’s good, so, therefore, we have to have it.”  I think I lean in the opinion of people should have a choice; they should always have a choice.

Dr. Weitz:            Right, I mean you’ve being-

Dr. Nolan:            I can’t-

Dr. Weitz:            Given a prescription drug without your consent, essentially.

Dr. Nolan:            I can’t go and just say “Hey, look you know what? Silver is great because it cleanses the water, let’s put it in the water.” I can’t go do that, okay, even if I knew it was a beneficial compound. I just told 330 million people they don’t have a choice; not that’s not fair, in my opinion.  So I’m with you on that, I think mandating that it’s in the water; I think people should have the choice.  Now, obviously, there’s been a lot of push back and forth between the dental community as well as, people who fluoridate the water, and things that.  I just think, at the end of the day, the citizens should have the choice, really.  I don’t think it comes, it doesn’t come to me; I don’t get that decision.  So, yeah, so I’m still kind of on a fence there, but I’m willing to question the limitations.  I think that that is okay and if that makes me a black sheep, it makes me a black sheep.  But look, if you’re looking at the data, the data’s going to tell you what you really want to know. And even though we do need more studies; it’s definitely raised an eyebrow for me because I’m like, “Well, how does that really… What kind of picture are we painting here? And the picture right now is not enough studies to confirm fluoridation in the water. Is it really working?  I don’t …. Maybe, maybe not.  I mean, so we have to question, and we have to at least pop that tomb open; we don’t really know where that rabbit hole’s going to go.  But yeah, so for now I’m okay with the topical fluoride; I still have some reservations about fluoridating.

Dr. Weitz:            Great. So there’s a lot more stuff we could talk about, but I think we provided some good information about oral health to our listeners. So how can everybody get a hold of you, and is your mouth rinse product commercially available now?

Dr. Nolan:            Yeah. So we launched it in September, we’re doing a rebrand now. So we’re going to be able to have all the new bottles and a lot more new product coming out probably in February.  So basically the website is elementasilver.com. And we do sell on Amazon, if you Google Amazon and then throw in Nanosilver rinse, our product will come up. And my Instagram handle is @ryannolandmd. I’m very interactive on my Instagram, I try and always post thoughtful stories and things to kind of … I don’t know if I’d be a podster, I don’t know if that’s the word for me, I’m not lurking, but I like to question things. So if you like someone who’s kind of questioning the existing paradigms, I’m probably a good person to follow. Because I do make a lot of posts about “Hey, what do you think about this?” And we do get a lot of people who say “Yay or Nay”, but they at least agree. “Hey look, this guy’s questioning a paradigm, he’s got some evidence. Let’s think about it.”  That’s a problem, so we have to think about things and address them as a society, not just as a dental community. So yeah, those are my handle.

Dr. Weitz:            I think that’s one of the keys to wisdom is always questioning our paradigms.

Dr. Nolan:            Absolutely. Oh, I should mention this, we do have an Instagram account for our product it’s at @elementaoralcare. So you can find us there and like you’re saying, we have a product that I think a lot of people are going like specifically because it’s a different way of approaching the same problem and we do have a fluoride free product. So if fluoride bothers you, it’s not really a concern.

Dr. Weitz:            Great. Awesome.  Thank you for joining us.

Dr. Nolan:            Hey, I appreciate your time. Thanks so much for having me. I had a really great discussion.

Dr. Weitz:            Excellent. I’ll talk to you soon.

 

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