Podcast Episode #361: All About Biologic Dentistry with Dr. Kristen Graham

Topics

1. News and updates from Liz [2:07]
2. Introducing our guest, biologic dentist Dr. Kristen Graham [3:12]
3. Becoming a biologic dentist [6:45]
4. What to look for in a biologic dentist [10:40]
5. A note on root canals [18:31]
6. Cavities [20:26]
7. Remineralizing teeth [22:27]
8. Fillings [24:38]
9. Oral hygiene – deep cleanings [30:18]
10. Grinding teeth and sleep apnea [35:47]
11. Removing mercury fillings [39:03]
12. Mouth ulcers and cold sores [45:08]
13. Oil pulling, charcoal, and tongue scraping [47:32]

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You’re listening to the Balanced Bites podcast episode 361.

Liz Wolfe: Welcome to the Balanced Bites podcast. I’m Liz; a nutritional therapy practitioner, and author of the Wall Street Journal bestseller Eat the Yolks; The Purely Primal Skincare Guide; and the online program Baby Making and Beyond. I live on a lake in the mystical land of the Midwest, outside of Kansas City.

I’m the co-creator of the Balanced Bites Master Class, with my podcast partner in crime, Diane. And together, we’ve been bringing you this award-winning podcast for almost 7 years. We’re here to share our take on modern healthy living, answer your questions, and chat with leading health and wellness experts. Enjoy this week’s episode, and submit your questions at http://blog.balancedbites.com or watch the Balanced Bites podcast Instagram account or Facebook group for our weekly calls for questions. You can ask us anything in the comments.

Remember our disclaimer: The materials and content within this podcast are intended as general information only, and are not to be considered a substitute for professional medical advice, diagnosis, or treatment. Before we get started, let’s hear from one of our sponsors.

Diane Sanfilippo: Today’s podcast is sponsored by Kettle and Fire bone broth and soups. We’ve talked about bone broth before and the many benefits, but to name a few, it’s been shown to reduce inflammation, improve digestion, and improve the quality of your skin. While I do like to make my own bone broth, there’s not always time for that. Kettle and Fire is the next best thing. They use organic chicken bones, and a slow simmer time to extract as much protein as possible. Not to mention that they use chicken feet; yay! Which increases the collagen and gelatin. And you can store it directly on your shelf for up to two years. Which is pretty cool, considering they’re a fresh, never frozen broth with no added preservatives or additives. Check them out at www.KettleandFire.com/BalancedBites and use coupon code BalancedBites for 10% off, plus free shipping when you get six cartons or more. That’s one per customer. It’s 10% off, and free shipping on six cartons or more.

1. News and updates from Liz [2:07]

Liz Wolfe: Ok friends, Liz here. All by myself. Well, not completely by myself. Diane is very busy working on her book, so I am taking over this interview today. And I’m really, really excited about it.

Before I get started, I’m just going to give folks a little bit of an update on Baby Making and Beyond. And that is; I’m still working on it! But we will definitely be releasing what we have this summer. If you are not already on the email list, go to BabyMakingandBeyond.com and type your name in there and submit it if you want to be notified when it’s ready to go.

We don’t have pricing on it yet. We’re still trying to figure out what’s most fair, and what’s going to work best, and how we’re going to structure it. But it will not be publicly released. So I’m going to release the opportunity to get the program privately. And that way we basically have a group of beta testers coming in and helping us make the program better before we have a big public release. So you’ve got to be on the list. So make sure you are.

And that’s all I really have today. I’m so excited about this interview that we’re going to, so I’m just going to jump right in.

2. Introducing our guest, biologic dentist Dr. Kristen Graham [3:12]

Today I have Dr. Kristen Graham on the show to chat about biological dentistry. And to cover as many of the topics you submitted questions on via Instagram, as we possibly can. But first I’ll give you a quick background on Dr. Graham.

Dr. Kristen Graham graduated from the University of Maryland with a BS in biological sciences. She then continued on to dental school, and graduated from the University of Maryland School of Dentistry in 2013. In pursuit of biological dentistry, she became a board-certified naturopath; BCNP in 2017 by the American Naturopathic Medical Certification Board with training from the American College of Integrative Medicine and Dentistry, with additional certifications in Integrative Biologic Dental Medicine. That’s IBDM.

She recently graduated from AFMCP; Advanced Functional Medicine and Clinical Practice, at the Institute for Functional Medicine in 2018. Dr. Kristen works with clients one on one in her online practice, addressing each client as the individual they are. She focuses on systemic, oral, physical, and emotional well being from a functional, biologic, and spiritual approach.

Dr. Kristen resides in Maryland, and her husband and she have two Rhodesian ridgebacks. (That’s cool.) Learn more about her work online at BeyondPearlyWhites.com. So, welcome, Dr. Graham.

Dr. Kristen Graham: Well, thank you. I’m so excited to be here.

Liz Wolfe: Is it ok if we call you Kristen from here on out?

Dr. Kristen Graham: Yes!

Liz Wolfe: OK. I’ll try to remember Dr. Kristen.

Dr. Kristen Graham: That’s fine.

Liz Wolfe: Ok! {laughs} Ok, good. I’m not so great. So you have a lot of acronyms.

Dr. Kristen Graham: Yes.

Liz Wolfe: Many credentials. Many certifications. And did you pursue all of those because you felt like you needed to round out your dental education? Can you give me a little bit?

Let’s back up, because I’m not going to start grilling you immediately. First, let’s do something fun, and then I’m going to ask you my questions. {laughs}

Dr. Kristen Graham: Sure.

Liz Wolfe: Selfishly, all the questions that I have. So our first segment before we dig in is something new I’m digging. And for me, I’m digging my new iPhone X. I went ahead and got one, because I felt like my Instagram pictures were just not up to snuff. And the portrait mode is giving me life right now. It’s amazing. And as if I didn’t already have a bajillion pictures to get through on my iCloud now. I’m going to have even more. So I went ahead and splurged on that. Could not afford it; did it anyway. Oh well.

