← The Peter Attia Drive

#166 - Patricia Corby, D.D.S.: Importance of oral health, best hygiene practices, and the relationship between poor oral health and systemic disease

Jun 21, 2021 2h 32 insights
<p>Dr. Patricia Corby is Associate Professor of Oral Medicine and Associate Dean of Translational Research at Penn Dental Medicine. Her work focuses on the importance of providing dental services alongside critical public healthcare services, like cancer treatment. In this episode, Pat provides an overview of dental anatomy, the importance of oral hygiene to overall health, and the association of poor oral health and systemic diseases like cancer and diabetes. She addresses tooth decay, oral hygiene in children, the utility of dental products, and ideal oral care regimens for different populations. She also discusses issues specific to immunocompromised patients and those with chronic illnesses as well as her own research with cancer patients undergoing radiation treatment.</p> <p> </p> <p>We discuss:</p> <ul type="disc"> <li>Anatomy of teeth and the purpose of the dental pulp—a highly vascularized and innervated region of the tooth [<a href="2021-06-16%2003:00:00%20EDT">3:00</a>];</li> <li>Types of teeth and the different purpose they serve [<a href="2021-06-16%2014:15:00%20EDT">14:15</a>];</li> <li>Anatomy of the oral cavity, bacteria in the mouth, and what a healthy mouth looks like [<a href="2021-06-16%2018:10:00%20EDT">18:10</a>];</li> <li>Pat's study demonstrating the importance of flossing [<a href="2021-06-16%2023:00:00%20EDT">23:00</a>];</li> <li>Detrimental effects of sugar and the importance of fluoride and oral hygiene [31:45];</li> <li>Oral health challenges for cancer patients and immunocompromised people [39:45];</li> <li>Pat's current research on cancer patients undergoing radiation treatment and the oral health risks associated with human papilloma virus (HPV) [50:00];</li> <li>Periodontal disease: caries and root canals [57:30];</li> <li>The relationship between poor oral health and systemic health diseases [<a href="2021-06-16%2001:11:00%20EDT">1:11</a>:00];</li> <li>Potential connection between oral hygiene and COVID-19 [<a href="2021-06-16%2001:17:45%20EDT">1:17:45</a>];</li> <li>Dry mouth leading to oral infections and ways to prevent it [<a href="2021-06-16%2001:22:30%20EDT">1:22:30</a>];</li> <li>What determines the appearance of teeth, methods of teeth whitening, and whether you should remove mercury fillings [<a href="2021-06-16%2001:27:30%20EDT">1:27:30</a>];</li> <li>Importance of fluoride for preventing tooth decay, and dental care for children [<a href="2021-06-16%2001:32:45%20EDT">1:32:45</a>];</li> <li>Useful dental products: floss, electrics toothbrushes, and more [<a href="2021-06-16%2001:39:15%20EDT">1:39:15</a>];</li> <li>Ideal oral care regimens [<a href="2021-06-16%2001:47:30%20EDT">1:47:30</a>]; and</li> <li>More.</li> </ul> <div> <span>Learn more: </span><a href="https://peterattiamd.com/"><span>https://peterattiamd.com/</span></a></div> <div> </div> <div> <span>Show notes page for this episode: <a href="https://peterattiamd.com/patriciacorby">https://peterattiamd.com/patriciacorby</a> </span></div> <div> </div> <div> <span>Subscribe to receive exclusive subscriber-only content: </span><a href="https://peterattiamd.com/subscribe/"><span>https://peterattiamd.com/subscribe/</span></a></div> <div> </div> <div> <span>Sign up to receive Peter's email newsletter: </span><a href="https://peterattiamd.com/newsletter/"><span>https://peterattiamd.com/newsletter/</span></a></div> <div> </div> <div> <span>Connect with Peter on</span> <a href="http://facebook.com/PeterAttiaMD"><span>Faceboo</span></a><span>k</span> <span>|</span> <a href="http://twitter.com/PeterAttiaMD"><span>Twitter</span></a> <span>|</span> <a href="http://instagram.com/PeterAttiaMD"><span>Instagram</span></a><span>.</span></div>
Actionable Insights

1. Daily Floss for Oral Health

Flossing daily is crucial for preventing gingivitis and periodontal disease by removing anaerobic bacteria hiding between teeth, as evidenced by studies showing rapid inflammation and bacterial overgrowth when flossing stops.

2. Brush Teeth with Fluoride

Regularly brush teeth with fluoride toothpaste (1000-1500 ppm, ideally ADA-endorsed) to effectively remove biofilm, stimulate gums, and protect against cavities by hardening enamel.

3. Brush Thoroughly Before Bed

Brush teeth thoroughly at night before bed, and avoid giving children baby bottles overnight, as reduced saliva during sleep creates an ideal environment for bacterial growth and severe decay.

4. Brush First Thing Morning

Brush teeth immediately upon waking to remove biofilm that accumulates overnight due to reduced saliva flow and a closed, oxygen-deprived mouth environment.