So, Kristen. What’s one thing you're digging currently? It can be nutrition, lifestyle, book, app, treat, anything.

Dr. Kristen Graham: Ooh. I would have to say dry brushing.

Liz Wolfe: Ah!

Dr. Kristen Graham: Dry brushing, and using the infrared sauna after. I feel like after I do those two things, I feel amazing. And it really helps with lymphatic drainage and detoxification.

Liz Wolfe: Kind of along those lines; one thing. And I can’t remember if I said this on a previous podcast. I might have. But something kind of along those lines that I’m digging currently is gua sha.

Dr. Kristen Graham: Yes! Oh my gosh, yes.

Liz Wolfe: And I probably said it wrong. But I think that would be a really great compliment to dry brushing.

Dr. Kristen Graham: Yeah, you said it right. Gua sha feels amazing. It really relieves so much tension where you're tight, too.

Liz Wolfe: Yeah. Facially, too. It really; it actually is really helpful. I think I did talk about this on a previous podcast, because we had somebody ask a question about bags under the eyes. And it’s really, really helpful for bags under the eyes when they’re caused by excess fluid.

Dr. Kristen Graham: Oh! I haven’t tried that. That’s really good to know.

3. Becoming a biologic dentist [6:45]

Liz Wolfe: Alright. So, now we can jump into the interview. I would love for you to share a little bit of your story. What I was jumping right in to ask you before we did our what I’m digging segment. I was wondering why you decided to do all these extra certifications. How you came to be a biologic dentist. And kind of explain how it’s different from conventional dentistry, and how the path you took expanded on your foundational education.

Dr. Kristen Graham: Yeah, really good questions. I’m going to start with my story, because that will help explain some of it. I was out practicing conventional dentistry for about a year and a half. I had a chronic health crisis, pretty much. I started having some severe GI symptoms. I stopped getting my period. Hormone imbalances and chronic fatigue. And I kind of put it off for a while, as we all do. I was just hoping it would go away. And it didn’t. So I finally made an appointment with a GI doctor. And he diagnosed me with ulcerative colitis; which was a big one.

I asked him during our appointment, after he wrote me six prescriptions, and he told me there was an 80% chance I was going to need surgery. I asked him if changing my diet would help at all. And he told me no; changing my diet would not do anything. All my large intestine does is reabsorb water. And there’s an 80% chance that I would need surgery.

Liz Wolfe: Wow; All? All it does is absorb water?

Dr. Kristen Graham: Yep. That’s all he said.

Liz Wolfe: Ok.

Dr. Kristen Graham: And I was like; wait a second. I learned in dental school that your immune system is in your gut, too. So that didn’t resonate with me at all. So I kept looking for more answers. And funny enough, Sarah Ballantyne actually posted the next day something about the autoimmune protocol diet. And I started that diet, and within two weeks, my symptoms had gone away and I completely came out of my flare without starting any medicine. And that has been such a testament to me that diet is so important to healing.

So then from there, I was eventually seen at a top clinic. A government funded clinic, because I was still having all these issues, and no one could figure it out. They ran a ton of tests, and still couldn’t find anything. This was all conventional medicine. And what they said to me was; you’re pretty much the healthiest unhealthy person we’ve ever seen. Go back on birth control, and just manage your ulcerative colitis. I was like; wow. Ok.

So, at that point, I was still hopeful. But I was getting a little more nervous. I consulted with Jessica Flannagan; AIP lifestyle. I love her. She’s amazing. We were going over some of my blood work. And I was asking her why my candida antibodies were so elevated. And she stopped and she looked at me and she said; you know, mercury feeds off of candida. Have you ever heard of biologic dentistry?

That was such a pivotal moment in my life. It completely changed the trajectory for my path. Then I just pursued biologic dentistry. Because I don’t even have any mercury fillings in my mouth. But my exposure through my job was making me sick.

Liz Wolfe: Gotcha. That’s probably a real occupational hazard for dentists, wouldn’t it be?

Dr. Kristen Graham: Yeah. Dentists and dental assistants all have much higher illnesses; lower fertility rates. Lots of things, yes.

Liz Wolfe: Ok. So tell me really quickly; is a biologic dentist the same as a holistic dentist?

Dr. Kristen Graham: It is, yes.

Liz Wolfe: Ok. So we can use the names interchangeably.

Dr. Kristen Graham: Yes.

4. What to look for in a biologic dentist [10:40]

Liz Wolfe: And at this point, it’s kind of a matter of; when you're researching and looking for a biologic dentist. What are we looking for? Is it just advanced certifications? Is there any kind of governing body that certifies and says, “You’re a good biologic dentist”? Because you know, we have good regular dentists, and we have not so good regular dentists. How do we know what to look for?

Dr. Kristen Graham: Yes, great question. A couple of things you want to look for; what I would say that the most important thing is to find someone who you trust, and someone who listens to you. You have to feel comfortable with this person. Because being in a dental office is very vulnerable, and it’s important to feel like your voice matters, and to know all of your options. And the pros and cons of both.

There are a few organizations that are great. My favorite one is IAOMT; the International Academy of Oral Medicine and Toxicology. The reason I like them so much is they have some certification programs that you can go through. And one that I would recommend that everyone look for in a biological dentist is someone who is SMART certified. That stands for Safe Mercury Amalgam Removal Technique.

So these practitioners have been trained on exactly how to remove amalgams. And we follow a very specific protocol.

Liz Wolfe: OK, so the $64,000 question; do you find that insurance covers amalgam removal?

Dr. Kristen Graham: Often times, they do. Because amalgams, usually if they’re older than 5 or so years, they’re probably starting to fracture and break down where it meets the tooth. So those fillings probably need to be replaced anyway. So often times, insurance will cover it.

Liz Wolfe: OK. Taking that information straight to my parents and loved ones after we’re done with this podcast.

Dr. Kristen Graham: Absolutely.

Liz Wolfe: Ok, so just real quick. Give us a list of what to look for in a biologic dentist.

Dr. Kristen Graham: Yeah, there are a couple of things that would be really great. See if the office uses digital radiographs, because it’s a lot less radiation exposure. Another thing you want to ask is; does the office use, or do they have access to a cone beam or a 3D imaging system. These are really great, and important for evaluating health, and to ensure that there’s no silent chronic oral infections. This also evaluates the airway to make sure you have enough room to breathe.

A few other things; ask if the office uses medical grade ozone in the practice. Because that’s really great in helping to kill pathogens, reduce sensitivity, help to modulate the immune system, etc.

Liz Wolfe: And that’s an injection?

Dr. Kristen Graham: That would be an injection, yeah. You can also use it topically around the tooth; after you remove a filling. If you use it and kind of infiltrate it in the area, it can really help reduce sensitivity.

Another thing you can ask is does the office do any functional testing? Any DNA testing of the gums and of the teeth. Do they do any biocompatibility testing? Heavy metals testing? Nutritional testing? Or stool testing?

And another thing is asking them if they use PRF. Which is platelet rich fibrin. You can use that during an extraction. And what the dentist will do is draw blood, spin it down, and after the extraction they’ll take part of that and place it into the socket. This really helps reduce healing time, and any pain or discomfort associated with extraction.

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Liz Wolfe: So I want to share a little bit of an anecdote. Someone close to me has had, for many, many years, a problem with halitosis. Just totally random bad breath. Have you found that the removal of amalgam fillings can help with stuff like that? Because this person actually had their amalgams swapped out, and the problem has been pretty much gone ever since.

Dr. Kristen Graham: Yes.

Liz Wolfe: Wow.

Dr. Kristen Graham: Amalgam can cause dysbiosis in the oral microbiome, as well as the gut microbiome. So by removing the amalgams, it can actually clear up a lot of bad bacteria.

Liz Wolfe: That’s fascinating. It was kind of something that we were wondering about; but we were like, well I’d never actually heard that. So really interesting.

Folks are going to have to be ready for me asking a ton of questions for my own benefit during this show.

Dr. Kristen Graham: That’s ok.

Liz Wolfe: It’s so interesting to me, because I have had horrible teeth since childhood. And we know that there are different reasons for that. Prenatal stuff. Childhood diet. All kinds of different things. All things that I can’t do anything about now. So in many ways, I’m still kind of suffering the consequences of that, even though I’m doing all that I can.

Many of us who find whole, real food nutrient dense eating find it because we have some kind of issue we’re trying to work out. I personally just really found it because I was into CrossFit, and I kind of came about it that way. But some of the benefits that I’ve seen is that not only have things like my vision stopped getting worse, but my teeth also kind of really hit a plateau. And I mean that in a good way. It was always every year it was something. Something had to be done. Even though I was brushing, flossing, yada, yada, yada.

So for me, this is a really, really interesting topic. Because I have finally found a holistic dentist in Kansas City. Dr. Juli Babcock, who is wonderful. And she’s really the closest to a biological holistic dentist that we have. So it’s been really interesting. And when you said previously that you need to find somebody that will listen to you and that will talk to you; that’s the firs thing she did with me. We sat down. We talked about my entire health history. We talked about MTHFR. We talked about all different kinds of things that play into the health of your mouth. And that was really important to me.

But yet; I’ve gone 33, I went 33 years, without having any hint. Any clue about biologic dentistry. And I had, I believe, amalgam fillings as a kid. In my baby teeth.

Dr. Kristen Graham: Yep.

Liz Wolfe: My baby teeth were awful.

Dr. Kristen Graham: Oh gosh. And that’s why I’m so excited to be here, because I love sharing this with people. And once the word starts to get out, I think it will force a paradigm shift in dentistry. Because a lot of the things that are still being done are so old school.

Liz Wolfe: And that’s where you get that; I don’t know what the word would be for it. But that negative connotation of just drill and fill, right?

Dr. Kristen Graham: Correct.

Liz Wolfe: And there’s so much more that dentists can do and help us with. Because the health of our mouth is really kind of reflective; it’s both reflective of the health of our bodies, and it also impacts the health of our bodies. Would that be accurate to say?

Dr. Kristen Graham: Yes. They say it’s the window to your soul.

Liz Wolfe: {laughs} Well. Oh lord, ok. Well. I need to do some cleaning up there.

5. A note on root canals [18:31]

Liz Wolfe: Ok. So we are going to talk; we’ve been talking about, and it depends how long we go today. We’ve been talking about doing a separate show on root canals, which I totally want to do. Because as I told you, off the air, I have three of them. And two of them were in my youth. I didn’t know any better. You just do what the dentist tells you to do, when you have tooth pain or they say you need something, then you do it. And you feel better and you move on.

Well, I just had to have another one recently because of a whole saga; it was entirely self-inflicted. But there’s a point where you know that there’s more information out there. But you don’t know how to synthesize it, and you don’t know who to talk to. I mean, I really wish that I had gotten into contact with you before I got my latest root canal. But I had an infection, and everything had to be taken care of right away. So there’s no time to think.

And it would be great if this information is just readily available. People knew where to find it, and they were getting it through their dentists, so that people can make better, more informed decisions.

Dr. Kristen Graham: Yes. And that’s what I’m doing with my blog, too. I want to post a lot of articles and a lot of information there so people can find this more easily. They can make better decisions for themselves.

Liz Wolfe: Very good. So hopefully we’ll do a whole separate show on that. Because I think there’s a lot to talk about. And we also want to be really gentle; because as I said, I have horrible teeth. I’m walking around with three root canal teeth, and I have some concerns about them, and I feel stuck. Like, a lot of people do, because I haven’t been able to find anybody who I really trust to outline a path for me going forward.

So, hopefully we can help people be a little self-directing here and help people find some resources if they’re curious about what’s going on in their mouths. They feel like maybe they need to do something different or have some work done by a biological dentist.

Dr. Kristen Graham: Yes.