5. Floss After Initial Brush

Floss after an initial brush, then rinse well or brush again, to remove dislodged bacteria and prevent them from recolonizing other areas of the mouth.

6. Brush Your Tongue

Incorporate tongue brushing into your routine, using a separate soft-bristled brush, to remove bacteria that accumulate on its surface and prevent colonization of other areas.

7. Regular Dental Cleanings

Get professional dental cleanings and check-ups every six months as a primary preventative measure to identify and address cavities and periodontal disease early.

8. Address Decay Early

Seek dental care for decay as soon as possible to prevent its progression to the pulp, which often necessitates a painful root canal procedure.

9. Chew Food Thoroughly

Chew food thoroughly to initiate the digestive process in the mouth, allowing saliva to mix with food and maximize nutrient extraction.

10. Minimize Sugar Intake

Reduce consumption of all types of sugar (glucose, fructose, sucrose, starch) as cavity-causing bacteria metabolize them to produce acids that destroy enamel.

11. Stay Hydrated, Stimulate Saliva

Sip water throughout the day and use sugarless chewing gum or lozenges (xylitol-based preferred) to stimulate saliva flow and keep the mouth hydrated, avoiding any sugar content.

12. Choose Electric Toothbrush

Select an electric toothbrush (e.g., Oral-B or Sonicare) based on personal comfort and preference, as both mechanical and sonic types are efficacious in cleaning.

13. Clean Your Toothbrush

Rinse your toothbrush with warm water and soap after each use and allow it to dry, as this decontaminates it and prevents bacterial growth.

14. Avoid Daily Mouthwash

Refrain from using mouthwash daily as it indiscriminately kills both good and bad oral bacteria, potentially disrupting a healthy microbiome; use only for short periods when brushing is not possible.

15. Intensive Care for Vulnerable

Caregivers for individuals with disabilities or cognitive impairment should be educated and provide intensive preventive oral care, including regular brushing and fluoride application, as these populations are often neglected.

16. High-Risk Dental Cleanings

High-risk individuals (e.g., with systemic health issues like diabetes, or undergoing radiation) should consider more frequent professional dental cleanings (e.g., three times a year) and prescription-strength fluoride toothpaste nightly without rinsing.

17. Oral Hygiene During Illness

Prioritize and maintain excellent oral hygiene, including brushing and flossing, especially if hospitalized or dealing with infectious diseases like COVID, to prevent systemic complications like pulmonary infections.

18. Address Dry Mouth Causes

If experiencing dry mouth, consider medication side effects and consult a doctor, as a lack of saliva can lead to a shift in the oral microbiome and opportunistic infections.

19. Minimize Teeth Discoloration

Reduce consumption of substances known to discolor teeth, such as black tea and red wine, to lessen the need for whitening procedures.

20. Cautious Teeth Whitening

If whitening teeth, consult a dentist to ensure you are a suitable candidate, follow correct timelines, and use FDA-approved products to avoid potential demineralization and gum harm from excessive use.

21. Prefer Breast Milk

Choose breast milk over formula with added sugar for infants to significantly reduce the risk of early childhood dental decay.

22. Fluoride for Children

Ensure children are exposed to fluoride through brushing with very small amounts of fluoride toothpaste (after their first tooth appears) or consider fluoride drops/varnish every six months as additional prevention.

23. Preserve Natural Teeth

Prioritize preserving natural teeth over extraction and implants, as natural teeth provide superior function and implants, being metal, come with their own potential issues.

24. Microscope-Guided Root Canals

If a root canal is necessary, seek an endodontist who performs the procedure under a microscope for a more precise, aseptic, and effective outcome, reducing the risk of complications.

25. Toothpicks Not Substitute

Using toothpicks is benign and can stimulate gums, but it is not a substitute for proper flossing, which cleans around the entire tooth surface.

26. Keep Mercury Fillings

Do not remove well-functioning mercury fillings if there is no decay underneath, as there is no proven harm from them, and replacement can sometimes lead to complications.

27. Disregard Root Canal Pseudoscience

Disregard unsubstantiated claims linking root canals to systemic diseases like cancer or Alzheimer’s, as there is no scientific evidence to support such associations.

Understand that oral health is intrinsically linked to systemic health, and poor oral hygiene can exacerbate overall inflammation and disease progression in the body.

29. Own Oral Health Responsibility

Recognize that oral health is often neglected by medical doctors, making personal responsibility and proactive care crucial for overall well-being.

30. Mask-Wearing & Oral Health

Be aware that prolonged mask-wearing can contribute to dry mouth, reinforcing the need for diligent oral hygiene to counteract potential negative effects.

31. Mechanically Disrupt Biofilm

Understand that the primary goal of brushing and flossing is the mechanical disruption of the biofilm/plaque matrix to prevent its accumulation and subsequent harm.

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