6. Cavities and fillings [20:26]

Liz Wolfe: Ok. So let’s jump into some of the questions that came in. First we’re going to talk about cavities and fillings. Can you just give an overview of what causes cavities? And also tell me; what I tell my daughter at night is we have to brush our teeth because otherwise she’ll get cavities. And cavities are like owies on her teeth.

Dr. Kristen Graham: {laughs}

Liz Wolfe: That’s the best I got.

Dr. Kristen Graham: Yes. So cute. I’m really excited to share this with you today, because a lot of people are really familiar with the Miller’s acidogenic theory. Which pretty much talks about how acid plus sugar causes cavities. And if you don’t either of those, you shouldn’t get cavities. Which that’s great. But in clinic, we don’t see that. I see so many women who are super healthy, eating organic, exercising, doing all the right things. And they’re still getting cavities.

So there are two scientists that have done decades of research. And what they came up with is that the endocrine system is actually connected with tooth decay. So they discovered that there is a hypothalamic parotid gland access, and something called dentinal fluid flow. So the parotid gland is a gland that sits right in the side of your cheeks, on both sides of your mouth. One simple way to think about it, is that health teeth are supposed to sweat. So nutrients, and blood flow, and all the good stuff comes in to the tooth. And it kind of has this outward flow to it.

When the dentinal fluid flow is not moving in the right direction, certain things that cause it to reverse. Like sugar, stress, lack of exercise, nutrition, hormones, and even certain bacteria, the flow reverses. And that’s when opportunistic bacteria can take advantage of that. They get inside and cause decay.

7. Remineralizing teeth [22:27]

Liz Wolfe: Ok. So, we hear a lot of talk about remineralization. And the question that I want to ask you is pretty simple; is it possible to reverse/remineralize cavities? But I also would like you, if possible, to address it in the context of what’s going on; what’s causing cavities in the first place. Because if we’re just thinking about remineralizing, it’s almost like saying that whole acidification theory is all it is. And we just need to follow up with remineralization protocols. But what you're saying is that there’s more going on. And maybe this idea of remineralization is only a small part of the overall picture.

Dr. Kristen Graham: Yeah. Yes and no. So dental caries; I think of it as a systemic issue. The answer to your question; is it possible to remineralize teeth? The answer is yes, and the answer is no.

If the cavity is in the outer hard layer of the tooth, which is called the enamel. If it’s caught early, it can be remineralized. One product that I like; I don’t love it because it does have propylene glycol in it. But it works really well, it’s called MI paste. That can be used to remineralize teeth.

Liz Wolfe: And you need a dentist for that, right? A prescription?

Dr. Kristen Graham: You need to buy it at an office, yes.

Liz Wolfe: Gotcha.

Dr. Kristen Graham: The other thing that’s really important for remineralizing teeth is; one, making sure you're getting enough minerals in your diet, in your water. Two, getting enough vitamin D3. So getting outside and/or supplementing. And three, getting enough vitamin K2. And ideally, you want the MK7 form. Its derived from natto, and that’s the most easily absorbed. You need both the D3 and the K2 to really, really help build teeth.

Liz Wolfe: OK. And our friend of the show, Chris Masterjohn, has a bunch of information on vitamin K2 at ChrisMasterjohnPHD.com if people just want to know more about what it is, and the different types and whatnot. So that’s fascinating.

8. Fillings [24:38]

Liz Wolfe: So when somebody comes in with a cavity, and it’s to the point where you just have to fill it. What do you do? Ideally, what would one do?

Dr. Kristen Graham: Yeah. If the cavity has crossed the layer; the hard outer layer and is now into the inner, softer part of the tooth, then that is when we recommend restoring the tooth. Because the dentin is a living tissue, and the cavity will take advantage of that and just keep getting closer and closer to the nerve.

So what we would do; people think sometimes that holistic or biologic dentistry is kind of woo-woo, and we wave magic wands and we do all this crazy stuff. It’s not true. We still have to use drills, and we still have to remove decay. And then, depending on the location and the size, hopefully it would just need a new filling. And we would restore it using a BPA-free material that’s biocompatible with your body. And then you’ll be all set.

Liz Wolfe: Ok. Can you define what biocompatible means? Because I’m guessing it’s going to come up again.

Dr. Kristen Graham: Yes. So biocompatible means that it works in a friendly way with your body.

Liz Wolfe: Got it.

Dr. Kristen Graham: An example is that in biologic dentistry, we will use ceramic or zirconia implants instead of titanium implants. Because a lot of people have metal allergies. Even if you don’t have a metal allergy at the time of your implant, probably within a couple of years, you might.

Liz Wolfe: I, interestingly, have. And I’ve been toying around with the idea of root canal tooth removal and implants. It’s going to be a long road for me to figure out what I want to do. But we have to realize that our bodies change over time. And one of the things that’s really interesting to me is that I have developed a sensitivity to metals. I can no longer wear earrings; of any kind. And I believe it’s because of the metal posts. My mom also cannot wear most earrings, unless they’re 24 karat gold.

So one of the things I was thinking about is your sensitivities can change. Whether it’s caused by, or just you have consequences because of metals in your mouth. It was really interesting to me to think about; wow. Who knows what it’s going to be like for me 10 years from now. Do I want to implant a material in my tooth that could potentially be a problem in the future?

Dr. Kristen Graham: The same thing happened to me too. I think it’s from the mercury exposure. But it’s like; once you have an allergy to one metal, it’s just a matter of time. If you're consistently exposed to another one, that you become allergic to that one, too.

Liz Wolfe: I think part of what has gone on for me personally is the massive wave of stress that came along with postpartum anxiety. I have always really been ok, other than; I was maybe a healthy unhealthy person. Despite the fact that my teeth weren’t great as a kid, and my eyes aren’t great. I’ve always been physically healthy; athletic. I’ve always really felt good. Not been sick a lot. That type of thing.

And then after my daughter was born, and I had this wave of systemically dysregulating stress, ongoing, for three years. I mean, I didn’t start really going to therapy and tackling it until my daughter was almost three. I really thing all of that stress; you kind of mentioned stress a little bit earlier, as a factor in dental caries. Which is the same as cavities, right? Caries/cavities.

Dr. Kristen Graham: Yep.

Liz Wolfe: Ok. It just changed my system. I found myself sensitive to different things. That’s when the metal sensitivity popped up. That’s when a couple of other things popped up. And it really; I feel like all came from that wave of stress. Do you see that happen with people who are in a really stressful time of life, and all these things start to pop up?

Dr. Kristen Graham: Yes. And it’s so funny you bring that up. Because often times, I’ll have women who have just had children. And they’ve never had a cavity their entire life; and then we find five cavities.

Liz Wolfe: Yeah.

Dr. Kristen Graham: And they’re like; what? I’ve never had a cavity. I’m like; oh my gosh. I’m so sorry. I know. And I feel terrible. And that’s part of the reason I went down that, what else causes cavities. Because I know these women are doing an amazing job with their oral health. And there’s something else. And stress is one of the huge triggering factors for decay. And I think that’s another reason why sometimes children can have cavities.

Liz Wolfe: That makes sense. And you know; I misspoke earlier. I actually had the one root canal forever and ever ago, when I was much younger and had no idea. My second root canal was a few months after my daughter was born. And then the third one was pretty recently. But I had a pretty gnarly mouth infection.

I’m just a mess. I sound like a mess right now. I do not sound like a health podcaster.

Dr. Kristen Graham: No. Well, the thing you need to remember though; at some point, you have to make a decision. And you need to make the best decision for you at the time. And I’m not anti-root canal. I think if that is the best decision for you at the time, then that is what has to be done. You can always later take the tooth out. If it’s your front tooth, and you don’t want to part with it that day, I totally understand that.

Liz Wolfe: Yeah; I wasn’t ready that day. {laughs}

Dr. Kristen Graham: Yeah. And dentists need to respect people and meet people where they are.

Liz Wolfe: Right. And when you're in a ton of pain, you’ve just got to do what you’ve got to do to get rid of the pin.

Dr. Kristen Graham: Exactly. And honestly, that is probably the smarter decision at the time. You want to make sure whatever decision you make, you don’t regret it. And you can’t ever reverse and extraction. But you can always go forward with a root canal. So I think there’s no wrong answer there.

Liz Wolfe: Yeah. It’s just so fascinating what stress can do.

Dr. Kristen Graham: Mm-hmm.

9. Oral hygiene- deep cleanings [30:18]

Liz Wolfe: Ok. So let’s talk a little bit about oral hygiene. And feel free; even if it’s not addressed in the questions that I’m asking. If there’s anything you want people to know, and it’s on your mind, you go ahead and riff on it. Talk about it.

Oral hygiene. Do we need to get deep cleanings done? And if so, how often?

Dr. Kristen Graham: Great question. And I’m really excited to talk about this, because I know a lot of people are asking. And the answer is a little bit complicated, because it really is individual. It’s based on how you present what some of your measurements are. Your gum pockets, and how much bone loss you have, and any radiographic calculus, or tartar buildup that shows up on X-rays. That is a sign that you probably need a deep cleaning.

And the reason that you need that is because you as a patient cannot individually go in there and clean that out. You need special instruments to go remove that hardened biofilm. But the goal is that after you have one deep cleaning, hopefully with regular maintenance you wont ever need that again.

Liz Wolfe: Hmm. Ok. Along those lines; why do some people build up scale so fast, and others done?

Dr. Kristen Graham: Great question. That has a lot of answers. One; diet definitely plays a huge role. Biofilms; sugar feeds the bad bacteria, and the biofilm. So diet is important. Some of it is just genetics. I see some patients who have the best oral hygiene, and sometimes they just do build calculus faster than other people.

One my favorite ways to reduce it is using an electric toothbrush. That’s helped a lot of people, because sometimes when you're manually brushing, you're not paying attention to well and you tend to miss some spots. So using an electric toothbrush has really been a gamechanger.

Liz Wolfe: Yeah. I asked my dentist, “Is this Sonicare thing, is this for real?” And she was like, yes.

Dr. Kristen Graham: Yes.

Liz Wolfe: Get one! Get one now!

Dr. Kristen Graham: It is for real.

Liz Wolfe: So it’s not that conventional dentistry is just wrong, wrong, wrong. It’s that they are in need of some adaptations.

Dr. Kristen Graham: Yes.

32.43

Liz Wolfe: OK. That makes a lot of sense. What are your thoughts on fluoride? Do you recommend it? Is it necessary to prevent cavities? I think a lot of folks are also wondering this with regard to their children.

Dr. Kristen Graham: Yeah. So, depending on who you ask, most biologic dentists will say no fluoride. Conventional dentists love fluoride. We don’t personally recommend fluoride in our office. In multiple studies, and control group, the fluoride and the control group had the same number of cavities. Fluoride is not essential for human growth or development, nor is it required for any physiologic process in the body.

Liz Wolfe: Interesting. So one of the things I’ve done is use a calcium nano hydroxyapatite toothpaste. I don’t know much about it, other than to say I have seen rumblings that it is as effective as fluoride without the fluoride. Do you have any opinion on that?

Dr. Kristen Graham: Yeah. That sounds great. It’s similar to what’s in the MI paste.

Liz Wolfe: Gotcha.

Dr. Kristen Graham: And just going back to the fluoride real quick. There are two scientists; one was from Harvard, I believe, and the other was from Mount Sinai. In 2014, they identified fluoride as one of 12 industrial chemicals known to cause neurotoxicity. And in addition, fluoride displaces iodine, which is critical for thyroid function. How many people do we know today who have thyroid issues?

Liz Wolfe: Yeah. So if folks are interested, then, in the calcium nano hydroxyapatite toothpaste. You said you can get MI toothpaste, which you would get from your dentist. But for a daily toothpaste, I don’t want to be a conspiracy theorist, but it really doesn’t seem like it’s sold anywhere in the US. You can’t just go to Walgreens and find it, because everything has fluoride in it.

But I do order mine from Amazon, from a brand called Apagard. It’s in a different language {laughs} but you can go in, you can read the reviews, and decide if you're comfortable ordering it or not. And I use it for myself and for my daughter.

So, that’s not a recommendation, it’s just what I do. And I’ve been comfortable with it. So hopefully that’s not the worst idea in the world.

Dr. Kristen Graham: Yeah. And then there’s one that I also like. The name is so funny. The brand is Squigle. And they have a toothpaste called tooth builder. It’s great if you have any recession. You can put it on those sensitive areas. I sometimes put it on floss, and then I floss my teeth, and I just go to bed. I don’t rinse after. I just leave it on my teeth.

Liz Wolfe: Oh, that’s a great idea. And on that topic, I have actually found that my tooth sensitivity has reduced significantly since I’ve been regularly using the nano hydroxyapatite toothpaste.

Dr. Kristen Graham: That’s great.

10. Grinding teeth and sleep apnea [35:47]

Liz Wolfe: Alright. Here are a couple of other questions. Let’s talk about clenching and grinding. Why is that happening, and what can we do to prevent it?

Dr. Kristen Graham: There are a lot of reasons for clenching and grinding. But I’ve found the main reason is actually because someone has a compromised airway. So when you clench the muscles in your mouth area, it actually causes the muscles in your neck, around your airway, to relax. So by tightening these muscles up top, you relax the airway muscles, and you can breathe easier.

Liz Wolfe: Wow.

Dr. Kristen Graham: So that’s something where if you're a chronic clencher and grinder. I mean, sometimes stress can cause it too. I don’t want to rule that out. But if you are a consistent clencher and a grinder, it’s definitely worth having a dentist who is familiar with any sleep disordered breathing or sleep apnea. Just take a look. Maybe do a home sleep study. I really love the 3D imaging system. It’s called a cone beam. That can give a lot of information about any chronic silent oral infections. In addition, it can show your airway. And if it’s narrow, or if it’s wide, and it can give a lot of insight.

Liz Wolfe: So if your airway is narrow, what can you do about that?

Dr. Kristen Graham: There are a couple; from a biological standpoint, there are several functional appliances that we can use to help expand the arch and therefore expand the airway. There’s even one that moves your lower jaw forward. And that can really help. That’s kind of the other option, instead of using a CPAP, you can use one of these mandibular repositioning devices.

Liz Wolfe: OK. And those are nightly solutions, or are they permanent solutions? Do they permanently move your jaw forward or expand your palate? Or is it just something you use at night?

Dr. Kristen Graham: The appliances can permanently expand the jaw forward. They do not permanently move your lower jaw forward. That would be a nighttime. This thing; it’s really big and bulky. {laughs} You could not wear it during the day. It’s a nighttime appliance only.

Liz Wolfe: Gotcha. Ok, so speaking of that; sleep apnea. Why is it happening, and how can we address it?

Dr. Kristen Graham: This is going to be a long answer. Sleep apnea. So, there are a lot of reasons that we’re seeing an increase in sleep apnea. Either it was under diagnosed before, which is also possible. But today, diet. It goes back to diet too. We’re not eating hard, chewy foods anymore. We’re not chewing as much. Our heads, our palates, and our cranium, it’s just under developed. And we need lots of space for our tongue, our tonsils, our airway.

Experts on orofacial development recommend a two-years minimum of breast feeding. Two years. And most of us are lucky if we can breastfeed for a year. And when I say two years; I mean baby on boob. Because the actions that’s happening, with the tongue and the movement, cause proper facial development.

11. Removing mercury fillings [39:03]

Liz Wolfe: Interesting. Ok. So, let’s go back really quickly to mercury fillings. I don’t know if we addressed this fully, or not. Or if you have more to say on it. But a lot of our listeners are not sure what to do when they already have mercury fillings in their mouth. Whether they have decided to keep them or have them removed. Can you speak a little bit to the pros and cons of each, and how urgent this decision is, and how to move forward?

Dr. Kristen Graham: Yeah, great question. With my journey and how I got so sick was the placing of amalgam fillings and the removing of amalgam fillings is actually the worst part for you. The most mercury is released in a vapor form.

So I think if you have mercury fillings, you're in a great spot. Because you still have the power to make a safe choice. Even if you never see a biological dentist for anything else; I would say try; really heavily consider seeing one just at least to get the mercury amalgams removed. We take an extra, I don’t know, 30 steps to ensure the patient’s safety, our safety, and the safety for the environment.

And if you have gotten them removed by a biological dentist; awesome. But if you haven’t I would say wait and try to see one if you can. Mercury is getting released from these; usually on a daily basis. And that’s never good. But definitely the most dangerous part could be during the placing and removing.

Liz Wolfe: OK. So biologic dentists have a whole protocol for removing mercury fillings that is safer than what; do they remove them in conventional offices, or are the only people removing mercury fillings. Or, sorry, amalgam fillings.

Dr. Kristen Graham: Yeah, amalgam.

Liz Wolfe: Are the only people removing amalgam fillings biologic dentists?

Dr. Kristen Graham: No, no, no. Everyone removes them. And if you're in a conventional office, you’ll just go in, open your mouth, and they take it out.

Liz Wolfe: Wow.

Dr. Kristen Graham: So you're being exposed to the powder and the vapor of the mercury, and the tin, and the copper, and the silver. All those things, you’re absorbing directly into your body.

Liz Wolfe: What is the history of amalgam fillings? Why did we start putting mercury in people’s mouths in the first place?

Dr. Kristen Graham: It’s a little political.

Liz Wolfe: Of course.

Dr. Kristen Graham: So there was a group of dentists; they were in a surgeon group. And they didn’t believe the same things as the American Dental Association. So they vowed that they would never place amalgam fillings. But the ADA ended up being bigger. And the ADA actually; I’ve read. I don’t know 100% if this is true. But I’ve read that they had a patent on amalgam fillings. So they were making money off of it. And they would never come out now and say; oh yeah, this is terrible for you. It causes all these problems. Because that would be a huge class action lawsuit.

Liz Wolfe: Right. And there are situations like that even within the holistic community, where we have found something to be potentially dangerous. And people don’t want to just say, “Oh hey, yeah, sorry we were telling you to do that for 10 years.”

Dr. Kristen Graham: Exactly.

Liz Wolfe: It’s tough. It’s tough to admit you were wrong, and then the consequences of that are difficult. And then once it becomes systemic, then it’s even harder to dredge yourself out from that kind of situation.

Dr. Kristen Graham: Yeah. And I know a lot of people know their MTHFR status. I have two hits on those genes. So I detox mercury at 25% efficiency of someone who has no SNPs. So I think there’s also a genetic component. Because some people could have mercury fillings their whole life, and be totally fine. I see those people. But then there’s other people who have just a little bit of exposure, it’s like their whole life is upside down.

Liz Wolfe: Right. And I think that’s kind of one big weakness in some of the research that we have. Right? Because you may have every variable controlled. But you still have human beings, with different life experiences, and different stress levels, and different other factors in play that make people respond to certain things differently.

Dr. Kristen Graham: Yes. Exactly. And let me go back really quick to the amalgam fillings. One more thing I want people to know is another great reason to get them safely removed is because amalgam, because it’s a metal, it expands and contracts with fluctuations in temperature. So think hot coffee, and then ice tea. So over time, the expansion and contraction puts all these forces on tooth structure. And it can actually cause your tooth to fracture.

Liz Wolfe: Wow.

Dr. Kristen Graham: So that can be one reason that people eventually need root canals with amalgam fillings. Because the fractures get deep enough that they go into the nerve. So that can be avoided; hopefully, ideally, by removing these metal fillings that are constantly expanding and contracting.

Liz Wolfe: Fascinating.

Liz Wolfe: The Balanced Bites podcast is sponsored in part by the Nutritional Therapy Association. The NTA trains and certifies nutritional therapy practitioners and consultants (including me; Liz, I’m an NTP), emphasizing bio-individuality and the range of dietary strategies that support wellness. The NTA emphasizes local, whole, properly prepared nutrient dense foods as the key to restoring balance and enhancing the body’s ability to heal.

The NTA’s nutritional therapy practitioner program and new fully online nutritional therapy consultant program empower graduates with the education and skills needed to launch a successful, fulfilling career in holistic nutrition. To learn lots more about the NTA’s nutritional therapy programs, go to http://www.NutritionalTherapy.com. There are workshops in the US, Canada, and Australia, so chances are you’ll be able to find a venue that works for you.

12. Mouth ulcers and cold sores [45:08]

Liz Wolfe: Ok. Mouth ulcers. What causes them, and what can you do to prevent it?

Dr. Kristen Graham: Mouth ulcers; no one really knows 100%. But, from what I’ve learned, is that usually it’s a systemic underlying issue that shows up in the mouth. Chronic recurrent aphthous ulcers is usually an inflammatory immune reaction.

And let me just clarify that these are different than cold sores or the herpes virus. That’s a viral activation; these are ulcers that are usually on your cheeks, or your tongue. And they can last for weeks and weeks. And I know they’re so painful.

It’s usually an immune response. And it can be many things that trigger them. Certain additives; even sodium laurel sulfate in toothpaste can trigger ulcers. Certain foods, like wine, even chocolate, unfortunately. All the good stuff. And then if someone is consistently getting recurrent ulcers, that can be an oral manifestation of celiac disease.

Liz Wolfe: Oh. Ok.

Dr. Kristen Graham: So I always start with looking at the gut first. Looking at gut health. Looking at food. Looking at what they’re using in their mouth. Even products on their skin.

Liz Wolfe: Ok. Really fascinating. Another question; I’m drawing all these connections in my brain. If I’m totally off base, just let me know. What about the activation of, for example, herpes virus, cold sores. Can those kind of be activated by the stress, the environment in the mouth due to amalgam fillings?

Dr. Kristen Graham: I have not seen any published literature on that. But I would 100% say that’s definitely possible.

Liz Wolfe: Gotcha. Really interesting. I’m so fascinated by this. And for a long time, I think people do this. A long time I was already so concerned about my oral health, and all the problems that I’ve had in my life, that I just didn’t want to learn more. Because I didn’t want to find out all of the terrible things that are going to happen to me {laughs} because of the state of my mouth. But I’m finally in that place where I don’t want to bury my head in the sand anymore.

Dr. Kristen Graham: Yeah. And I think the best part about our world today, is that you have access to all this information. And that’s why I really want to get this out there so people can learn about it. And then hopefully this helps them.

13. Oil pulling, charcoal, and tongue scraping [47:32]

Liz Wolfe: Yeah. Ok, let’s talk about a couple of things that folks in our community love to do, and let’s do a yay or nay. Oil pulling; yay or nay?

Dr. Kristen Graham: Ooh. Yes; occasionally. Definitely not every day.

Liz Wolfe: Ok.

Dr. Kristen Graham: If you're using coconut oil, the caprylic acid in coconut oil actually kills all the good bacteria too. So you definitely don’t want to be killing your good microbiome in your mouth every day.

Liz Wolfe: Gotcha. So what is the function, then, of oil pulling? Is it kind of a deep clean?

Dr. Kristen Graham: Yeah, it kills bacteria. Some people say it helps whiten their teeth. I haven’t experienced that, but I think everyone is different.

Liz Wolfe: Yeah. Ok. Charcoal toothpaste; yay or nay.

Dr. Kristen Graham: Same thing; just not every day. It’s awesome for tooth whitening. I think it works great. But it’s way to abrasive to use on a daily basis. Charcoal is super abrasive. It will wear down your enamel. A better clay is something like kaolin clay. It’s probably the most gentle clay to use in your mouth.

Liz Wolfe: OK. So, I’m not sure if Redmond Clay is kaolin; I think it’s something similar.

Dr. Kristen Graham: Yeah, it might be bentonite.

Liz Wolfe: Bentonite; yeah. Is that similar?

Dr. Kristen Graham: Yeah. That’s not nearly as abrasive as charcoal.

Liz Wolfe: Ok. Now, what about baking soda?

Dr. Kristen Graham: I wouldn’t use it everyday either.

Liz Wolfe: OK. Great to know. A long all of these lines, is there anything you really just want people to know? We’ll save the root canal discussion for our next interview. But what do you want people to know? You’re like, everything. I want them to know everything. {laughs}

Dr. Kristen Graham: {laughs} I know! It’s so hard to pick just one.

Liz Wolfe: I know. Well maybe let’s start with a good oral hygiene routine. Something really simple. And then maybe stuff will occur to you that you can plug in as you discuss that.

Dr. Kristen Graham: Yeah. Ok. Tongue scraping; everyone should do it.

Liz Wolfe: Yes, ok.

Dr. Kristen Graham: This is awesome. Everyone can do this. It takes 2 seconds in the morning. And that really helps remove a lot of the bad bacteria off of your tongue. We already talked about an electric toothbrush. I personally love the Sonicare toothbrush. There’s team Oral B and team Sonicare. I’m on team Sonicare, but whichever one works the best for you, they both are awesome.

Flossing. And the floss that you buy does matter. Ideally you want to get a floss that does not have wax on it. If it’s unwaxed, it will actually pick up more food particles, and biofilm, and plaque.

Liz Wolfe: What if you're teeth are really tight together, and it’s hard to get {laughs} unwaxed floss.

Dr. Kristen Graham: Definitely use whatever floss you can get in there.

Liz Wolfe: Ok. So some floss is better than no floss.

Dr. Kristen Graham: Yes. And by the way; I want to talk about that study. Not the study; that idea that came out that you don’t really need to floss. It’s totally not true. And I would 100% keep flossing. There’s no research on it, because no one is going to pay for something that they know actually works.

Liz Wolfe: Very interesting. A long, long, long time ago. I think when I was in my teens, my dentist said; if you had to choose between flossing and brushing, floss. And I was like; that’s ridiculous.

Dr. Kristen Graham: When people ask me; should I floss? I’m like, only floss the teeth you want to keep. {laughs}

Liz Wolfe: {laughs} Fair enough. Ok, what else did I want to ask you about? OH, here’s a question for you. The tongue. Do dentists get any education; it’s a weird term. Tongue health? What the tongue should look like, and how to take care of your tongue in dental school? Is this something we even need to worry about?

Dr. Kristen Graham: In my class, I did not get any education about the tongue. In my training at dental school. I did get education on that in my post-doctorate programs; a lot of it, actually. Because it’s all related to ayurvedic medicine, and yeah. The tongue is so important. It can really show you a lot of what’s going on systemically. There are people that literally just read tongues. So there’s a lot to learn there, and it’s definitely worth taking care of your tongue. And the best way to do that is to just start by tongue scraping.

Liz Wolfe: Ok. Well definitely pull that tongue scraper out that I’ve got in my cabinet and try to use that more frequently. It’s so easy, I don’t know why I forget sometimes, but I do.

Dr. Kristen Graham: I think, out of sight, out of mind. I mean, the reason I’ve been into dry brushing recently is because I leave my brush out. If I don’t see it, then I forget to do it.

Liz Wolfe: Yeah. And I feel like, for me as well. I can’t remember if I said this earlier. But in the discussion about post pregnancy, oral health. I’ve heard the expression one child, one tooth. I feel like it’s kind of like; one child, all routines just go to crap, and you start forgetting about all of it. So really, step one for me is building up something that I can be consistent with and going from there. And I think I can probably be consistent with tongue scraping. Does not sound too hard.

Dr. Kristen Graham: Yes. It only takes maybe 10 seconds.

Liz Wolfe: Yeah. And it’s right there next to the toothbrush. So I’ll start working on that. Do you have a favorite tongue scraper? Does it matter what kind you get?

Dr. Kristen Graham: I use a copper one. Probably any one will work fine. I know there are plastic ones on the market, but I try to avoid plastic when possible. Any one that’s not plastic I would say would be fine. I mean, people can even us the back of a spoon.

Liz Wolfe: Ok, fair enough. And you know, when I first did some gua sha, I used a little ceramic dish. So we don’t have to get fancy, folks. Just figure out a way to get it done and get it done.

Dr. Kristen Graham: Yep.

Liz Wolfe: Any favorite type of toothbrush for a manual toothbrush besides a Sonicare or an Oral B? Something if you're just scrubbing away. Is there any type of toothbrush that you like?

Dr. Kristen Graham: As long as it has soft bristles. Soft or even extra soft bristles, then it should be good.

Liz Wolfe: Soft of extra soft. Why is that?

Dr. Kristen Graham: You can cause recession and abrade your gum tissue away if you're pushing too hard or using bristles that are too hard.

Liz Wolfe: Oh, ok. Have you ever heard of something called the Bass brushing technique?

Dr. Kristen Graham: I have not heard of that. What is that?

Liz Wolfe: OK. We can maybe work that into our next episode. We can revisit that one. Because we are almost out of time. Is there anything else you want folks to know?

Dr. Kristen Graham: No.

Liz Wolfe: Listen to our next episode; that’s what we want folks to know.

Dr. Kristen Graham: Yeah! {laughs}

Liz Wolfe: Listen to our next episode, where I ask Dr. Kristen all about my own dental problems, for everybody to hear.

Dr. Kristen Graham: Yeah. And if people want more information, they can go to my website. BeyondPearlyWhites.com.

Liz Wolfe: Alright, perfect. Thank you so much, Kristen.

Dr. Kristen Graham: You're welcome! Thank you. It was a pleasure.

Liz Wolfe: Alright, so everyone can find Kristen at BeyondPearlyWhites.com. Or on Instagram at BeyondPearlyWhites. And she is great about answering people back on Instagram. So don’t be shy, go visit her over there. And that’s it for this week. You can find me, Liz, at http://realfoodliz.com/. Remember to join my email lists for free goodies and updates that you don’t find anywhere else on our website or on the podcast. While you’re on the internet, we’d appreciate an iTunes review. See you next week.